Medicare advantage plan

[grayv]

If you choose not to decide, you still have made a choice.

https://www.rush.com/songs/freewill/

 

[PokeNTexas]

SteveC,
As you can see, there are strong opinions both ways.

However, I can't stress enough when one is asking this question, recognize that there are different "kinds" of Medicare Advantage Plans.

..............OR by someone who is enrolled in a "EGWP" Medicare Advantage Plan (Employer Group Waiver Plan) which many are enrolled in via retirement from their employer.

.........
I think it is essential to find out from anyone answering your question which type they are speaking about.

OK, I'll go first. Of the six lives I reported upthread, none are with a EGWP. All are available to any Medicare eligible senior. We've been quite satisfied.

 

[REWahoo]

OK, I'll go first. Of the six lives I reported upthread, none are with a EGWP. All are available to any Medicare eligible senior. We've been quite satisfied.

Are the 6 all PPO plans?

 

[SteveC]

Thanks for all the responses so far. There are at least 2 kinds of Advantage plans, HMO and PPO and it does seem that the PPO is liked a lot more. In my zip code there are about 8 PPO plans available. I'm going to research them some more. I'm still open to all ideas, I have until October before I'm 65. Besides the cost of a G plan the other main reason I'm reluctant to go that route would be not having dental coverage.

 

[RetiredHappy]

Thanks for all the responses so far. There are at least 2 kinds of Advantage plans, HMO and PPO and it does seem that the PPO is liked a lot more. In my zip code there are about 8 PPO plans available. I'm going to research them some more. I'm still open to all ideas, I have until October before I'm 65. Besides the cost of a G plan the other main reason I'm reluctant to go that route would be not having dental coverage.

With a supplement plan, you can buy dental coverage separately, under $30 per month.

 

[Teacher Terry]

I know 2 people that are only still alive because they could seek the best care for their diseases out of state. This wouldn’t have happened on an advantage plan. Part b and my supplement plan together are one of my biggest expenses but I can’t put a price on my life.

 

[skipro33]

My retiree health care deal required me to join their specific Medicare Advantage plan, so I can't help with the shopping around and comparison.

But I do have a helpful hint that I learned just yesterday, my 2nd day on Medicare. Medicare (and my Advantage plan) do cover eye exams, but they don't cover refraction testing (that's the part where they figure out your eyeglasses prescription) so I had to pay the optometrist $40. I wish I would have known last week, because my old health insurance covered it and I could have done it then. So you might want to take care of that before you go on Medicare.

Same here. When I went for the exam, I asked the doc to write the prescription. He did and handed to me. No charge. The next year, same thing, only there was a charge that showed up. I called the number on the bill and they removed it for me. I guess what I'm saying is that it pays to ask for the prescription and if billed the $40, ask to have it removed.

This year, I wanted to get a contact lens prescription. (I find they are easier to wear when skiing than glasses under goggles.) Went to Costco. $110 or something like that. I sent the bill to the insurance company for reimbursement and they covered it!

****EDIT****
BTW, I have United Health Care Senior Advantage PPO through work where I retired as part of my pension coverage.

 

[zl55lz]

Thanks for all the responses so far. There are at least 2 kinds of Advantage plans, HMO and PPO and it does seem that the PPO is liked a lot more. In my zip code there are about 8 PPO plans available. I'm going to research them some more. I'm still open to all ideas, I have until October before I'm 65. Besides the cost of a G plan the other main reason I'm reluctant to go that route would be not having dental coverage.

If cost is part of the equation, some speak very highly of Medigap Plan G-HD which is comparatively quite low priced and maybe worth looking into for your situation? Depending on your State maybe it could keep your options open with Medigap?

Others here seem to be quite knowledgeable about Medigap plans so maybe they can comment on G vs. G-HD etc.

 

[SteveC]

Yes, if I go the Medigap route it would probably be N or HDG

 

[Dtail]

OK, I'll go first. Of the six lives I reported upthread, none are with a EGWP. All are available to any Medicare eligible senior. We've been quite satisfied.

Same here for my response and it is a PPO plan.

 

[MissMolly]

I know 2 people that are only still alive because they could seek the best care for their diseases out of state. This wouldn’t have happened on an advantage plan. Part b and my supplement plan together are one of my biggest expenses but I can’t put a price on my life.

You don't know that. My PPO plan will cover me ANYWHERE, whether in state or out of state, at the same level of coverage as long as the provider accepts Medicare. Including Mayo Clinic.

 

[sengsational]

I have suffered through limited networks, over-booked doctors and annual arbitrary changes in the rules while on ACA policies. I have no intention of continuing that pain. They throw in some "free" stuff, most of which I don't need, or if I need it, I can buy it outright without hassle and without much financial impact.

If you can't afford a medigap policy, then your only choice is a Medicare Advantage plan, and it might work out fine. As indicated above, if you start to require significant medical services, which is my primary reason to get the right insurance, that's when you find out that insurance company with the slick ads is going to throw as much friction into the process as possible in order to keep the profits up. That's not something I want to be managing if I'm going through a medical problem.

 

[ShokWaveRider]

There are plans and there are plans. The one's that are provided as a benefit by employers after retirement are a completely different animal, they have to be to be sponsored by the company.

My next-door neighbor has one, and as others here have said he is very happy with it. He is a retired Judge, his PPO has never given him or his wife any issues, it does have some small co-pays, but his MOOP after co-pays is $0 (Covered by his old Company's Agreement). It also covers the Mayo Clinic that is unheard of in these parts for an Advantage plan. It is a United Healthcare Advantage plan.

Another friend who is not so well off has a similar plan he got privately after retirement because it was all he could afford at the time, and it is basically the same plan. He has no end of issues getting approved and his OOP and MOOP is very high for him. He cannot change to a Supplement Plan because of underwriting. I think he regrets it.

That made our decision to go with the AARP Part G a no brainer. I did talk to an independent broker and Advantage plans were originally designed for those who cannot, or do not want to afford Regular Medicare + a Supp.

For us, we cannot put a price on our healthcare coverage and the small part of our WR that is costs us is worth it. It is one of the things we worked for.

 

[savory]

We are a having a good experience with ours, but it is a Medicare Advantage PPO plan.

This is different from the most available Medicare Advantage plans, which are simply HMOs with all of the limitations and restrictions of HMOs. Our Medicare Advantage PPO acts much like our retire medical PPO before medicare. A network of doctors to choose from across the country, no need for preapprovals, out of country coverage, etc.

These are rarer since they are usually open to only a limited group (e.g. retirees of a particular company), and are co-sponsored by the company. Perhaps that is one reason they act better.

DW used it a lot last year, with a fractured ankle and rehab, as well as thumb issues which needed rehab. No problems getting anything covered. She even received reimbursement for acupuncture beyond what Medicare covers.

I'm not saying all Medicare Advantage plans are good. But I find little differentiation between Medicare Advantage HMO and Medicare Advantage PPO plans when people bring up the ills of Medicare Advantage plans. It is important to note the difference.

I am having a similar experience as jollystomper although I have not had an emergency issue. I do have coverage for traveling which is a must for us.

I think the conversation is mixing two concepts. Some people seem to be addressing their comments as if MA is an HMO and doctor choice is very narrow. There is more than one type of MA as Jolly pointed out. There is a PPO format that allows for choice.

Having said that, I was very concerned when first joining Kaiser where I was a member for 5 years. However, I was pleased with the care I received from a format that did not provide a 'any doctor' choice. It was the first time I felt my care professionals were proactive about my health. I do not know if the HMO under MA is coordinated in the same way as Kaiser. But, if they are it would make a great choice, short of our travel needs. Having said that, Kaiser did have a method to manage travelling as part of their policy. Perhaps the MA HMO policies also provide the feature.

 

[Sarah S]

Do the medicare advantage ppo’s require prior approval for any durable medical equipment or procedures? Do they limit rehab stay lengths? These are issues beyond provider availability. I don’t have experience as a patient with medicare advantage but as a provider I saw advantage patients being pushed out of rehab quickly and had to do prior authorizations for mris and cat scans which made for waits original medicare patients didn’t have.

I also recently saw a study of ALS patients with medicare advantage plans who had delays in approval of bipap ( needed for respiratory support as ALS causes respiratory failure)

I honestly don’t know how the ppo model works for these things as when I was in practice there were no medicare advantage ppos in my state.

 

[Teacher Terry]

Miss Molly, You probably have a retiree MA plan and that’s entirely different than what someone can buy themselves. 60 minutes did a segment on how MA plans are costing people their lives and there’s countless articles written about it. I am not talking about the ones provided by employers.,

 

[Ian S]

You don't know that. My PPO plan will cover me ANYWHERE, whether in state or out of state, at the same level of coverage as long as the provider accepts Medicare. Including Mayo Clinic.

You are fortunate. While Mayo treats most anyone on an emergency basis, they don't accept most MA plans https://www.medpagetoday.com/special-reports/exclusives/101320 for non-emergency care. Several years after I went on Medicare (traditional with supplement), I was diagnosed with a rare esophageal disorder called achalasia. While there is no cure, the symptoms can be alleviated by surgery. The surgery, to be successful, requires a highly skilled and experienced surgeon. Many with the condition get misdiagnosed for years and suffer extreme weight loss and declining health. Many get subjected to cheaper but less than ideal procedures which don't last. Some with achalasia can't find local experienced doctors and have to go out of state. I can only imagine the hoops I'd have had to jump through with a run-of-the-mill MA plan. With traditional Medicare, I had the option of going to any of the top clinics nationwide for the treatment of this of this disorder. I went with one of the best and most experienced specialists in Arizona and have done well after the surgery.

 

[savory]

Do the medicare advantage ppo’s require prior approval for any durable medical equipment or procedures? Do they limit rehab stay lengths? These are issues beyond provider availability. I don’t have experience as a patient with medicare advantage but as a provider I saw advantage patients being pushed out of rehab quickly and had to do prior authorizations for mris and cat scans which made for waits original medicare patients didn’t have.

I selected DME coverage for no specific reason. Using this as an example, Sarah perhaps you and others could comment about this coverage in an MA PPO plan vs traditional Medicare or other.

Medical equipment and supplies
Your doctor often needs approval from us before we cover these services. This is called prior authorization or pre‑certification.

Benefit Your in‑network costs Your out‑of‑network costs
Durable medical equipment (DME), like CPAP* machines, wheelchairs and
oxygen

0% ‑ 20% In network ---- 40% after your plan deductible out of network

Prosthetics, such as braces and artificial limbs

20% in network -------40% after your plan deductible out of network

 

[Rjhasti]

Getting close to signing up for Medicare, and I'm considering an advantage plan because of the cost savings. In general they seem to be the "WD-40" of the Medicare world, everyone loves to hate them, but I've got a couple of friends that really like there's, so I'm looking to see if there are others that are having a good experience with them.

Medicare advantage is great........I have studied this out. Go to a broker and they will help you pick the right plan for you according to your needs.
Example........if you need lots of dental work.......so pay more than others etc

 

[Qs Laptop]

I know 2 people that are only still alive because they could seek the best care for their diseases out of state. This wouldn’t have happened on an advantage plan. Part b and my supplement plan together are one of my biggest expenses but I can’t put a price on my life.

^^ THIS ^^

What are you saving your money for, if not to prolong your life?

I went on Medicare with a Medigap part N plan last year. I was not going to put up with being tied to one network of doctors, weeks and/or months long waits for appointments, annual changes in terms and coverage, etc. Deductibles of thousands of dollars, out of pocket maximums, etc. I was tired of dealing with that crap. Just so done with that business model.

In December 2022 I made an appointment with a urologist I had seen while still on my wife's work PPO plan. The earliest I could see my urologist in April, over 3 1/2 months in the future. Yes, I could get "care" by emailing his staff through the clinic's portal. But actually see a doctor? No.

When I went on Medicare I found a different doctor that could see me in 8 days. Turns out he's an excellent urologist and his staff is very responsive. Just last Friday I suspected I had a UTI so I contacted the new doctor through their website and a nurse called me back within an hour telling me to get into the clinic for a urine test. I thought that was impressive.

 

[pacergal]

We have Kaiser Medicare Advantage, have not had a problem with it. Actually tried work plan Kaiser a couple years before retirement to see how it was.

As with any medical, it is important to be a strong advocate for yourself. We have never been denied any request for referral, medications/changes, etc.

 

[Rjhasti]

Sorry for all you went through.
Some things in your story just don't add up..........i.e. did you go to a broker to get your medicare advantage.......or was it an 800 number. I think you will find that to be a better experience.
Do what is best for you but at least check with a broker

 

[rodi]

My sister is on a Medicare advantage through her teacher retiree benefits. She has Kaiser Permanente. Her plan is better than the Medicare advantage Kaiser Permanente available to the general public in that it has lower co-pays and less out of pocket. She loves it. She's been on Kaiser most of her adult life. I'm on Kaiser but pre-medicare. I plan to switch to a high deductible g plan when I reach Medicare age. I don't have a problem with Kaiser but would like to have more flexibility when it becomes affordable as I reach Medicare age. I am currently on a high deductible Kaiser plan through the ACA.

A lot of comments here seem to discard the idea that people can have very good retiree plans that are advantage plans and better than what you can get through the open market.

 

[tennisno1]

Another emerging issue to consider is large medical groups dropping out of MA. Who you sign up with for treatment today may not be avaible in the future. Ironically when you open the article right below the headline is an ad with Joe Namath hawking a MA plan!!

Two Large Medical Groups Shun Medicare Advantage Plans
— San Diego doctor groups latest to withdraw, citing low pay, prior authorization problems
Signaling what may be an emerging national trend, two influential medical groups with San Diego-based Scripps Health are cancelling their Medicare Advantage contracts for 2024 because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage

https://www.medpagetoday.com/specia... may be an,new doctors, or different coverage.

 

[CRLLS]

Trying to save a few bucks on a cell phone plan, an internet plan or some streaming/cable/satellite service vs is great. You know what you are getting and are not locked in as your life changes. Many of us have joined the FIRE movement by, in part, making such decisions throughout their lives. Health services is not an area that I care to find the cheapest provider. While many entering the Medicare arena, with many choices, look to for the lowest cost now, I look for the best, most beneficial to me plans. Being healthy at 65, has no indication of being healthy at 70. To paraphrase J.G. Wentworth, "It's my money and I need it now". That's what I planned for, saved for and what I am spending the best coverage on.

A PPO MA plan transfers more power to the individual over the cheaper non-PPO MA plan. As far as individual's power of choice to see who they want is concerned, any MA PPO plan is no substitute for a traditional MC plan with good Supplement and drug plans when my personal health is involved.

If a person does their due diligence and finds a MA plan works for them, great. I have no gripes. From the people that I have talked to that have MA plans, most of them like their plans. Of course, most of them are healthy. I wonder how much they will like them when they have severe medical issues and want the best care possible.