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Old 09-18-2017, 07:06 PM   #41
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I have not had a Medicare Advantage plan, but I have had network provider plans with both UHC and BCBS and was regularly surprised by extra bills from non-network providers. Even when I took care to ask everyone I could in advance if they were in the network, some specialists and technicians turned up as non-network in billing and I was required to pay non-network rates that could be 10 times higher than network rates. I'm very nervous about whether this is possible if I choose a Medicare Advantage plan.

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Old 09-18-2017, 10:54 PM   #42
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I'm a few years away from retiring, but have briefly compared traditional Medicare and Medicare advantage plans. We have had a Kaiser Permanente HMO plan through my wife's employer for the last 28+ years and haven't had any significant issues. So I've kind of been leaning towards continuing with them as a Medicare Advantage option once we retire. If it ain't broke, don't fix it.

I know a lot of people are really picky about who their doctor is, but I've never really cared who I had. I don't need a specialist every time I fall ill. As long as they can make me healthy again I'm happy. I can still choose a different doc in the HMO if there is a personality clash or something, but in nearly three decades that has never happened. We don't travel much, so the whole in-network thing hasn't been an issue either. Kaiser covers out-of-network for emergencies anyway, so if I break a leg while on vacation I'm covered.

I won't be making a final decision for a while, but so far an advantage plan seems fine with me.

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Old 09-19-2017, 05:02 AM   #43
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Here is another problem with advantage plans. If they remove your drug from the formulary,you can't easily change your plan if you have a preexisting condition. With a Medicare part D drug plan, you can change the drug plan every year. I was thrilled a few years ago when Aetna pulled out of the advantage plan market, which allowed my wife to switch to a supplement.
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Old 09-19-2017, 05:46 AM   #44
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Originally Posted by aja8888 View Post
I keep seeing this throughout the forums as to how healthy "us early retirees" are.
I've noted in the past: My 61 year old brother was an Iron Man, Triathlete and Marathoner. Swam 25 laps every morning and ran a couple hundred miles a month.
Four months before his RE he had a massive stroke. His med bills (thank God for his employer's health insurance) has now topped half a million.

Tomorrow belongs to no one.
Living well is the best revenge!
Retired @ 52 in 2005
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Old 09-19-2017, 06:01 AM   #45
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Originally Posted by FiveDriver View Post
I've been in UHC's Medicare Advantage plan since enrolling 3 years ago. Their Premium is reasonably low and it's deducted from my Pension check.

The Charleston Diet will reek havoc on LDL, but we control it with a generic that costs me $10 a month.

Will a little thing like cholesterol meds prevent me from getting into a Plan F HD or a Plan G ??
It depends on the insurance company and name of the medication. Any experienced agent can tell you which companies will still accept you at the lower preferred rate. AARP/UHC is generally the most lenient and would accept you at the lower preferred rate they call 'Level 1' but they do not offer F-HD. You would also need to select a Part D plan.
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Medicare vs. Medicare Advantage
Old 09-20-2017, 04:52 AM   #46
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Medicare vs. Medicare Advantage

Originally Posted by marko View Post
Tomorrow belongs to no one.
Great quote.

A little late to this party, but in addition to all the good points others have made:

When DW turned 65, I did a bit of research into the Medigap vs. Medicare Advantage question. These notes may be of interest:

“[per] a recent report by a researcher at the Center for Medicare and Medicaid Services (CMS)… The real bottom line you need to understand is that the insurer might want to keep you enrolled only as long as you’re relatively healthy…. The study, published recently in the Medicare and Medicaid Research Review, confirmed what some who are familiar with the Medicare Advantage program, including me, have suspected: when people enrolled in MA plans become critically ill, many realize that the only way they will get coverage for the care they need – and at a facility of their choice – is to return to the traditional Medicare program.”
And if you search for the study in question, you find this:
“concerns about care experiences among sicker enrollees [in Medicare Advantage programs].” “Dissatisfaction with care sometimes leads to disenrollment of higher cost individuals to FFS [fee for service, i.e. Original Medicare + Medigap]… beneficiaries in FFS [Original Medicare] rated the care they received more highly than enrollees in managed care [Medicare Advantage]…. these differences in ratings between MA and FFS [were] larger for sick than healthy enrollees…. Analysis of survey results revealed that respondents in fair or poor health were more likely to report problems with care access or meeting specific needs as a reason for disenrollment [i.e. leaving Medicare Advantage]…. Problems with costs and benefits were also frequently cited by less healthy disenrollees [people leaving Medicare Advantage] as reasons for disenrollment.”
And per Judith Stein, executive director of the Center for Medicare Advocacy, a watchdog group based in Connecticut:
"Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled. This is particularly true for our clients with long-term and chronic conditions…. They are often denied coverage for necessary skilled care, or it is terminated before it should be, while the same coverage would be available in traditional Medicare."
Per the nonprofit Medicare Rights Center, at :
“… private health plans [i.e. Medicare Advantage] often fail to deliver what they promise. Plan members encounter an obstacle course when trying to get care and coverage, and they may pay more out of pocket costs than what they would have in Original Medicare.”
Anecdotally, when DW and I talked to local specialists who counsel individuals in Medicare enrollment, they more or less indicated "our clients who have assets tend to opt for traditional Medicare (i.e. Medigap, Part D, etc.), whereas those who are more cash-constrained tend to opt for Medicare Advantage."

Also anecdotally, when I call BCBS, they try to steer us toward Medicare Advantage. The coverage network of doctors is almost the same as with the Medigap policies, they say, it's cheaper, etc., etc. But whenever something is cheaper - there must be a reason.

Now, all that notwithstanding - As others have said, if (a) someone is willing to do deep research to confirm that, in their particular state and situation, Medicare Advantage is really equivalent in doctor choice, etc., to Medigap; and if (b) someone is fortunate enough to live in a state in which they can switch at any time to Medigap + Part D... then the cost savings might make Medicare Advantage worthwhile. Even then, though, there's the consideration that, if you need to switch to Medigap, it's probably because you have a medical crisis going on - and do you really want to be contending with switching health insurance at a time when you may not be conscious enough to do so, and/or your spouse may not be well-versed enough in the details to make it happen.

Net / net - We came to the conclusion that Medigap etc. sounds more advantageous than Medicare Advantage in general, if it's affordable.

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