Medicare advantage plan

[NXR7]

I'm 69 and on traditional Medicare with the G supplement and a Part D drug plan. My premiums are $3,900 a year so say $4,000. My dental care and eyeglasses care cost less than $1,000 a year so let's say my healthcare is $5,000 out of pocket.

If your Medicare Advantage costs (deductible, co-pays, whatever) approach $5,000 ($417 per month) then ask yourself why you would NOT want to be on traditional Medicare instead of dealing with private insurance companies.

A recent IG report confirmed what everyone knew, Medicare Advantage companies throw up roadblocks, delays, and deny care inappropriately forcing people to appeal. Up to 20% of the reviewed cases had care denied or delayed when traditional Medicare would have just paid it. I don't have many years left and I do not want to spend them fighting insurance companies while my conditions worsen.

I had two cataract surgeries last year (fully covered) and will have other medically-necessary procedures next year. So far my health is good but if the world comes crashing down on me one thing I will not need to worry about is how to pay for healthcare.

 

[Gumby]

With a cancer diagnosis it's highly unlikely he will pass underwriting to go back on original Medicare.

As I understand it, the underwriting is on the Medigap or supplemental policy. Medicare itself has to take everybody.

 

[saydiver]

As I understand it, the underwriting is on the Medigap or supplemental policy. Medicare itself has to take everybody.

Correct. I should have written a Medicare supplemental plan. He can go back on original Medicare, but will be responsible for 20% of Medicare's allowable, which can easily bankrupt someone, especially with a cancer diagnosis.

 

[troutnut1]

When early lung cancer was recently detected on a CRT scan I was so thankful not to have a "Not Medicare-Not an Advantage" plan. I have had multiple consults for surgery in another state and I don't have to ask anyone, or get any approvals. This because I have real medicare, and a real supplment. I found the top surgeon in the country for this surgery and didn't waste a lot of time doing it.

Anyone considering these scam plans to take you off medicare should youtube "Christopher Westfall" and spend some time making this decisions. Once something happens to your health, you can't pass medical underwriting to get back to real medicare. Lots of hospitals are now refusing these scam plans outright. There are congressional hearings about this on youtube as well.

But you won't get free dental, help paying your utility bills, or Joe Namath giving you rides to your appointments. So there's that...

 

[NXR7]

But you won't get free dental, help paying your utility bills, or Joe Namath giving you rides to your appointments. So there's that...

But will I qualify for a reverse mortgage at my zip code?

 

[zl55lz]

Just to clarify some of the posts above---Medigap (Supplemental) plans are NOT "original" Medicare. Original Medicare is Part A and Part B. One does not need underwriting for Parts A and B.

 

[FinBiz]

I consulted a broker and attended seminars. They all said it’s, “Pay now (with a supplement plan) and pay nothing more” or “Pay as you go (with a MA-PPO plan) and have co-pays, first 3-5 days of hospital stay, etc. The only time I could be guaranteed coverage without underwriting was when I made my first selection. I chose original Medicare and plan G. My Part D was just reduced to .50 cents per month.

I have friends on MA plans that have worked out okay and they rave about the free Silver Sneaker’s benefit. I didn’t decide based on gym benefits! Also, many dentists offer discounts for people with no dental insurance (mine does). I chose to be safe with original Medicare vs the potential unknowns of an MA plan.

 

[Guamaniac]

I've posted this before but I think most people don't read attachments because they can be very long. This one is about a page long that includes two graphs. So it's a quick read.

https://retireearlyhomepage.com/medicare2023_expense_ratio.html

Here's a recap any way:

-Traditional Medicare spends about 1.3% of program costs on administration.
With Medicare Advantage, your insurer is allowed to siphon off up to 15% of the $12,000 to admin costs.

-Medicare Advantage insurers can screw you a second time by forcing you to do business with a related or captive company they profit from. To get a medical or drug expense to count towards your deductible, you must do business with an in-network doctor or hospital, and your insurer's captive pharamacy benefit manager (PBM). The reason your Medicare Advantage Plan is offering you a "free" Part D drug benefit, is because they're charging you double or triple the price on generic drugs. That overcharge goes directly to parent company's profit and excessive Executive Compensation, and doesn't count towards the 15% limit on overhead & profit for the insurance company since the drugs are a medical expense to the insurance plan itself. As demonstrated in the table below, Kaiser Permanente is far and away the innovator in this approach.

-The public policy advocacy group Physicians for a National Health Plan estimate that Medicare Advantage plans are overcharging taxpayers somewhere between $88 Billion and $140 Billion per year. If you clawed back that $140 billion per year, that would be enough to eliminate the Part B Medicare premium for each of the 66 million Medicare beneficiaries ($169.90/month for 2023).

-But by far the biggest testament to the deplorability of Medicare Advantage comes from the agents and brokers who sell Medicare Advantage plans. When asked what choice they'd make for their own health coverage, "most of the brokers and agents say they would personally choose Traditional Medicare with Medigap over Medicare Advantage plans. The reason? Better coverage and choices, especially as people get older."

The author is obviously not a fan of Advantage plans but I know from posts on another retirement board that he has many millions in savings and investments. For many-especially those who have social security and little to no savings-MA plans may be the best option.

 

[Rjhasti]

MA in SW MO.....no extra premium and all those benefits that are free such as dental, free well visit, small co pays for tests.........colonscopy was nearly free, major surgery and 3 days in the hospital was around $500 including the surgeon fee.
I mean really guys...........this was a lot better than my group insurance when I was working.
why would I want to pay over $200 a month more for zero out of pocket when 0 out of pocket pays for 95%?
You cost shared during your working years........99% of you did.
Yes I understand if you are sickly once you were retired...........90% of you are not that way.

just go to several insurance brokers that sell this stuff and compare. The problem is that most will stop at 1 broker and then reply on what is said at the barber shop..
Anyway.......this conversation is way to exhausting so I am done. Thanks for reading.

 

[youbet]

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.

You have some confusion with your terminology pugmom. It is NOT the supplement that "allows for getting care wherever it is best for you, or most convenient." It is the fact that traditional Medicare has a nationwide network that most providers have joined and have also agreed to accept Medicare assignment. A supplement pays for the percentages that Medicare doesn't pay (depending on the supplement). But your supplement won't pay where Medicare doesn't.

 

[NXR7]

I mean really guys...........this was a lot better than my group insurance when I was working.

Haha, yes, indeed! My wife is on the Unaffordable Care Act and pays a touch over $1,200 every month for a no-deductible 50% co-pay plan that only works in the geographical area where we live.

She needs to take out a travel insurance plan to visit her sister on the other side of the state for any length of time, even though our healthcare system has facilities there. She sees how easy my original Medicare plan works and that's what she's moving to next year.

An MA plan is simply another private insurance plan that can change radically or get discontinued every year, unlike original Medicare.

why would I want to pay over $200 a month more for zero out of pocket when 0 out of pocket pays for 95%?

You clearly do not have a reason and that's good for you. But not for me and others. You have no idea of our family histories, work histories of how much our bodies were beaten up, etc.

You cost shared during your working years........99% of you did.

Cost-sharing is not the issue for me. It's dealing with denials, script-readers, and soon-to-be alleged AI reviewing submissions.

Yes I understand if you are sickly once you were retired...........90% of you are not that way.

Insurance protects against future expenses. As we age most of us are going to become more sickly, not less.

 

[Tracer]

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.

I'm 75 and have been on the same "no premium" Humana Plan since I've been on Medicare. I know a lot of people hate advantage plans but it has saved me countless thousands of dollars in supplement plan premiums, drug plan premiums and co-pays/deductibles over the years.

Almost every prescription I've gotten has been zero co-pay. I haven't paid anything for Viagra in 10 years. My primary and specialist doctors are great who I never pay a cent to. Virtually every hospital in town accepts the plan. I just had gall bladder surgery, stayed 2 nights in the hospital and cost me nada. I had to use an urgent care a few times. Cost zero. Not to mention a free eye exam and 2 pairs of glasses every year and $5000 per year in dental coverage.

I get reward cards for getting screenings, blood tests and getting physicals on a regular basis plus tons of over-the-counter products ($600 worth per year). I got a free Fitbit watch from them.

I get a free gym membership. They actually pay me in gift cards to go to the gym regularly which I do.

Referrals, which are always granted, are sometimes a minor inconvenience but who cares when it's saving me thousands.

My dad was on advantage plans till he passed at 98. It served him well. The advantage plan haters are out there. I'm not one of them.

 

[NXR7]

Just to clarify some of the posts above---Medigap (Supplemental) plans are NOT "original" Medicare. Original Medicare is Part A and Part B. One does not need underwriting for Parts A and B.

Correct, and Medigap plans are ONLY available with "original" Medicare.

While a sickly person could transition from MA to original Medicare at any time they would then be liable for 20% of all covered costs with no out-of-pocket maximum without some kind of Medigap supplement.

To me that makes a supplement a mandatory part of original Medicare because I could not afford that other 20%, even though technically it is not mandatory.

My wife (pre-Medicare) had a knee replacement surgery a year ago. With her Obamacare plan she had $6,900 out-of-pocket expense on a bill that was $32,000.

20% of $32,000 is $6,400. Essentially she paid the same as she would if she had original Medicare and no Medigap supplement. And she still had the other 364 days of the year to have other medical costs with more out-of-pocket costs.

Why is she on Obamacare? She was a firefighter/paramedic for over a quarter-century and got partially disabled on the job. Ohio's Police and Fire Pension Plan forces pre-Medicare employees who are retired for any reason, including on-the-job disability, on to Obamacare.

 

[youbet]

To me that makes a supplement a mandatory part of original Medicare because I could not afford that other 20%, even though technically it is not.

.

I've been on original Medicare + F + D for 11 years, so pretty well tuned into the gig.

Most folks will pay more in premiums for their supplemental Medigap policies than they would have paid had they paid the 20% Medicare doesn't pay. That's how insurance works and it's how it's worked for me. The aggregate amount of the 11 years of supplement policy premiums I've paid is far in excess of the amount I would have paid if I was paying the 20% myself. It's "insurance." that's how insurance works.

But, yes, as you say, most of us need to insure against the risk that some expensive and ongoing medical situation would bankrupt us and therefore we buy the insurance.

I will point out that if you do wind up without a supplemental policy for some reason, there is some good news. You are helped by the fact that Medicare typically pays a small percentage of what is billed, frequently in the 15% - 25% range depending on the procedure. Your 20% is calculated from what Medicare pays, NOT from what the provider bills.

For example, early in 2023 I had a procedure to place an implant in my heart and the bills totaled roughly $120k. Medicare approved roughly $35k and paid 80% of that. ($28k) My supplement paid 20% ($7k) So my cost for that procedure and pre-testing that cost $120k would have been about $7k. Not too bad given that the original bills from the providers totaled $120k.

I'm definitely not advocating forgoing a supplemental policy, I'm keeping mine, but just pointing out that if all you had was Part A and Part B, most of us would likely be shielded from bankruptcy unless the billed amount ran well into the millions.

 

[DrRoy]

We travel a lot and don't need to scrape for the cheapest plan. I haven't looked at detailed numbers yet but have pretty much decided to go with regular + Medigap.

 

[meleana]

We went with Plan G from the get go. Other than the annual deductible we have never laid out a cent except for the refraction for eyeglass prescriptions.


And I had spine surgery this past year. My husband had to go to the emergency room and have a heart monitor for a month. We had colonoscopies. I had my mammogram and other tests. Hubby visits a urologist. We visit the primary doc and have blood work, etc.


We can go where ever we want whenever we want.

 

[oscar1]

Internet says about 51% of retires on Medicare Advantage plans in 2022 and trending up last few years. I have heard doctor groups are increasingly frowning on Medicare because of paperwork on low reimbursement rates, causing some of the uptick in people selecting MA plans (or is it all of the aggressive marketing causing the uptick?). I’m 62, wife turns 65 this year. We are both gym rats and very active in our sports. Some domestic and international travel. Traditional Medicare + Supplemental, with some dental, vision, drug coverage will run DW no more than $500/month ($6k per year, $60k over 10 years). I’m guessing we’ll use it rarely if the last 10 years is any indication. So, that’s about $240k over the next 20 years once I join in the age 65 fun. I know, I know, reality is we will be on the same specialists, joint replacement, drugs, health care treadmill as everyone else. If you can afford it, take the peace of mind. If not, keep playing the annual copay, deductible, doctor/referral search game every year. It’s compelling to me to think if I invested $120k of the $240k if we could get through the next 20 years. It’s a dice roll on when the health care needs will really kick in.

 

[meleana]

Internet says about 51% of retires on Medicare Advantage plans in 2022 and trending up last few years. I have heard doctor groups are increasingly frowning on Medicare because of paperwork on low reimbursement rates, causing some of the uptick in people selecting MA plans (or is it all of the aggressive marketing causing the uptick?). I’m 62, wife turns 65 this year. We are both gym rats and very active in our sports. Some domestic and international travel. Traditional Medicare + Supplemental, with some dental, vision, drug coverage will run DW no more than $500/month ($6k per year, $60k over 10 years). I’m guessing we’ll use it rarely if the last 10 years is any indication. So, that’s about $240k over the next 20 years once I join in the age 65 fun. I know, I know, reality is we will be on the same specialists, joint replacement, drugs, health care treadmill as everyone else. If you can afford it, take the peace of mind. If not, keep playing the annual copay, deductible, doctor/referral search game every year. It’s compelling to me to think if I invested $120k of the $240k if we could get through the next 20 years. It’s a dice roll on when the health care needs will really kick in.

Many docs are actually refusing the Advantage plans, not traditional Medicare with a supplement like G or N. My sense is the docs love it when they see I have plan G.



Medicare Part B plus our G supplement and el cheapo D plan costs me $300 per month. Part A of course, is free.



As for your health- yeah. I exercised most of my life. Retired and was hiking and snow shoeing and yoga, walking, isometrics, stationary bike, etc. daily. Was even a pesci vegetarian for a long while. Took lots of vitamins. You get the picture. Then suddenly find out I have a degenerative spine condition and ended up with spinal surgery last year.


Then there is the issue that if you suddenly do need care switching plans could cause you to go through underwriting.

 

[DuluthGA]

My plan says if the doc takes original they will take my MA. I’m in Georgia

 

[sengsational]

Most folks will pay more in premiums for their supplemental Medigap policies than they would have paid had they paid the 20% Medicare doesn't pay. That's how insurance works and it's how it's worked for me. The aggregate amount of the 11 years of supplement policy premiums I've paid is far in excess of the amount I would have paid if I was paying the 20% myself. It's "insurance." that's how insurance works.

Yep, that's what it's all about. You're lucky health-wise and unlucky wallet-wise (the good alternative). You don't want to be lucky wallet-wise and be getting poked and sliced, then incinerated, LOL!

You are helped by the fact that Medicare typically pays a small percentage of what is billed, frequently in the 15% - 25% range depending on the procedure. Your 20% is calculated from what Medicare pays, NOT from what the provider bills.

The "negotiated rates" are also what it's all about. On traditional Medicare, you get the negotiated rates, literally, for free. And the rates apply nearly everywhere. Medicare Advantage plans also have negotiated rates that the insured does benefit from, but only if they only get services from the set of companies that have contracts with the insurance company (limited network). And although some people can have success, dealing with these networks is a known PITA for me, after having to deal with them for the past 10 years on PPACA policies.

I wonder if the fraction of people heading into Medicare who are coming off of employer plans go with Medicare Advantage plans at a higher rate. They haven't felt the pain of these limited networks as much. It seems like employer plans are less of a PITA when it comes to having a limited network that can't handle the volume of patients subscribed. With the limited network bronze PPACA plans I've had, even the worst doctors, the ones that had no experience and maybe didn't have command of the English language were booked out for months. There was no other choice. The network prevented me from going out of the metro area to find someone who could see me sooner. I don't care how many "free" dental exams, eye exams, and gym memberships they offer, I ran away screaming from any plan that limited who I could get care from.

 

[zl55lz]

I've been on original Medicare + F + D for 11 years, so pretty well tuned into the gig.

Most folks will pay more in premiums for their supplemental Medigap policies than they would have paid had they paid the 20% Medicare doesn't pay. That's how insurance works and it's how it's worked for me. The aggregate amount of the 11 years of supplement policy premiums I've paid is far in excess of the amount I would have paid if I was paying the 20% myself. It's "insurance." that's how insurance works.

But, yes, as you say, most of us need to insure against the risk that some expensive and ongoing medical situation would bankrupt us and therefore we buy the insurance.

I will point out that if you do wind up without a supplemental policy for some reason, there is some good news. You are helped by the fact that Medicare typically pays a small percentage of what is billed, frequently in the 15% - 25% range depending on the procedure. Your 20% is calculated from what Medicare pays, NOT from what the provider bills.

For example, early in 2023 I had a procedure to place an implant in my heart and the bills totaled roughly $120k. Medicare approved roughly $35k and paid 80% of that. ($28k) My supplement paid 20% ($7k) So my cost for that procedure and pre-testing that cost $120k would have been about $7k. Not too bad given that the original bills from the providers totaled $120k.

I'm definitely not advocating forgoing a supplemental policy, I'm keeping mine, but just pointing out that if all you had was Part A and Part B, most of us would likely be shielded from bankruptcy unless the billed amount ran well into the millions.

You bring up a good point. One of the big risks to only Part A and Part B with nothing else could be that OUTPATIENT surgical procedures and such are covered under Part B. An outpatient procedure can be expensive, as you mentioned. But the big risk I see is if one is not "admitted" to a hospital but instead taken in the hospital for "observation." Even though in the hospital for several days, I think this is billed under Part B, not Part A. Anyone who has seen a bill for several days in a hospital knows this can be a huge amount. That 20% with no supplemental or secondary insurance could be a very large amount (and no max cap). Especially if this happened several times in a year. For that reason alone I would never personally go without secondary coverage.

 

[Gonz]

I've done my due diligence beforehand. Realized it won't work for me because I travel a lot out of country and second home in another state. So Medigap plan G for me.


I'm also now suspicious and turned off by Medicare Advantage plan because of being heavily bombarded with junk snail mail,junk email,and 95% of the commercials in stream services like Freevee from late Spring to December of 2023.
I'm sick of them.

 

[CRLLS]

Many docs are actually refusing the Advantage plans, not traditional Medicare with a supplement like G or N. My sense is the docs love it when they see I have plan G........

We used to have a very good GP. He didn't belong to any network. He ran an old-school independent office, still associated somehow with the local hospital. He did charge significantly less than other Drs of the time. We were his patients for many years. I often overheard him say to other patients, "It isn't that I don't accept xyz insurance, it is that they don't accept (pay) me". IOW, he didn't want to join some network and overcharge for his office visits just to have that insurance company cut the agreed payment and show the patient how much they saved. The restrictions and paperwork that the insurers put on the Dr's was overwhelming.

 

[ShokWaveRider]

We used to have a very good GP. He didn't belong to any network. He ran an old-school independent office, still associated somehow with the local hospital. He did charge significantly less than other Drs of the time. We were his patients for many years. I often overheard him say to other patients, "It isn't that I don't accept xyz insurance, it is that they don't accept (pay) me". IOW, he didn't want to join some network and overcharge for his office visits just to have that insurance company cut the agreed payment and show the patient how much they saved. The restrictions and paperwork that the insurers put on the Dr's was overwhelming.

Isn't that effectively what Medicare does?

 

[CRLLS]

Isn't that effectively what Medicare does?

I was about to include that he likely wouldn't accept Medicare payment if he were still practicing. I couldn't say that for certain. I also don't know how the Dr-Medicare agreements are done. To answer your question, I don't know how to answer.

My point was not that Dr's don't accept insurance claims, but he and others didn't join a network that stood between him and his patients. This is what Advantage plans do. It is not what Supplement providers do. It is clear that Advantage plans' main goals are to make a profit. Supplement providers must, by law, cover what the Plans G federally require of them. They are not gatekeepers, part of the decision process. Their only way to make the profit is to set the premium rates.