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Classic Medicare & Medigap vs. Medicare Advantage
Old 12-20-2010, 10:37 PM   #1
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Classic Medicare & Medigap vs. Medicare Advantage

I got letter a week or so ago saying that the clinic where my doctor works will no longer take patients with classic Medicare beginning January. Only a short list of their approved Medicare Advantage Plans. I have until Dec 31 to do something, if I am to to change over.

This is really not enough time for me to find out all the differences between these two types of plan. I originally chose Classic Medicare because of greater control and flexibility. Finding what I could on the state government insurance commissioner's page, it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave. You can switch MA plans at certain times, and you can go back to original Medicare and get a drug plan- but you are not guaranteed acceptance into a Medigap plan.

I am leaning toward changing doctors rather than be levered into this change on short notice, although I really like the doctor and have gone to him for a long time.

Anyone have observations or suggestions? I know these things vary from state to state, but any comments would help I think.

Ha
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Old 12-21-2010, 06:21 AM   #2
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Quote:
Originally Posted by haha View Post
Anyone have observations or suggestions? I know these things vary from state to state, but any comments would help I think.
This Google search gave me this:

Quote:
How do I leave a Medicare Advantage plan?
September 20, 2009 by admin

AnswerId:
45

QuestionLong:
How do I leave a Medicare Advantage plan?



Generally, if you join a Medicare Advantage Plan or Medicare Prescription Drug Plan, you can only change plans from November 15 through December 31 of every year. This change will be effective January 1 of the following year. If you are also eligible for Medicaid, you can switch plans at anytime.If you are eligible for a Medicare Advantage Plan, you can also join or switch Medicare Advantage Plans from January 1 to March 31 of any year, but you can't join or drop Medicare prescription drug coverage during this time. For instance, if you are in a Medicare Advantage Plan with prescription drug coverage, you could return to the Original Medicare Plan, but you'd have to also join a Medicare Prescription Drug Plan at the same time. If you have questions about whether or not you can join or switch Medicare plans, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.You can switch your plan in one of three ways:
  1. Join another plan.
  2. Write or call the plan you want to join.
  3. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you want to switch from a Medicare Advantage Plan to the Original Medicare Plan, you need to contact your current plan or call 1-800-MEDICARE (1-800-633-4227). If you want to buy a Medigap policy, simply signing up for the Medigap policy won't end your Medicare Advantage Plan coverage. You must disenroll. In some cases, you may have certain Medigap protections that give you the right to buy a Medigap policy, but in other cases, you may not be able to buy any Medigap policy. Your rights to buy a Medigap policy can vary by state. If you want to talk to someone who can help you decide what to do, call your State Health Insurance Assistance Program.Their number can be found in the Helpful Contacts section of this web site.
DateCreated:

2001-06-27

DateUpdated:
2009-05-04

FAQ_Category:
Medicare Advantage Plans

RelatedAnsIds:
44,43,93,1412,2051
The Google search also gives other (possibly better) answers to your question. I am begging off giving any personal advice because, after looking at it, your question is actually quite complicated... and, of course, there is that very narrow window for action.
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Old 12-21-2010, 07:49 AM   #3
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Originally Posted by haha View Post
I originally chose Classic Medicare because of greater control and flexibility. Finding what I could on the state government insurance commissioner's page, it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave.
Hmmm. I didn't realize Medicare Advantage programs were such roach motels (great metaphor). So, the American public gets the privilege of paying extra to provide a "more privatized" care program designed to trap seniors and undermine the traditional program at the same time. Wonderful approach to health care reform. I can't remember what happens to Advantage under Obamacare. At one time the subsidies were on the cutting board. Will they be gone? If so, will participants have a way out and into standard medigap policies (i.e. will no pre-existing conditions apply to medigap?)
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Old 12-21-2010, 12:02 PM   #4
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Hmmm. I didn't realize Medicare Advantage programs were such roach motels (great metaphor). So, the American public gets the privilege of paying extra to provide a "more privatized" care program designed to trap seniors and undermine the traditional program at the same time. Wonderful approach to health care reform. I can't remember what happens to Advantage under Obamacare. At one time the subsidies were on the cutting board. Will they be gone? If so, will participants have a way out and into standard medigap policies (i.e. will no pre-existing conditions apply to medigap?)
In my state anyway, it appears that you can only transit from one Medigap company to another with underwriting. So right away, this flies in the face of the idea that if you have continuous coverage you are "in the system", and therefor not subject to being underwritten.You can move from one Medicare Advantage to another MA plan, during an annual open enrollment. It also seems that if your MA plan folds up shop you can buy a Medigap upon returning to original Medicare. Also, it appears that there are some other "exceptions", but it is very careful language that seems to not allow security about the meaning of it.

Overall it seems to be the usual "screw you , Citizen, that we have grown to know and love in almost all areas of the private health system in America.

Ha
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Old 12-21-2010, 12:14 PM   #5
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I got letter a week or so ago saying that the clinic where my doctor works will no longer take patients with classic Medicare beginning January. Only a short list of their approved Medicare Advantage Plans. I have until Dec 31 to do something, if I am to to change over.

This is really not enough time for me to find out all the differences between these two types of plan. I originally chose Classic Medicare because of greater control and flexibility.
Ha, You have three choices: find another doctor (as you said), find a MA plan, or call SHIBA.

On the second choice, you are in luck! Every carrier is currently running open enrollment seminars. Look for ads from Regence, Group Health, and Essence (to name a few in the Seattle area).

If you don't see/hear ads, there are 800 numbers and the friendly customer service folks are happy to answer any questions you have. Including identifying if any prescriptions you have are in their formulary, and talking with you about the difference between MA and the Sup plans they have available. The same would be true by attending a sales seminar. These are low-key events geared to providing information.

Note: Medicare requires insurance carriers have dedicated staff -- meaning they are licensed agents who are expert in the medicare products and deal only with those products (your tax dollars hard at work).

The Medicare Advantage and MedSup plans are exactly the same from any carrier. What differentiates them is the premium charged and any access to other goodies (for MA clients: health club memberships, discounts on hearing aids, etc.).

The risk with Medicare Advantage, however, is the same risk any of us have with private insurance: the clinic may stop working with a particular plan, or a plan may choose not to continue offering the health plan. So in Washington state, the three largest insurers are Regence, Premera, and Group Health. Only Regence and Group Health offer MA (but there are plenty of other carriers operating). Choosing a local carrier may offer a higher chance of them staying in the MA business -- or not. Premera pulled out several years ago and only sells MedSup.

The third choice is SHIBA. In Washington state, the insurance commissioner has a special department dedicated to helping consumers sort out the choices (Statewide Health Insurance Benefit Advisors). This is a volunteer organization -- and it is a excellent source of info. SHIBA HelpLine - We make finding health care easier!

Quote:
Originally Posted by haha View Post
it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave.
This one is a matter of perspective. I would say that Traditional Medicare is the roach motel: you're stuck there until open enrollment. No amount of supplement insurance will break you out. The quality of care is the issue here -- it is not substandard in either program. Being stuck is up to you.

The reality is that MA plans offer a broader set of benefits than Medicare, plus goodies (see above), and the doctors like it better. Why? They get paid more and faster. That's why your doctor will no longer be seeing you if you don't have Medicare Advantage.

Quote:
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I am leaning toward changing doctors rather than be levered into this change on short notice, although I really like the doctor and have gone to him for a long time.
Again, Ha, it's a choice. I know the staff at Regence and I know and understand how the Medicare sales reps operate. Customer service there is first rate and they really love dealing with seniors. It's a big part of their business. Oh, yeah, and they pay my pension and subsidize the cost of that retiree group health insurance thingy.



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Old 12-21-2010, 12:20 PM   #6
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This is another thread that proves this is the best Forum on the Internet.
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Old 12-21-2010, 12:23 PM   #7
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This is another thread that proves this is the best Forum on the Internet.
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Old 12-21-2010, 12:27 PM   #8
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Thank you, I try my best!
Yeah. You, too.
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Old 12-21-2010, 03:47 PM   #9
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Thank you, I try my best!
Ah yes Rita, and your best is very very good!

Ha
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Old 05-12-2011, 10:16 PM   #10
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If it's not prying toooooo much, have you resolved this issue and which way did you choose? I ask because the choice between Medicare+Medigap and Medicare Advantage is currently a trade I'm researching.

It appears from the discussion on this thread that Medicare Advantage might potentially get a person access to better care. Is that based on the assumption that doctors in high demand are the best in their expertise and therefor more able to be selective in the type of insurance they will accept?

Is there a quality of care advantage with Advantage polices?
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Old 05-14-2011, 10:02 AM   #11
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I just had to make this decision since I go on Medicare in June. I elected to go w/the Medicare Advantage plan my current Dr & hospital take because:

I will not need a Part D (Rx) plan-its included
I already have an HMO type plan so I am familiar w/the 'rules'
It is a plan from a company I have already had an HMO plan with
I can change plans in 7 months if I decide I need to do so
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Old 05-14-2011, 10:25 AM   #12
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If it's not prying toooooo much, have you resolved this issue and which way did you choose? I ask because the choice between Medicare+Medigap and Medicare Advantage is currently a trade I'm researching.

It appears from the discussion on this thread that Medicare Advantage might potentially get a person access to better care. Is that based on the assumption that doctors in high demand are the best in their expertise and therefor more able to be selective in the type of insurance they will accept?

Is there a quality of care advantage with Advantage polices?
I hurried up and did nothing. Decision still in the future.

Ha
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Old 05-17-2011, 09:45 AM   #13
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Medicare Advantage plans can be bad for those who travel extensively in the US, such as snow birds. Most MA plans have a list of doctors in the area where you join. This preferred provider list are those Docs. who accept the plan. Going to docs outside the plan can be a big problem. If you are in the Group Health Plan in the Seattle area and go to Palm Springs for the winter, you can't really go to the Dr. down there, except for the emergency rooms where you will have the $deductible, and big wait. If you are on Medicare plus a supplement, you can go to any dr. who takes Medicare.
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Old 05-17-2011, 09:53 AM   #14
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Medicare Advantage plans can be bad for those who travel extensively in the US, such as snow birds. Most MA plans have a list of doctors in the area where you join. This preferred provider list are those Docs. who accept the plan. Going to docs outside the plan can be a big problem. If you are in the Group Health Plan in the Seattle area and go to Palm Springs for the winter, you can't really go to the Dr. down there, except for the emergency rooms where you will have the $deductible, and big wait. If you are on Medicare plus a supplement, you can go to any dr. who takes Medicare.
That isn't what Group Health told me at their meeting. They said that a Group Health Card functions as a Kaiser Permanente Card when Group Health members are in Kaiser territory. It appears to be complex and full of hard to interpret conditions.
https://provider.ghc.org/open/render...kaiserperm.xml

Kaiser Permanente Medical Care - Palm Springs, CA, 92262 - Citysearch

Also, many PPO Advantage Plans that are part of the Blue network seem to offer good coverage out of area, but I am not experienced in how well this actually works.

Ha
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Old 05-17-2011, 12:14 PM   #15
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Also, many PPO Advantage Plans that are part of the Blue network seem to offer good coverage out of area, but I am not experienced in how well this actually works.

Ha
Seemlessly. You make an appointment with the provider and present your card. They take any co-pay, if applicable, submit the claim to the local Blue plan and they get paid as they do normally. Your original plan reimburses the Blue plan (it all gets done behind the curtain, young man!)

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Old 05-17-2011, 12:29 PM   #16
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Glad I don't sell MA...
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Old 05-17-2011, 04:30 PM   #17
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Seemlessly. You make an appointment with the provider and present your card. They take any co-pay, if applicable, submit the claim to the local Blue plan and they get paid as they do normally. Your original plan reimburses the Blue plan (it all gets done behind the curtain, young man!)

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Thanks Rita, for your always well informed answers and also for this
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Ha
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Old 05-17-2011, 05:10 PM   #18
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As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....
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Old 05-17-2011, 07:05 PM   #19
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As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....
Well, this prroves to me once again- believe litle of what you hear from someone who is trying to sell you something. This Group Health rep stood in front of a room ful of people and said as if it was an everyday fact that GHC members could get seamless care at Kaiser Permanente.

Ha
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Old 05-17-2011, 07:45 PM   #20
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As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....
Are you sure you're describing Kaiser and not CareFirst BCBS?
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