Why not Medicare Advantage PPO?

[Sunnymar]

I now have Medicare supplement Plan N, since moving to a new zip code I can get a Medicare Advantage PPO with better coverage and lower premium. I did have a Medicare Advantage PPO plan I loved but it left my zip code. I will not consider a HMO plan.

Reading this forum, I see many prefer the supplement plans, especially the Plan F-HD. I did find a Plan F-HD with very low premiums but of course I need to qualify. I called a local agent who said I can apply, see if I qualify, then decide. The agent also said I should be able to contact Blue Shield directly to change my current BS plan from N to F-HD.

What do you think I should do, keep N, move to F-HD or Advantage PPO.
I am healthy now but I'm always looking toward an unknown future for the best plan to take the best care of me. A lower premium today is less important than future good coverage.

 

[Moemg]

My SO has a medicare advantage PPO and it has been great . He has had heart surgery and two total knees while he had this insurance and the coverage was great .Minimal out of pocket and excellent Physicians .

 

[audreyh1]

I'm confused. N and F-HD sound like Medicare Supplement plans, not Medicare Advantage plans.

 

[GrayHare]

I'm confused. N and F-HD sound like Medicare Supplement plans, not Medicare Advantage plans.

I think they are, and that the OP is comparing them. An Advantage PPO sounds appealing to me but I don't know the various Medicare options well.

 

[Gotadimple]

The OP did have an PPO Medicare Advantage plan, but, it withdrew from her area. So she moved to a Medigap Plan. She has now moved and can once again apply for Medicare Advantage PPO plan. She will not consider an HMO option for Medicare Advantage.

She is on Medicare Supplement Plan N. It is similar to Plan F. From ehealth's Medicare.com website: https://medicare.com/medicare-supplement/medicare-supplement-plans-f-g-and-n/
"Medigap Plan N covers all the same benefits as Plan F with the exceptions of the:

• Medicare Part B deductible
• Medicare Part B excess charges

You would need to pay these cost differences out of pocket. Plan N is also a little different from Plan F because although it pays for 100% of the Part B coinsurance in most cases, there are exceptions"

- Rita

 

[Gotadimple]

Just an actuarial rule of thumb to apply when comparing plans (I'm not an actuary but I did work for many years for an health insurance carrier):

Whenever a plan covers more of a deductible, co-pay, or coinsurance, the premiums will be higher. Think of it as prepaying for these items through your premium payment.

Higher out of pocket items (the cost of deductibles, co-pays, and coinsurance) only apply if you make a claim. The premiums will be lower when you have a higher out of pocket share of the coverage. Think of it as only paying for what you use as you go along.

So if the question is should I take the plan with expensive premiums and virtually no out of pocket, or the plan where I have to pay as I go along and the premiums are lower by X%? It all depends: how secure do you want to feel? If you are more comfortable knowing your out of pocket will only be $XXX, when you make a claim, then a full-meal-deal high premium plan may be what you want.

 

[Running_Man]

Isn’t the main advantage of a supplemental plan than you can go to any specialist you want to that takes Medicare. A advantage plan, while cheaper limits your medical choices by design. My father in law who is 92 had cancer treatment and for it was able to go to Mayo in Scottsdale. He had a heart valve replacement 2 years ago and was able to get a leading specialist in that area for the surgery. He has Plan F. That alone would keep me in plan F as long as I could afford it, if money is an issue then Medicare advantage is much less expensive and may be a required alternative.

 

[audreyh1]

Yeah, a Medigap plan is broader than any PPO plan.

 

[Sunnymar]

Some of you have confirmed my thought to get the Plan F-HD.

GAD that is my thought save money while I'm healthy, pay later if I need more care. If I don't use it I'm saving money, if I do use it I'm still equal to Plan F.

RM knowing I can choose any treatment is why I'm considering a supplemental plan. My previous advantage plan gave me almost any treatment.

Thanks for the input.

 

[Bamaman]

The big hospital chain to the north of me refuses to accept Medicare Advantage patients. They have 1700 physicians, numerous hospitals and who knows how many hundreds of clinics in 6 states. That means thousands of Medicare Advantage patients have had to get new doctors and go to hospitals they didn't prefer.

Make sure your doctors and hospitals accept whatever plans you sign up for.