Medicare Advantage more common that I expected

[mamadogmamacat]

I'm not medicare eligible yet. And, after reading about some of the issues regarding accessibility to needed care, especially when one has a serious illness and need specialists or want the services of a specific hospital,as well as the issue of medical underwriting if one wants to return to regular Medicare in future yrs, I have no intention of getting Medicare Advantage when I am old enough. Will probably go with plan g.

That said, I saw this article today in my home page news feed (from AP, so hopefully that is not a source that will trigger anyone in a negative way. If it does, please don't shoot the messenger, just add me to your ignore list or whatever it is, we will both be better off that way):

EarthLink - Politics


What surprised me, beyond the interesting details about insurance company lobbying, was the statement that 2 in 5 Medicare recipients are on Advantage plans. 40% had no idea it was that large.

Reminds me of the phrase" "everything old is new again"
Remember the HMOs from the 80s and 90s, and all the horror stories in the media about denial of care? Looks like we are heading down that road again, especially if "Medicare for All" continues to gain traction despite the eye popping cost of it. I can easily see the big insurance companies getting on board with it and touting the advantage plan as a "cost saving" option.

 

[davebarnes]

The USA has the most complicated form of medical care/insurance for old people in the world.
Medicare Advantage provides a simpler (less complicated) version.

Simplification is one reason that I like it.
Another reason, for me, is one stop shopping. All my records in one place.

And, so far, I have not encountered (in 5 years) any cost cutting annoyances. In fact, one of my Kaiser docs recommended an MRI after my chemo and I said no. It would be waste of money. I have never felt rushed in any of doc/PA encounters.

 

[MissMolly]

When I was working and had employer provided insurance it was an HMO. Never ever had a problem getting needed health care. Now we have an Advantage Plan (a PPO, not HMO) and thus far, no issues.

 

[Dtail]

DGF has Medicare Advantage PPO by United Healthcare in FLA. Next year premium is 0.
Only 1 doctor (and she sees many) turned her down.

 

[Buckeye]

Hubby (69) likes to spend a lot of time (at least some time up there 3 days a week) on the roof blowing off the leaves and cleaning leaves out of the gutters. I keep him on regular Medicare and a supplement plan (N, $152 per month) because I want to be able to access the best providers should we need to put him back together if he falls off the roof (or ladder). He is very fit, strong and agile but things happen. Plan for the worst and hope for the best!

 

[Bamaman]

When I was working and had employer provided insurance it was an HMO. Never ever had a problem getting needed health care. Now we have an Advantage Plan (a PPO, not HMO) and thus far, no issues.

We too had Kaiser Permanente's HMO when living in Atlanta, and found them great for the sniffles and day to day health issues. But we had terrible service with them for my wife's serious ob/gyn and orthopedic problems. After her suffering for years under Kaiser, switching to conventional healthcare insurance and her problems were immediately diagnosed and taken care. And spinal stenosis caused her legs to "go out" causing her to fall down steps. If serious health issues come up, we don't want to be under a HMO or even Medicare Advantage plans that works somewhat like a HMO.

If something really serious comes up with our healthcare, we prefer to go to the big hospital chain 100 miles north of us. The problem is that they don't accept any Blue Cross Blue Shield ACA or Medicare Advantage plans in network. They virtually only have contracts with United Healthcare ACA and Advantage plans. This hospital manages and controls regional hospitals in 6 states and over 1,700 physicians are excluded from BCBS HMO or Advantage.

Before someone switches to ACA or Medicare Advantage, they need to check with their area hospitals to see if they do business with their insurance companies. Otherwise, they may end up at another hospital with new physicians.

Another complaint I've been reading about are emergency room physicians, pathologists, radiologists and anesthesiologists that often work as subcontractors at hospitals. They can be "out of network" on insurance plans, and patients end up paying for services or much of the bills out of pocket. Only the big hospital mentioned above has their own anesthesiologists that are accepted as in network--in a huge geographic area. Inquiring about specialty physicians' insurance company relationship is very important prior to having a procedure--if possible.

 

[El Magnifico Loco]

I am not Medicare eligible yet (15 more months to go), but I started doing some research. Several years ago, I had heard Advantage plans were horrible as they (a) were too restrictive in terms of what physicians one could see and (b) what procedures they would cover. But in talking with my insurance agent, he tells me he is putting 75% of his clients into Advantage plans, and he is getting NO complaints from them or fielding calls to switch them to Medicare Supplemental/Medigap plans. The reason, he says, is that gov't funding to the insurance companies for their Advantage plans has substantially increased, and the insurance companies can afford to be more liberal with their product offerings.

I am still suspicious, as I believe there is no guarantee one can switch from Advantage to Medigap, if the Advantage plans again become substandard. I believe one has to undergo a "qualifying event" (like moving out of state) in order to guarantee acceptance back into a Medigap policy. I would rather pay a little more for a Medigap policy and sleep better at night. At least that is what my thinking is today. Any additional insight would be appreciated . . . .

 

[Another Reader]

Sounds like a sales pitch to me. Is this an agent that specializes in health insurance? If not, I suggest you talk to ones that specialize in Medicare, such as Boomer Benefits and Senior Savings Network, that are often referenced here. I believe there is a video on the SSN page about the disadvantages of Advantage plans.

 

[MichaelB]

But in talking with my insurance agent, he tells me he is putting 75% of his clients into Advantage plans, and he is getting NO complaints from them or fielding calls to switch them to Medicare Supplemental/Medigap plans. The reason, he says, is that gov't funding to the insurance companies for their Advantage plans has substantially increased, and the insurance companies can afford to be more liberal with their product offerings.

+1@AR. This sounds like a sales pitch. He does get higher reimbursement for Medicare Advantage over MediGap.

I am still suspicious, as I believe there is no guarantee one can switch from Advantage to Medigap, if the Advantage plans again become substandard. I believe one has to undergo a "qualifying event" (like moving out of state) in order to guarantee acceptance back into a Medigap policy. I would rather pay a little more for a Medigap policy and sleep better at night. At least that is what my thinking is today. Any additional insight would be appreciated . . . .

See rules for guaranteed issue here. Basically, if you are enrolled in Medicare Advantage and want a MediGap policy you have to lose the MA coverage, which is not typical. Otherwise the insurer is free to underwrite and has no obligation to accept. Exception being state laws, such as California.

 

[REWahoo]

Here is required reading for anyone considering a Medicare Advantage plan. (And yes, I know there are a few exceptions, like Kaiser):

Pitfalls of Medicare Advantage Plans

Medicare Advantage plans may sound enticing. Many offer $0 premiums, but the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick and only want you as a customer when you’re healthy.

 

[Dtail]

Here is required reading for anyone considering a Medicare Advantage plan. (And yes, I know there are a few exceptions, like Kaiser):

Pitfalls of Medicare Advantage Plans

Good article. My DGF has the Medicare Advantage plan at age 57 due to disability.
I wonder if she would switch to Medicare at age 65 for example, would there be a cost penalty, since this is the traditional age of first time coverage?

 

[MBSC]

Otherwise the insurer is free to underwrite and has no obligation to accept. Exception being state laws, such as California.

California's Birthday Rule (no underwriting) is for switching between Medigap plans of equal or lessor benefits. Switching from Advantage to Medigap in CA requires underwriting unless there is a qualifying event for guaranteed issue.

CT, MA, and NY are the year round Medigap guaranteed issue states.

Connecticut, Massachusetts, and New York require continuous guaranteed issue for Medigap; Maine requires guaranteed issue for one month every year for at least Medigap Plan A.

Source: http://files.kff.org/attachment/Iss...-and -Consumer-Protections-Vary-Across-States

 

[MBSC]

Good article. My DGF has the Medicare Advantage plan at age 57 due to disability.
I wonder if she would switch to Medicare at age 65 for example, would there be a cost penalty, since this is the traditional age of first time coverage?

No penalty. Everything is reset during the age 65 open enrollment period. Under current rules, she will be able to purchase a Medigap plan at the preferred rate just like everyone else.

 

[Dtail]

No penalty. Everything is reset during the age 65 open enrollment period. Under current rules, she will be able to purchase a Medigap plan at the preferred rate just like everyone else.

Good to know. Was hoping that was the response. Didn't review it, as it is 8 years away.
Thanks so much.

 

[ivinsfan]

I believe a lot of it's about money. A couple both on Medicare with excellent Medigap coverage spend a boatload of money. I know, I'm shocked at what it costs. Now we can afford it and made that decision with open eyes. I'm in MN an oddball state that does not offer all the letter plans for Medigap.

Throw in the fact that I read here and realize you have to look at your Medigap choice as getting one bite of the apple so you should go high instead of low for the future. Add in a payment for Part D and with two people you are looking at real money going out every month.


330 thousand people in this state lost their cost/choice plans due to federal regulations this year. BCBS who wrote most of them opened one plan for Medigap and three for advantage. The Medigap cost 190 a month and two of the three Advantage plans were free and included part d coverage. I liked the look of their new Medigap plan and it's cheaper then the one I have now, I'm in my 6 month open enrollment period. When I took a good look at this I got concerned that the new Medigap option wouldn't get many takers and that the rate was a teaser rate and those two concerns kept me from switching Medi-gap plans.

If at any point I get sick of paying these premiums and don't travel out of state for the winter I might get an Advantage plan. I did read the documents for the Advantage plan and it does include language for changing your "home base network" when out of the area for extended travel. Each plan seemed to have different rules for this a you needed to call and ask about specifics. For a state like this with so many snowbirds that's a valuable addition.

 

[ShokWaveRider]

My HC insurance agent is somewhat of a friend after all these years of her getting us great ACA coverage. She did not recommend MA for me when I turned 65, she recommended plan g. She explained MA is the cheapest solution for a reason. Some of her customers do insist on it because of that. She is also compensated more on it. She explained that she would NOT write a MA plan for any of her family, even if they insisted because of her experiences with customers who have/had them.

 

[ivinsfan]

My HC insurance agent is somewhat of a friend after all these years of her getting us great ACA coverage. She did not recommend MA for me when I turned 65, she recommended plan g. She explained MA is the cheapest solution for a reason. Some of her customers do insist on it because of that. She is also compensated more on it. She explained that she would NOT write a MA plan for any of her family, even if they insisted because of her experiences with customers who have/had them.

In fact you never really know why agents push certain plans, it's always best to do your own research ahead of time.

 

[ShokWaveRider]

In fact you never really know why agents push certain plans, it's always best to do your own research ahead of time.

Of course, and we do. Although over the years ours has been very honest. She did say only really the folk who are financially challenged go for MA plans, it is better than nothing or just plain Medicare. For me she recommended a G, she has shared with us in the past at social gatherings, that she does not get extra comp for the G, (Note Extra) She is salaried. I have been doing my DD for over a year before I needed coverage. However for every MA plan she writes she gets a $240 bonus at signing and another $240 for annual renewals directly from the insurance company. Those are current bonus numbers as of 2018

 

[Which Roger]

I'm not eligible yet, so have just started learning about Medicare, but my first impression of Medicare Advantage was that the coverage DW and I could get would be very similar to what we're currently getting thru her employer's PPO. Same provider (BCBS), same doctors/network, similar costs. Maybe it depends on where you live and whether there are a lot of medical facilities in the area. But like I said, I'm just starting to learn.

 

[Dtail]

I'm not eligible yet, so have just started learning about Medicare, but my first impression of Medicare Advantage was that the coverage DW and I could get would be very similar to what we're currently getting thru her employer's PPO. Same provider (BCBS), same doctors/network, similar costs. Maybe it depends on where you live and whether there are a lot of medical facilities in the area. But like I said, I'm just starting to learn.

Bolded - yes that can make a big difference. DGF has many choices of doctors in our area of FLA and quite a few hospitals too. Really no different than my ACA choices due to where we live.

 

[ShokWaveRider]

Bolded - yes that can make a big difference. DGF has many choices of doctors in our area of FLA and quite a few hospitals too. Really no different than my ACA choices due to where we live.

But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic.

My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

 

[ivinsfan]

But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic.

My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

Did you buy a plan D you have to count that too. take a couple 2 grand each plus plan D each......that's probably at least 5K a year every year....it's not pocket change....add in 300 a month for both Part B premiums and boom another 3600 a year...some people just can't swing that annually.


I see it both ways, right now my DH was a heavy user last year..I've been a very light user so far. But we don't expect my DH's issue to reoccur but of course who really knows. I guess one could assume that if hit that max 6.4 for too many years you'd be dead. Remember it's not a deductible it's basically a co-pay issue. So you'd ring up a boatload of bills before you'd hit that max. It's the out-of-network issue that worries me more.

 

[ShokWaveRider]

Did you buy a plan D you have to count that too.

Yes Plan D is $13pm not a lot.

 

[MissMolly]

But again, not all Advantage Plans are the same. Mine is $500 deductible, $1,200 MOOP, and includes drug coverage with NO deductible and NO dough nut hole. And it's a PPO and almost universally accepted by doctors and hospitals where I live. In fact, I don't know of any that don't accept it.

 

[Chuckanut]

I am still suspicious, as I believe there is no guarantee one can switch from Advantage to Medigap, if the Advantage plans again become substandard. I believe one has to undergo a "qualifying event" (like moving out of state) in order to guarantee acceptance back into a Medigap policy. I would rather pay a little more for a Medigap policy and sleep better at night. At least that is what my thinking is today. Any additional insight would be appreciated . . . .

This might be helpful.

https://www.mymedicarematters.org/after-enrollment/time-to-re-evaluate/

Can I Switch from Medicare Advantage to Medigap?

There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting.
If you joined a Medicare Advantage plan when you were first eligible for Medicare and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.
If you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan.
Remember, If you had a Medigap policy in the past then left it to get an MA plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a “trial right” or “guaranteed issue” right.