Medicare Advantage vs. Medigap vs. ?????

[sakowitzm]

I'm a few years away from Medicare, and only generally familiar with these options. I had a vague notion that Medicare Advantage was the way to go, but these articles have me re-thinking that MediGap might be the better long-term path. Posting to share this info, and wondering how folks view the Advantage vs. MediGap question. TIA for your input.

Start here, which introduces the topic:

https://www.medpagetoday.com/public...BLQv-OI8-mvBjfc08OQGXhM-6-IasY4AJCk5igJRLBX4I

Details on MediGap:

https://www.pbs.org/newshour/economy/making-sense/how-do-medigap-plans-work-heres-a-tutorial

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

 

[MichaelB]

Thread moved to the Health and ER Forum.

Thanks for the links. This has been of increasing interest over the past year couple of years.

 

[REWahoo]

This is well-plowed ground on the forum, but FWIW:

Medigap is our choice for a number of reasons, primarily for the ability to utilize any physician or facility that accepts Medicare assignment.

 

[kaneohe]

I like Medigap...........no limited network of doctors as for Advantage that may change w/ time. You can even see doctors in other geographic areas like when traveling or if you need a specialist for a serious disease.
Plans standardized and easier to compare. I believe you can easily switch back at open enrollment time each yr from Medigap to Advantage , but not necessarily the other way so you could start w/ Medigap , evaluate and then change if desired.

 

[ShokWaveRider]

Basically if you are concerned about the "Initial" costs, do not mind a limited availability of service providers, do not need national coverage, do not mind checking with the provider rep every time you need something done to confirm coverage, then MA is for you.

If you do not mind the ~$200 a month ($2,400 pa + ~$200 deductible) extra costs with none of the above limitations then the "G" supplement is for you.

Depending on your drugs an extra Part D will also be needed with the supplement.

Remember though that the MOOP for the MA plans is about ~$6,700, quite high. I paid $3,791 for all in 2019, and used every bit of it and then some. It would have cost me almost double with an Advantage plan.

So it is a pay me now or pay me later for some folks depending on your ailments. Remember after 6 months or 1 year to switch to a Supplement form a MA plan requires medical underwriting.

So there you go.

 

[MichaelB]

Basically if you are concerned about the "Initial" costs, do not mind a limited availability of service providers, do not need national coverage, do not mind checking with the provider rep every time you need something done to confirm coverage, then MA is for you.
./.
So there you go.

Some Medicare Advantage plans have broad nationwide PPO networks that require no preapproval and include drug coverage. Like many other members, my choice is traditional Medicare with Supplemental and Plan D, but Medicare Advantage is a viable option for many.

Edit to add - low income seniors who cannot afford supplemental MediGap coverage plus separate Plan D drug, and also do not need a broad nationwide provider network may be better served with Medicare Advantage.

 

[Chuckanut]

I'm a few years away from Medicare, and only generally familiar with these options. I had a vague notion that Medicare Advantage was the way to go, but these articles have me re-thinking that MediGap might be the better long-term path. Posting to share this info, and wondering how folks view the Advantage vs. MediGap question. TIA for your input.

Start here, which introduces the topic:

https://www.medpagetoday.com/public...BLQv-OI8-mvBjfc08OQGXhM-6-IasY4AJCk5igJRLBX4I

Details on MediGap:

https://www.pbs.org/newshour/economy/making-sense/how-do-medigap-plans-work-heres-a-tutorial

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

It would be better if you gave us an idea of what's in the article that is a matter of concern to you.

 

[ShokWaveRider]

Remember a "Few Years" can be a lifetime when it comes to US HealthCare and decisions made regarding it.

 

[Dtail]

A related side question.
My DGF who is receiving SSDI at 58 y.o., is currently on an MA plan.
If she switched out of it before 65 y.o., would there be an underwriting required?

 

[davebarnes]

Every plan is different.
Welcome to complicated decisions.

I chose Medicare Advantage with Kaiser as I like the one stop shopping. My costs are very low. Even when I had colon cancer (surgery + chemo). All my records are in one electronic bucket. For me, it works (has worked) very well.

 

[Teacher Terry]

I wouldn’t do a advantage plan because of the step process and needing referrals. You can be dead by the time you get to the step you need.

 

[ShokWaveRider]

I have to agree with DaveBarnes with regards to Kaiser, our experience for our 15 years in SoCAL when we lived there was great, I would take an MA with them. All our services were under one roof too, MRI, Stress Test, Cardiologist, GP etc., all in the same building. On could easily see 2 or 3 specialists in one visit. Excellent service and accessibility etc. too. But other areas of the country, especially the poorer managed states, HMOs are a no-no in my books. So AARP UHC Part G it is.

 

[davebarnes]

I wouldn’t do a advantage plan because of the step process and needing referrals. You can be dead by the time you get to the step you need.

I have not seen any of this with Kaiser.

 

[Sue J]

I’m currently weighing these options as I start Medicare Feb 1.

As a lifelong frugal person I’ve considered Medicare Advantage just because I can get it for no extra cost over the Part B $144.60/mo.

But I like the options and choices with a Medigap. Checking prices so far I can get a Part G for about $115 (AARP UHC) and a Part D for under $15. DH will start Medicare on Apr 1 so we both have to make this decision.

DHs pension system includes a HRA of $337/mo. to be used to offset any of these costs so we will pay for all of these and then can be reimbursed. Having the HRA makes medigap and Part D a reasonable expense vs trying to be frugal and going with Medicare Advantage just because it’s cheap. The HRA can be used for expenses in an MA plan, too.

So far, I’m leaning toward medigap and part D because we can afford it. The pension system may reduce or eliminate the HRA in the future, we could still afford it with the option of changing to MA if needed.

 

[KB]

I wouldn’t do a advantage plan because of the step process and needing referrals. You can be dead by the time you get to the step you need.

I haven't seen that with Kaiser either. I have been with Kaiser since 2002 but only had Medicare Advantage for two years. Since I was already familiar with Kaiser, it made sense to stay with them for Medicare.

 

[wolf]

I haven't seen that with Kaiser either. I have been with Kaiser since 2002 but only had Medicare Advantage for two years. Since I was already familiar with Kaiser, it made sense to stay with them for Medicare.

IMHO. Advantage plan = HMO. Kaiser, is an "advantage plan". If you go,
outside of the advantage plan, (out of network), you need pre-approval.

Kaiser, is a "one stop shopping". Great reviews, here in San Francisco Bay
area. I think, for 2020, monthly premium is $ 87 or so.

Friends and relatives, like Kaiser. Brother, just had 3 stents installed. Only,
cost, something like $ 87, or so. Everything covered.

I still have original Medicare. Supplement (gap) AARP Plan F ($183.41 to$ 193.42 for 2020), Humana part D. $ 13.20. only take tier 1 and 2 drugs.

Will change to AARP, PlanG, before year end. (about $30 month cheaper).

So, Supplement / gap, plan much cheaper. And Kaiser, in our area, very good reviews.

These $ numbers are for, San Francisco, bay area, California.

 

[Bamaman]

In my eyes, the Advantage plans are like a HMO. No freedom of doctors or hospitals. My wife suffered for years with a chronic problem, and it got solved in a simple 30 minute procedure when we went to regular health insurance.

The hospital chain north of us refuses to accept Medicare Advantage programs. They have over 1700 physicians in the practices purchased and control dozens of hospitals in 5-6 states. Thousands of previous patients have had to change doctors and go to hospitals in other cities for treatment. No thanks!

 

[RobbieB]

I'm going advantage, Kaiser Senior Advantage. Eighteen dollars a month -

 

[MissMolly]

Advantage Plans vary across the board, so I take issue with blanket statements that Advantage plans are bad. An Advantage Plan like mine, which is a retiree benefit, is a PPO, not HMO. No network of doctors. Only $500 deductible and $1,500 MOOP. Drug plan included with no donut hole. Dental cleanings included ( 1 per year ). Silver Sneakers membership included. Provides nationwide coverage and emergency overseas coverage. No pre-approvals required. All at a great cost of $0.00 to me. So far, no complaints.

 

[jimbee]

All Medicare Advantage plans are not HMOs.

 

[mf15]

One more item about MA. Drugs are not counted towards MOOP.
Olmike

 

[kaneohe]

Agree that the difference between the plan types can be difficult to judge.
DW has employer Advantage. I have Medigap. We go to the same large medical group which has many doctors and numerous locations. Historically I have paid more for the Medigap but this past yr, the Advantage is slightly more expensive and will be more so next yr. However the coverage is not the same since the Advantage plan includes Rx drugs, dental (small surcharge), glasses, hearing aids (we got 1K+ reimbursement). Still there is some annual concern about whether the medical group is still in network or not........

 

[badatmath]

Edit to add - low income seniors who cannot afford supplemental MediGap coverage plus separate Plan D drug, and also do not need a broad nationwide provider network may be better served with Medicare Advantage.

Not to quibble with any of your other points that some MA are good, but the low income people is who i worry for most. The out of pocket can be way greater for MA and really hurt those that cannot spare it.


Of course in a good year that might not happen. . . .

 

[steelyman]

Advantage Plans vary across the board, so I take issue with blanket statements that Advantage plans are bad. An Advantage Plan like mine, which is a retiree benefit, is a PPO, not HMO. No network of doctors. Only $500 deductible and $1,500 MOOP. Drug plan included with no donut hole. Dental cleanings included ( 1 per year ). Silver Sneakers membership included. Provides nationwide coverage and emergency overseas coverage. No pre-approvals required. All at a great cost of $0.00 to me. So far, no complaints.

This sounds similar to my (pre-Medicare) retiree plan. It’s basically an Advantage plan, PPO nationwide (not HMO which would limit me to coverage in a state I no longer live in). $375 deductible. There are in-network and out-of-network providers and they have different out-of-pocket limits ($1500/$6000). Drug coverage included but not dental or many of the current perks. No PCP required but I choose to have one that I like.

I’m good with it right now but for sure will pay close attention as I get close to Medicare. All these plan choices seem maddening just when your life decisions should be simpler!

[ADDED] To date, all services I’ve received have been in-network but I think where you live makes a big difference. There are many providers/hospitals in my area.

 

[KB]

I'm going advantage, Kaiser Senior Advantage. Eighteen dollars a month -

I have found the Advantage plus to be worth the extra cost. It provides some dental, vision and the Silver $ Fit Gym membership. Maybe hearing aid too. I wear glasses and between that and the dental plan, I save more than the extra $20 or so a month that it costs.