Is Original Medicare really so awful?

[W2R]

I probably have the least expertise of anyone on the forum when it comes to this topic, but did that ever stop me? I'll try to stick with what I DO know.

I can report that quite a few older people that we know here in New Orleans opt for a local Medicare Advantage plan that is cheap and is supposed to be really good. That is what F is choosing; I posted here about it earlier here, and discussed with everyone; by now, he is locked into the MA plan and has his card and everything. He turns 65 this summer and is thrilled that he won't be paying his sky high conventional insurance monthly fee after this month.

As for me, I have federal employee/retiree BCBS health insurance along with Medicare Part B, and I plan to keep this coverage. When I qualified for Medicare, my insurance converted to a Medicare supplement and now it covers more than it used to cover (although I still pay the same, plus I have to pay for Medicare Part B too).

[Teacher Terry]

I wouldn’t take the advantage plan due to the possibility of traveling for treatment you can’t get locally. Right now we pay a fourth of our gross income for HI and copay, etc. Hoping this reduces once my husband is 65 in 5 years and we can get off my state insurance.

[aja8888]

Medicare Advantage plans are great from a cost perspective....until you need a real specialist. But, then again, I hear that most people will die in their sleep at home and never get cancer or need a heart or other organ transplant.

[Gotadimple]

Medicare Advantage Plans are great - IF
* the plans in your area offer something other than HMOs. HMO's can often have limited primary and specialist networks, and there is usually no coverage out of the service area. The exception is an HMO in a large metropolitan area with a broad provider network (but then you are in an area of the country with a lot of specialists).

You have to spend time with a sales person/agent to understand the network.

* the plan in your service area is part of a BCBSA network. Many BCBSA plans offer coverage, but the MA plan doesn't carry the BlueCross/BlueShield logo, so it's local doctors only.

Medicare is very good about identifying the plan specifics.

[ivinsfan]

Quote:

Originally Posted by aja8888 Medicare Advantage plans are great from a cost perspective....until you need a real specialist. But, then again, I hear that most people will die in their sleep at home and never get cancer or need a heart or other organ transplant.

This isn't always true, it's vary wildly be area. Someone area might have great coverage, what is true is you will have limited choices and might not be comfortable traveling outside of your area.

[aja8888]

Quote:

Originally Posted by ivinsfan This isn't always true, it's vary wildly be area. Someone area might have great coverage, what is true is you will have limited choices and might not be comfortable traveling outside of your area.

How true, but you don't know what's in store for you until after you sign on. Why gamble with unknown consequences (unless of course, you like to gamble). Switching out of a MA plan to Medicare/Supp can be difficult after the fact.

[John Galt III]

Quote:

Originally Posted by ivinsfan JG, can you afford the monthly premiums no one actually wants to pay them but in this case it would be 115 a month well spend IMO...I'd go with the plan N.

I think you've hit on something here, ivinsfan. I can afford it, but don't want to pay it. I'm going from being spoiled on the ACA, getting great insurance for free.

I'm in denial that the good old days are gone forever.....

[trumpeting_angel]

Quote:

Originally Posted by ivinsfan Medicare has more possible penalties and issues then you want to think about. But be sure and do some research before you hit 65. And disclaimer I am not a professional so Google what I say before you take it to the bank....

For sure, sign up for Part A when you turn 65, and don’t let employer-sponsored insurance lapse without signing up for Part B. COBRA doesn’t count. The penalties are severe, and for life.

I’ve been on HMO and cheaper PPO health plans when I was younger. I tend to need more health care now and I certainly want to choose my own doctor and hospital. I’ve worked in healthcare too long to leave that choice to a MA plan if I get sick with something serious. They might have the right doc for the job, or a hospital with low infection rates, but you can’t count on it.

I live in Vermont but the nearest specialty center is Dartmouth Hitchcock, which is in New Hampshire. I paid a few extra dollars for out of state coverage. Our local hospital is going into Chapter 11, closed their childbirth center, and laid off a lot of people. You bet I’ll go to DHMC if I need a specialist, not locally.

I plan to be healthy, too. I plan not to start any new, expensive meds. I eat right, raise organic vegetables, exercise, etc. But we ain’t always that lucky!

[H2ODude]

If you take a Medicare Advantage doesn't that subject you to the "network" trap? As in even if you don't travel and you have some emergency acute need (hospitalization) in your hometown hospital roaming physicians can look in on you and bill for whatever they want and if not in your proper network the bill is on you?

[audreyh1]

Quote:

Originally Posted by H2ODude If you take a Medicare Advantage doesn't that subject you to the "network" trap? As in even if you don't travel and you have some emergency acute need (hospitalization) in your hometown hospital roaming physicians can look in on you and bill for whatever they want and if not in your proper network the bill is on you?

Yes, exactly, even local network is the problem with MA. Usually quite limited.

Some plans have a lot of choice, but that seems to be the exception.

[CardsFan]

Quote:

Originally Posted by John Galt III I think you've hit on something here, ivinsfan. I can afford it, but don't want to pay it. I'm going from being spoiled on the ACA, getting great insurance for free. I'm in denial that the good old days are gone forever.....

Well, buck up buttercup. Insurance is not FREE. Some one is paying, and that would be the rest of us.

I'm glad you got a good deal with ACA, and if you want to take the risks, have at it. But from here on forward you will be expected to pay your share, with or without insurance.

Do you feel lucky? well do you?

[John Galt III]

Quote:

Originally Posted by CardsFan Well, buck up buttercup. Insurance is not FREE. Some one is paying, and that would be the rest of us. I'm glad you got a good deal with ACA, and if you want to take the risks, have at it. But from here on forward you will be expected to pay your share, with or without insurance. Do you feel lucky? well do you?

lol.....

[ohsusana]

I've been on Medicare with an Advantage plan since February. Drug plans is included. After paying $699 per year for $7900 deductible for YEARS, this has been wonderful!
The plan I'm on has a "passport" program that one can use for travel within the USA (say, for snow-birds). And ER care through-out the USA is always covered for all plans.
I'd suggest to anyone nearing Medicare age to contact their state insurance agency (In Ohio it is called OSSHIP). They have a program every month to inform people of their choices. I thought long and hard before I made my choice.

[Jerry1]

My initial plan is to go with original Medicare and a supplemental plan. Personally, I think the risk of a major unplanned event is more scary than a known, large, monthly payment. Plus, as others have said, I’m not excited about a limited network. I’ve never been in one and I hope I don’t ever end up in one.

[trumpeting_angel]

I’ve been in limited networks and had good luck. But I was younger and healthy. I’m retiring from working in a hospital, and have worked in other healthcare settings, and I don’t want to be at the mercy of the choices of my insurance company. There are great physicians and mediocre physicians, and if something goes very badly I want a great one.

[Telly]

Quote:

Originally Posted by John Galt III .........If you don't want to read all the examples below, my main question is whether it really is better to have a Medicare Advantage plan than plain Medicare and why. I understand there is no cap on the Plan B 20% . Maybe that's the whole thing right there. lol. I've been looking at the copays and coinsurances for Medicare Advantage plans, and realized they are about the same as original medicare would be. I am not considering Medicare Supplements now since they have monthly premiums I want to avoid. I was hooked on plan N for a while which would be $97 per month plus $17 for Plan D, which is pretty cheap, but still........

Since you don't want monthly premiums (other than the Part B premium that you must pay, no matter what, if you want Medicare anything), that leaves you with a zero-premium MA plan as the only choice.

I suggest you use the Medicare.gov tool to look at MA plans available at your zipcode, filtering for Zero-Premium. Last year, I looked just to see. I live in an area with many hospital choices. The zero plan listed ONE hospital in my county in their plan... a hospital I never heard of. It may be an old RV parked behind a building. I think an HMO would be even drearier if your mandated PCP is a Gris-gris man. It was abysmal.

When people talk about having a "MA Plan", I really don't think they mean a "Zero-Premium MA Plan", at least not around here.

As to your question "is Original Medicare that bad?" (meaning having Medicare Part A & B, but no Medigap Plan, and no Part D)... well, it's better than what elderly people had before 1965, which was, nothing. Something was a lot lot better than nothing, but having to cover the 20% with the sky's the limit did start to perturb some, as did drug costs that skyrocketed over the years. The optional coverage enhancements have to cost somebody something.

[Katsmeow]

I would never have original Medicare without a supplement (and at least a cheap prescription drug plan) for that matter. I would never risk having to pay 20% unlimited. Some health problems are really, really expensive even at Medicare reimbursement rates.

If I had a choice of Medicare with no supplement or a zero premium Medicare Advantage plan I would take the zero premium Medicare Advantage plan. And, I don't like Medicare Advantage plans at all! I especially wouldn't want a zero premium Medicare Advantage plans. Those tend to be the less desirable plans. The better plans still have a premium.

But I would pick Medicare + supplement. I want to be able to choose my physician and hospital.

Oh - as for cost of supplement. When my mom died at the age of 94 with Plan G, her monthly premium was $391. It gets higher -- a lot higher -- with older age. This is one reason DH and I chose to go with AARP United Healthcare supplement.

[John Galt III]

Quote:

Originally Posted by Telly Since you don't want monthly premiums (other than the Part B premium that you must pay, no matter what, if you want Medicare anything), that leaves you with a zero-premium MA plan as the only choice. I suggest you use the Medicare.gov tool to look at MA plans available at your zipcode, filtering for Zero-Premium. Last year, I looked just to see. I live in an area with many hospital choices. The zero plan listed ONE hospital in my county in their plan... a hospital I never heard of. It may be an old RV parked behind a building. I think an HMO would be even drearier if your mandated PCP is a Gris-gris man. It was abysmal. When people talk about having a "MA Plan", I really don't think they mean a "Zero-Premium MA Plan", at least not around here. As to your question "is Original Medicare that bad?" (meaning having Medicare Part A & B, but no Medigap Plan, and no Part D)... well, it's better than what elderly people had before 1965, which was, nothing. Something was a lot lot better than nothing, but having to cover the 20% with the sky's the limit did start to perturb some, as did drug costs that skyrocketed over the years. The optional coverage enhancements have to cost somebody something.

Was the 20% rule there from the very beginning? The good news is it's 20% of the allowed amount, which is almost always less than half of the billed amount. And sometimes only 10 % to 25% of the billed amount. And I noticed that even if you have an MA plan to cover the 20%, the MA plans do NOT cover the 20% for chemo drugs, even if the MA plan has drug coverage.

[Dtail]

DGF has the MA plan with no premiums, although typical 20-30 co pay with extensive doctor choices in our area. So far so good.

[mpeirce]

MA plans sure get beat up around here. DW has an Anthem PPO based MA plan here in Ohio and is very happy with it. It's very similar to the Anthem PPO that she had before (and I'm still on). Similar coverage and the same network. We chose the anthem PPO when we moved here because it's a solid plan that works for us.