Approaching 65 (Medicare) Having difficult time with Advantage vs Supplemental Plans

[ShokWaveRider]

Anyone Else in the position of having to make a Medicare Decision in short order? I know we have discussed it a little, but I thought I would Make a Poll to see if I am in good company. Who else is going to have to make a decision soon, what are your thoughts?

 

[Mdlerth]

Not enough of an Advantage

Don't need to make the decision imminently. But if I were choosing today, I'd go with one of the Supplement (Medigap) options.

 

[Katsmeow]

I will be medicare age next April. So a little past 6 months but not by much. I would never consider an Advantage plan. Never. My mother recently died. She had traditional Medicare with Supplemental Plan G. She had no problem finding doctors to take her. She could go to any doctor that takes Medicare. There were no issues with coverage.

I have another relative who is on Medicare Advantage. It has been so much more of a pain as it isn't good enough for her to go to anyone who takes Medicare. She has to go to someone who is in network. Also, she can't just decide to go back to traditional Medicare as I doubt she could qualify for a supplemental plan.

That is the real issue with Medicare Advantage. If you want to go back to traditional Medicare you may not be able to medically qualify. If it wasn't for that then it wouldn't be that big of an issue. And, even a healthy person can develop something that causes them to not be able to medically qualify.

 

[Moemg]

My SO has a Medicare Advantage plan through Humana. He first had an HMO and it was awful . He switched to a PPO and has had heart surgery and two knee replacements . He was able to pick from a wide choice of Doctors and had minimal co-pays and no problems with coverage . He has been on this plan for five years . There are many Advantage plans so you really after to compare them closely .

 

[Fedup]

That is the real issue with Medicare Advantage. If you want to go back to traditional Medicare you may not be able to medically qualify. If it wasn't for that then it wouldn't be that big of an issue. And, even a healthy person can develop something that causes them to not be able to medically qualify.

This thread perks my interest. My sister will be retiring next year when she gets Medicare. I’m curious to why you may not be able to medically qualify. I thought everybody qualifies for Medicare.

 

[Dawg52]

Next summer I will be getting serious with my options. Right now I am leaning to Medicare Supplement G and may convert to a HD-G if/when that is offered.

 

[ShokWaveRider]

Next summer I will be getting serious with my options. Right now I am leaning to Medicare Supplement G and may convert to a HD-G if/when that is offered.

Me too, but I am noticing my "trusted" Healthcare agent, she has been great leading us through ACA insurance, always seems to promote Advantage first. Probably because the premiums are so cheap vs Part G.

 

[davebarnes]

I love Advantage.
But, then, I think Kaiser is great.
My colon cancer treatment was excellent and only cost me $2500 over 2 years.

 

[ivinsfan]

Here's a real world example of what you give up when you go an Advantage Plan, even when you are in network. They usually have a higher co pay and OOP for out of network.

DH has a complex mitral valve replacement.. this Spring.... rate rack on the Medicare EOB...just for the surgeon

11,192.25 Medicare approved amount 3,349.85 our co pay would have been 669 without a medicare supplement which we have. It's about the "in network" negotiated price the Advantage company and the doctor agree on. it's not going to be a 60% reduction it could quite a bit higher and that's the number they will use for your co pay. When Medicare is not the PRIMARY payer as in an Advantage plan the approved Medicare rate means nothing, compare this with the out of network issue and you are giving up a lot with an Advantage plan.


I start Medicare Oct 1 and ruled out an Advantage plan for just this reason, in fact if you read around you'll see people who ring up large bills on Advantage are less then satisfied about the program. Catch 22 when you have a problem you can't switch back if the orginal 6 months of no underwriting have passed.

I wanted the HD plan F I think that closes to new enrollment on Jan 1 2020 but my agent who owns a big agency said he has almost no one on this plan and in this state it's pretty low enrollment which made me concerned about big premium jumps as the plan members age out and die.

 

[Dtail]

My DGF has Medicare Advantage and is happy with it.
Shokwave - the network in Florida as you know is extensive and it is no different with Medicare Advantage.

 

[Bestwifeever]

Plan G.

 

[omni550]

Plan G.

omni

 

[Another Reader]

I'm in line to make the switch in a couple of months and I'm in California. No way would I allow an insurance company to limit my selections to a bunch of second and third tier yahoos so no Advantage plan for me. I'm probably going to go with AARP Plan F unless someone convinces me to go with Plan G. The costs of all these plans are so low in comparison to what I'm paying now in premiums for the pre-Medicare retiree policy, I just don't care. The only issue for me is the Plan D choice. Irrelevant today, but who is the easiest to work with when you need the million dollar cancer drug? Go low tier today and switch to a more comprehensive plan when I'm older and sicker?

 

[ncbill]

Helped an older relative signup for Plan G (& Plan B, plus a drug plan) this spring.

Since it kicked in (July 1) they've been in the hospital for over a week, rehab facility for longer, and now rehab is talking about a skilled nursing placement, probably on Hospice.

I think they're going to be very glad they went with Plan G.

 

[jonat]

My wife is on a Medicare Advantage plan from United Health, sponsored by AARP. It includes all our doctors and, unusually, has the same copay for in-network and out-of-network - just the OOP limits are different. It's also cheap - she is paying $81/mo for it.

The pharmacy coverage is a bit weird. The medication she is on long-term is zero cost, when using their mail-order pharmacy. But she had to pay $45 for a Shingrix shot (I paid zero) and another medication her dermatologist suggested is not covered at all (but my plan doesn't cover it either.) I am not yet of Medicare age.

We decided against Medigap because we travel a lot.

 

[ivinsfan]

My wife is on a Medicare Advantage plan from United Health, sponsored by AARP. It includes all our doctors and, unusually, has the same copay for in-network and out-of-network - just the OOP limits are different. It's also cheap - she is paying $81/mo for it.

The pharmacy coverage is a bit weird. The medication she is on long-term is zero cost, when using their mail-order pharmacy. But she had to pay $45 for a Shingrix shot (I paid zero) and another medication her dermatologist suggested is not covered at all (but my plan doesn't cover it either.) I am not yet of Medicare age.

We decided against Medigap because we travel a lot.

I'm confused this info seems backwards if you travel you want Medigap.

 

[Souschef]

We are on Medicare Advantage and are quite happy with it. One thing you have to be aware of if you, like DW, are on a lot of meds.
There is a thing called the "Doughnut Hole" The numbers are old , but the concept is the same.

In 2010, basic Medicare Part D coverage works like this:

• You pay out-of-pocket for monthly Part D premiums all year.
• You pay 100% of your drug costs until you reach the $310 deductible amount.
• After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.
• Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
• After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs.

 

[omni550]

I'm confused this info seems backwards if you travel you want Medigap.

+1

As a 6-month snowbird, I would only consider a Medigap plan.

omni

 

[REWahoo]

Medigap Plan N for us.

 

[travelover]

Medigap Plan N for us.

OK, I've gotta ask. Most everyone goes with F or G - what is the special appeal of N?

 

[Moemg]

AARP.org/bulletin Has an interesting article on Medicare Advantage plans this month.

 

[REWahoo]

OK, I've gotta ask. Most everyone goes with F or G - what is the special appeal of N?

Plan N differs from Plan G in three ways:

-No coverage for Part B excess charges

-You may have a copay of up to $20 for doctor visits and $50 for ER visits that don’t result in admission.

- Due to the above, ~20% lower premium costs

 

[HtownRose]

This thread perks my interest. My sister will be retiring next year when she gets Medicare. I’m curious to why you may not be able to medically qualify. I thought everybody qualifies for Medicare.

IMO it's not that you won't be able to qualify for Medicare, it's that you will be subject to medical underwriting for the supplements you will likely want along with Medicare.

My Mom is in this situation - went with Medicare Advantage (TexanPlus) when she turned 65, it worked well for a while, but now she's 83 & didn't like her options when she needed rehab after a 2nd hip replacement. TexanPlus offers a more expensive version which we will be looking into along with other MA plans during her enrollment window this fall. She can switch to another Medicare Advantage plan no problem, but if she went to regular Medicare & wanted a supplement, there would be underwriting for the supplement. (This is my understanding - please correct me if I'm wrong.)

I now understand why people stay at my employer even when they are eligible for retiree medical (only available until age 65) & Medicare - the company's insurance is so much better & less expensive than Medicare.

 

[Luvdogs]

I did a lot of research on this when DH turned 65 earlier this year. We went with Plan F which is the most comprehensive and most expensive. In a nutshell you pay the monthly premium and there are no copays or deductible for most normal things.

For example, a couple of months ago DH was in the hospital for several days with chest pains, etc (prior history of heart attack). Did tons of tests, etc. We owe zero.

We just did not want any surprises.

This does exclude prescriptions. You really need to go over every rx you take. They are based on tiers 1-4. Got DH drs to change some meds (he is on many) so the cost on that is down to negligible.

But weird thing is that the Shingrix vaccine cost him around $175 and mine through BCBS cost 0.

It should have been zero for him. It's obviously cheaper to pay for the vaccine than the treatment but that's for another vent.

His medicare insurance is more expensive than our retiree health insurance which came as a surprise since most people are relieved to pay for Medicare vs their regular insurance.

 

[Katsmeow]

This thread perks my interest. My sister will be retiring next year when she gets Medicare. I’m curious to why you may not be able to medically qualify. I thought everybody qualifies for Medicare.

It is not Medicare. It is the supplement if you don't get it when you take Medicare. Basically when you go on Medicare you have a window of time to sign up for a supplement without medically qualifying. You can sign up for any supplement you want.

But if you go on a Medicare Advantage plan and then later decide to go back to Medicare you will have to medically qualify for the supplement (not Medicare itself) unless an exception applies.