Medicare vs Advantage Plans Comparisons

[marko]

Two part question on Medicare Advantage plans from the gurus here.

I just joined Medicare in June (age 65) and do not yet have either an Advantage or Supplement plan. In poking around my head is about to explode. (How do really old folks wade through all of this??)

In looking at BCBS HMO plans I'm struck by how similar they are in coverage to regular Medicare. There's a $39 plan (plus my Part B payment) that seems to mirror Medicare coverage but also included Rx and international coverage of some sort...somewhat important to me.

So,
1) Does anyone know of a site where I can compare Advantage plans against regular Medicare?
2) As I have no such coverage now, should I sign before October 1 or wait until that time? Other than the obvious need for coverage, would there be a benefit to getting a plan before the October 1 date and then renewing at that time?

Any insight appreciated.

 

[athena53]

I'm not an expert (eligible early next year) but two things discourage me from even thinking about Medicare Advantage plans. One factor is that they've usually got a very limited network, so your doctor, or a specialist you may need in the future, may not be in-network. The other is that if you decide to dump Medicare Advantage and go with a Medicare Supplement, the Medicare Supplement carriers can decide not to take you based on pre-existing conditions. I went through Medicare sign-up with DH after I retired (he'd been on my employer's plan) and that was a dealbreaker for us. I'm blessed with amazing good health but if that changes I don't want to be tied to one plan.

International: we were told DH's Medicare Supplement through United Healthcare/AARP covered international- never had to test it, thank heaven. I've started buying trip insurance with good primary medical coverage. I don't leave the country more than twice a year and I figure this way I'm covered, including some nasty potential expenses like having to change plans while I languish in a hospital, paying for a family member to come get me, air ambulance from somewhere in the Sea of Cortez, etc. I'm a very active traveler and am most interested in protection in case of an accident. I DID fall off my bike last week while trying to pedal and unwrap a granola bar at the same time!

Edited to add: this site keeps showing up in my FaceBook feed but it looks like good solid information on Medicare Supplements vs. Advantage. They're an insurance agency.

http://www.boomerbenefits.com

 

[MichaelB]

There's probably no single source of comparison, not all Advantage plans are the same. Some states put together a helpful summary, not sure if yours does.

Medicare Advantage plans provide all the coverage of Medicare A&B, and often include prescription drug coverage. You continue to pay the Medicare B premium, but will be subject to the cost sharing (deductibles, copays) of the Advantage plan. There also may be network restrictions.

If you opt for a supplemental plan, you also need a separate Plan D. One advantage of this options is you can change your plan D policy yearly, and customize it to your current prescription intake.

We chose MediGap G for DW, it looked like the most comprehensive coverage option, and includes a bit of limited coverage out of the country.

 

[growing_older]

Medicare Advantage plans provide all the coverage of Medicare A&B, and often include prescription drug coverage.

Provided you stay IN THE NETWORK. This has all the same problems as regular insurance with in-network and out of network rates. Even if you are at an in-network facility being treated by an in-network doctor and an in-network lab, you can still be hit by an out of network bill by an anesthesiologist, radiologist or technician. Medicare won't do that because there is no network. Advantage plans can.

 

[marko]

Hmmm....sounds like I need to shift my attention to a supplemental plan. We spend our winters in FL and we'd be out of network (I think) for half the year.

Looks like a supplemental plan would give me more flexibility and I already have a Rx plan.

Athena53: Thanks. I hadn't thought of travel insurance for my (now) occasional overseas trips.

More work to do. Anyone care to comment on the AARP Supplemental plans? Are most plans similar?

 

[aja8888]

Are most plans similar?

Same coverage each plan letter between companies offering coverage.

 

[omni550]

Hmmm....sounds like I need to shift my attention to a supplemental plan. We spend our winters in FL and we'd be out of network (I think) for half the year.

Looks like a supplemental plan would give me more flexibility and I already have a Rx plan.

Athena53: Thanks. I hadn't thought of travel insurance for my (now) occasional overseas trips.

More work to do. Anyone care to comment on the AARP Supplemental plans? Are most plans similar?

I, too, spend a big chunk of time in FL while residing in MI.

There's a gentleman named Christopher Westfall who has some excellent YouTube videos on Medicare Supplemental Insurance. He found me a well-priced Plan G (sort of a "sleeper" version of Plan F) through Aetna.

Plan availability and pricing is driven by your zip code and age.

omni

 

[Gotadimple]

All of the supplemental plans are similar: An AARP Plan G is the same as a Humana Plan G. What varies is the premiums. Companies can vary premiums by zip code, age, and location - but they can't change the terms of the supplemental contracts - those are governed by the Federal government.

AARP doesn't sell plans, United Healthcare does. AARP collects a royalty for the use of its brand. I"d compare both on price - the contents are exactly the same, service is exactly the same.

- Rita

 

[braumeister]

I DID fall off my bike last week while trying to pedal and unwrap a granola bar at the same time!

Effectively putting the lie to all those people who keep telling us granola is healthy food.

 

[MichaelB]

I always wondered about granola. Now I'm sure.

Hmmm....sounds like I need to shift my attention to a supplemental plan. We spend our winters in FL and we'd be out of network (I think) for half the year.

Looks like a supplemental plan would give me more flexibility and I already have a Rx plan.

Athena53: Thanks. I hadn't thought of travel insurance for my (now) occasional overseas trips.

More work to do. Anyone care to comment on the AARP Supplemental plans? Are most plans similar?

There are Medicare Advantage plans with large national networks, but participating providers that take Medicare assignment are by far the largest group. This is especially important when dealing with specialists, hospitals and labs.

Another advantage - for participating practitioners there is no balance billing. If the service provider is a participating provider, they can't bill you excess charges. See here Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services | The Henry J. Kaiser Family Foundation

Here's a Medicare PDF on MediGap policies you may find helpful https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

 

[calico1597]

Since we are Arizona snow birds, we were advised to stay away from the Medicare Advantage plans. A independent insurance agent can provide multiple options plans for supplement plans. I went with CSI.

 

[marko]

OK. Two more questions and I'm done; promise! :

What is the risk if I do NOT take a supplement plan (I currently don't have one, nor an Advantage plan) and I wait 2-3 years to do so. Is there a chance of penalty or denial?

If I take a 'core' plan can I update a 2-3 years from now to a more comprehensive plan?

Note: I asked this question on another thread but I think it referred to Advantage plans.

BTW, I'm zeroing in on the AARP/United HC Core plan ($106 starter rate).

 

[omni550]

OK. Two more questions and I'm done; promise! :

What is the risk if I do NOT take a supplement plan (I currently don't have one, nor an Advantage plan) and I wait 2-3 years to do so. Is there a chance of penalty or denial?

If I take a 'core' plan can I update a 2-3 years from now to a more comprehensive plan?

Note: I asked this question on another thread but I think it referred to Advantage plans.

BTW, I'm zeroing in on the AARP/United HC Core plan ($106 starter rate).

Without a Supplemental Plan (and only having Medicare A & B)I believe you'll be on the hook for paying the 20% that Medicare Part B doesn't pay for any medical expenses.

I'm not clear what you mean by "Core" plan....is that an Advantage plan?

omni

 

[aja8888]

OK. Two more questions and I'm done; promise! :

What is the risk if I do NOT take a supplement plan (I currently don't have one, nor an Advantage plan) and I wait 2-3 years to do so. Is there a chance of penalty or denial?

Yes, you will have to qualify medically and that ain't easy, especially if you have a preexisting condition. Diabetes and cancer history is possibly and automatic denial.

 

[Silver]

Yes, you will have to qualify medically and that ain't easy, especially if you have a preexisting condition. Diabetes and cancer history is possibly and automatic denial.

Just to add....you have 6 months from the month when you turned 65 and enrolled in Medicare part B to purchase a medigap plan, or you may be refused.

 

[aja8888]

If DW had a Medicare Advantage plan, I doubt very much that she would have been able to choose the surgeon in the Baylor School of Medicine who developed the "keyhole" heart valve replacement procedure she had done two weeks ago. (replaced valve without sternum fracturing)

Choosing your physician and surgeon is not an element of the Medicare Advantage plans I have seen.

Think about it.

 

[Sarah S]

I think you must be in Massachusetts based on your comment about core plan? We are different here and instead of having supplement plans that are f, g etc as referred to we have, as you found , two levels core and supplement1 . No I am virtually certain that you can not switch from one level to the other without medical underwriting and risk of refusal. So pick the level you want to end up on

I think you have already decided agsinst medicare advantage plans but just in case- aside from the travel/ snowbird issues the provider networks are definitely limited. At the time I was in practice we were only allowed to participate as providers for one senior hmo. For regular hmos ( non medicare) I was credentialed to many plans- BC, tufts , hchp, fallon etc but my group had to pick just one senior plan so the odds of finding all the specialists you might pick on your pcps plan are probably not good

 

[MBSC]

BTW, I'm zeroing in on the AARP/United HC Core plan ($106 starter rate).

I'm not clear what you mean by "Core" plan....is that an Advantage plan?

Massachuetts allows two Medigap plan designs, 'Core' and 'Supplement 1'. They do not use the standardized plans A-N like most other states.

Again, here in Mass, the state motto is "take the money and run; ask questions later".

Medigap in Massachusetts

Core Plan doesn't cover:

Part A: inpatient hospital deductible.
Part A: skilled nursing facility coinsurance.
Part B: deductible.
Foreign travel emergency.

Reference: https://www.medicare.gov/supplement...igap/massachusetts/medigap-massachusetts.html

 

[meierlde]

Look carefully to see if the what the premiums as you age might be, all go up but some go a lot further than others.

 

[wmc1000]

Just signed DW up starting Oct. 1 Spoke to both agencies referred to earlier: Chris Westfalls seniorsavingsnetwork.org and boomerbenefits.com.

Both provided excellent information although we had already decided to go with plan G and Part D Walgreens Rx through previous research. Ended up using boomerbenefits as they provide enrollment services for both medicare supplement and Part D while seniorsavingsnetwork.org does enrollment for Medicare supplement plans but only referred us to input everything into medicare.gov as the Rx plans only pay the agents about $3 per mo.

 

[Corporateburnout]

I think you must be in Massachusetts based on your comment about core plan? We are different here and instead of having supplement plans that are f, g etc as referred to we have, as you found , two levels core and supplement1 . No I am virtually certain that you can not switch from one level to the other without medical underwriting and risk of refusal. So pick the level you want to end up on

Incorrect. In MA the law allows an individual to switch between a core and supplement plans before the end of the month for coverage to start the following month without medical underwriting or risk of refusal.

DW switched from BCBS core to supplement 1 when she had a scheduled surgery and now she switched back to core.

 

[Corporateburnout]

Massachuetts allows two Medigap plan designs, 'Core' and 'Supplement 1'. They do not use the standardized plans A-N like most other states.
Medigap in Massachusetts

Core Plan doesn't cover:

Part A: inpatient hospital deductible.
Part A: skilled nursing facility coinsurance.
Part B: deductible.
Foreign travel emergency.

Reference: https://www.medicare.gov/supplement-...achusetts.html

BCBS Medex core provides full foreign travel coverage the same as Medex Bronze (supplement 1)

 

[youbet]

There are Medicare Advantage plans whose network is the same as Medicare's. DW's plan is good wherever the provider accepts Medicare assignment.

Just study the situation and know exactly what you're getting.

 

[growing_older]

There are Medicare Advantage plans whose network is the same as Medicare's.

I would dearly like to know which plans those are. I have not been able to find any.

 

[wmc1000]

While some Medicare Advantage plans have large networks that may cover most providers or are possibly PPO style plans, our concerns were the co-pay and potential OOP costs IF there were major illness issues especially later in life.