Medicare Advantage disadvantage

[lem1955]

Why do news articles and other comparisons of Medicare Advantage to Medigap Plans focus on the limitations of networks for Advantage plans rather than the large deductibles? Sure, the Advantage plans have lower premiums but the deductibles can be very costly.

[MichaelB]

Probably because, as we well know here, “numbers is hard”.

[VanWinkle]

Many plans have zero deductibles. You might be referring to Out of Pocket maximums of 2900 to 6700 per year. I'm not judging which is better for each person because it is a very personal decision based on circumstances and ability to accept risk.

[Car-Guy]

The ONLY reason they are this business is to make money. They work all the angles and then "try" to make their plans attractive to different groups of people. When things aren't as profitable as they "calculated", they'll raise the rates, increase co-pays/deductibles, cut services or cancel the plans.

[ShokWaveRider]

Probably because access is key. It could be very cheap, but if access is limited then it really does not matter. Most are HMOs now, at least the cheap one's are. Most (We have not found one that doesn't in our area) Doctors take Medicare + Supplement / Medigap. Very few take so called Medicare Advantage HMO plans. There are more that take MA PPOs, but again they are somewhat limited.

Real HMOs like Keiser in California are OK. But contrived HMOs, which really are not proper HMOs, just a random collection of doctors in a given region IMHO is not the way to go. At least it is like that here where we are.

We had Keiser in SoCAL when we lived there through my w*rk, it was great, GPs, specialists, Testing, MRI, CT, etc., all under one roof. One simply walked across the hall to get a blood test or stress test. Not so in Florida, again at least where we are.

[lem1955]

Quote:

Originally Posted by VanWinkle Many plans have zero deductibles. You might be referring to Out of Pocket maximums of 2900 to 6700 per year. I'm not judging which is better for each person because it is a very personal decision based on circumstances and ability to accept risk.

Yes, that's right, out of pocket maximums. Thanks. I'm not judging which is better. Personally, Medicare Advantage worked great for my DW from age 65 - 74, then she changed to Medigap Plan N.
I went to Plan N right off the bat because we could then afford it and didn't want to take a chance on waiting too long. Plus we wanted coverage nationally and internationally.

[ShokWaveRider]

I am not sure why anyone here (Us FIRE'd Types) would want to skimp on their health insurance after 65, when they are coming up to their most vulnerable years, health wise that is. The FIRE title implies they do not have to.

Why would one go for a MA plan with Copays and/or Deductibles with $7,900 MOOP and a limited network (No Mayo) just for a $0 monthly premium when they can get Medicare with Part G & D for basically worry free healthcare for ~$4,000 all in (Minus Dental and Vision coverage which is even more limited on MA plans).

These numbers are actual for our area. To me it is a no brainer. MMDV

[CRLLS]

Quote:

Originally Posted by VanWinkle Many plans have zero deductibles. You might be referring to Out of Pocket maximums of 2900 to 6700 per year. I'm not judging which is better for each person because it is a very personal decision based on circumstances and ability to accept risk.

While I'm not an Part C Advantage fan, I will say that $6,700 annual OOP is inline with the ACA plan we had from a few years ago, and before that, a BCBS individual plan. I much prefer our Medicare Supplement Plan G and Part D. I still avoid Drs as much as possible even with the virtually zero deductible and 0 copay.

[VanWinkle]

Quote:

Originally Posted by ShokWaveRider I am not sure why anyone here (Us FIRE'd Types) would want to skimp on their health insurance after 65, when they are coming up to their most vulnerable years, health wise that is. The FIRE title implies they do not have to. Why would one go for a MA plan with Copays and/or Deductibles with $7,900 MOOP and a limited network (No Mayo) just for a $0 monthly premium when they can get Medicare with Part G & D for basically worry free healthcare for ~$4,000 all in (Minus Dental and Vision coverage which is even more limited on MA plans). These numbers are actual for our area. To me it is a no brainer. MMDV

My MA plan is country wide, 3900 OOP max. That is 100 less than the 4000 all in with medigap and plan D. There is some risk involved and I understand some copays may increase the cost. Do not rule it out for anyone over 65 as that is not taking into account the personal situation and risk ability of many people. I also invest in equites and accept that risk.
I am a Senior Health Insurance Counselor volunteer in my state and extensive training in Medicare options. No one option is best for everyone.

Also it is a PPO and no advance approvals needed from Insurance to see specialists.

Regards,

VW

[MissMolly]

Our MA plan is a PPO. It has nation-wide coverage. Annual MOOP is $1,200. I have never found a doctor/specialist in our area that doesn't accept it. We rarely travel so the nationwide coverage will probably never be needed. We have a large university in town, a cancer center and a heart center. We have not had any issues with getting approval for any procedure. Our MA plan works just fine for us.

[ShokWaveRider]

It is obviously VERY location dependent, as mentioned in our area (MCOL) it is not advantageous for me at all. I would like to know why certain areas are so much lower than others.

[mpeirce]

Quote:

Originally Posted by MissMolly Our MA plan works just fine for us.

Same here.

Some people seem to have either had a bad experience with MA or are ideologically opposed to them.

[Ian S]

Quote:

Originally Posted by VanWinkle My MA plan is country wide, 3900 OOP max. That is 100 less than the 4000 all in with medigap and plan D.

Do you have to pay Part B premiums? My ~$4,000 all in (Parts A, B, and D plus Medigap G Plan) includes Part B premiums.

[Car-Guy]

My OOP max is $3000 per year per insured person... But that's for using in network providers and "approved" services/procedures... If you use out of network providers or having something done that's not on their "approved" list of services, it cost more (sometimes a lot more). And of course that only applies to medical coverage and doesn't account for the annual premiums you pay. Dental, vision and drug plans all have their own limits.... YMMV by plan.

[RetiredHappy]

In terms of getting the best possible care and outcome, Medicare Supplement trumps Medicare Advantage every time. We were with Kaiser in CA did not not know better and my husband stayed with Kaiser after he became eligible for Medicare.

When we moved to NV, we wanted to get him on Medicare Supplement and the agent had him apply to AARP United Healthcare Supplement plan. He was denied tier 1 pricing and was offered $500 a month for Plan F. We passed. He went on Aetna MA PPO and at end of 2019, Aetna removed all orthopedists from the PPO network in Las Vegas region and we were in total shock. The closest was Pahrump. We switched to Humana MA PPO in Feb 2020. Aetna has since added back orthopedists to Las Vegas region.

We decided to apply to Humana Medicare Supplement Plan F for 2022 and he was accepted. We are thrilled. His premium for Plan F will be $320 per month and going with a $68 per month drug plan.

[Bamaman]

We have a large hospital to the north of us that has bought many, many other hospitals, and physicians' practices throughout the region. They accept regular Medicare Supplements, but don't allow their 1700 physicians to accept Medicare Advantage plans.

Many Advantage patients have had to change doctors and go to hospitals in other cities. And the finest surgeons and specialists are affiliated with this hospital--and don't accept Advantage.

My wife has a number of problems requiring surgery in the past, and I'm Type II diabetic. We stick with Plan F, and have seen virtually no co-pay bills of any kind and $0 deductibles on Plan B Durable Goods. And we get the best specialists too.

[Livefree]

My Advantage Plan is a Blue Cross PPO plan, and is accepted by most doctors. I don't take prescriptions, and in good health, so it's a good fit for me right now.


Also, if I decide to change out of the Advantage plan, there's no underwriting here in Mass


I only pay $148 for part B each month.

[ShokWaveRider]

How much are those who have and like their MA plans paying in monthly premiums, or are they all $0?

[aja8888]

Quote:

Originally Posted by ShokWaveRider How much are those who have and like their MA plans paying in monthly premiums, or are they all $0?

We are in the Houston, Texas area where some of the best medical care is available nationwide. I have good friend who has a Humana PPO (Advantage) Plan and he pays $10/month plus the $148.00 medicare charge.

With that PPO plan, he can chose any in-network doc he wants and does not need any preauthorization. All his doctors take the plan and his copay's and deductibles are very reasonable. He has never had any problems finding great doctors or surgeons on this plan. It's my understanding that HMO versions of MA plans are much more restrictive.

[ShokWaveRider]

I did not think that Premiums for MA and Medicare Part B went towards MOOP? So MA Premiums + $1,776 + MOOP is the actual cost of any MA plan. Unless I am mistaken.