Oct 24, 2012
My doctor of many years recently dropped me because he would not take Medi-Cal anymore. I receive Medicare and Medi-Cal, ADAP and "extra help" pays my share of cost. I currently get care through an established HIV clinic but miss working with a private practice M.D. Should I consider going with a PPO or Medicare plan? How can I pick one that is right for me? I went to the AMA site to look for HIV doctors in this area but did not find it very helpful. There is an insurance agent at one of our ASOs but I wonder if he will steer me to my best option. Thanks for all the great advice you give.
Response from Mr. Chambers
This is the open enrollment period for Medicare so now is a good time to review your coverage.
You don't say, but I assume that you are currently on original Medicare, also called fee-for-service Medicare. While most doctors take Medicare patients, you do have to pay 20% of doctors' charges. Depending on what state you live in, you may have a chance to purchase a Medigap or Medicare Supplement Plan, but many will require medical underwriting which you would not get. Plus those supplement plans are not cheap for persons under age 65. Insurance companies know that if you are on Medicare and are under age 65, you are disabled.
During this period, you have the chance to switch to a Medicare Advantage Plan, which usually include drug coverage, as well as switch Part D Drug Plans. Not knowing what state you live in, I can't say what your choices are, although you can find them by going to www.medicare.gov and click on "Find Health and Drug Plans."
Most Medicare Advantage Plans are HMOs which limits your choice of physicians. The key is how knowledgeable the HMO's HIV doctors are.
In some areas, there are PPO Medicare Advantage Plans, and they can be good because they offer a broader choice in physicians. Get a list of what plans are available to you, then perhaps your insurance agent that volunteers for an ASO can answer which Medicare Advantage Plans have the best HIV doctors in their network.
Good luck, Jacques
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