Is Original Medicare really so awful?

[John Galt III]

I know the vast majority of people opt to get additional ins to 'cover the 20%
that original medicare doesn't cover' . But..... it seems to me that the additional insurance really does not cover it.

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.....

Getting back to orig medicare 20% thing:

For example, inpatient hospital stay is $300 per day for the first 5 days in many MA plans. In orig medicare it is whatever the medicare allowed amount is (my guess is $250 per day?) up to cap of $1,364 for the first 60 days. Looks cheaper with orig medicare. Actually, I think there is no 20% here since it is Part A.

Durable medical equipment is 20% coins in both orig med and in MA.


Chemo drugs are 20% coins in orig medicare and MA plans.


Primary care doc visit is 20% of allowed amt in orig med, which equals $20 approx.


Specialist visit is 20% of allowed amount, so maybe $30. Same as MA plans.


Ambulance in orig medicare is 20% of allowed amt, equals 20% of $400 equals $80. MA plans are charging $200 to $350 copays for one-way ambulance ride. So orig medicare is actually cheaper here.

Emerg Room. 20%. This could get high, even with low allowed amounts, since the hospitals like to do lots of different tests. MA copay is $90 for ER. I think MA comes out ahead here.

Diagnostic tests and procedures: 20% $100 and up for MA plans.

Lab services: 20% $5 to $30 for MA plans.

Diagnostic radiology services (e.g., MRI): 20% . $250 for many MA plans.

Outpatient x-rays: 20% $40 to $50 copay MA.

Outpatient hospital coverage. 20%. MA charges $350 per visit for outpatient hospital, but they don't say what it is. Murky area.


And so on..... I guess my point is that 20% of the medicare allowed amount is pretty low, and (often?) lower than what the MA plan copays are.


One advantage I do see in the MA plans is the cap on max out of pocket at $6,700. Chemo drugs at 20% could add up quickly.


Anyone out there know anyone with plain vanilla medicare and whether they like it?

Thanks

 

[audreyh1]

Most people I know are on original aka traditional Medicare plus Supplement and are very happy with it.

We plan to go that route ourselves. Mainly due to largest nationwide network and portability. I don’t want to be stuck in some restricted local network when battling a major disease.

No way would I go without the Medicare supplement. Medicare has no max OOP, and 20% of expensive cancer drugs can run to 10s of thousands a year. Traditional Medicare reported spending $300K to treat a relative’s late stage cancer over 2 years. Would you want to be personally responsible for the remaining $75K?

 

[braumeister]

I think it probably depends on how much your healthcare costs. We are quite healthy, and our Medicare supplemental policy has paid out anywhere from $300 to $1,800 per year since we started on traditional Medicare. So if my premiums were low it would certainly be a good deal. Ours doesn't cost anything (Tricare) so it's a very good deal.

 

[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.

If the choice is only Medicare with no supplement or MA I'd take the MA. . to.answer your question No I don't know anyone personally who only uses Medicare.

Now my DH has VA care but his heart doctors are not in the VA system, it's possible that if he hadn't had heart issues he might have used Medicare combined with only VA care . His issues has been addressed now and if money became an issue, that might happen.

 

[REWahoo]

Most people I know are on original aka traditional Medicare plus Supplement and are very happy with it.

We plan to go that route ourselves. Mainly due to largest nationwide network and portability. I don’t want to be stuck in some restricted local network when battling a major disease.

No way would I go without the Medicare supplement. Medicare has no max OOP, and 20% of expensive cancer drugs can run to 10s of thousands a year. Traditional Medicare reported spending $300K to treat a relative’s late stage cancer over 2 years. Would you want to be personally responsible for the remaining $75K?

^ what audrey1 said.

 

[aja8888]

. I don’t want to be stuck in some restricted local network when battling a major disease.

This is well worth the price of admission.

Ask my wife about her heart valve replacement WITHOUT having to crack her sternum and chest wide open. It's all about doctor selection.

 

[John Galt III]

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.

If the choice is only Medicare with no supplement or MA I'd take the MA. . to.answer your question No I don't know anyone personally who only uses Medicare.

Now my DH has VA care but his heart doctors are not in the VA system, it's possible that if he hadn't had heart issues he might have used Medicare combined with only VA care . His issues has been addressed now and if money became an issue, that might happen.

Plan N would be $115 a month now, and apparently only minimal increases each year, like 3%. (community based). Which is not too bad.


But how do some people end up paying $300 or $400 per month for a supplement when they get older?

I would expect that in Plan N I could stay forever as long as the company exists and I keep paying the premium, and expect the premium to only increase 3 % per year. (with an occasional higher increase, maybe, but never ending up paying $300 per month, right?)

 

[SumDay]

Yes, what Audrey said. If you don't travel much (or at all) Advantage is probably OK. That said, we don't travel much and have a Supplement G. Less than $150 a month and well worth it.

A friend of ours has a rare cancer and has to travel from the midwest to San Diego as there are only a few places that treat it. He's pretty happy he has traditional Medicare and a Supplement.

Our Medicare "guide" told us he gets paid more for signing people up for Advantage than he does a Supplement. And he never encourages anyone to take the Advantage option but will help them with it if they are adamant about it. He is not a fan and has some personal and professional horror stories.

Not the greatest comparison I've ever seen, but it's the only one I can find at the moment: https://www.ehealthmedicare.com/med...s-of-medicare-advantage-vs-original-medicare/ I've heard the Advantage copays can be worse than a Supplement premium.

I had similar questions before DH got on Medicare. Some good responses in these posts:
http://www.early-retirement.org/forums/f38/medigap-to-advantage-to-medigap-91368.html
http://www.early-retirement.org/forums/f38/medicare-no-supplements-88404.html

Some in our neighborhood are very pleased with Advantage, but they always buy travel insurance. YMMV

 

[Chuckanut]

It's not the monthly fee for the Medicare Supplement plan I want to avoid.
It's the tens of thousands of dollars I might have to pay without the Supplement that I want to avoid.

 

[ivinsfan]

Plan N would be $115 a month now, and apparently only minimal increases each year, like 3%. (community based). Which is not too bad.


But how do some people end up paying $300 or $400 per month for a supplement when they get older?

I would expect that in Plan N I could stay forever as long as the company exists and I keep paying the premium, and expect the premium to only increase 3 % per year. (with an occasional higher increase, maybe, but never ending up paying $300 per month, right?)

A lot of it depends where you live..rates can vary tremendously in the US. Not unlike regular HI...

 

[ivinsfan]

It's not the monthly fee for the Medicare Supplement plan I want to avoid.
It's the tens of thousands of dollars I might have to pay without the Supplement that I want to avoid.

Yes, the OP says it doesn't get the MA because the co-pays are about the same as Medicare...it's not the co-pays you need to worry about it's the big stuff.

 

[candrew]

I would only add that if one opts for Medicare Advantage at initial enrollment, then decides later to switch to traditional Medicare with a supplement, you may very well be subject to medical underwriting.

 

[ivinsfan]

I would only add that if one opts for Medicare Advantage at initial enrollment, then decides later to switch to traditional Medicare with a supplement, you may very well be subject to medical underwriting.

And of course the same would be true if you opt for only original Medicare I'm assuming here the OP meant Medicare plus Part B.. once your open enrollment period is over, underwriting, in most areas of the country anyway.

 

[candrew]

And of course the same would be true if you opt for only original Medicare I'm assuming here the OP meant Medicare plus Part B.. once your open enrollment period is over, underwriting, in most areas of the country anyway.

+1

Thank you for further clarifying my post!

 

[marko]

And isn't there a penalty of sorts if you delay taking a supplement? Or am I wrong, per usual?

 

[ShokWaveRider]

This is my first year on Medicare with a plan G. $166 pm + usual Medicare premiums. I have the cheapest drug plan I can find that does not cover hardly anything of substance as all my meds are free from the local Grocery Store (BP Meds). I resent paying the $13 a month for something that I will never use.

So far I have been to the docs once this year for a Pacemaker Check (2 a year). cost towards deductible $44. for which I have not been billed yet, it was done in January this year.

BUT next year my Pacemaker needs replacing so I still consider it an investment.

 

[ivinsfan]

And isn't there a penalty of sorts if you delay taking a supplement? Or am I wrong, per usual?

I believe the penalty is for not taking Part B within the time allotted after you turn 65. Now there is penalty for not taking a Part D plan within a certain time frame, the longer you wait the bigger the penalty, Part D does not require underwriting.

 

[marko]

I believe the penalty is for not taking Part B within the time allotted after you turn 65. Now there is penalty for not taking a Part D plan within a certain time frame, the longer you wait the bigger the penalty, Part D does not require underwriting.

Thanks! I knew there was some penalty for something out there

 

[candrew]

Or am I wrong, per usual?

You are in good company Marko. We are both members of the broken clock club!

 

[ivinsfan]

Thanks! I knew there was some penalty for something out there

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....

 

[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]

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.