October 3, 2023

I'm switching.

I just found out staying in the union’s HIP VIP Premier (HMO) will cost me $2K next year. And as far as I know, I’m not even sick.

That’s because the HIP plan, which has honestly served me well all these years, has a nasty little cost I had overlooked. 

Part B drugs are covered at only 80%, which means an out-of-pocket 20% when I need to get one of those twice a year.

GHI Senior Care doesn’t do that, and the new Aetna plan wouldn’t have either.

Here’s how this happened, and why I didn’t expect it.

Doctor recommends a “shot” to boost bone density. I have to get this thing at a facility, in my case, the infusion center at the hospital. First time round, no bill – and I hadn’t expected one either. I thought a shot’s a shot, always covered, even though I know Part B drugs don’t always work the same way in Medicare as Part D drugs. I still thought the union’s got me covered. 

So I take the 6-month repeat dose of this thing a month ago and get a bill yesterday for $1000. That can’t be, I’m thinking, it must be a coding error. So I called the plan only to find out it’s correct, I need to pay 20%. 

Why wasn’t I billed first time round?  Because something like this needs pre-certification by the doctor before the plan pays out. The first time, the office staff had failed to go through that process with the plan, so the plan wouldn’t pay out. The office also missed a 3-month window to correct the situation and had to actually eat that mistake, they weren’t allowed to pass the cost on to me.

Learning the bitter truth of biannual bills at $1000 a pop for the rest of my life, I checked the comparison documents on the OLR site to see what Senior Care people pay for Part B drugs.  Results were clear: my HIP plan charged me 1000 times what the other two were charging (except for a $50 deductible in GHI).

So if I stay with my HIP plan into next year, I will definitely be stuck with $2000 or more a year for those useful shots. If I switch to Senior Care, there will only be that $50 deductible.  

As I said, no brainer. Have to switch.

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