Classic Medicare & Medigap vs. Medicare Advantage

[haha]

I got letter a week or so ago saying that the clinic where my doctor works will no longer take patients with classic Medicare beginning January. Only a short list of their approved Medicare Advantage Plans. I have until Dec 31 to do something, if I am to to change over.

This is really not enough time for me to find out all the differences between these two types of plan. I originally chose Classic Medicare because of greater control and flexibility. Finding what I could on the state government insurance commissioner's page, it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave. You can switch MA plans at certain times, and you can go back to original Medicare and get a drug plan- but you are not guaranteed acceptance into a Medigap plan.

I am leaning toward changing doctors rather than be levered into this change on short notice, although I really like the doctor and have gone to him for a long time.

Anyone have observations or suggestions? I know these things vary from state to state, but any comments would help I think.

Ha

 

[RonBoyd]

Anyone have observations or suggestions? I know these things vary from state to state, but any comments would help I think.

This Google search gave me this:

How do I leave a Medicare Advantage plan?
September 20, 2009 by admin

AnswerId:
45

QuestionLong:
How do I leave a Medicare Advantage plan?



Generally, if you join a Medicare Advantage Plan or Medicare Prescription Drug Plan, you can only change plans from November 15 through December 31 of every year. This change will be effective January 1 of the following year. If you are also eligible for Medicaid, you can switch plans at anytime.If you are eligible for a Medicare Advantage Plan, you can also join or switch Medicare Advantage Plans from January 1 to March 31 of any year, but you can't join or drop Medicare prescription drug coverage during this time. For instance, if you are in a Medicare Advantage Plan with prescription drug coverage, you could return to the Original Medicare Plan, but you'd have to also join a Medicare Prescription Drug Plan at the same time. If you have questions about whether or not you can join or switch Medicare plans, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.You can switch your plan in one of three ways:

1. Join another plan.
2. Write or call the plan you want to join.
3. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you want to switch from a Medicare Advantage Plan to the Original Medicare Plan, you need to contact your current plan or call 1-800-MEDICARE (1-800-633-4227). If you want to buy a Medigap policy, simply signing up for the Medigap policy won't end your Medicare Advantage Plan coverage. You must disenroll. In some cases, you may have certain Medigap protections that give you the right to buy a Medigap policy, but in other cases, you may not be able to buy any Medigap policy. Your rights to buy a Medigap policy can vary by state. If you want to talk to someone who can help you decide what to do, call your State Health Insurance Assistance Program.Their number can be found in the Helpful Contacts section of this web site.
DateCreated:

2001-06-27

DateUpdated:
2009-05-04

FAQ_Category:
Medicare Advantage Plans

RelatedAnsIds:
44,43,93,1412,2051

The Google search also gives other (possibly better) answers to your question. I am begging off giving any personal advice because, after looking at it, your question is actually quite complicated... and, of course, there is that very narrow window for action.

 

[donheff]

I originally chose Classic Medicare because of greater control and flexibility. Finding what I could on the state government insurance commissioner's page, it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave.

Hmmm. I didn't realize Medicare Advantage programs were such roach motels (great metaphor). So, the American public gets the privilege of paying extra to provide a "more privatized" care program designed to trap seniors and undermine the traditional program at the same time. Wonderful approach to health care reform. I can't remember what happens to Advantage under Obamacare. At one time the subsidies were on the cutting board. Will they be gone? If so, will participants have a way out and into standard medigap policies (i.e. will no pre-existing conditions apply to medigap?)

 

[haha]

Hmmm. I didn't realize Medicare Advantage programs were such roach motels (great metaphor). So, the American public gets the privilege of paying extra to provide a "more privatized" care program designed to trap seniors and undermine the traditional program at the same time. Wonderful approach to health care reform. I can't remember what happens to Advantage under Obamacare. At one time the subsidies were on the cutting board. Will they be gone? If so, will participants have a way out and into standard medigap policies (i.e. will no pre-existing conditions apply to medigap?)

In my state anyway, it appears that you can only transit from one Medigap company to another with underwriting. So right away, this flies in the face of the idea that if you have continuous coverage you are "in the system", and therefor not subject to being underwritten.You can move from one Medicare Advantage to another MA plan, during an annual open enrollment. It also seems that if your MA plan folds up shop you can buy a Medigap upon returning to original Medicare. Also, it appears that there are some other "exceptions", but it is very careful language that seems to not allow security about the meaning of it.

Overall it seems to be the usual "screw you , Citizen, that we have grown to know and love in almost all areas of the private health system in America.

Ha

 

[Gotadimple]

I got letter a week or so ago saying that the clinic where my doctor works will no longer take patients with classic Medicare beginning January. Only a short list of their approved Medicare Advantage Plans. I have until Dec 31 to do something, if I am to to change over.

This is really not enough time for me to find out all the differences between these two types of plan. I originally chose Classic Medicare because of greater control and flexibility.

Ha, You have three choices: find another doctor (as you said), find a MA plan, or call SHIBA.

On the second choice, you are in luck! Every carrier is currently running open enrollment seminars. Look for ads from Regence, Group Health, and Essence (to name a few in the Seattle area).

If you don't see/hear ads, there are 800 numbers and the friendly customer service folks are happy to answer any questions you have. Including identifying if any prescriptions you have are in their formulary, and talking with you about the difference between MA and the Sup plans they have available. The same would be true by attending a sales seminar. These are low-key events geared to providing information.

Note: Medicare requires insurance carriers have dedicated staff -- meaning they are licensed agents who are expert in the medicare products and deal only with those products (your tax dollars hard at work).

The Medicare Advantage and MedSup plans are exactly the same from any carrier. What differentiates them is the premium charged and any access to other goodies (for MA clients: health club memberships, discounts on hearing aids, etc.).

The risk with Medicare Advantage, however, is the same risk any of us have with private insurance: the clinic may stop working with a particular plan, or a plan may choose not to continue offering the health plan. So in Washington state, the three largest insurers are Regence, Premera, and Group Health. Only Regence and Group Health offer MA (but there are plenty of other carriers operating). Choosing a local carrier may offer a higher chance of them staying in the MA business -- or not. Premera pulled out several years ago and only sells MedSup.

The third choice is SHIBA. In Washington state, the insurance commissioner has a special department dedicated to helping consumers sort out the choices (Statewide Health Insurance Benefit Advisors). This is a volunteer organization -- and it is a excellent source of info. SHIBA HelpLine - We make finding health care easier!

it appears but is not certain that Medicare Advantage is a roach motel, you can enter, but only under very unusual circumstances can you leave.

This one is a matter of perspective. I would say that Traditional Medicare is the roach motel: you're stuck there until open enrollment. No amount of supplement insurance will break you out. The quality of care is the issue here -- it is not substandard in either program. Being stuck is up to you.

The reality is that MA plans offer a broader set of benefits than Medicare, plus goodies (see above), and the doctors like it better. Why? They get paid more and faster. That's why your doctor will no longer be seeing you if you don't have Medicare Advantage.

I am leaning toward changing doctors rather than be levered into this change on short notice, although I really like the doctor and have gone to him for a long time.

Again, Ha, it's a choice. I know the staff at Regence and I know and understand how the Medicare sales reps operate. Customer service there is first rate and they really love dealing with seniors. It's a big part of their business. Oh, yeah, and they pay my pension and subsidize the cost of that retiree group health insurance thingy.



-- Rita

 

[RonBoyd]

This is another thread that proves this is the best Forum on the Internet.

 

[Gotadimple]

This is another thread that proves this is the best Forum on the Internet.

Thank you, I try my best!

 

[RonBoyd]

Thank you, I try my best!

Yeah. You, too.

 

[haha]

Thank you, I try my best!

Ah yes Rita, and your best is very very good!

Ha

 

[Zero]

If it's not prying toooooo much, have you resolved this issue and which way did you choose? I ask because the choice between Medicare+Medigap and Medicare Advantage is currently a trade I'm researching.

It appears from the discussion on this thread that Medicare Advantage might potentially get a person access to better care. Is that based on the assumption that doctors in high demand are the best in their expertise and therefor more able to be selective in the type of insurance they will accept?

Is there a quality of care advantage with Advantage polices?

 

[marvholly]

I just had to make this decision since I go on Medicare in June. I elected to go w/the Medicare Advantage plan my current Dr & hospital take because:

I will not need a Part D (Rx) plan-its included
I already have an HMO type plan so I am familiar w/the 'rules'
It is a plan from a company I have already had an HMO plan with
I can change plans in 7 months if I decide I need to do so

 

[haha]

If it's not prying toooooo much, have you resolved this issue and which way did you choose? I ask because the choice between Medicare+Medigap and Medicare Advantage is currently a trade I'm researching.

It appears from the discussion on this thread that Medicare Advantage might potentially get a person access to better care. Is that based on the assumption that doctors in high demand are the best in their expertise and therefor more able to be selective in the type of insurance they will accept?

Is there a quality of care advantage with Advantage polices?

I hurried up and did nothing. Decision still in the future.

Ha

 

[SteveL]

Medicare Advantage plans can be bad for those who travel extensively in the US, such as snow birds. Most MA plans have a list of doctors in the area where you join. This preferred provider list are those Docs. who accept the plan. Going to docs outside the plan can be a big problem. If you are in the Group Health Plan in the Seattle area and go to Palm Springs for the winter, you can't really go to the Dr. down there, except for the emergency rooms where you will have the $deductible, and big wait. If you are on Medicare plus a supplement, you can go to any dr. who takes Medicare.

 

[haha]

Medicare Advantage plans can be bad for those who travel extensively in the US, such as snow birds. Most MA plans have a list of doctors in the area where you join. This preferred provider list are those Docs. who accept the plan. Going to docs outside the plan can be a big problem. If you are in the Group Health Plan in the Seattle area and go to Palm Springs for the winter, you can't really go to the Dr. down there, except for the emergency rooms where you will have the $deductible, and big wait. If you are on Medicare plus a supplement, you can go to any dr. who takes Medicare.

That isn't what Group Health told me at their meeting. They said that a Group Health Card functions as a Kaiser Permanente Card when Group Health members are in Kaiser territory. It appears to be complex and full of hard to interpret conditions.
https://provider.ghc.org/open/rende...ndEligibility/groupHealthPlans/kaiserperm.xml

Kaiser Permanente Medical Care - Palm Springs, CA, 92262 - Citysearch

Also, many PPO Advantage Plans that are part of the Blue network seem to offer good coverage out of area, but I am not experienced in how well this actually works.

Ha

 

[Gotadimple]

Also, many PPO Advantage Plans that are part of the Blue network seem to offer good coverage out of area, but I am not experienced in how well this actually works.

Ha

Seemlessly. You make an appointment with the provider and present your card. They take any co-pay, if applicable, submit the claim to the local Blue plan and they get paid as they do normally. Your original plan reimburses the Blue plan (it all gets done behind the curtain, young man!)

-- Rita

 

[dgoldenz]

Glad I don't sell MA...

 

[haha]

Seemlessly. You make an appointment with the provider and present your card. They take any co-pay, if applicable, submit the claim to the local Blue plan and they get paid as they do normally. Your original plan reimburses the Blue plan (it all gets done behind the curtain, young man!)

- Rita

Thanks Rita, for your always well informed answers and also for this

(it all gets done behind the curtain, young man!)

Ha

 

[SteveL]

As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....

 

[haha]

As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....

Well, this prroves to me once again- believe litle of what you hear from someone who is trying to sell you something. This Group Health rep stood in front of a room ful of people and said as if it was an everyday fact that GHC members could get seamless care at Kaiser Permanente.

Ha

 

[dgoldenz]

As a former GHC member who tried to go to Kaiser in SoCal in 2009, using my GHC card, let me tell you that it doesn't work. Kaiser won't take your GHC card. You have to go through a lengthy process and in effect join Kaiser. This isn't easy. Then, with your new Kaiser number you can seek treatment from Kaiser. In you are in Palm Desert, this means driving to Riverside. And, you can't just go, you have to go through their nurse triage system. The nurse then decides if you can see a dr. Then, at the end of things, they tell you to go to urgent care, and you are back dealing with the emergency room fees. This, even though the Kaiser people told you to go.....

Are you sure you're describing Kaiser and not CareFirst BCBS?

 

[SteveL]

Since I retired, my former employer changed how our health insurance was handled a number of times. Sometimes I have had GHC, sometimes BCBS, sometimes a different plan. You have to go to what they offer you. Currently have BCBS. Yesterday, I called them to ask about their Medicare Advantage plan and whether or not they have doctors you can go to in Palm Desert, for example. The answer is yes. So, for BCBS (BS here in WA) if you do Med Ad, you can travel in the US. The person I spoke to said to check because they don't have docs everywhere.

Regarding GHC. When we were down there in 2009, I hurt my shoulder at the gym, and wanted to see a doc. Was trying to avoid the $300 em room ded with GHC. Here in the Seattle area, GHC has urgent care at many of their offices that you can go to on the weekend, and avoid the em room. Well, Kaiser has limited facilities in the Palm Springs/Palm Desert area. They have some contract docs in various places, but no urgent care. After I went through the nonsense to get a Kaiser #, I tried to get an appointment, but it would have been a week wait to see a gp. Alt. I could drive to Riverside to get urgent care, or go to the emergency room. I still ended up paying the $300.....

Still, it has been two years since my experience. Perhaps GHC and Kaiser have done more to meld their computer systems since my experience. GHC has great care if you don't travel much. Very easy, very efficient, great on-line experience. They have a Med Ad plan, but being gone for four months each year makes that choice questionable to me.

 

[Zero]

SteveL, thanks for sharing that information and your experiences. I'm still on company retiree insurance with 3 years to go before Medicare. I have a choice of HMO or PPO and I chose PPO from the get go. I never looked back. I love BCBS PPO.

Now, that is not to say I wouldn't have loved an HMO just the same, BUT, as I go toward the age 65 decision, my current thinking is taking our company subsidized Med Advantage PPO option because of exactly what you mentioned. Travel.

I have a college buddy/cardiologist at Weill-Cornell in NYC and I go to him for yearly checkups and BCBS pays regular as rain. I go to San Diego doctors for most other things and no problems with payments. I chose the doctors, I can refer myself to specialists and I really like those aspects.

But I really wonder if Medicare + Medigap is the answer or whether Medicare Advantage really does have an advantage. That's hard to noodle out.

 

[SteveL]

Currently on BCBS of MA PPO. It works well, and you can find docs via their web site most places. Unfortunately, this ends later this year when we switch to Medicare. We can continue retiree med, but the plan goes from BCBS to Aetna, and there will no longer be a list of Docs who accept the plan. Coverage stays the same in terms of copays and deducts, but you have to find docs who will accept medicare. My alts are Medicare with a Medigap supplement, or Med AD plans avail here. With the Retiree Med, you can get it with drugs or w/o if you want your own D plan. We are paying $700 month for medical now. Looks like the cost will be much the same between paying for Med B, and whatever options we choose. I have to look into the MAdvantage plans a bit.

Looks like the govt. will be gradually phasing out the extra subsidy for MAd plans.

One of the good things about staying on Ret Med, is if you want to change later, you can switch to a medigap/plus d later on with no penalty.

There is a group of clinics here (Virginia Mason) that accept medicare and we already use them.

Haven't decided what to do. Lots of other retirees here from my co. and they have all done different things, but most seem happy with their choice, so not sure if you can go wrong.

 

[Brat]

We had Kaiser for years until moving out of their service area. I agree it is much easier to use if you are in their service areas. I haven't had occassion to use urgent care out of their service area for 55 years (my parents were subscribers) and I recall that the office tried to give Mom the run-arround but backed off when they found that I was hospitalized after I returned.

I am a Fed retiree so have GEHA as an option (Medicare is always primary if you have that). My issue after moving from the Seattle area to Portland has been finding a primary care physician who accepts Medicare. Kaiser is more expensive than GEHA so my wallet was determinative.