Advantage vs Supplement

[msefren]

We are still trying to decide which way to go. We have had Medicare A/B and BCBS Supplement for 4 years. Supplement premiums continue to increase with age, predictably. We fortunately live in an area with many hospitals and emergicare facilities, so finding a facility that accepts either type of insurance is no problem. We only see our healthcare primary once a year.

We are inclined to look closely at Medicare Advantage plans this fall.

The only thing we have found is "if you do not need to see a doctor often, then an Advantage Plan may be your best choice" and the fact that there is an out of pocket cap with Advantage plans, as we understand.

We also understand the medical conditions will likely arise and do not want to make a regretful decision. There is no crystal ball. Travel is not an issue. Pretty much homebodies.

We would welcome any advice you may have. We apologize in advance if this topic is redundant and perhaps already addressed. Thank you

H 69 yo
W 68 yo

 

[Katsmeow]

There have been a lot of threads on this. I am 65, DH is 71 and we have traditional Medicare with AARP UHC supplement. I would not consider Medicare Advantage for a ffew reasons.

1. With traditional Medicare, I have no network. I can see any doctor that takes Medicare. Last year I had one relative on traditional Medicare who was ill and then in rehab. The other relative was on Medicare Advantage. This was in a major metro. The one with Medicare Advantage had a lot of constraints on where they could go for rehab. The other one had a huge choice. I was told by a family member of the one with Medicare Advantage that she would have liked to consider the rehab my mom was at. But, it wasn't in network so wasn't an option. I had enough of networks pre-Medicare and absolutely one of the best things about Medicare is getting rid of networks.

It may not matter to you when healthy. But, what if you get cancer and the state of the art center doesn't take Medicare Advantage? What if you need surgery and the great surgeon doesn't take your plan? I don't want to have those constraints.

2. Once you go on Medicare Advantage there is no guarantee you can go back to a supplement. You would have to medically qualify and you might not be able to. That is a risk I won't take.

3. It is way easier to just have traditional Medicare and a supplement. The thing about an out of pocket max on Medicare Advantage is irrelevant to me with Plan G. Plan G pays everything covered by Medicare except the one deductible. I don't need a cap on out of pocket max because I don't have anything out of pocket except a deductible.

When my mom was in her 90s the fact she didn't have to worry about a network or an out of pocket max or co-payments, etc. made everything so much easier for her.

 

[Souschef]

We have Advantage and are very happy with it We have a great PCP, and all the tests and procedures DW has to go through are covered, with some copay.

 

[joeea]

I have to sign up for Medicare this month and am trying to make the same decision.

There are 2 Advantage plans in my area that would work for me - both with the same insurer we currently have.

The plans cover our PCP as well as my oncologist. As far as I can tell, everything I would likely need is within their network.

I'm still looking at Medigap plans. They are all more expensive for the same coverage, and I just don't see where they are better. Maybe I haven't looked closely enough yet.

Unless I find something unexpected, I'll decide on one of the two Medicare Advantage plans (the only difference is dental coverage).

 

[MissMolly]

We have an Advantage Plan. It's a PPO and out-of-network is exactly the same as in-network. Nationwide coverage. Only $500 deductible and $1,200 MOOP. It's a retiree benefit so the cost to me is $0 and only $74/month for my spouse. Part D is included. No donut hole on Part D for me.

 

[kaneohe]

http://www.early-retirement.org/forums/f38/medigap-plans-to-rule-out-93148.html

this sticky is titled re: supplements but there is also info on Advantage plans.
I like supplements since I can go pretty much anywhere....locally and nationally and am not restricted by network. Also be aware the no OOP limit for most supplements means that it is a meaningless term.....Medicare says N/A.
I have not paid a penny in OOP.......only the monthly premiums despite lots of big medical bills.

 

[Animorph]

I'm signing up for A&B with Plan G and Plan D supplements. I travel quite a bit, so no network restrictions is important. I get a little international insurance with Plan G as well. My DM had to find a new Advantage plan when her original one was terminated. Caused a bit of distress, but she did have a choice of two plans that covered her favorite medical center.

 

[MBSC]

We have had Medicare A/B and BCBS Supplement for 4 years. Supplement premiums continue to increase with age, predictably.

H 69 yo
W 68 yo

Due to the BCBS name recognition, sick people tend to choose them as their supplement causing their premiums to be higher in some markets. If you have not already done so, I would consult with an insurance agent first to determine if you are healthy enough to pass medical underwriting and switch to a lower cost supplement company.

“Who are the top 10 Medicare supplement insurance companies?”

This question is a little tricky to answer, as the best supplemental insurance with Medicare is really whichever plan has the lowest rate and the lowest rate increase history in your area.

After all, benefits are standardized so that the benefits for each plan letter are the same from company to company. Medicare supplement companies also pay your bills like clockwork because Medicare is the decision maker, so we never hear that any of them have slow-pay issues like the Medicare Advantage plans often do.

And if you are enrolling through Boomer Benefits, you never have to worry which insurance company has the best customer service because you won’t ever have to deal with them. We do all that for you.

Reference: https://boomerbenefits.com/top-10-medicare-supplement-companies/

 

[homestead]

Suggest you go to a Health Insurance Broker , they can help you in choosing a plan that's best in your situation.
We are happy with our BCBS Advantage plan.

 

[Z3Dreamer]

I see a number of you have Medicare Advantage. In rural communities, or at least in mine the network is very small. The senior center does a lot of counseling. They do not recommend Medicare Advantage in our community.

Another issue is medical underwriting when switching plans. Any one done this and what stories do you have with medical underwriting.

I hope my question is not stealing your thread as no matter which plan OP selects switching plans is still an issue. No?

 

[Teacher Terry]

For all the reasons others mentioned I won’t go on a advantage plan. The only people I know on them are poor and don’t have a choice.

 

[REWahoo]

If you have not already done so, I would consult with an insurance agent first to determine if you are healthy enough to pass medical underwriting and switch to a lower cost supplement company.

+1

Many of us here have used BoomerBenefits.com to assist in choosing a supplement and I don't think I've heard anything but positive reviews on them.

 

[Bamaman]

The big hospital chain north of us accepts regular Medicare--but not Medicare Advantage. They control hospital locations in 4+major cities as far as 400 miles away and small town hospitals in between--with over 1700 doctors. And they own hundreds of doctors' practices.

Thousands of patients are now having to drive long distances to different counties with non-affiliated hospitals. And thousands have had to change to doctors in other cities.

Advantage looks great on paper. But in reality, it doesn't work that well. And I have no desire to drive back and forth 50 or 100 miles over and over to the doctor or hospital. It's not like that everywhere, but it is there.

 

[MissMolly]

For all the reasons others mentioned I won’t go on a advantage plan. The only people I know on them are poor and don’t have a choice.

I am not poor and I have a choice. Please don't paint with a broad brush.

 

[Souschef]

I am not poor and I have a choice. Please don't paint with a broad brush.

+100

 

[razztazz]

I am not poor and I have a choice. Please don't paint with a broad brush.

That's not TT said

 

[Teacher Terry]

Yes if you have money you made a choice. Just saying that the people I know that have chosen it don’t.

 

[SheitlQueen]

+1

Many of us here have used BoomerBenefits.com to assist in choosing a supplement and I don't think I've heard anything but positive reviews on them.

I just started Medicare and used Boomer Benefits and highly recommend them. Not only can they help you pick out which type of plan is best for you, they can find the cheapest premiums and they also will help later if you have problems with billing.

 

[EarlyBirdly]

I will quote/paraphrase from this letter to the Editor in the AAII Journal a few months ago (May 2019). I photocopied it for my reference in 4 years when I turn 65.


" I sold health insurance for over 30 years. The best favor you can do for yourself is to buy..."Original Medicare"....make sure you get the Supplement within 6 mos. of turning 65....so that you can not be turned down for medical reasons. Get Part D drug coverage. You will now have the the Cadillac of health plans for 65 and over. NEVER change it."

" If you are tempted to switch to Medicare Advantage...you may never get your Medicare Supplement back...If you do...you will pay a lot more because you are older. ...Advantage also has co-insurance payments which may be required before your Advantage plan pays anything. This is a real "gotcha"....it's not the same as a co-payment which is a set amount. "

It seems the second post in this thread (from Katsmeow) bears witness to all the above with real life experience.

I'm pretty sure what I'll be doing in 4 years.

BirdMan

 

[Dtail]

The big hospital chain north of us accepts regular Medicare--but not Medicare Advantage. They control hospital locations in 4+major cities as far as 400 miles away and small town hospitals in between--with over 1700 doctors. And they own hundreds of doctors' practices.

Thousands of patients are now having to drive long distances to different counties with non-affiliated hospitals. And thousands have had to change to doctors in other cities.

Advantage looks great on paper. But in reality, it doesn't work that well. And I have no desire to drive back and forth 50 or 100 miles over and over to the doctor or hospital. It's not like that everywhere, but it is there.

Just like the ACA, it depends where one lives.
DGF has MA and has a wide choice of close to and in network doctors and hospitals with no premium, plus some eye and dental coverage.

 

[John Galt III]

Msefren wrote :
The only thing we have found is "if you do not need to see a doctor often, then an Advantage Plan may be your best choice" and the fact that there is an out of pocket cap with Advantage plans, as we understand.

----------------------------------------------------------------------- I have a Medicare Advantage plan. The customer service rep said there is 20% coinsurance on certain drugs, and no cap on this 20% coinsurance, not even the $6,700 'max out of pocket'. I should call back and get a different rep (one of the flaws of MA plans is incompetent reps) and ask again.

 

[ShokWaveRider]

Just like the ACA, it depends where one lives.
DGF has MA and has a wide choice of close to and in network doctors and hospitals with no premium, plus some eye and dental coverage.

Yes, Dtail, but remember we are not in a poorer rural area, we are in urban/semi urban Florida, in affluent counties. We are fortunate enough to trip over doctors bending over backwards to take most plans. I do not know anywhere Florida Blue is not taken. Others are not so fortunate. in our area they are talking about a new hospital an about a dozen additional healthcare facilities.

I personally would not want an MA plan, but again that is choice. My pretty affluent neighbor and his wife do, as it is covered 100% by his former employment. They get just as good service as I do on my AARP MS (Via Boomerbenefits).

DW is on ACA basically the same as an MA for pre-65's and she also gets top notch care for minimal costs. As I have said before now I am on Medicare my costs are more than triple hers. No I am not complaining before others chime in to say so, just stating the facts. As I have said before, mine now are predictable, currently the ACA still is not.

 

[mpeirce]

Advantage looks great on paper. But in reality, it doesn't work that well.

Some people like advantage plans, some don’t.

My DWs advantage plan has worked out very well for her.

My DF too. And he’s been a pretty heavy user of healthcare: knee replacement, open heart surgery, and more.

Decide what’s important to you and check out your options. You might be surprised what is best for you.

 

[MichaelB]

One thing to keep in mind when comparing Original Medicare with Supplemental plans vs Medicare Advantage.

MediGap Supplemental plan coverage is regulated, so all plans with the same letter are exactly the same, and the networks are the same, which is all physicians, hospitals, labs and other service providers that participate in Medicare.

Medicare Advantage plans are all different. They all must cover Medicare A and B, but additional coverage can vary, the physicians and hospitals that participate can be limited and they can have HMO structure where preauthorization is required.

Medicare plus Supplemental plus Drug coverage offers more choices a bigger network of provides, and less cost sharing. That’s why it often costs more.

Medicare Advantage usually offers less choice, may have some restrictions, and has higher cost sharing. That’s why is might cost less.

 

[REWahoo]

Medicare Advantage usually offers less choice, may have some restrictions, and has higher cost sharing.

These restrictions are why I've never considered a Medicare Advantage plan.

As an example, in this part of the world MD Anderson Cancer Center is considered to offer the best care for many types of cancer. I want the option of seeking treatment there for both DW and I should the need arise, but might not be able to do so if we were on an Advantage plan:

From the MD Anderson website:

Medicare Part C, also known as the Medicare Advantage Plan, replaces traditional Medicare. Kelsey-Care Medicare Advantage is the only Medicare Advantage plan with which MD Anderson is contracted. However, we have a working relationship with some Medicare Advantage HMO and PPO plans. Please contact your plan to determine if they will work with MD Anderson.