The supplemental trap

 When I retired the Educational Retirement Health Care Authority offered two choices for a provider. BCBS or Presbyterian. BCBS worked with all medical facilities and with Pres you were locked into just their doctors.

I chose BCBS and then Pres announced they would not honor BCBS. That stuck me with Lovelace, which doesn't have as many doctors or facilities as Pres. I did get good doctors and needed little more that treatment for diabetes.

When I reached 65 and went on Medicare the choices were a lot more. BCBS offered the only supplemental plan, Pres, United Health, Humana have advantage plans.

My mother was on the supplemental plan, it cost more, but everything was covered that Medicare didn't. I've been pretty happy with it until the doctor I had was so tied up I couldn't get in to see him and he's left Optum which took over Lovelace. 

Oak Street Health recently came into New Mexico and was advertising. I got an appointment last February, had an initial consultation and did a blood test. In March when going over the results the doctor was concerned the prostate test was too high and could be cancer. He said he'd do a referral to a urologist. I told him not to book one with Pres as they don't take BCBS.

For five years the Optum doctor never did a blood test for prostate cancer for a patient over 65!

In May I get a referral to a Pres doctor. I declined telling someone in Virginia to contact the doctor and get a referral to Optum. I called Optum and was told they don't have a urology department. Let that sink in, the second largest medical provider in this state doesn't have a urology department!

I scheduled an appointment with the doctor in August, since I was getting nowhere on getting a referral to either UNM Hospital or NM Cancer Center for an appointment. I explained the problem again about BCBS. 

August 21 I've got a referral, and it said if I haven't heard anything from the doctor named to call thier number and let them know. I called the person in Virginia who said they'd do another referral. I wait two weeks and getting someone else they said contact the doctor to get the appointment. I did.

I now have an appointment for March 1. It's taken a full year to see a doctor about possible cancer.

Part 2.

I got the packet for open enrollment for this year. The same offerings are there, and I planned on taking the poison pill and going with Pres, but I looked over the other Advantage Plans. Pres does not have a supplemental.

BCBS supplemental is $240 a month. Pres Advantage 1 is $98, but there are copays, but $2,500 max for the year. United Health's Advantage 1 is $46/month with copays half those of Pres, and $2,500 max/year.

I calculated the 240 I paid last year against United's 46 and even if I maxed out for the year, I paid 52 dollars more for a plan that I barely used for the last five years. Nearly 200 extra month I've been paying.

Now I know just as I might be getting to the point of maxing out the plan.