Medicare advantage plan

[rk911]

Of course there are. If you are aware of the potential downsides and want to try MA why not

Because, as mentioned, while you can switch back to traditional Medicare, one may not be able to get a supplement plan without going thru underwriting. We did the 'deep dive' and chose to run, not walk, away from MA. We have Medicare A&B plus a BC/BS supplement Plan F and Part D plan. As mentioned we're happy to pay and even happier, and fortunate, that we are able to pay.

 

[Irishgirlyc58]

I always find these discussions about Medi-Care & supplement vs MA plans interesting. Every time I read them I rethink about what I have selected for myself.
I went on Medi-Care this past September. I went with my employer provided UHC MA
Plan. It’s not cheap- my cost this year is $418/month. The only other out of pocket cost is for prescriptions. My current prescriptions are minimal cost. Everything else is 0- with MOO at zero.
However, I could do much better this year on a plan G supplement. But here’s the catch- the MA plan offers a robust prescription coverage. I look up medications that people say they pay astronomical amounts for and my plan covers it for $30/90 days. I don’t need these medications now but what if next year I do?

It doesn’t help that I have an inherent distrust of insurance companies in general. I don’t think they will ever do what’s in a person’s best interests unless they are forced to.

Anyhoo- I get what everyone says about the evils of MA plans obtained out in the wild vs MC supplemental plans. If I were in that position I would totally go with a supplemental and plan D.

 

[sengsational]

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

A broker will usually sell the thing that makes them the most money, if what they sell might be a reasonable solution for the customer. Of course either or any Medicare decision can be considered "reasonable". But there is absolutely no doubt in my mind that the business model where there's a profit-driven business between me and medical services is not "optimal".

The Medicare Advantage plans are VERY complicated. The book they give you is over 100 pages, and that's a summary of the plan! You can't even get a copy of the actual plan document, or at least I couldn't wrangle one. Those documents are on the order of 750 pages. I got the impression you did your research. Did you analyze either of these documents? Were they easy to understand?

This seems analogous to the variable annuity vs spia, for the investment geeks in the audience. The variable annuity must be "sold" by a broker, who makes a ton of money on the sale.... nobody just buys one. The rules for a variable annuity are long, complicated, and nearly impossible to understand. Contrast that with a fixed annuity, which people seek out and buy, and commissions are minimal. Sounds a lot like the contrast between Medicare Advantage and Traditional Medicare.

 

[Rjhasti]

A broker will usually sell the thing that makes them the most money, if what they sell might be a reasonable solution for the customer. Of course either or any Medicare decision can be considered "reasonable". But there is absolutely no doubt in my mind that the business model where there's a profit-driven business between me and medical services is not "optimal".

The Medicare Advantage plans are VERY complicated. The book they give you is over 100 pages, and that's a summary of the plan! You can't even get a copy of the actual plan document, or at least I couldn't wrangle one. Those documents are on the order of 750 pages. I got the impression you did your research. Did you analyze either of these documents? Were they easy to understand?

This seems analogous to the variable annuity vs spia, for the investment geeks in the audience. The variable annuity must be "sold" by a broker, who makes a ton of money on the sale.... nobody just buys one. The rules for a variable annuity are long, complicated, and nearly impossible to understand. Contrast that with a fixed annuity, which people seek out and buy, and commissions are minimal. Sounds a lot like the contrast between Medicare Advantage and Traditional Medicare.

We certainly agree on variable annuities!!!!!!!!

But every urban area that has great hospitals will also have great medicare policies that great 'brokers'. i.e. independent agents would be happy to get you the best medicare policy for you. No conspiracies.
Unfortunately far too many will call an 800 number or will listen to others who called an 800. You have to go out there and talk with at least 2 independent agents.
That's it........I am down with this back and forth........this is really too easy.

out

 

[rk911]

When we turned 65 we were still traveling around the country in our motor home and spending the winter in AZ. We didn't want to fool around with 'in' or 'out' of network docs and hospitals so, without hesitation, we went with traditional Medicare.

As for a supplement we chose Blue Cross/Blue Shield. Both of us had BC/BS health coverage through our employers and had good experience with them. No claims hassles and on-shore customer service. Without hesitation we chose them for a Plan F supplement. We also went with BC/BS for our Part D plan. No regrets.

 

[molly312]

I have Supplement F for which my children are grateful. No billing problems, pretty much everything is paid for. I can visit anybody and have coverage AND pick any MD I want. If I don't like the MD or hospital, I can move on.e
When my husband passed away - we had extraordinary services in the ICU in an attempt to save him. Bills following his death --- ZERO

Yes it is way more expensive every month when you are healthy. Now I happily pay this bill!

 

[jollystomper]

The Medicare Advantage plans are VERY complicated. The book they give you is over 100 pages, and that's a summary of the plan! You can't even get a copy of the actual plan document, or at least I couldn't wrangle one. Those documents are on the order of 750 pages. I got the impression you did your research. Did you analyze either of these documents? Were they easy to understand?

This seems analogous to the variable annuity vs spia, for the investment geeks in the audience. The variable annuity must be "sold" by a broker, who makes a ton of money on the sale.... nobody just buys one. The rules for a variable annuity are long, complicated, and nearly impossible to understand. Contrast that with a fixed annuity, which people seek out and buy, and commissions are minimal. Sounds a lot like the contrast between Medicare Advantage and Traditional Medicare.

Wow, I did not fully realize what I bolded above. Our Medicare Advantage PPO plan is easily downloaded and also mailed to us. The plan document is about 75 pages, but 20 or so of those pages are listings of medicines and to what degree they are covered. The rest is very straightforward. That is one reason why we chose it. In truth, if we had to go into the "open market" we would have stuck with Medicare and supplements and avoided the "public" Medicare Advantage plans.

I agree that the more the rules are long and complicated, the less likely it is a plan that can be trusted. If they make it difficult or impossible to share the actual plan document, I would run away screaming into the night.

 

[ivinsfan]

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.

Maybe they are as good and maybe they aren't...a lot of things factor into it. The general downside to all MA plans is that you in reality don't actually use Medicare, so that's a limit. I've seen the way Medicare actually slashes provider charges which is something to consider if you aren't tied to a employee option.

 

[ivinsfan]

I have Supplement F for which my children are grateful. No billing problems, pretty much everything is paid for. I can visit anybody and have coverage AND pick any MD I want. If I don't like the MD or hospital, I can move on.e
When my husband passed away - we had extraordinary services in the ICU in an attempt to save him. Bills following his death --- ZERO

Yes it is way more expensive every month when you are healthy. Now I happily pay this bill!

I don't know if you can use the term "way" more expensive. You would have to pick a plan you could live with and see what that premium actually cost.


I sorry you lost your DH, but not having to worry about if and what's covered in something like this is a big deal. In fact my DH had a huge surgery and hospital stay 6 months before Medicare which led us to choose a premium plan.

 

[rk911]

I have Supplement F for which my children are grateful. No billing problems, pretty much everything is paid for. I can visit anybody and have coverage AND pick any MD I want. If I don't like the MD or hospital, I can move on.e
When my husband passed away - we had extraordinary services in the ICU in an attempt to save him. Bills following his death --- ZERO

Yes it is way more expensive every month when you are healthy. Now I happily pay this bill!

Precisely. Condolences on your loss.

 

[rk911]

[-]i[/-]

Maybe they are as good and maybe they aren't...a lot of things factor into it. The general downside to all MA plans is that you in reality don't actually use Medicare, so that's a limit. I've seen the way Medicare actually slashes provider charges which is something to consider if you aren't tied to a employee option.

We had a PCP for a number of years that stopped taking medicare and switched to MA. Don't know if he accepted all MA plans, just one or something in between. We swictched to another doc in the same practice which worked out..we like him better.

 

[RetMD21]

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.

The only thing different about the MA-PPO is the provider choice. That is, they can still require prior authorization.

 

[Sarah S]

The only thing different about the MA-PPO is the provider choice. That is, they can still require prior authorization.

Thanks that is what I thought and is something people should strongly consider. My experience from the doctor side as I said is that it negatively impacted care when prior authorizations were required and then decisions delayed. I could look at a patient’s insurance and know that this plan ( mostly the local hmos) would quickly approve and others ot would be days. I sometimes had to send the latter group to the ED where they could get a CT for example without prior authorization instead of ordering it to be done outpatient and then being able to decide from there. Acute abdominal pain was a common issue if exam, labs and xrays were not enough to rule out something urgent in the office

 

[jollystomper]

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.

The only thing different about the MA-PPO is the provider choice. That is, they can still require prior authorization.

Not necessarily. There are several things we have experienced that did not require approval than others on MA HMO plans required approval for. Our plan also documents the things for which prior approval is needed. It is not a long list, and the things mentioned above are not on it.

Our experience has been, we go to our primary, they think we need some followup tests, they give us a choice where to go, we contact and schedule, the folks have never asked for authorization so far.

It all boils down to the plan details. I am glad that our plan at least provides detailed documentation that is easily accessible.

 

[PokeNTexas]

Are the 6 all PPO plans?

No. Three are HMO. One of the six is PPO. Two are HMO-POS.

 

[becca]

Our retiree healthplan (AT&T) pretty much forced us onto United Healthcare Medicare Advantage Plan starting 1/1/24. We considered staying on our supplemental plans, but the cost would've been close to $400 per month (for both of us) vs. $50 per month (DH is free, mine is $50). We are keeping our fingers crossed on this new plan. All of our doctors participate and this plan has a $900 per year maximum out of pocket which is much less than most Advantage Plans. There is a $30 copay for specialists which we never had on our old plan.

One big bonus on the Advantage Plan is we get a free gym membership at the nicest gym in our area, which would cost us about $200 per month (for a couple). I will use it a lot as I attend 2 or 3 yoga classes a week. DH has already been twice to work out (hope this continues.

Time will tell how this new plan works out for us.

 

[RetMD21]

Not necessarily. There are several things we have experienced that did not require approval than others on MA HMO plans required approval for. Our plan also documents the things for which prior approval is needed. It is not a long list, and the things mentioned above are not on it.

Our experience has been, we go to our primary, they think we need some followup tests, they give us a choice where to go, we contact and schedule, the folks have never asked for authorization so far.

It all boils down to the plan details. I am glad that our plan at least provides detailed documentation that is easily accessible.

Your plan is required by law to cover anything medically necessary that is covered by Medicare but how they will implement that is subject to their interpretation. I'm glad you haven't had any problems. Probably you won't but nevertheless there is potential for denial or delay of services that wouldn't be a problem under conventional Medicare.

 

[Sunset]

Our retiree healthplan (AT&T) pretty much forced us onto United Healthcare Medicare Advantage Plan starting 1/1/24. We considered staying on our supplemental plans, but the cost would've been close to $400 per month (for both of us) vs. $50 per month (DH is free, mine is $50). We are keeping our fingers crossed on this new plan. All of our doctors participate and this plan has a $900 per year maximum out of pocket which is much less than most Advantage Plans. There is a $30 copay for specialists which we never had on our old plan.

One big bonus on the Advantage Plan is we get a free gym membership at the nicest gym in our area, which would cost us about $200 per month (for a couple). I will use it a lot as I attend 2 or 3 yoga classes a week. DH has already been twice to work out (hope this continues.

Time will tell how this new plan works out for us.

We decided to stay with Medicare + supp, instead of switching to the AT&T sponsored health plan.
Since they had already cut retirement health benefits by removal of the cash payment, we felt in a few years they will again cut the plan in some way. At that point we wouldn't qualify for switching to a Medicare supplemental plan..

They really pushed this MA plan, and we called and refused to join, so they SLAMMED us (phone term) into it. !!
Even though they had sent us emails confirming our opt out choice.

We had to do a lot of phoning to get it corrected, including to our Medicare plans.

Even still , they sent me a package with my new MA membership, all the while I'm on Medicare and paying for my Supplemental insurance and part D.

AT&T is slimy and mismanaged it, so I don't trust their MA will be good in the future.

 

[GhostofTomJoad]

I've heard it said--- maybe right here--- that Medicare "Advantage" plans are for generally healthy people. But you never know what might happen. I went in to the Ear/Nose/Throat doctor to get surgery on my sinuses. Along the way, he found pre-cancerous cells on my larynx. Sent me to a different specialist for that. Good thing he did! Good thing I finally went and had that first visit, with the first guy, when I did. He told me: six months or a year from now, it would have been a REAL problem.

I had lower spine surgery 2 years ago. The cheaper supplemental Plan was useless. I did not want to do it, but I held my breath and upgraded to a "Cadillac" Plan. It felt like extortion. But I qualified for Plan F. Much better coverage, but I'm paying more than double each month, compared to my original Supplemental plan.

Traditional Medicare and a Supplemental plan certainly is the much better option, I'd say.

 

[a60dan]

From NPR today:

Older Americans say they feel trapped in Medicare Advantage plans

The article discusses how some who have Advantage plans run into problems when they have serious medical issues. For example, an individual who enrolled in an Advantage plan at age 65 and all was well until he was diagnosed with melanoma a few years later:

When the article says “he can’t “ go back to traditional Medicare, it’s misleading.

He can go back.

Unless he lives in one of the 4 states that prohibit underwriting for supplement plans, he can’t afford to or can’t get a supplement plan.

 

[Hermit]

My brother-in-law had a heart transplant at age 74 3/4 by the best heart replacement team in Houston via Medicare and a supplement policy. He's 83 now and doing well. Does anyone here think that would have happened if he was on an MA plan? I don't need any responses.

My good friend had brain surgery in his early 70s by the best surgens in Colorado while with Humana. It went quite well for him. I would hope to have as good of care. I have another friend that had rods placed along his spine which got him out of a "turtle shell" brace. He has been doing good for the last 5 or 6 years. Again he was with Humana. My plan is to move to the Denver area when I am too old to live in the mountains. I want to use Kaiser Permanente there. It has always had a stellar record. Until then I am with Humana and don't have any regrets.

 

[saydiver]

When the article says “he can’t “ go back to traditional Medicare, it’s misleading.

He can go back.

Unless he lives in one of the 4 states that prohibit underwriting for supplement plans, he can’t afford to or can’t get a supplement plan.

With a cancer diagnosis it's highly unlikely he will pass underwriting to go back on [-]original Medicare[/-] a Medicare supplemental plan.

 

[RPHDOC1]

Medicare Advantage

Recently signed up for a supplement not advantage. From my experience working with social workers and medical professionals medicare advantage is a disadvantage.

 

[saydiver]

Christopher Westfall, who is not my broker because he does not sell HD plans, has several videos on the disadvantages of having a Medicare Advantage plan.

https://www.youtube.com/@ChristopherWestfall

 

[pugmom]

Driving home the point

We did research and found out what several here have said, and thus DH and I got the UHC supplement (with Medicare) two years ago. It costs about $384 a month, but we have never paid another dime out of pocket, despite DH's two cancer surgeries and a hip replacement. 2023 had one of each, and the EOB's showed that they were billed at least $200,000. Even a CT scan was billed for about $20,000.
So... did we know when we signed up that we would have these medical expenses? No.
No one really does.

Similarly, a good friend just had heart valve replacement surgery. She and her DH have a Medicare Advantage plan. I haven't had the heart to ask her what her out of pocket will end up being, but I am guessing it will be substantial.

We are snowbirds as well, and did not want to be tied to a local area, as is the case for Medicare Advantage plans. But even if not, the supplement allows for getting care wherever it is best for you, or most convenient. What if you live in FL and your child lived in MN and you wanted to go to the Mayo Clinic... with a supplement you could.