Medicare+Medigap vs. Advantage

[Yipper]

Interesting take on who should choose traditional Medicare (A,B, D & Medigap) vs. Part C Advantage in WSJ.

https://www.msn.com/en-us/money/per...make-when-picking-a-medicare-plan/ar-AA1fiYHY

Essentially they say unless you have $250,000 (MFJ) or $125,000 (individual) as annual income, you should go with Advantage. Above those levels, go traditional with drug and gap plan.

 

[REWahoo]

Horse puckey.

 

[MichaelB]

$250k in income for a senior MFJ would place that household in the top 5%, and probably in the top 1% of all seniors. It sounds way too limiting.

 

[RetiredHappy]

Total BS.

 

[Yipper]

I agree - it went against most everything I’ve read and was surprised this was in the WSJ.

 

[MichaelB]

Horse puckey.

Total BS.

Don’t hold back, tell us what you really think.

 

[CardsFan]

Horse puckey.

Double Horse Pucky

 

[athena53]

Overall I thought it was a good article- except for the silly annual income figures quoted above. They also throw around some nasty out-of-pocket examples for Medicare B ($30K/year if you're getting Keytruda for cancer for $150K) but don't explicitly note later when they discuss Medigap that Medigap would cover that $30K.

To me, the extra costs of traditional Medicare plus Medigap (plus IRMAA surcharges ) is worth the increased network and easier access to needed treatments without having to jump through extra hoops such as "step therapy".

 

[GenXguy]

Goes against what I usually hear going with dis-Advantage. But, I'm too far out to concern myself with that right now.

 

[CRLLS]

I thought it was pretty complete for a short article.

To be fair, he did write:

People with lower incomes could afford this choice, but make sure that the level of coverage suits you.

That goes without saying for any Medicare product, traditional or Advantage plans. I took the income to be from SS, RMDs and all other income streams, not specifically income from a job.

 

[badatmath]

Horse puckey.

+1

 

[zl55lz]

I would think it would be the other way around, since Advantage Plans can have out of pocket max year after year after year, while Medigap can pick up the 20% after Part B.

Seems the $2000 Part D out of pocket max limit starting in 2025 could have an impact too on scenarios.

And, Plan G HD could possibly bring costs down over time?

 

[ivinsfan]

Huh, that's ass backwards IMO

 

[ERhoosier]

To me, the extra costs of traditional Medicare plus Medigap (plus IRMAA surcharges ) is worth the increased network and easier access to needed treatments without having to jump through extra hoops such as "step therapy".

IRMAA surcharges still apply for those on Medicare Advantage, because Medicare Advantage requires one to pay their Part B (& D if applicable) premium of which IRMAA is a part (for higher income beneficiaries).

https://www.socialsecurityintelligence.com/the-2023-irmaa-brackets/

 

[ERhoosier]

Total BS.

Yup. Bovine Scat.

 

[CWradio]

Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many "closed block of business." (deadpool) policies the company has.

This is done because the current book of business have people who have become older and therefore have more illnesses meaning more claims. They close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.

In most states you will be unable to change supplement insurance companies without medical underwriting. A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

 

[VanWinkle]

The article does make some sense. Like other financial porn, it also misses the mark in some areas.

I'm on Medicare Advantage, my SO will be on Medigap in a year when Medicare eligible. There are good reasons for each of us to be on the plan we have chosen. It is related to income and medical history. I spent 40 plus years on a PPO plan from private insurance with no issues. I see no reason to change just because I'm 65. I am in very good health and have the ability to pay the OOP max of 3200 each year. So far I have paid less than 250 each year for the last 4 years. I received more than 250 each year in dental coverage and over the counter products. It has worked fine for me.
My SO has several ongoing health concerns and will be better served by a G Medigap plan. I am SHIP certified in Illinois and have been trained on all aspects of the different plans.

 

[Teacher Terry]

My costs for Medicare and supplemental insurance are my second biggest expense. It’s a lot considering my income but I am not going to gamble with my health or life to save money being on an advantage plan. I would have to be really poor to do that.

 

[VanWinkle]

My costs for Medicare and supplemental insurance are my second biggest expense. It’s a lot considering my income but I am not going to gamble with my health or life to save money being on an advantage plan. I would have to be really poor to do that.

It is not a gamble, just another way to obtain health coverage. Your Medigap plan sounds like the best option for you and if that secure feeling is what you get, you made the right decision.

VW

 

[Teacher Terry]

It is not a gamble, just another way to obtain health coverage. Your Medigap plan sounds like the best option for you and if that secure feeling is what you get, you made the right decision.

VW

It’s definitely a gamble to take an advantage plan. Since they are allowed to use step therapy you could be dead or too sick to matter by the time you get to the step you need. A friend of mine almost died because she’s on an advantage plan and couldn’t get a doctor to order the needed tests and treatments in a timely manner. She couldn’t go out of network and have it covered.

Finally she was able to see the department head doctor who was appalled at her lack of treatment by the doctors under her and prescribed a medication that helped greatly and put her on oxygen. She had oxygen levels in the mid to low 80’s for months before this finally happened and none of the loser doctors on her plan were very concerned.

 

[Ian S]

Horse puckey.

+1

 

[ncbill]

MA is fine if you are content to have your treatment limited when your doctor recommends an expensive, first-line treatment for whatever nasty ailment you've developed.

The MA plan will instead require you to try much cheaper options to start, no matter if the doctor is telling both you & your MA plan "this is the only thing that works!"

Sure, you can appeal but IIRC the first two levels of appeal are internal to the MA plan.

Good luck getting anything $$$ approved until it can be appealed to an outside, 3rd party.

One company I found online which advises new retirees notes they see their clients develop serious health issues late 60s to early 70s, no matter how healthy they were before.

So they usually recommend signing up for Medigap instead of MA, at least to start.

 

[pacergal]

Medicare choice is another one of those decisions that every person needs to spend time reviewing options and really understanding the full picture.

You can have great providers and medical facilities with an Advantage plan or original Medicare, or you can have lousy ones with either also. Do your research.