Approaching 65 (Medicare) Having difficult time with Advantage vs Supplemental Plans

[audreyh1]

Has anyone purchased supplemental insurance through a private exchange from their employer? My megacorp gives employees a certain amount in a nominal account that you can use to purchase insurance either from megacorp (prior to medicare eligibility) or from a private exchange after medicare eligibility.


My concern is that I don't know much about the exchange, and if I sign up for a supplemental plan with them, and then don't like it, I won't be able to change plans without medical underwriting.

There is not an exchange for Medicare supplemental insurance. You purchase that directly from the insurance company. Not being able to change is why folks are careful about choosing, but the plans are standardized by letter. So the difference for a given letter is price and whether it increases as you age.

 

[Another Reader]

There is not an exchange for Medicare supplemental insurance. You purchase that directly from the insurance company. Not being able to change is why folks are careful about choosing, but the plans are standardized by letter. So the difference for a given letter is price and whether it increases as you age.

There are private entities that contract with large employers and act as an "exchange" for those employers. Via Benefits/One Exchange is probably the largest. To get the cost reimbursement from the employer, retirees usually have to go through the entity chosen by the employer to buy the supplement.

 

[audreyh1]

There are private entities that contract with large employers and act as an "exchange" for those employers. Via Benefits/One Exchange is probably the largest. To get the cost reimbursement from the employer, retirees usually have to go through the entity chosen by the employer to buy the supplement.

OK - thanks - that was confusing

 

[omni550]

Has anyone purchased supplemental insurance through a private exchange from their employer? My megacorp gives employees a certain amount in a nominal account that you can use to purchase insurance either from megacorp (prior to medicare eligibility) or from a private exchange after medicare eligibility.


My concern is that I don't know much about the exchange, and if I sign up for a supplemental plan with them, and then don't like it, I won't be able to change plans without medical underwriting.

My pre-retirement employer, Mega Motors, uses One Exchange (OE) and also has an annual amount they give retirees to use towards health expenses or medical insurance.

I found that OE did not offer a full selection of Supplemental Plan providers and the ones they offered were priced much higher than the ones I found by doing my own research.

OE was also very persistent in calling me, much like a telemarketer, trying to set up phone appointments to get me to "seal the deal' with them. I found this incredibly annoying.

There are private entities that contract with large employers and act as an "exchange" for those employers. Via Benefits/One Exchange is probably the largest. To get the cost reimbursement from the employer, retirees usually have to go through the entity chosen by the employer to buy the supplement.

Fortunately, the reimbursement funds are put into an account for me annually. If I purchase a Supplemental Plan from a non-OE insurer, OE will not pay the premiums directly. I have to pay the premiums out-of-pocket and submit them for reimbursement which I've been doing for the last 3 years. It's a small hassle to bundle the receipts and send them in for reimbursement to get the benefit of freedom of choice, imho.

omni

 

[Another Reader]

My pre-retirement employer, Mega Motors, uses One Exchange (OE) and also has an annual amount they give retirees to use towards health expenses or medical insurance.

I found that OE did not offer a full selection of Supplemental Plan providers and the ones they offered were priced much higher than the ones I found by doing my own research.

OE was also very persistent in calling me, much like a telemarketer, trying to set up phone appointments to get me to "seal the deal' with them. I found this incredibly annoying.



Fortunately, the reimbursement funds are put into an account for me annually. If I purchase a Supplemental Plan from a non-OE insurer, OE will not pay the premiums directly. I have to pay the premiums out-of-pocket and submit them for reimbursement which I've been doing for the last 3 years. It's a small hassle to bundle the receipts and send them in for reimbursement to get the benefit of freedom of choice, imho.

omni

I remember you saying that in a previous post. I checked and at least the UHC/AARP plans for us are the same price as through AARP.

I also dislike the pressure of "we are calling to set up your sign up appointment." Just another pushy insurance sales outfit. Sorry, I want information, I want to compare prices with other sources, and I want to see if one of these other agents will provide better service. I want to know if I can submit the supplemental policy bills from the better agent for reimbursement from you as the reimbursement servicer if your services don't cut it.

In addition to Boomer Benefits, there was an agent in Florida IIRC several people recommended. He had a series of interesting videos, but I lost his name. Would someone please remind me?

 

[Katsmeow]

Has anyone purchased supplemental insurance through a private exchange from their employer? My megacorp gives employees a certain amount in a nominal account that you can use to purchase insurance either from megacorp (prior to medicare eligibility) or from a private exchange after medicare eligibility.

AS others have mentioned -- Via Benefits (was One Exchange) is one company that does this. I am not on Medicare yet but will be next year. Supposedly I have to use my HRA from Megacorp to buy through Via Benefits. I am not sure if I forego the HRA money entirely if I don't buy through them. I wouldn't like that. I do think I could buy my Part D through them but the HRA is likely to be more than the premiums for the Part D coverage are.

There is not an exchange for Medicare supplemental insurance. You purchase that directly from the insurance company.

There are private exchanges for some people where you can get your Medigap supplement policy and Part D coverage.

 

[audreyh1]

There are private exchanges for some people where you can get your Medigap supplement policy and Part D coverage.

Yes, I understand that now that those are exchanges used by employers who pay for at least part of the Medigap plan for their retirees.

 

[NoMoreJob]

Plan N differs from Plan G in three ways:

-No coverage for Part B excess charges

-You may have a copay of up to $20 for doctor visits and $50 for ER visits that don’t result in admission.

- Due to the above, ~20% lower premium costs

And in one more way - Plan N does not cover excess charges. This only comes into play if you happen to use a provider that does not accept Medicare assignment. Providers can take Medicare but not agree to Medicare's standard reimbursement rates. They are still limited but can charge in the neighborhood of 10% more for many things (technically 15% but due to complicated rules it turns out to be less than that). Plan N does not cover these 'excess charges' but Plans F and G do. 'Excess charges' can be avoided by choosing providers that accept Medicare assignment but there are some (often high profile) providers that do not so if you happen to end up at one with plan N you may be on the hook for substantial out-of-pocket amounts.

I know about this because I ended up in this situation. Fortunately I had plan G so all the excess charges were covered by my supplement.

One other thing I'll mention is that some of these high profile facilities will not accept patients with Medicare Advantage plans at all. This is one reason I chose Traditional Medicare + Medigap over Medicare Advantage and am very thankful that I did.

 

[REWahoo]

And in one more way - Plan N does not cover excess charges.

That was the first of the three differences I listed.

 

[NoMoreJob]

That was the first of the three differences I listed.

Sorry, obviously didn't have my mind fully engaged. I think it is worthwhile to explain 'excess charges' though. i didn't fully understand them until I had to deal with them.

 

[Katiek]

Thanks for the information re the exchanges. It sounds like it pays to examine because in some cases the plans may be more expensive, but in others, they may be the same price. In my megacorp, if you don't buy through the exchange post-medicare, you don't get the money.



If I retire before I'm medicare eligible, I can use the account for insurance through the company and that may end up using most of the reimbursement account, so I may not have to worry about using it for a supplemental plan.

 

[omni550]

I remember you saying that in a previous post. I checked and at least the UHC/AARP plans for us are the same price as through AARP.

I also dislike the pressure of "we are calling to set up your sign up appointment." Just another pushy insurance sales outfit. Sorry, I want information, I want to compare prices with other sources, and I want to see if one of these other agents will provide better service. I want to know if I can submit the supplemental policy bills from the better agent for reimbursement from you as the reimbursement servicer if your services don't cut it.

In addition to Boomer Benefits, there was an agent in Florida IIRC several people recommended. He had a series of interesting videos, but I lost his name. Would someone please remind me?

You may be thinking of Christopher Westfall https://seniorsavingsnetwork.org/

I chose my original Medicare Supplement Plan provider with his assistance. An associate of his has called me each year to discuss whether I wish to stay with the same provider or shop for a different one, as the premiums increased slightly.

omni

 

[Another Reader]

You may be thinking of Christopher Westfall https://seniorsavingsnetwork.org/

I chose my original Medicare Supplement Plan provider with his assistance. An associate of his has called me each year to discuss whether I wish to stay with the same provider or shop for a different one, as the premiums increased slightly.

omni

Yes, that's the one. Thank you. Unfortunately, he is evacuated for the hurricane right now, but my questions are not urgent anyway.

 

[omni550]

Yes, that's the one. Thank you. Unfortunately, he is evacuated for the hurricane right now, but my questions are not urgent anyway.

From his site: We are still returning calls remotely. Reach us at 1-800-729-9590.

Wondering if there may be a drop in incoming call volume with all the evacuations underway?

omni

 

[Another Reader]

I sent an email. The idiots at Via Benefits have given me three different reimbursement amounts. I'm assuming the lowest of the three, which is printed in the pamphlet that arrived in the mail coincident with my Medicare card.

 

[John Galt III]

I'm in Pa and just called SHIP (State Health Insurance Something?) and talked to someone for 20 minutes confirming my general current knowledge of Medicare. He referred me to a local volunteer agency called Apprise, for my county, and a medicare counselor from Apprise will call me in the next few days to set up an appointment. After Apprise, I plan to contact someone at Boomer Benefits online for another round of information-gathering and decision-making. May end up in Medigap Plan N, or a Medicare Advantage plan.

 

[MichaelB]

I found that OE did not offer a full selection of Supplemental Plan providers and the ones they offered were priced much higher than the ones I found by doing my own research.

This is news to me. I knew about private employer insurance exchanges but was under the impression that MediGap policies were offered at the same price as elsewhere.

 

[omni550]

This is news to me. I knew about private employer insurance exchanges but was under the impression that MediGap policies were offered at the same price as elsewhere.

OE did not offer a full spectrum of providers/insurers. They seemed to offer mid-and high-priced ones.

I spent days educating myself about Medicare, and researching and comparing plans. Talk about a system "clear as mud". No wonder folks throw up their hands and just fall for OE's menu -- as it seems as though it's a less complicated way of choosing a plan, albeit for more $$$. And the fact that OE pays the premiums directly if one has a reimbursement account is also perceived as a benefit by many.

I was able to find the policy I wanted (Plan G) at a much better price from a provider I found on my own through Christopher Westfall's organization.

omni

 

[Another Reader]

I'm in Pa and just called SHIP (State Health Insurance Something?) and talked to someone for 20 minutes confirming my general current knowledge of Medicare. He referred me to a local volunteer agency called Apprise, for my county, and a medicare counselor from Apprise will call me in the next few days to set up an appointment. After Apprise, I plan to contact someone at Boomer Benefits online for another round of information-gathering and decision-making. May end up in Medigap Plan N, or a Medicare Advantage plan.

This guy makes an excellent case for avoiding Advantage plans.

https://seniorsavingsnetwork.org/medicare-advantage/

I would not let an insurance company control my healthcare and direct me to less than the highest caliber providers.

 

[NoMoreJob]

This guy makes an excellent case for avoiding Advantage plans.

https://seniorsavingsnetwork.org/medicare-advantage/

I would not let an insurance company control my healthcare and direct me to less than the highest caliber providers.

I will just point out that Medicare does that to the extent that not all providers accept Medicare. So even with Medicare you have some limitations. However, I agree that I want as much choice as possible which is why I chose Traditional Medicare with a supplement that pays 'excess charges' (plan F or G).

 

[Dtail]

This guy makes an excellent case for avoiding Advantage plans.

https://seniorsavingsnetwork.org/medicare-advantage/

I would not let an insurance company control my healthcare and direct me to less than the highest caliber providers.

Mostly true, but in FLA there is an extensive network of doctors available to Advantage users.

 

[MichaelB]

Mostly true, but in FLA there is an extensive network of doctors available to Advantage users.

True. I had some concerns when my mum's retirement benefit was changed from a MediGap supplemental to a Medicare Advantage plan with UHC, but it has a broad, nationwide provider network that covers all our demanding needs.

Despite that, I'm with Another Reader and will not choose the Advantage plan for myself, as the insurer is free to make future changes that would limit access.

 

[Walt34]

For us the choice was easy, the decision was made in June of 2002 to stay in the former employer's group insurance plan. I could pay 20% of the premium and get HI for one year after retirement at age 52 for every year of service (29 years) or I could pay 30% of the premium and both DW and I could stay in it for life. That was a no-brainer, I pay 30% of the premium. Since I went on Medicare three years ago it is secondary to Medicare and picks up where Medicare leaves off. When DW goes on Medicare then it will be secondary to Medicare as well.

 

[John Galt III]

Something I haven't seen mentioned is that the premiums with a medicare advantage plan are often $0 per month, and the advantage plan actually pays for your monthly plan B premium, which saves lower income folks $134 per month. That's a good thing, but still, after seeing medicare advantage plans in action with my parents, it revealed that there is a lot of vigilance and worry involved in making sure everything is in network, no out-of-network people snuck in, etc. But isn't out-of-network still a problem with a supplement plan?

 

[SumDay]

We went with Humana Plan F initially, and within the 6 month window switched to G (lowered premiums by $50 a month). Humana was the only one in our area that offered Silver Sneakers, which appealed to DH. Also used Silver Scripts for Plan D. Frankly I'm shocked at how generous that coverage is, especially for the premium. Far better than the megacorp plan I had when I was w*rking. I'm not 65 for another 4 years, and will probably do what DH did.