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

[Bdroc]

Advantage

I will be medicare age next April. So a little past 6 months but not by much. I would never consider an Advantage plan. Never. My mother recently died. She had traditional Medicare with Supplemental Plan G. She had no problem finding doctors to take her. She could go to any doctor that takes Medicare. There were no issues with coverage.

I have another relative who is on Medicare Advantage. It has been so much more of a pain as it isn't good enough for her to go to anyone who takes Medicare. She has to go to someone who is in network. Also, she can't just decide to go back to traditional Medicare as I doubt she could qualify for a supplemental plan.

That is the real issue with Medicare Advantage. If you want to go back to traditional Medicare you may not be able to medically qualify. If it wasn't for that then it wouldn't be that big of an issue. And, even a healthy person can develop something that causes them to not be able to medically qualify.

Advantage plans include drug coverage, vision, and dental and are often less expensive than medigap plans. Finding a doctor that accepts Advantage shouldn't be a problem in most areas but that might not be the case anywhere.

Years ago I was shopping for my mother and I was told that traditional Medigap plans would accept her even though she had cancer. The only restriction was if she had renal failure.

 

[Archman]

Supplements don't usually cover meds you need a separate drug plan, Advantage plans are not required to offer drug coverage but the vast majority do. There might be some out there that don't but I've never run across them.

Do you ever leave your plans service area because those out of network numbers are sobering?

Yes.

 

[Katsmeow]

Advantage plans include drug coverage, vision, and dental and are often less expensive than medigap plans. Finding a doctor that accepts Advantage shouldn't be a problem in most areas but that might not be the case anywhere.

Years ago I was shopping for my mother and I was told that traditional Medigap plans would accept her even though she had cancer. The only restriction was if she had renal failure.

I wouldn't count on that years ago for underwriting now.

I would never sign up for a Medicare Advantage plan because (1) I don't want to be in a network - I prefer the choice you get with traditional Medicare and (2) I would not take the huge financial risk of potentially not being able to medically qualify if I wanted to go back to traditional Medicare.

My personal experience with people who have Medicare Advantage is that it is fine right up until the time you are really sick and your choices of where you get treatment are severely limited.

When my mother was ill before her recent death the response of every provider I dealt with was relief she was on traditional Medicare...

 

[lawman3966]

My circumstances are pretty specific, as I'm under-65 and on SSDI. Medigap is very expensive for people in this category.

Because of the cost of Medigap, and the fact that we have a good Medicare Advantage provider here in Washington (Kaiser), I'm going with Advantage. One bonus for me is that I'm already with Kaiser under the ACA, and my doctors, and various coverage levels, and very convenient computer database of my medical record, will remain mostly unchanged. My costs will decline moderately on M-care Advantage in comparison to my current ACA coverage.

 

[HunterAdvisor]

Expat Medicare Options

I had a nice long post that was lost so here’s the short version.
Mother is 86 and moving to Puerto Vallarta, Mexico. In addition I’ll qualify in 18 months. Great providers here, all cash out of pocket at about 20% the US rates.
What plan do you recommend since we cannot receive Medicare benefits here?
Thanks

 

[ShokWaveRider]

I did not think that one could get an insurance plan in Mexico for healthcare if you are over 65.

 

[ivinsfan]

I had a nice long post that was lost so here’s the short version.
Mother is 86 and moving to Puerto Vallarta, Mexico. In addition I’ll qualify in 18 months. Great providers here, all cash out of pocket at about 20% the US rates.
What plan do you recommend since we cannot receive Medicare benefits here?
Thanks

My advice would be for you to redo the post you lost and start a new thread your question will get buried here....

 

[ShokWaveRider]

OK. Today I spoke to AARP, UHC (Through AARP) and an Independent agent. I am going to go with plan F. In Florida the difference between F & G premiums is basically the Deductible.

The advantage of going through AARP is that there will be no underwriting if one moves from a plan F to G later (2020). Why? Because it is one of the items that permits UHC to be sponsored by AARP. Going direct to UHC does not get this benefit (In writing). It is written into the AARP/UHC contract. G is considered a Lesser plan that F even though the only difference is the Deductible exclusion. Moving to a Lesser plan currently do not require underwriting.

 

[zaqxsw]

I'll be choosing the 1st half of next year. I've read a couple of books, played with the plan finders and am narrowing down what I'm interested in. Probably Medigap + drug + dental.

What I don't understand is why the Medicare.gov Medigap plan finder only shows the results it does? An example is if I choose Plan G, it doesn't show UHC or Anthem for my zip code, but if I go to those company sites, I find that they do offer Plan G in my area.

Everything I've read treats the Medicare.gov plan finders as THE place to go.

 

[Duke of Sands]

I have UHC Advantage PPO through megacorp retirement plan and am happy with the coverage experience I have had, especially the portability. DW has AARP/UHC supplemental plan F which we chose due to her medical issues. Have been quite happy with her coverage, except no Silver Sneakers (which I have with my plan) and hefty charges for the new shingles shot and HepA vaccine. I had the same charges for my plan. Also, we are snowbirds and are Florida residents, spending summers in Michigan. My Advantage plan covered my CPAP machine expenses in Michigan while her potential CPAP equipment provider refused to deal with her just because the policy was written in FL. These are two different providers so that could account for the disparity, however (mine is affiliated with U. of Michigan Health).

Aside from the above nuisance issues, we are happy with our arrangements although we have yet to experience major medical procedures over the 5 years that we have been on Medicare. I should note that I pay $40 per month for both medical and drug coverage (some additional cost subsidized by megacorp) and she pays around $230/month for both.

 

[MBSC]

What I don't understand is why the Medicare.gov Medigap plan finder only shows the results it does? An example is if I choose Plan G, it doesn't show UHC or Anthem for my zip code, but if I go to those company sites, I find that they do offer Plan G in my area.

Everything I've read treats the Medicare.gov plan finders as THE place to go.

There are two sections on the Medicare.gov website. One section is the "Health Plan Finder". Part C (Medicare Advantage) and Part D (drug) plans are listed here. The information in this section is required to be as accurate as possible since government funding is involved.

Supplements are not government subsidized health plans so they are relegated to a different section of the site. The carrier maintains the information and chooses how often to update it. There are also cases where a carrier is listed but is no longer offering plans in that area. It leaves much to be desired. The best place to start for supplements is your state Department of Insurance (DOI) website.

Ohio Medigap carriers and premiums as of April 2018 are in the link below. Anthem Plan G is not listed so it must be a new offering. https://www.insurance.ohio.gov/Consumer/OCS/Pages/OCSPubIndexTab6.aspx

 

[Dave in VA]

What are the best Medicare options for retired military? I am 63 and currently on Tricare Standard, with a Tricare supplement that I got through MOAA. What are your experiences going from Tricare to Medicare/Tricare for life?

 

[misanman]

Plan G

 

[braumeister]

What are the best Medicare options for retired military? I am 63 and currently on Tricare Standard, with a Tricare supplement that I got through MOAA. What are your experiences going from Tricare to Medicare/Tricare for life?

Transition from the MOAA Tricare plan to TFL was smooth and seamless. Don't worry about it.

 

[zaqxsw]

There are two sections on the Medicare.gov website. One section is the "Health Plan Finder". Part C (Medicare Advantage) and Part D (drug) plans are listed here. The information in this section is required to be as accurate as possible since government funding is involved.

Supplements are not government subsidized health plans so they are relegated to a different section of the site. The carrier maintains the information and chooses how often to update it. There are also cases where a carrier is listed but is no longer offering plans in that area. It leaves much to be desired. The best place to start for supplements is your state Department of Insurance (DOI) website.

Ohio Medigap carriers and premiums as of April 2018 are in the link below. Anthem Plan G is not listed so it must be a new offering. https://www.insurance.ohio.gov/Consumer/OCS/Pages/OCSPubIndexTab6.aspx

Thank you very much for the reply! I am using the correct section, but as you mentioned, the information is not accurate.....

 

[zack59]

Yes, it is confusing. The only info I have on this is from the thread I linked. Because of that, I am not counting on being able to change policies without underwriting once I enroll. In pre-ACA Florida I was denied insurance by both BCBS and UHC due to preexistíng conditions, so I expect the same outcome in the future if a plan requires underwriting.

Based on some Medicare threads here, I am also looking at MediGap N. The price difference is $50 per month, or $6K over 10 years.

What can be the worst case scenario in having a Florida Plan N instead of Plan G?
A long term hospital stay where doctors that that don't accept assignment treat you? If so is there a maximum OOP?

And am I understanding there may be an Oct 1 deadline to switch from N to G with AARP without underwriting or has it not been concluded.

 

[NoMoreJob]

OK. Today I spoke to AARP, UHC (Through AARP) and an Independent agent. I am going to go with plan F. In Florida the difference between F & G premiums is basically the Deductible.

The advantage of going through AARP is that there will be no underwriting if one moves from a plan F to G later (2020). Why? Because it is one of the items that permits UHC to be sponsored by AARP. Going direct to UHC does not get this benefit (In writing). It is written into the AARP/UHC contract. G is considered a Lesser plan that F even though the only difference is the Deductible exclusion. Moving to a Lesser plan currently do not require underwriting.

You may want to double check on the ability to change from F to G without underwriting. My agent recently sent out an email to his AARP/UHC clients on plan F with the following statement.....

URGENT ATTENTION:

Your ability to change to a Plan G (Medicare Supplement) at AARP UHC with just a phone call, and NO medical underwriting, will end on Sept 30th, 2018. This reflects a NEW internal rule change regarding your ability to change supplement plans at AARP UHC easily.

This could vary by state but I'd suggest checking if you're counting on being able to change.

 

[bmcgonig]

Article from Reuters about plan F and G

https://www.reuters.com/article/us-...-changing-what-you-need-to-know-idUSKCN1LZ18F

 

[ShokWaveRider]

I think it is a shame no one can seem to get the story right on this. Here in Florida I have called EVERONE (Agents) and every company and they tell me there will be no underwriting as long as you go to a lesser plan. G is lesser than F even by just the deductible. In Florida the differences in premiums between the 2 is not as dramatic as other states.

So sad making it so confusing for those who need the services most. It is a real shame.

 

[NoMoreJob]

I think it is a shame no one can seem to get the story right on this. Here in Florida I have called EVERONE (Agents) and every company and they tell me there will be no underwriting as long as you go to a lesser plan. G is lesser than F even by just the deductible. In Florida the differences in premiums between the 2 is not as dramatic as other states.

So sad making it so confusing for those who need the services most. It is a real shame.

One problem is that everything is not exactly the same from state to state. Even though Medicare is a federal program there are differences.

As far as underwriting is concerned it's my understanding that Medicare has guidelines but that insurers' policies on the matter can vary especially if they are more lenient. Apparently AARP/UHC has been fairly lenient but is tightening up, at least in some states and with regard to Plan F.

 

[ShokWaveRider]

Here is something I saw today: Florida does have open Enrolment not necessarily on one's birthday but from October 15 through December 7th for 2018.

State of Residence
Unfortunately, many people are going to be coerced into dropping their Plan F and purchasing a Plan G by agents who are either looking for easy business or just don’t understand all of the variables at play. If you live in a state that allows an open enrollment on your birthday, keeping a Plan F may make sense. This rule allows individuals to switch from one Plan F to another Plan F on their birthday or effective date (depending on state) without answering any underwriting questions. This helps individuals offset possible increases by changing carriers.

Called Boomer Benefits. CURRENTY it is a stipulation of the AARP agreement that plan switching to a lesser plan (G) would not be underwritten. That may change in 2020.

 

[TwoByFour]

My wife was a teacher and had a very good medical plan at work (it was Blue Cross/Blue Shield). They gave her the option of keeping it when she retired, which we did. It is now our secondary insurance to Medicare. At first I was skeptical of it and advocated that we just get a part D and part G as it would be cheaper premiums. But DW insisted we keep the BCBS secondary because it has greater benefits. Fast forward 3 years, and DW has a medical problem that is treated with a drug that costs about $4000/month. She has been on the drug for 2 years and it has cost us pennies.

Moral of the story - if you have a plan with work that you can keep when you retire, you might consider it rather than Medigap. Especially if you have any medical issues.