Medicare Advantage vs. Medigap vs. ?????

[mf15]

One more item about MA. Drugs are not counted towards MOOP.
Olmike

[kaneohe]

Agree that the difference between the plan types can be difficult to judge.
DW has employer Advantage. I have Medigap. We go to the same large medical group which has many doctors and numerous locations. Historically I have paid more for the Medigap but this past yr, the Advantage is slightly more expensive and will be more so next yr. However the coverage is not the same since the Advantage plan includes Rx drugs, dental (small surcharge), glasses, hearing aids (we got 1K+ reimbursement). Still there is some annual concern about whether the medical group is still in network or not........

[badatmath]

Quote:

Originally Posted by MichaelB Edit to add - low income seniors who cannot afford supplemental MediGap coverage plus separate Plan D drug, and also do not need a broad nationwide provider network may be better served with Medicare Advantage.

Not to quibble with any of your other points that some MA are good, but the low income people is who i worry for most. The out of pocket can be way greater for MA and really hurt those that cannot spare it.


Of course in a good year that might not happen. . . .

[steelyman]

Quote:

Originally Posted by MissMolly Advantage Plans vary across the board, so I take issue with blanket statements that Advantage plans are bad. An Advantage Plan like mine, which is a retiree benefit, is a PPO, not HMO. No network of doctors. Only $500 deductible and $1,500 MOOP. Drug plan included with no donut hole. Dental cleanings included ( 1 per year ). Silver Sneakers membership included. Provides nationwide coverage and emergency overseas coverage. No pre-approvals required. All at a great cost of $0.00 to me. So far, no complaints.

This sounds similar to my (pre-Medicare) retiree plan. It’s basically an Advantage plan, PPO nationwide (not HMO which would limit me to coverage in a state I no longer live in). $375 deductible. There are in-network and out-of-network providers and they have different out-of-pocket limits ($1500/$6000). Drug coverage included but not dental or many of the current perks. No PCP required but I choose to have one that I like.

I’m good with it right now but for sure will pay close attention as I get close to Medicare. All these plan choices seem maddening just when your life decisions should be simpler!

[ADDED] To date, all services I’ve received have been in-network but I think where you live makes a big difference. There are many providers/hospitals in my area.

[KB]

Quote:

Originally Posted by RobbieB I'm going advantage, Kaiser Senior Advantage. Eighteen dollars a month -

I have found the Advantage plus to be worth the extra cost. It provides some dental, vision and the Silver $ Fit Gym membership. Maybe hearing aid too. I wear glasses and between that and the dental plan, I save more than the extra $20 or so a month that it costs.

[RobbieB]

For me it's 18 vs 79 a month. Might pay more later as visits go up, but now think it's less for standard vs enhanced.

[Hermit]

I decided to go with Medicare Advantage. The main reason was so I could get in the Kaiser system when I get old enough to move out of the mountains. Kaiser was available here in the mountains for a couple of years, but they have pulled back out starting next year. I have used Humana for the last few years. All seem to use the same doctors in this area.

[rk911]

Quote:

Originally Posted by REWahoo This is well-plowed ground on the forum, but FWIW: Medigap is our choice for a number of reasons, primarily for the ability to utilize any physician or facility that accepts Medicare assignment.

this. plus we wanted to stay with Blue Cross/Blue Shield. we travel the country for months at a time in our RV. their part c plans (medicare advantage) plans (at the time in 2015) required us to notify them 2-weeks in advance if we were changing our location. we sometimes don't know where we'll be in 2-days much less 2-weeks. their part c plans may no longer have that restriction but we like having the freedom to see any doc who accepts medicare without a referral.

[MBSC]

Quote:

Originally Posted by Teacher Terry I wouldn’t do a advantage plan because of the step process and needing referrals.

MA PPO plans do not require referrals.

Quote:

PPO plans do not require that beneficiaries use in-network providers and do not require a referral to see a specialist. Source: https://www.ehealthmedicare.com/faq/...hmos-and-ppos/ Referrals: PPO plans have never had this requirement, and many of today’s HMO plans are going to “open access” and dropping their referral requirements altogether. Source: https://www.psmbrokerage.com/blog/a-...dvantage-plans

[Dtail]

Quote:

Originally Posted by MBSC MA PPO plans do not require referrals.

MBSC
As one of the main resident experts on Medicare rules on this site, can you look at my Post #9 and let me know your thoughts?

[MBSC]

Quote:

Originally Posted by Dtail A related side question. My DGF who is receiving SSDI at 58 y.o., is currently on an MA plan. If she switched out of it before 65 y.o., would there be an underwriting required?

Quote:

Originally Posted by Dtail MBSC As one of the main resident experts on Medicare rules on this site, can you look at my Post #9 and let me know your thoughts?

If she also lives in FL, then yes Medigap underwriting would be required. It's usually an automatic denial for those under 65 outside their 6-month Medigap Initial Enrollment Period who do not qualify for a Medigap Guarantee Issue right (ie. moving outside the MA service area).

Also, Under 65 Medigap Plan G is about $450-$500/month in Tampa. At age 65, she will be entitled to the same Medigap Open Enrollment Period everyone else gets and will pay the same preferred rate as others.

[Dtail]

Quote:

Originally Posted by MBSC If she also lives in FL, then yes Medigap underwriting would be required. It's usually an automatic denial for those under 65 outside their 6-month Medigap Initial Enrollment Period who do not qualify for a Medigap Guarantee Issue right (ie. moving outside the MA service area). Also, Under 65 Medigap Plan G is about $450-$500/month in Tampa. At age 65, she will be entitled to the same Medigap Open Enrollment Period everyone else gets and will pay the same preferred rate as others.

Thanks MBSC.
Sounds like she will keep the MA plan for the foreseeable future. All doctors in this area (Tampa) accept her plan, plus the MOOP is 5,900 currently.

[DektolMan]

I turn 65 next year so I have been doing my research as well. My friends have an Advantage plan, zero premiums and lots of extras and they love it. So I know they travel 6-8 weeks a year with their RV and I asked if they are covered in out of network.


They said there plan includes Emergency/Urgent care coverage while traveling. So I called the insurance company to dig deeper and they confirmed that the emergency travel is covered.


Then I ask what is the out of network deductible and they say I have zero coverage out of network. So I ask if I'm in a car accident out of state, go to the Emergency room and admitted to a hospital bed for 3 days am I covered? Well the emergency room is covered but as soon as you leave emergency care and go to a hospital bed you have zero coverage and you are responsible for 100%.


I plan on getting Medicare with Plan G-HD to make sure I have coverage while traveling.

[John Galt III]

Quote:

Originally Posted by ShokWaveRider Basically if you are concerned about the "Initial" costs, do not mind a limited availability of service providers, do not need national coverage, do not mind checking with the provider rep every time you need something done to confirm coverage, then MA is for you. If you do not mind the ~$200 a month ($2,400 pa + ~$200 deductible) extra costs with none of the above limitations then the "G" supplement is for you. Depending on your drugs an extra Part D will also be needed with the supplement. Remember though that the MOOP for the MA plans is about ~$6,700, quite high. I paid $3,791 for all in 2019, and used every bit of it and then some. It would have cost me almost double with an Advantage plan. So it is a pay me now or pay me later for some folks depending on your ailments. Remember after 6 months or 1 year to switch to a Supplement form a MA plan requires medical underwriting. So there you go.

ShockWave, the $3,791 is premiums plus out-of-pocket costs? Curious what you had to pay for besides premiums, since I keep hearing people with a supplement never have to pay anything except the premiums. Thanks. I have a MA plan now but am still thinking of going to supplement possibly.

[kaneohe]

Here's a table of the standardized supplement plans. Standardization is nice because all the plans w/ the same letter are the same. A common plan these days is Plan G.............there is a small deductible but after that all costs are covered which makes it easy to track what you owe.......which is nothing.
There are some other plans that have copayments.

btw ......a YES in the table means it is covered.

https://www.medicare.gov/supplements...digap-policies

[ShokWaveRider]

Quote:

Originally Posted by John Galt III ShockWave, the $3,791 is premiums plus out-of-pocket costs? Curious what you had to pay for besides premiums, since I keep hearing people with a supplement never have to pay anything except the premiums. Thanks. I have a MA plan now but am still thinking of going to supplement possibly.

No OOP costs just Medicare and supplement premiums. That is the Point. The MOOP on most MA Plans in our area is $6700 minimum.

[Teacher Terry]

I have a friend on a Medicare advantage program that is not getting the surgery she needs. She has been in and out of the hospital and was told she needed surgery for a leaky heart valve. Her BF has been trying to advocate for her. Now she’s back in the hospital with fluid filling up. She is 78.

[Katsmeow]

I went with traditional Medicare and a Supplement (G) for two reasons:

1. I don't want to have to pick doctors in a network. I don't want to be even in a PPO with lesser reimbursement for out of network doctors. The great relief of Medicare is that I no longer had to worry about any of that. Why would I want to put myself back into that? I like being able to see any doctor that takes Medicare and almost all of them do. Since DH was on Medicare (6 years) and I have gone on Medicare this year I have only found one doctor I wanted to see who didn't take Medicare (an allergist). Otherwise, it really hasn't been an issue.

2. The big dealbreaker though is that if you leave Medicare Advantage and want to go back to traditional medicare you usually have to have underwriting for your supplement and you may not be able to qualify. Sure, I might be able to qualify now but who know what happens later. I would not want to be locked into Medicare advantage.

[mf15]

Quote:

Originally Posted by DektolMan I turn 65 next year so I have been doing my research as well. My friends have an Advantage plan, zero premiums and lots of extras and they love it. So I know they travel 6-8 weeks a year with their RV and I asked if they are covered in out of network. They said there plan includes Emergency/Urgent care coverage while traveling. So I called the insurance company to dig deeper and they confirmed that the emergency travel is covered. Then I ask what is the out of network deductible and they say I have zero coverage out of network. So I ask if I'm in a car accident out of state, go to the Emergency room and admitted to a hospital bed for 3 days am I covered? Well the emergency room is covered but as soon as you leave emergency care and go to a hospital bed you have zero coverage and you are responsible for 100%. I plan on getting Medicare with Plan G-HD to make sure I have coverage while traveling.

As of this time, there is no Plan G-HD.
Oldmike

[DektolMan]

I was told that since Plan F and Plan F-HD will not be available to new Medicare applicants that there will be a Plan G-HD. Pricing will come out sometime in December.
I called Boomer benefits and they confirmed this.