Medicare advantage plan

[SteveC]

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.

 

[Gumby]

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.

 

[Sunset]

We went with regular medicare , even though we could get a good medicare advantage plan for free. Because medicare works in the entire country, so be sure the medicare advantage plan you pick works "In network" for the areas you think you will be living.

 

[REWahoo]

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:

Timmins, though, discovered that his enrollment in a Premera Blue Cross Medicare Advantage plan would mean a limited network of doctors and the potential need for preapproval, or prior authorization, from the insurer before getting care. The experience, he says, made getting care more difficult, and now he wants to switch back to traditional, government-administered Medicare.

But he can't. And he's not alone.

"I have very little control over my actual medical care," he says, adding that he now advises friends not to sign up for the private plans. "I think that people are not understanding what Medicare Advantage is all about."

Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans' share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers' aggressive sales tactics and misleading coverage claims.

Enrollees, like Timmins, who sign on when they are healthy can find themselves trapped as they grow older and sicker.

 

[Texas Proud]

We went with regular medicare , even though we could get a good medicare advantage plan for free. Because medicare works in the entire country, so be sure the medicare advantage plan you pick works "In network" for the areas you think you will be living.

+1


The Advantage plans looks great when you are 'young' and healthy... you are saving money and do not have a lot of expenses.... but have something happen to you and find out that you have a $6K deductible and max OOP that could be higher and those savings evaporate quickly...


Except for medications I know what my annual health care costs will be... my medicare premiums, my medigap premiums and a few hundred more...


And that 'in network' can be a killer... one of my sisters lives in two places... she had an eye problem where there was no network and her plan did not want to pay anything for her problem... she needed an expert, not an emergency room but they would only pay for emergency....


I am tired of the games the insurance companies play...

 

[CardsFan]

I am in the traditional Medicare with supplement camp. Like the example above, I have a history of skin cancers, including melanomas. I want to go to the best doctors in the area, not just the ones in some plan.

I helps that my retiree medical plan gives me a supplement that covers over 2/3's of the supplement cost, but that was not a deciding factor.

Now, if I had a very lean FIRE, I might need to go Advantage to make ends meet. But, I had a friend, since passed, who had more serious issues and was forever fighting with his Advantage provider. He had several cases where he needed to go a rehab facility. The places they put him were abysmal. Luckily for him his daughter was a nurse, but even she had a hard time navigating the system. No Thanks.

 

[bada bing]

I'm now signed up for Medicare. I'm another who elected to go traditional Medicare plus G&D.

JMO, but you get what you pay for. I have access to an previous employer's Advantage plan that is better than available on the open market. I still think it's worth it in my situation to pay ~$325/month for the "Cadillac" of Medicare options (A&B + G&D) and for me the choice isn't even close. Individual budget and needs will make for different choices. That was mine.

 

[ShokWaveRider]

We avoided (Not Real Medicare) Dis-Advantage plans. Ask Clark Howard.

 

[NameTaken2]

A decision that should not be based on a couple pals liking their Medicare Advantage plans.
Do a deep dive-
A LOT to learn, and lots of info online to make an informed decision.
Example: Only a few states allow switching from Medicare Advantage to Medigap without underwriting -do you live in one?
I declined "free" Medicare Advantage to go with traditional Medicare.

 

[MC Rider]

This seems to be one of those things where "free" might potentially become really expensive. Choose wisely.

 

[Calico]

I wouldn't take a Medicare Advantage plan if it was offered to me free on a silver platter. But that's just me. Everyone has to decide for themselves. The plans work for some folks.

Having had breast cancer in 2018, I feel like I'm paying for peace of mind every month when I pay for my Medicare supplemental plan.

I can go to any doctor, anywhere, any time for any reason. I have no reason to think the cancer will come back, but if it ever does, the last things I want to be worried about are pre-approvals or networks, etc. etc.

Yes, the supplement costs a bit. I'm willing to pay (and feel fortunate to be able to pay) so I have total peace of mind in that one area.

Goodness knows there are enough other things I can devote myself to worrying about!

 

[RetMD21]

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.

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

 

[Trailwalker]

My mother loves her Advantage Plan. She's in her eighties, in good health, and rarely sees the doctor. Lives in Iowa. Unlikely to ever leave. Although I'm healthy now, I plan on moving about the country, and I didn't live nearly as clean a life as she did. So I'll be picking traditional Medicare with the best Medigap that I can buy.

 

[ShokWaveRider]

My mother loves her Advantage Plan. She's in her eighties, in good health, and rarely sees the doctor. Lives in Iowa. Unlikely to ever leave. Although I'm healthy now, I plan on moving about the country, and I didn't leave nearly as clean a life as she did. So I'll be picking traditional Medicare with the best Medigap that I can buy.

Highlighted by me, that is why she likes it.

 

[badatmath]

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

Because it might be hard to get out of and get a supplement later? Depends on your state if you have to pass underwriting.

 

[Calico]

^^^^This x100

 

[aja8888]

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.

 

[Katsmeow]

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.

You seem to be cutting out a lot of feedback here including people who have traditional Medicare and love it and people who have Medicare Advantage and hate it.

I had a family member who I think overall liked her Advantage plan. Of course, that changed when she broke her hip and the only rehab places the insurer would approve were not ones she liked. She really wanted to go to the rehab place my mom was in at the same time but it wasn't approved by her insurer. Of course, for my mom it wasn't an issue because she had traditional Medicare.

Medicare Advantage plans work for 2 groups of people.

One are people who are too poor to be able to afford Part B and a good supplement. They sign up for the low [-]cost [/-] premium Medicare Advantage plan and gamble they will never need actual care.

The other are people who get lucky and die before they need much medical care. If you don't need actual care then the MA plan can seem low cost. Of course, for people who do need care a Medicare Advantage plan is often very expensive, far exceeding the cost of a Plan G supplement. Many people will say they are healthy so they are OK with a MA plan. The thing is that we all die eventually. When I turned 65 I rarely saw a doctor. I took no prescriptions. Now I am 69 and I have a cardiologist and will be regularly seeing doctors for the rest of my life.

I like the fact I can basically see anyone. If I need rehab I can choose where I go. I like the fact that once I pay my premiums I pay the Part B deductible and then I am done (except for prescriptions and mine are very cheap at this time).

Lot of people like MA plans until they actually need expensive health care.

Hint: The cost savings for Medicare Advantage are saving in initial premiums. MA plans are very profitable...for insurance companies. Do you think they are signing up people because it is less expensive for people than traditional Medicare plus supplement? No. It overall is far more profitable for insurance companies not for you.

 

[MC Rider]

Sounds like a good argument for choosing traditional Medicare. At 65 you were good, at 69 not so much. Be well!


I need to decide this month.


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

You seem to be cutting out a lot of feedback here including people who have traditional Medicare and love it and people who have Medicare Advantage and hate it.

I had a family member who I think overall liked her Advantage plan. Of course, that changed when she broke her hip and the only rehab places the insurer would approve were not ones she liked. She really wanted to go to the rehab place my mom was in at the same time but it wasn't approved by her insurer. Of course, for my mom it wasn't an issue because she had traditional Medicare.

Medicare Advantage plans work for 2 groups of people.

One are people who are too poor to be able to afford Part B and a good supplement. They sign up for the low [-]cost [/-] premium Medicare Advantage plan and gamble they will never need actual care.

The other are people who get lucky and die before they need much medical care. If you don't need actual care then the MA plan can seem low cost. Of course, for people who do need care a Medicare Advantage plan is often very expensive, far exceeding the cost of a Plan G supplement. Many people will say they are healthy so they are OK with a MA plan. The thing is that we all die eventually. When I turned 65 I rarely saw a doctor. I took no prescriptions. Now I am 69 and I have a cardiologist and will be regularly seeing doctors for the rest of my life.

I like the fact I can basically see anyone. If I need rehab I can choose where I go. I like the fact that once I pay my premiums I pay the Part B deductible and then I am done (except for prescriptions and mine are very cheap at this time).

Lot of people like MA plans until they actually need expensive health care.

 

[jollystomper]

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.

 

[Dtail]

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.

Agree.
This year my brother who is currently healthy to note, I signed up for a MA plan.
It is a PPO with the same access to all the current doctors he was using on the ACA.
There are also many doctors across the country who are in the plan.
The leading heart hospital and cancer hospital in our area are in the plan.
No premiums, reasonable OOP, reimbursement of his Medicare Part B of 164.90 monthly (not 174.70).
Various coverage of vision, dental.
Monthly monies for drug purchases.
We shall see.
My decision for myself is coming in 2025.

 

[Gumby]

Mine is also a Medicare PPO plan. From what I can tell, it gives me everything I had on my traditional retiree health plan, although I'm sure there are a few twists like the eye refraction test I mentioned earlier.

 

[PokeNTexas]

.......so I'm looking to see if there are others that are having a good experience with them.

Six votes here, each with good experiences. Wife and I (67 years of age, healthy). Dad and mom (88 yo, lots of medical problems), see lots of doctors. FIL (87 yo, lots of medical problems), sees lots of doctors. MIL passed three years ago, but also was on MA plan and received extraordinary care for her many problems including a serious heart condition and cancer.

No one has been denied care or had care delayed. Eye refraction covered. Dental covered. Drugs covered.

 

[jollystomper]

Mine is also a Medicare PPO plan. From what I can tell, it gives me everything I had on my traditional retiree health plan, although I'm sure there are a few twists like the eye refraction test I mentioned earlier.

The only small hiccup I encountered in my plan was also vision related. The optometrist I have gone to for the last 8 years for my annual eye exam does not accept medical vision insurance, only vision insurance plans. They are in network with our Medicare Advantage provider, but only for the vision insurance plans. However, customer service assured me (as was documented in the plan) that the exam, including refraction testing, would be covered and reimbursed. So I had to pay for the exam and submit the bill, instead of the optometrist submitting it. Fortunately I could this all online. 2 days later the claim was processed, covered, and reimbursed.

 

[zl55lz]

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.

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.

In my research, it is essential to know if the answers are by someone enrolled in a publicly offered Medicare Advantage Plan--the ones usually seen on TV or which call, 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.

These EGWP MA plans are generally much more robust--for example, my former employer offers a selection of them and they have ZERO extra premium, ZERO deductible, ZERO out of pocket per year, excellent built-in Rx coverage, dental and vision, they are all a PPO, and are offered by major insurance companies with very large networks.

As one can see, these probably appear far more attractive to most people than a publicly offered MA plan.

So back to my initial comment, I think it is essential to find out from anyone answering your question which type they are speaking about.