Medicare Advantage more common that I expected

[ShokWaveRider]

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Originally Posted by Dtail Bolded - yes that can make a big difference. DGF has many choices of doctors in our area of FLA and quite a few hospitals too. Really no different than my ACA choices due to where we live.

But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic.

My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

[ivinsfan]

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Originally Posted by ShokWaveRider But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic. My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

Did you buy a plan D you have to count that too. take a couple 2 grand each plus plan D each......that's probably at least 5K a year every year....it's not pocket change....add in 300 a month for both Part B premiums and boom another 3600 a year...some people just can't swing that annually.


I see it both ways, right now my DH was a heavy user last year..I've been a very light user so far. But we don't expect my DH's issue to reoccur but of course who really knows. I guess one could assume that if hit that max 6.4 for too many years you'd be dead. Remember it's not a deductible it's basically a co-pay issue. So you'd ring up a boatload of bills before you'd hit that max. It's the out-of-network issue that worries me more.

[ShokWaveRider]

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Originally Posted by ivinsfan Did you buy a plan D you have to count that too.

Yes Plan D is $13pm not a lot.

[MissMolly]

But again, not all Advantage Plans are the same. Mine is $500 deductible, $1,200 MOOP, and includes drug coverage with NO deductible and NO dough nut hole. And it's a PPO and almost universally accepted by doctors and hospitals where I live. In fact, I don't know of any that don't accept it.

[Chuckanut]

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Originally Posted by El Magnifico Loco I am still suspicious, as I believe there is no guarantee one can switch from Advantage to Medigap, if the Advantage plans again become substandard. I believe one has to undergo a "qualifying event" (like moving out of state) in order to guarantee acceptance back into a Medigap policy. I would rather pay a little more for a Medigap policy and sleep better at night. At least that is what my thinking is today. Any additional insight would be appreciated . . . .

This might be helpful.

https://www.mymedicarematters.org/af...o-re-evaluate/

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Can I Switch from Medicare Advantage to Medigap? There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting. If you joined a Medicare Advantage plan when you were first eligible for Medicare and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining. If you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan. Remember, If you had a Medigap policy in the past then left it to get an MA plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a “trial right” or “guaranteed issue” right.

[SumDay]

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Originally Posted by davebarnes The USA has the most complicated form of medical care/insurance for old people in the world. Medicare Advantage provides a simpler (less complicated) version.

Fixed it for you.

[MichaelB]

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Originally Posted by MBSC California's Birthday Rule (no underwriting) is for switching between Medigap plans of equal or lessor benefits. Switching from Advantage to Medigap in CA requires underwriting unless there is a qualifying event for guaranteed issue. CT, MA, and NY are the year round Medigap guaranteed issue states.

An important detail, thanks.

[ivinsfan]

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Originally Posted by MissMolly But again, not all Advantage Plans are the same. Mine is $500 deductible, $1,200 MOOP, and includes drug coverage with NO deductible and NO dough nut hole. And it's a PPO and almost universally accepted by doctors and hospitals where I live. In fact, I don't know of any that don't accept it.

How much is it and where do you live, I might need to move!!!

[youbet]

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Originally Posted by davebarnes The USA has the most complicated form of medical care/insurance for old people in the world. Medicare Advantage provides a simpler (less complicated) version. Simplification is one reason that I like it. Another reason, for me, is one stop shopping. All my records in one place. And, so far, I have not encountered (in 5 years) any cost cutting annoyances. In fact, one of my Kaiser docs recommended an MRI after my chemo and I said no. It would be waste of money. I have never felt rushed in any of doc/PA encounters.

Medicare Advantage plans are frequently discussed here as though they are all the same. They aren't.

Like you, my DW is going through a bout of cancer while covered by a Medicare Advantage plan. There have been no coverage issues. The plan allows her to see any doc or use any resource that accepts regular Medicare. And, so far, she has not encountered any provider that accepts regular Medicare that won't accept her plan. As far as I can tell, she's done exactly what she would have done if she was on regular Medicare with a type F supplement (like me).

Having said that, I freely admit I wish she had gone with regular Medicare and a supplement since now that she's a cancer patient she'll likely never pass underwriting to go back to Medicare + supplement. Everything has been fine so far, but I worry there might be changes to her plan making it less flexible in the future. Hopefully I'm worrying about nothing.

[ivinsfan]

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Originally Posted by youbet Medicare Advantage plans are frequently discussed here as though they are all the same. They aren't. Like you, my DW is going through a bout of cancer while covered by a Medicare Advantage plan. There have been no coverage issues. The plan allows her to see any doc or use any resource that accepts regular Medicare. And, so far, she has not encountered any provider that accepts regular Medicare that won't accept her plan. As far as I can tell, she's done exactly what she would have done if she was on regular Medicare with a type F supplement (like me). Having said that, I freely admit I wish she had gone with regular Medicare and a supplement since now that she's a cancer patient she'll likely never pass underwriting to go back to Medicare + supplement. Everything has been fine so far, but I worry there might be changes to her plan making it less flexible in the future. Hopefully I'm worrying about nothing.

This is good to read and I hope things go well for both of you....it's my understanding that you can move freely between Advantage plans without underwriting during open enrollment. So you would be able to look for a better plan is necessary. Why did your DW go with an Advantage plan in the first place?

[Gotadimple]

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Originally Posted by ivinsfan This is good to read and I hope things go well for both of you....it's my understanding that you can move freely between Advantage plans without underwriting during open enrollment. So you would be able to look for a better plan is necessary. Why did your DW go with an Advantage plan in the first place?

You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available.


Most MA plans are HMO's and that does limit choices of doctors and hospitals with no out of plan coverage. If one can find a MA plan that is a PPO you aren't locked to their network, but you will pay a higher percentage of the costs as it is out of network. Most $0 premium plans are HMO's.


As someone else said, the details matter because they tell you why the premium is the way it is. A low premium plan usually has a restricted network, high deductibles, and high co-pays. A high premium plan can have a restricted network with a lower set of deductibles and co-pays. It all depends on how much you want to pay up-front to get the services later on at a higher/lower cost.


- Rita

[youbet]

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Originally Posted by ivinsfan Why did your DW go with an Advantage plan in the first place?

She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the Medicare Advantage premium deducted from her pension check and the fed gov't bills her for the Part B premium.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement.

I would have had her go with regular Medicare and a supplement but it was her choice. Thankfully, it's a PPO style Medicare Advantage plan (not HMO style) and despite utilizing a lot of providers and specialists this past couple of years due to her cancer, there have been no issues, no restrictions, no refusal of providers to accept the coverage and no surprises.

Other than the absence of the infamous "donut hole" in her drug coverage and the minor perk of Silver Sneakers paying for her health club membership, I haven't seen any advantages over regular Medicare + supplement. But, OTOH, I haven't seen any disadvantages beyond me needing to know the ins and outs of two different programs.

Inexplicably, customer service has been extraordinarily good. Far superior to my BCBS type F plan where phone trees and long waiting times are the norm.

[MichaelB]

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Originally Posted by youbet She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the premium deducted from her pension check.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement.

My mum is also retired from Illinois and has a UHC PPO Advantage. Her original benefit was a MediGap, but she was automatically enrolled in MA after they changed plans a couple of years ago. We haven’t had any problems either, even after she moved to S Fla.

I’m sure some MA plans, such as this one, are adequate and offer a valuable option for lower income seniors. Personally, I’ve chosen to pay more for MediGap coverage.

[ivinsfan]

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Originally Posted by Gotadimple You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available. Most MA plans are HMO's and that does limit choices of doctors and hospitals with no out of plan coverage. If one can find a MA plan that is a PPO you aren't locked to their network, but you will pay a higher percentage of the costs as it is out of network. Most $0 premium plans are HMO's. As someone else said, the details matter because they tell you why the premium is the way it is. A low premium plan usually has a restricted network, high deductibles, and high co-pays. A high premium plan can have a restricted network with a lower set of deductibles and co-pays. It all depends on how much you want to pay up-front to get the services later on at a higher/lower cost. - Rita

I did say you could move between Advantage Plans....that's all I was referring to.

[ShokWaveRider]

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Originally Posted by youbet She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized.

From what I can tell, these MA plans are far better than those available to Joe Public. My neighbor has one that was sponsored by his union, it is fine for the most part.

I have another who purchased his from an agent on the open market at 65, his is a disaster.

Unfortunately most of us do not have a preferred option.

[ivinsfan]

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Originally Posted by youbet She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the Medicare Advantage premium deducted from her pension check and the fed gov't bills her for the Part B premium.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement. I would have had her go with regular Medicare and a supplement but it was her choice. Thankfully, it's a PPO style Medicare Advantage plan (not HMO style) and despite utilizing a lot of providers and specialists this past couple of years due to her cancer, there have been no issues, no restrictions, no refusal of providers to accept the coverage and no surprises. Other than the absence of the infamous "donut hole" in her drug coverage and the minor perk of Silver Sneakers paying for her health club membership, I haven't seen any advantages over regular Medicare + supplement. But, OTOH, I haven't seen any disadvantages beyond me needing to know the ins and outs of two different programs. Inexplicably, customer service has been extraordinarily good. Far superior to my BCBS type F plan where phone trees and long waiting times are the norm.

Your story leads me to think we are inevitably but slowly moving to MA plans..I'll be paying close attention to what happens in my state now that all the cost plans for over 350K people have been eliminated. We have access to fantastic medical care in this state but premiums reflect that.

[haha]

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Originally Posted by Gotadimple You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available.

Does this mean that if one has Kaiser Medicare Advantage and she moves to an area with no Kaiser she can switch to original Medicare and a Medigap without underwriting?

Also, how is an area with no Kaiser defined? One's city, county, or entire state has to have no Kaiser? I guess if someone really hated a Medicare Advantage choice, might not be too bad to move to Ct or Mass or NY for a period to get a redo. I could easily stand another year in Back Bay, or maybe Brookline. I have trad Medicare and Medigap, but my GF has Kaiser. So far it seems fine for her.

Ha

[youbet]

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Originally Posted by MichaelB My mum is also retired from Illinois and has a UHC PPO Advantage. Her original benefit was a MediGap, but she was automatically enrolled in MA after they changed plans a couple of years ago. We haven’t had any problems either, even after she moved to S Fla. I’m sure some MA plans, such as this one, are adequate and offer a valuable option for lower income seniors. Personally, I’ve chosen to pay more for MediGap coverage.

Actually, there is very little cost advantage to DW's UHC PPO Advantage plan over my BCBS type F plan and Humana Part D plan. For BCBS medical service coverage, I pay higher premiums and have zero deductibles. She pays lower premiums and has higher deductibles. If you use enough medical services to pay your full deductible, the two are in the ball park of the same annual cost.

DW's prescription coverage does have some advantages over my Part D coverage (no donut hole, lower deductibles, lower co-pays), but that might just be the result of the Part D plan I chose. Maybe I just wasn't a good shopper during the annual enrollment period.

I agree with you regarding the traditional Medicare + supplement route and that's what I do. But, so far, results have been substantially identical for her compared to mine on most fronts: cost, convenience, coverage. She has a strong edge regarding customer service.

DW did have a choice between an UHC Advantage PPO plan and an UHC Advantage HMO plan, as I'm sure your DM did. One fear we have is that they'll stop offering the PPO plan and we would definitely not like her going to an HMO situation. Fortunately, according to BCBS, if UHC dropped her PPO plan, only offering the HMO plan, that would be a "qualifying event" and DW could then switch to a traditional supplement plan, like mine, without underwriting and that's what she'd do.

[Dtail]

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Originally Posted by ShokWaveRider But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic. My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

That goes back to my original question. My DGF has an MA plan at 57 y.o. due to disability. So being that she has pre existing conditions, can she switch at age 65 to Medigap without issues?

[MissMolly]

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Originally Posted by ivinsfan How much is it and where do you live, I might need to move!!!

Actually is part of my pension benefits so it’s free.