Medicare Advantage vs. Traditional Medicare

[lawman]

Can someone explain the differences to me between a Medicare Advantage PPO plan with drug coverage vs. a Traditional Medicare plan with a G supplement and a cheap drug plan.... Would one spend as much on drugs with the Advantage plan as the traditional plan? Should I expect the Supplement "G" premium to go up a lot as I age? It seems that the Advantage plan would save me a lot of money but I'm suspicious about what I may be losing..Thanks

[fh2000]

Quote:

Originally Posted by lawman Can someone explain the differences to me between a Medicare Advantage PPO plan with drug coverage vs. a Traditional Medicare plan with a G supplement and a cheap drug plan.... Would one spend as much on drugs with the Advantage plan as the traditional plan? Should I expect the Supplement "G" premium to go up a lot as I age? It seems that the Advantage plan would save me a lot of money but I'm suspicious about what I may be losing..Thanks

It is a big topic. It could take you weeks, months to go thru the information to make a decision. I am still learning myself and youtube has some helpful channels about MA, and Medigap.

https://www.youtube.com/channel/UCvH...CgD77H_598wrWQ

https://www.youtube.com/channel/UC4v...7gkHDsBTIlR_3A

https://www.youtube.com/channel/UCA1...POeRVneHpaQiGQ

[lawman]

Quote:

Originally Posted by fh2000 It is a big topic. It could take you weeks, months to go thru the information to make a decision. I am still learning myself and youtube has some helpful channels about MA, and Medigap. https://www.youtube.com/channel/UCvH...CgD77H_598wrWQ https://www.youtube.com/channel/UC4v...7gkHDsBTIlR_3A https://www.youtube.com/channel/UCA1...POeRVneHpaQiGQ

Lots of good stuff there..Thanks! I'm still not clear how they compare on drug costs.. As a general rule for someone who takes 3 - 4 maintenance drugs is the Advantage plan significantly cheaper?

[REWahoo]

Quote:

Originally Posted by lawman I'm still not clear how they compare on drug costs.. As a general rule for someone who takes 3 - 4 maintenance drugs is the Advantage plan significantly cheaper?

I don't think there is any way to determine "as a general rule". There are hundreds of different advantage and Part D plans and each may have different deductibles, costs and covered drugs.

[Z3Dreamer]

You can go to mymedicare.gov, set up an account, set up your drugs, then explore the costs. This is only for Part D - drugs and Medicare Advantage. Supplements AKA Medigap typically are on your state's government insurance site. Or here:
https://www.medicare.gov/medigap-sup...surance-plans/

But to answer your questions: In some areas (Florida to name one), the MA plans have extensive lists of providers and services. Going with them makes sense. In rural communities, no.

Plan G will absolutely increase with age.

What you are losing with an MA plan is the ability to travel as their network won't have coverage outside your area.

[lawman]

Quote:

Originally Posted by Z3Dreamer You can go to mymedicare.gov, set up an account, set up your drugs, then explore the costs. This is only for Part D - drugs and Medicare Advantage. Supplements AKA Medigap typically are on your state's government insurance site. Or here: https://www.medicare.gov/medigap-sup...surance-plans/ But to answer your questions: In some areas (Florida to name one), the MA plans have extensive lists of providers and services. Going with them makes sense. In rural communities, no. Plan G will absolutely increase with age. What you are losing with an MA plan is the ability to travel as their network won't have coverage outside your area.

Great! Thanks!

[wmc1000]

Quote:

Originally Posted by Z3Dreamer You can go to mymedicare.gov, set up an account, set up your drugs, then explore the costs. This is only for Part D - drugs and Medicare Advantage. Supplements AKA Medigap typically are on your state's government insurance site. Or here: https://www.medicare.gov/medigap-sup...surance-plans/ But to answer your questions: In some areas (Florida to name one), the MA plans have extensive lists of providers and services. Going with them makes sense. In rural communities, no. Plan G will absolutely increase with age. What you are losing with an MA plan is the ability to travel as their network won't have coverage outside your area.

One other thing is that most MA plans have some copays and significant max OOP costs compared to a plan G which for 2020 is a $193 deductible max.

[Teacher Terry]

If you need to go out of network for a specialist you need a referral. They are allowed to do step therapy so by the time you get to the step you need you could be dead. Also if you want to go back to regular Medicare you have to medically qualify.

[molly312]

You can always opt to leave Medicare Supplement and go to an Advantage Plan. The reverse is not true, except for a few states-and that would require underwriting. Were I in a nursing home or very old, I would prolly switch to the best Advantage plan I could find. However, currently traveling around the country and abroad----Advantage has many "disadvantages".

[Bamaman]

The way I take it that Advantage programs pay your primary doctor a set amount monthly for your care--no matter how many times you have to be seen. And it's not that much $ they pay.

Many hospitals and their clinics refuse to accept Advantage. Many in small markets have to travel 50-100 miles away to different doctors or hospitals than they want to use. If you often travel, you're going to be outside the area of coverage.

My doctor doesn't accept Medicaid and won't even accept new traditional Medicare patients without a good supplement. He opts out of Advantage plans. My wife has a # of nagging health problems and has 5 different doctors in 3 cities. Advantage wouldn't work well for her.

But it sure sounds good in marketing plans. No go for us.

[MissMolly]

Quote:

Originally Posted by Z3Dreamer You can go to mymedicare.gov, set up an account, set up your drugs, then explore the costs. This is only for Part D - drugs and Medicare Advantage. Supplements AKA Medigap typically are on your state's government insurance site. Or here: https://www.medicare.gov/medigap-sup...surance-plans/ But to answer your questions: In some areas (Florida to name one), the MA plans have extensive lists of providers and services. Going with them makes sense. In rural communities, no. Plan G will absolutely increase with age. What you are losing with an MA plan is the ability to travel as their network won't have coverage outside your area.

Not always the case. Mine is nationwide. It just depends.

[MissMolly]

Quote:

Originally Posted by Teacher Terry If you need to go out of network for a specialist you need a referral. They are allowed to do step therapy so by the time you get to the step you need you could be dead. Also if you want to go back to regular Medicare you have to medically qualify.

Again, not always true. My Medicare Advantage is PPO - no referrals required. Step therapy is not required, and quite frankly ANY plan is "allowed" to do step therapy.

[fh2000]

Quote:

Originally Posted by MissMolly Again, not always true. My Medicare Advantage is PPO - no referrals required. Step therapy is not required, and quite frankly ANY plan is "allowed" to do step therapy.

Molly has a good MA PPO plan. I think this is an exception other than a rule for all of the MA plans out there.

My friend has just switched to a MA HMO plan. His MOOP is only $899. Few dollars of co-pay. He thoroughly researched this and his existing doctors/specialists/hospital all within 10 miles from him. They have lots of goodies: dental/vision/hearing aid/gym/, 24 transportation trips, a free Fitbit ($150 value?).

So, his total cost for 2020 is $144 X 12 + $899 <= $2627. He does not travel so he is happy with that plan.

For me, I can not find such plan in my zipcode. I travel a lot. So, I will likely not choose MA when I am ready to sign up next October.

[MichaelB]

There have been many threads over the past couple of years on Medicare Traditional vs Medicare Advantage. Here are a few

http://www.early-retirement.org/foru...lan-95006.html
http://www.early-retirement.org/foru...nts-96370.html
http://www.early-retirement.org/foru...ath-94740.html
http://www.early-retirement.org/foru...age-97158.html
http://www.early-retirement.org/foru...vs-101032.html
http://www.early-retirement.org/foru...are-94475.html

All Medicare Advantage plans are different, some are HMO with limited provider networks, others are PPO with broad nationwide networks. Drug coverage varies greatly. Not sure why the same misconceptions are repeated so regularly.

[Teacher Terry]

If Medicare advantage was good for the customers they would let you go back and forth between them and regular Medicare. The fact that you cannot seems to indicate that it better for insurance companies.

[lawman]

Who pays what for Caduet or Evista and which plan are you on?

[Gotadimple]

Quote:

Originally Posted by Teacher Terry If Medicare advantage was good for the customers they would let you go back and forth between them and regular Medicare. The fact that you cannot seems to indicate that it better for insurance companies.

The insurance companies don't decide who can move between plans. There is only an annual restriction to go into a MA plan, one can always go back to a traditional Medicare plan - but one may not necessarily qualify for a supplement plan when coming from MA to traditional. The restriction comes from CMS.


CMS pays an insurance company something like 90-95% of your Part B premium for providing coverage and bearing all risk of loss - unless you have kidney disease. Your government would prefer to pass on the cost of care rather than take the risk of paying for it under traditional medicare. That's why there is a Medicare Advantage plan option. Insurance companies can remove some the risk they must bear by only offering a small HMO network and restricting a member to the network.

[Dtail]

As mentioned about Florida before, my DGF has an MA plan in Fla and every doctor takes the plan where we live and there is extensive coverage in FLA.
Haven't ventured much outside the USA or slow travelling, so not an issue for us currently.

[Katsmeow]

You can freely switch each year to Medicare Advantage but have to undergo underwriting to get back to a supplement plan if you go back on traditional Medicare. This is the biggest disadvantage of Medicare Advantage. It may seem great when one doesn't have huge medical problems. It can seem really bad if you end up with a health problem and are constrained by a network.

But -- at the end of the day -- the fact that you can't easily go back on Medicare indicates pretty clearly which choice is more beneficial for most people. Medicare Advantage generally spends less money on care than traditional Medicare spends. Medicare Advantage plan have an incentive to spend as little as possible on care.

As for whether a specific Medicare Advantage plan is better right this minute than traditional Medicare + Supplement, i think that asks the wrong question. Health changes over time. I considered not just right now but what my needs might be 10 or 20 years or longer from now.

[lawman]

Quote:

Originally Posted by Katsmeow You can freely switch each year to Medicare Advantage but have to undergo underwriting to get back to a supplement plan if you go back on traditional Medicare. This is the biggest disadvantage of Medicare Advantage. It may seem great when one doesn't have huge medical problems. It can seem really bad if you end up with a health problem and are constrained by a network. But -- at the end of the day -- the fact that you can't easily go back on Medicare indicates pretty clearly which choice is more beneficial for most people. Medicare Advantage generally spends less money on care than traditional Medicare spends. Medicare Advantage plan have an incentive to spend as little as possible on care. As for whether a specific Medicare Advantage plan is better right this minute than traditional Medicare + Supplement, i think that asks the wrong question. Health changes over time. I considered not just right now but what my needs might be 10 or 20 years or longer from now.

Good point..