Approaching 65 (Medicare) Having difficult time with Advantage vs Supplemental Plans

[audreyh1]

Something I haven't seen mentioned is that the premiums with a medicare advantage plan are often $0 per month, and the advantage plan actually pays for your monthly plan B premium, which saves lower income folks $134 per month. That's a good thing, but still, after seeing medicare advantage plans in action with my parents, it revealed that there is a lot of vigilance and worry involved in making sure everything is in network, no out-of-network people snuck in, etc. But isn't out-of-network still a problem with a supplement plan?

Not the same. Either a doctor or facility accepts Medicare or they don’t. There is no other distinction. So with traditional Medicare and supplement you have access to the broadest available “network”of any Medicare patient.

 

[SumDay]

Something I haven't seen mentioned is that the premiums with a medicare advantage plan are often $0 per month, and the advantage plan actually pays for your monthly plan B premium, which saves lower income folks $134 per month. That's a good thing, but still, after seeing medicare advantage plans in action with my parents, it revealed that there is a lot of vigilance and worry involved in making sure everything is in network, no out-of-network people snuck in, etc. But isn't out-of-network still a problem with a supplement plan?

From what I understand, if the doc takes Medicare, there are no worries with the supplement paying. If I'm wrong, I'd like to know before we get zinged. I'm sure I'll be duly corrected if I am.

 

[NoMoreJob]

But isn't out-of-network still a problem with a supplement plan?

Only if the provider doesn't accept Medicare. Where I live providers not accepting Medicare are few and far between.

As long as the provider accepts Medicare assignment the supplement always pays the 20% not paid by Part B. If the provider accepts Medicare but doesn't accept Medicare Assignment any 'excess charges' are paid in full only if you have Plan F or Plan G.

There is sometimes an exception for 2% of the 'excess charges' billed. This is due to a 'reconcilliation' bill passed by Congress a few years ago. Don't ask me to explain it, I just know I've been billed for it by a provider that doesn't accept assignment.

 

[NoMoreJob]

Not the same. Either a doctor or facility accepts Medicare assignment or they don’t. There is no other distinction. So with traditional Medicare and supplement you have access to the broadest available “network”of any Medicare patient.

There are three categories.

1. Those that accept Medicare Assignment
2. Those that participate in Medicare but do not accept Assignment
3. Those that opt-out completely

See my reply above re: the difference between #1 and #2.

If you don't have plan F or G it's important to make sure that the provider "accepts Medicare Assignment." Just confirming that they "accept Medicare" could leave you on the hook for 'excess charges.' If you have plan F or G the excess charges are covered by your supplement with the possible exception of the 2% 'reconciliation' amount.

As a practical matter, there are not a lot of providers (where I live at least) who don't accept assignment. But there are some, one of which is a nationally renown facility where I happen to be receiving treatment. I'm very thankful that they accepted me for treatment (not required) and that I had chosen Plan G about 3 months prior to that when I went on Medicare. I've paid about $300 out-of-pocket plus my $183 deductible for a year of very expensive (life saving) treatment.

 

[ivinsfan]

Something I haven't seen mentioned is that the premiums with a medicare advantage plan are often $0 per month, and the advantage plan actually pays for your monthly plan B premium, which saves lower income folks $134 per month. That's a good thing, but still, after seeing medicare advantage plans in action with my parents, it revealed that there is a lot of vigilance and worry involved in making sure everything is in network, no out-of-network people snuck in, etc. But isn't out-of-network still a problem with a supplement plan?

They are not "often" zero but some states and plans do have zero options..remember if you pick a plan with a lower or no premium your OOP will most likely be higher...if you know a plan that actually pays the Part B please share..Part B is paid by you directly to the government AFAIK....

 

[John Galt III]

They are not "often" zero but some states and plans do have zero options..remember if you pick a plan with a lower or no premium your OOP will most likely be higher...if you know a plan that actually pays the Part B please share..Part B is paid by you directly to the government AFAIK....

I may be wrong about medicare advantage plans paying the $134 Part B monthly premium. Was talking to an Apprise counselor today and she said she never heard of it.

 

[Dtail]

I may be wrong about medicare advantage plans paying the $134 Part B monthly premium. Was talking to an Apprise counselor today and she said she never heard of it.

My DGF is collecting SS and has Medicare Advantage. They deduct the Part B from the SS payment.

 

[Katsmeow]

But isn't out-of-network still a problem with a supplement plan?

No. Supplements (Medigap) plans don't have networks. Doctor has to accept Medicare. And as mentioned ideally you want someone who accepts assignment.

From seeing my mom's experiences with Medicare + Supplement and that of DH my experience has been:

Specialists and hospitals almost always accept traditional Medicare. Old people tend to have diseases and problems that get treated by specialists. That is, a cardiologist who doesn't take Medicare at all isn't very common as it would take away too many patients.

In my experience, most of them take assignment. There are exceptions but those aren't common.

The one area where doctors are not as plentiful for people on Medicare in my experience are primary care doctors. Some don't accept Medicare at all. Others will accept it

 

[sn2792]

Plan N differs from Plan G in three ways:

-No coverage for Part B excess charges

-You may have a copay of up to $20 for doctor visits and $50 for ER visits that don’t result in admission.

- Due to the above, ~20% lower premium costs

I went with plan N also because cheaper than G and in my state it is illegal to charge excess charges.

 

[REWahoo]

The one area where doctors are not as plentiful for people on Medicare in my experience are primary care doctors. Some don't accept Medicare at all. Others will accept it

What I've found is that almost all of those primary care doctors you describe as not accepting Medicare actually do. What they don't accept is NEW Medicare patients.

 

[Katsmeow]

What I've found is that almost all of those primary care doctors you describe as not accepting Medicare actually do. What they don't accept is NEW Medicare patients.

Well, yes, there are a lot of those doctors who will continue to treat people if they were patients before they went on Medicare. However, we moved after DH went on Medicare. In his case, my primary care doctor (I am not on Medicare) agreed to take him because I was a patient.

We have recently moved about 250 miles away and so DH is going to have to find a new primary care doctor as will I (I am going on Medicare next year). I plan to find someone this year....

 

[MichaelB]

Here's a link to a study by Kaiser Foundation on the size of Medicare Advantage plan physician networks across the country. https://www.kff.org/medicare/press-...percent-of-physicians-in-a-county-on-average/
On average, 46% of physicians in an area are included in Medicare Advantage, the range is 87% to 1%.

Around 95% of physicians accept traditional Medicare, although as indicated by REWahoo, not all accept new patients.

 

[MBSC]

..if you know a plan that actually pays the Part B please share..Part B is paid by you directly to the government AFAIK....

I may be wrong about medicare advantage plans paying the $134 Part B monthly premium. Was talking to an Apprise counselor today and she said she never heard of it.

Some MA plans reduce the Part B premium in certain counties, especially Florida. The reduction is usually in the $30-$60 range. When viewing the results of the Health Plan Finder on Medicare.gov, there is a column for Monthly Premium. Within that column is a Yes/No field for "Part B Premium Reduction".

For example, enter zip code 33024 and select "I don't get any extra help." In the results for MA plans with prescription drug coverage, the Allwell Premier plan shows Part B premium reduction is yes. Click on the plan name in blue and scroll down to costs. It should say Part B premium $54.00.

Medicare Advantage plans change each year, and depending on the estimated cost for each Medicare plan member, some also rebate all or a portion of your Medicare Part B premium back to you.

Please read the Medicare plan coverage details carefully as some plans found in the same area (or county) may not rebate any portion of the Medicare Part B premiums or rebate only a portion of the monthly Medicare Part B premium.

So for instance, if you enroll in the 2018 WellCare Dividend (HMO) (available to residents of Brevard county, Florida), you will receive a rebate toward your Medicare Part B premium. You may find that the same named Medicare Advantage plan in another county will rebate a higher Medicare Part B premium amount or offer no Part B premium rebate at all.

Reference: https://q1medicare.com/q1group/Medi...-should-I-start-ge&faq_id=582&category_id=138

 

[Sirka]

We already had Kaiser, so I went with Kaiser Advantage at 65. I get the same care for lot less money, because of Medicare. There are some limitations, YMMV.

 

[isisdave]

OK, I've gotta ask. Most everyone goes with F or G - what is the special appeal of N?

Cheaper than F or G. Supposedly there can be small copays but I've never been charged one. Same with "excess charges." But check locally on those.

 

[Elliotgb183]

I struggled with all of the varying plans and supplemental. I saw something on Facebook and decided to give it a try. Definitely worth it. It was BoomerBenefits.com. The have webinars and you can print out a worksheet to follow along with. At the end, if you like, you can call one of their agents who will guide you through choices and give you very close monthly estimates. It’s the route I took.

One interesting thing about a colonoscopy. Normally my supplemental drug plan covers all or most of my costs. The gastro people recommended a prep called SuPrep and the whole thing was out of pocket. Plan covered zip. But considering I have it done every 5 years the price averages out.

 

[Archman]

I have an Advantage plan that includes drug coverage, and I pay $0 in premiums.

 

[ShokWaveRider]

I have an Advantage plan that includes drug coverage, and I pay $0 in premiums.

What are your CoPays and Max OOP?

 

[ivinsfan]

I have an Advantage plan that includes drug coverage, and I pay $0 in premiums.

That's nice for you but what's your point..all Advantage plans include drug coverage.

 

[Another Reader]

I have an Advantage plan that includes drug coverage, and I pay $0 in premiums.

And your out of pocket expenses can be staggering if you need major surgery. Read this from SeniorSavingsNetwork:

https://seniorsavingsnetwork.org/medicare-advantage/

 

[Archman]

What are your CoPays and Max OOP?

In-network: $5 copay per visit
Physician (PCP) Out-of-network: 50% of the cost
Specialists In-network: $40 copay per visit
Out-of-network: 50% of the cost
Any additional
preventive services
In-network: $0 copay
Out-of-network: 0% -50% of the cost

Maximum Out of Pocket: $4,800 for in-network services annually
$10,000 for in and out-of-network services
combined.

 

[Archman]

That's nice for you but what's your point..all Advantage plans include drug coverage.

No they don't. And not all supplements, either.

 

[ivinsfan]

In-network: $5 copay per visit
Physician (PCP) Out-of-network: 50% of the cost
Specialists In-network: $40 copay per visit
Out-of-network: 50% of the cost
Any additional
preventive services
In-network: $0 copay
Out-of-network: 0% -50% of the cost

Maximum Out of Pocket: $4,800 for in-network services annually
$10,000 for in and out-of-network services
combined.

Those are some big numbers so they explain why your plan is free..I'm curious about the 0 -50 copay for out of network... the great majority of Advantage plans cover Meds although it is not required by law.

 

[ivinsfan]

No they don't. And not all supplements, either.

Supplements don't usually cover meds you need a separate drug plan, Advantage plans are not required to offer drug coverage but the vast majority do. There might be some out there that don't but I've never run across them.

Do you ever leave your plans service area because those out of network numbers are sobering?

 

[Another Reader]

I have an Advantage plan that includes drug coverage, and I pay $0 in premiums.

And your out of pocket expenses can be staggering if you need major surgery. Read this from SeniorSavingsNetwork:

https://seniorsavingsnetwork.org/medicare-advantage/