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By Matt Shepard

My father worked his entire career for a private insurance company.  When he retired before he was 65, he and my Mom were able to remain in the HMO that his company had used.  The company was located in the next state over from my parents’ home state, and so was the network.  That wasn’t a big deal for my folks, who lived right over the border, closer to those providers than most in their home state.  They happily continued paying premiums and enjoying their doctors.

When Dad hit 65, his coverage options changed, but the company still offered a similar HMO for Medicare-eligible former employees.  They lost their familiar old network, but remained in an HMO in their neighboring state.  Mom had to find a new primary care provider.  Dad got to keep seeing his cardiologist, but his primary provider also changed, as did their prescription coverage.  New locations, new hours, a little hassle, but pretty similar.

A couple years later,  the company stopped providing that plan, as well.  The company contracted with “the country’s largest private Medicare Marketplace” to find their Medicare-eligible retirees coverage, and offered a subsidy on any plan obtained through that exchange.  Dad, always having been happy with his HMOs, waded in looking for a nice Medicare Advantage plan – and the site certainly focused on Medicare Advantage plans.  They were the only option online.  If you were interested in traditional Medicare and a Medigap plan, you needed to call to speak to someone.  My Dad’s search for a plan came up with just two companies, both operating only in his home state, neither offering coverage that would allow him access to the physicians, pharmacies, etc. that he and Mom had used for years.  Although geographically closer than any in the offered networks, they were out-of-state, and therefore out of network.  For the first time, my Dad felt the restrictions of an HMO.

Luckily, Dad found a very good customer service rep. when he called.  When he explained his situation, she told him the very thing I had been telling him for two years – traditional Medicare, a Medigap plan, and a Part D plan would give him the flexibility he needed.

I got an excited phone call after he’d finished the process.  He explained that it was a lot of work to figure out what he and Mom had needed and get signed up, but now that it was all done, Not only did he get to keep his cardiologist, they could also now get prescriptions at both a national grocery chain and a national pharmacy chain – no more having to get them at one of two locations in the neighboring state.  Best of all, it looked like Mom could finally go back to her original primary care provider, thanks to traditional Medicare.

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