Medicare vs Advantage Plans Comparisons

[marko]

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.

I just called United Healthcare and they also assured me that in MA this is true.

 

[FiveDriver]

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. Easy-Peasy.

I'm very fortunate to not need a lot of Medical attention at this stage of life. I go every 6 months to my Primary who does a Lipid Panel to keep an eye on cholesterol. The Charleston Diet will reek havoc on LDL, but we control it with a generic that costs me $10 a month. Any other Doctorin' I try to find in-network. I don't think my co-pays and such would even meet any Medigap deductibles.

My general questions --
Has anyone used an Advantage plan first and then switched into something else ??

Will a little thing like cholesterol meds prevent me from getting into a Plan F HD or a Plan G ??

 

[Gotadimple]

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

This is true BUT DEPENDS ON the carrier. Some carriers will not contract with a provider in their commercial plans if they do not also accept Medicare. An example are the Regence branded health plans in Washington, Oregon, Idaho, and Utah.

Some also asked are there Medicare Advantage Plans that offer PPOs. Yes there are but they are few and far between. Go to Medicare.gov and search the approved plans for one. In Washington state, there is only one plan: Regence BlueShield's Medicare Advantage Classic, and they are not approved to sell in all counties in the state. You pay for the broader network.

Most plans are moving to HMO plans because there is lower cost to administering the provider network. Carriers have to visit each provider, annually they have to re-negotiate contracts, and maintain specialized fee schedules. Much easier and cheaper (for the member) to limit the network and keep administrative costs down. If a carrier can't limit administrative costs they can find they won't have a federal contract to sell Medicare Advantage.

- Rita

 

[youbet]

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

DW's Medicare Advantage plan is with UHC.

Personally, I went with traditional Medicare and a BCBS F supplement. I actually have a smaller network than DW since my supplement has a limited, local network for non-emergency hospital admissions. (I can change that at any time with a phone call if elected surgery at a non-network hospital is desired.)

Despite my personal preference for traditional Medicare + supplement, I've been pleasantly surprised by her UHC Medicare Advantage plan. She has cancer and has required two surgeries, chemo and radiation and we found we were free to use any doc and facility we could have used with traditional Medicare.

Costs have been about the same. She pays about $1k less in total premiums but has a deductible and $1k OOP max. So, since she is definitely far beyond the OOP max, her costs for the year are about the same as mine. If she didn't use her plan due to good health, she'd be $1k ahead.

My bottom line is that I wouldn't use a Medicare Advantage plan unless I was willing to do a deep dive into understanding exactly what I was getting. I wasn't and opt'd for traditional Medicare, a name brand type F supplement and name brand Part D plan. DW opt'd for the Medicare Advantage plan and so far, so good.

 

[youbet]

This is true BUT DEPENDS ON the carrier. Some carriers will not contract with a provider in their commercial plans if they do not also accept Medicare.

Yes. Thanks for confirming.

Some Medicare Advantage plans do have the same network as traditional Medicare.

 

[mpeirce]

Some also asked are there Medicare Advantage Plans that offer PPOs. Yes there are but they are few and far between. Go to Medicare.gov and search the approved plans for one.

There seems to be more PPO plans than HMO plans in my area (Ohio).

I just finished researching all this for my DW. She choose to go with the Anthem MediBlue PPO. Mostly because it was similar to the Anthem PPO we already had. Same doctors covered, labs, etc. She did switch pharmacies - from Meijer to Kroger - but other than that no big change for her.

It worked out being slightly cheaper than pre Medicare. Our monthly premium dropped by about $300 (it now just covers me and DS). She now pays Medicare $536 quarterly plus $73 monthly to Anthem.

So the savings is around $50 per month. Sadly we can't pump money into her HSA now that she's on the dole.

 

[wmc1000]

YouBet - If we had a Medicare Advantage ppo plan available with a max OOP of $1000 it might have made us think hard about that route for DW. In Indiana the max OOP for Medicare Advantage plans is $6700.

While DW's Plan G and Part D premium costs are $80/mo. higher than MA - the no doctor co-pays, and lower drug co-pays, (lower tier level ratings for some of her drugs vs MA), in her case made it a wash in premium cost so the deciding factor was MA's worst case high potential OOP making us decide to go the supplemental route.

 

[Katsmeow]

Not being guaranteed that I can leave Medicare Advantage and go to a supplemental plan without qualification is a deal breaker for me. Even if I am still healthy in 2 years when I become eligible I wouldn't take that risk. Health status can change quickly and then I would be stuck with Medicare Advantage.

 

[MissMolly]

In our pension system with have Humana Employer Advantage PPO with a $320 deductible/4% copay and a MOP of $1,000 or we can choose a plan that is more like a Medicare Supplement which costs more. Both are PPO. The Humana Advantage also covers drugs so no Part D is needed AND it eliminates the donut hole on the drugs. The Supplement still requires you to get a Part D plan and you still have to deal with the donut hole on the Part D.

The Advantage Plan also covers for unlimited days for in-hospital admission and provides world-wide coverage. There are no in-network/out-of-network differences.

Each year we can choose to be on the Advantage plan or the Supplement plan and switch back and forth as we want. Whichever one is chosen during open enrollment is the plan you must have for the entire year.

 

[mpeirce]

Not being guaranteed that I can leave Medicare Advantage and go to a supplemental plan without qualification is a deal breaker for me. Even if I am still healthy in 2 years when I become eligible I wouldn't take that risk. Health status can change quickly and then I would be stuck with Medicare Advantage.

I'm curious what "stuck with Medicare Advantage" plan means?

Seriously, what are the down sides?

My DF has an Advantage plan and it seems to have served him very well. I help him with his finances so I see what's he's spending and he's never had any especially large health expenses - even with open heart surgery and a valve replacement.

 

[razztazz]

I'm curious what "stuck with Medicare Advantage" plan means?

Seriously, what are the down sides?

My DF has an Advantage plan and it seems to have served him very well. I help him with his finances so I see what's he's spending and he's never had any especially large health expenses - even with open heart surgery and a valve replacement.

My mother was the same way. Diabetic. Heart attack. Bypass. Later on back surgery. Those recurring eyeball operations that some diabetics need for diabetic retinopathy. Almost never paid anything.

She did, however live north of Philadelphia along the I-95 corridor. The Advantage networks were probably quite robust in that area due to the humongous population.

 

[aja8888]

I'm curious what "stuck with Medicare Advantage" plan means?

Seriously, what are the down sides?

It depends on what state you are in and what plans are available. In Texas, MA plans are not popular, have limited specialists, in most cases you can't choose your brain surgeon, etc. I was in one for a short while and bailed while I had the chance.

Some states have great MA plans sponsors.

The Fed has ongoing plans to cut payments to MA sponsors and that (if it happens) will cut into services. Some MA plans close up when they go upside down.

 

[Katsmeow]

I'm curious what "stuck with Medicare Advantage" plan means?

Seriously, what are the down sides?

What if the network on the Medicare Advantage plan changes to doctors you don't like? What if you need care from a particular doctor who isn't part of the network? What if the laws on Medicare Advantage plans change and you decide it isn't worthwhile? What if the members of the network change or you move and you don't like your choices? What if for any of these reasons you decide to switch back to traditional Medicare?

Yes, you can switch back to traditional Medicare, but in most instances you would have to medically qualify for a supplement (medigap policy). if you can't qualify you don't get one. Some people say they aren't worried about that because they are healthy. But health status can quickly change.

So, if I joined a Medicare Advantage plan I would feel that I was potentially boxed into one forever even if I didn't want to stay in it if I couldn't qualify for a supplement. That is not a risk I want to take.

DH has traditional Medicare with Plan F supplement. Basically he pays his premiums and that is it. Every doctor he has ever wanted to see takes traditional Medicare. (Occasionally he might a prescription and need to pay something but he doesn't take any regular ones so it is no big deal).

 

[aja8888]

Some people say they aren't worried about that because they are healthy. But health status can quickly change..

I keep seeing this throughout the forums as to how healthy "us early retirees" are. (good luck with that in your Firecalc planning to 100!!)


Well, let me say that if we didn't opt for a Medigap policy early on and went with an MA one then DW and I would not have been able to pick the absolute best orthopedic and heart surgeons in Houston in the procedures we have had done in the last 5 years.

And BIL (local to us) had a heart transplant two years ago and if he didn't have Medigap and plan F, he probably would not have been able to pick the heart replacement team (yes, a team) and had it done in the Houston Medical Center.

 

[kaneohe]

I keep seeing this throughout the forums as to how healthy "us early retirees" are. (good luck with that in your Firecalc planning to 100!!)


Well, let me say that if we didn't opt for a Medigap policy early on and went with an MA one then DW and I would not have been able to pick the absolute best orthopedic and heart surgeons in Houston in the procedures we have had done in the last 5 years.

And BIL (local to us) had a heart transplant two years ago and if he didn't have Medigap and plan F, he probably would not have been able to pick the heart replacement team (yes, a team) and had it done in the Houston Medical Center.

Agree 100%.......time between being healthy and having a serious disease can be one day when the diagnosis is made. Even if the disease comes with symptoms over time, it may then be too late to get a Medigap policy if you have to get medically qualified.

 

[growing_older]

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.

 

[mountainsoft]

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.

 

[mf15]

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.
Old Mike

 

[marko]

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.

 

[MBSC]

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.

 

[TimeMeasure]

Medicare vs. Medicare Advantage

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 http://wendellpotter.com/2013/04/medicare-advantage-or-disadvantage/:

“[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 http://www.medicarerights.org/pdf/Too_Good_to_Be_True.pdf :

“… 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.