Advantage Plans

[earlyretirement]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

 

[ShokWaveRider]

OM without a doubt! Remember the Supplement (Part G Maybe) too.

 

[Flieger]

Lots of differing (but strong) opinions on this. Will be watching.

Flieger

 

[PaunchyPirate]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

Yes, there are certainly Advantage plans that have nationwide coverage. But you have to see what is available to you in your location and research their network coverages. Check out plans from AARP/UHC, Aetna, your local Blue Cross/Blue Shield, etc. You likely need to also research your medical providers in both locations to make sure they accept that Advantage plan. They may or may not. And not all plans provided by the same company will necessarily have the same geographic/network coverages. You need to compare them.

Or you can sign up for original medicare, if you are eligible to do so. Original medicare is accepted nationwide, assuming you choose medical providers that take it. Most do. Of course, if you go this route, you will want to pick a Medigap Supplement and a Medicare Part D plan for prescriptions and pay extra for these add-ons.

There is no one right answer for everyone.

 

[latexman]

I have a retiree Medicare advantage plan through my megacorp. It has national coverage since all the retirees are scattered all around the US.

 

[VanWinkle]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

United Healthcare has national coverage as well as Blue Cross/Blue Shield in many states. Humana also has nationwide coverage I am told.

 

[MichaelB]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

Yes, there are Medicare Advantage plans that have national networks. MA insurers are free to change their provider networks, so a plan with national coverage can change and reduce the network.

Is there a reason you want Medicare Advantage? Traditional Medicare plans have much greater breadth and depth of coverage and this is very useful for a snowbird.

You can always drop traditional Medicare and enroll in Medicare advantage (during open enrollment). You cannot drop MA and enroll in a Medicare Supplement without being subject to underwriting (in Florida).

 

[stedmakr]

I am a volunteer Medicare counselor in Florida.

Many in this forum will recommend a Medicare Supplement (medigap plan) over an Advantage plan. Medigap plans do not have the prior approval requirements that are found in Advantage plans. If Medicare pays the medigap provider pays - period. Advantage plans all have prior approval requirements for many procedures, treatments, or drugs that can delay, deny, or change a medical treatment recommended by physican and approved by the beneficiary. Advantage plans give the insurer a vote and that vote may not be in the best interest of the beneficiary.

In my experience every beneficiary I have seen that is subject to IRMAA has selected a medigap plan. A high percentage of other Individuals and couples that are comfortable with their financial situtation also select medigap plans vice Advantage plans.

Medicare plans both Advantage and medigap plans across the country are in turmoil at this time.
Some Advantage plans are dropping service in different areas and many are cutting way back on their extra benefits.
Medigap plans all have at least one cost increase each year. Recently these increases have been in or near the double digit range.
Stand alone prescription drug plans have experienced massive premium increases over the last couple of years. If a beneficiary has a medigap plan he/she needs to get a prescription drug plan. Unless the individual only takes generic medicines they may find the least expensive plan has a large monthly premium.

Medigap policies in Florida are among the most expensive in the country.

Even though there are close to 40 G plans to choose from in Florida, 3 plans account for over 80% of the marketplace (beneficiaries in a plan).

Prior to selecting a plan take time to review the concept of "closing the book" on many similiar threads in this forum. There are also Youtube videos that discuss this insurance concept.

Many of the most prestigious medical institutions no longer accept beneficiaries with advantage plans.

If the cost a a medigap plan is uncomfortable to you and you have relatively low annual medical costs/needs consider a high deductible G plan. Again, there are several videos on Youtube that explain high deductible plans. The montly premiums on thes plans is low and an agent or broker may not want to sell you this plan. You can purchase the plan directly from the provider.

If you are considering a medigap plan please be cautious of the "el cheapo" alternative. Understand the closing the book concept mentioned above, ask how long the specific plan has been in the market and what the market share or number of enrollees is in the state.

Good luck

 

[earlyretirement]

I am a volunteer Medicare counselor in Florida.

Many in this forum will recommend a Medicare Supplement (medigap plan) over an Advantage plan. Medigap plans do not have the prior approval requirements that are found in Advantage plans. If Medicare pays the medigap provider pays - period. Advantage plans all have prior approval requirements for many procedures, treatments, or drugs that can delay, deny, or change a medical treatment recommended by physican and approved by the beneficiary. Advantage plans give the insurer a vote and that vote may not be in the best interest of the beneficiary.

In my experience every beneficiary I have seen that is subject to IRMAA has selected a medigap plan. A high percentage of other Individuals and couples that are comfortable with their financial situtation also select medigap plans vice Advantage plans.

Medicare plans both Advantage and medigap plans across the country are in turmoil at this time.
Some Advantage plans are dropping service in different areas and many are cutting way back on their extra benefits.
Medigap plans all have at least one cost increase each year. Recently these increases have been in or near the double digit range.
Stand alone prescription drug plans have experienced massive premium increases over the last couple of years. If a beneficiary has a medigap plan he/she needs to get a prescription drug plan. Unless the individual only takes generic medicines they may find the least expensive plan has a large monthly premium.

Medigap policies in Florida are among the most expensive in the country.

Even though there are close to 40 G plans to choose from in Florida, 3 plans account for over 80% of the marketplace (beneficiaries in a plan).

Prior to selecting a plan take time to review the concept of "closing the book" on many similiar threads in this forum. There are also Youtube videos that discuss this insurance concept.

Many of the most prestigious medical institutions no longer accept beneficiaries with advantage plans.

If the cost a a medigap plan is uncomfortable to you and you have relatively low annual medical costs/needs consider a high deductible G plan. Again, there are several videos on Youtube that explain high deductible plans. The montly premiums on thes plans is low and an agent or broker may not want to sell you this plan. You can purchase the plan directly from the provider.

If you are considering a medigap plan please be cautious of the "el cheapo" alternative. Understand the closing the book concept mentioned above, ask how long the specific plan has been in the market and what the market share or number of enrollees is in the state.

Good luck

I already have a medigap plan, need it, and will continue to need it so it's the only option for me. My wife has an Advantage plan and the plan was to stick with it, she had cancer ten years ago and probably wouldn't get a G plan without an astronomical cost. My son who is knowledgable with insurance buy not this stuff in particular, said to just get the regular medicare and buy a drug plan. My head is spinning!

 

[sengsational]

... probably wouldn't get a G plan without an astronomical cost.

I believe you have guaranteed issue rights for Medicare Supplemental plans in Florida if you move there. So your wife would be paying the same as a "never diagnosed with anything" person. That's not to say that it would be cheap, but it wouldn't be inflated because of the previous diagnosis. You can shop medicare.gov for a specific county in Florida. I put in a Miami zip code and got this, for instance:

Medigap Plan G
Plan Details
View Policies
MONTHLY COST
Premiums range from $276-$524 for a 75 year old female that doesn't use tobacco.

You might not need a "G" if the monthly cost is annoyingly high..."N" is almost as good, and might save $50 or $100 per month. You can save $150 to $350 per month if you go "G-high deductible."

ETA: You'd have to officially move your residence from CT to FL to get the special enrollment period, and no dilly-dallying ... the SEP lasts like 2 months and then you're outta luck.

 

[rk911]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

This is why we chose traditional Medicare with a supplement. At the time we were traveling in our RV for up to 5-6 months at a time and didn't want the hassle of finding a doc that was "in the plan" wherever we found ourselves. Even though we no longer travel we've stayed with traditional Medicare and our 'Plan F.

 

[VanWinkle]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare

I am a volunteer Medicare counselor in Florida.

Many in this forum will recommend a Medicare Supplement (medigap plan) over an Advantage plan. Medigap plans do not have the prior approval requirements that are found in Advantage plans. If Medicare pays the medigap provider pays - period. Advantage plans all have prior approval requirements for many procedures, treatments, or drugs that can delay, deny, or change a medical treatment recommended by physican and approved by the beneficiary. Advantage plans give the insurer a vote and that vote may not be in the best interest of the beneficiary.

In my experience every beneficiary I have seen that is subject to IRMAA has selected a medigap plan. A high percentage of other Individuals and couples that are comfortable with their financial situtation also select medigap plans vice Advantage plans.

Medicare plans both Advantage and medigap plans across the country are in turmoil at this time.
Some Advantage plans are dropping service in different areas and many are cutting way back on their extra benefits.
Medigap plans all have at least one cost increase each year. Recently these increases have been in or near the double digit range.
Stand alone prescription drug plans have experienced massive premium increases over the last couple of years. If a beneficiary has a medigap plan he/she needs to get a prescription drug plan. Unless the individual only takes generic medicines they may find the least expensive plan has a large monthly premium.

Medigap policies in Florida are among the most expensive in the country.

Even though there are close to 40 G plans to choose from in Florida, 3 plans account for over 80% of the marketplace (beneficiaries in a plan).

Prior to selecting a plan take time to review the concept of "closing the book" on many similiar threads in this forum. There are also Youtube videos that discuss this insurance concept.

Many of the most prestigious medical institutions no longer accept beneficiaries with advantage plans.

If the cost a a medigap plan is uncomfortable to you and you have relatively low annual medical costs/needs consider a high deductible G plan. Again, there are several videos on Youtube that explain high deductible plans. The montly premiums on thes plans is low and an agent or broker may not want to sell you this plan. You can purchase the plan directly from the provider.

If you are considering a medigap plan please be cautious of the "el cheapo" alternative. Understand the closing the book concept mentioned above, ask how long the specific plan has been in the market and what the market share or number of enrollees is in the state.

Good luck

I am a volunteer Medicare counselor in Florida.

Many in this forum will recommend a Medicare Supplement (medigap plan) over an Advantage plan. Medigap plans do not have the prior approval requirements that are found in Advantage plans. If Medicare pays the medigap provider pays - period. Advantage plans all have prior approval requirements for many procedures, treatments, or drugs that can delay, deny, or change a medical treatment recommended by physican and approved by the beneficiary. Advantage plans give the insurer a vote and that vote may not be in the best interest of the beneficiary.

In my experience every beneficiary I have seen that is subject to IRMAA has selected a medigap plan. A high percentage of other Individuals and couples that are comfortable with their financial situtation also select medigap plans vice Advantage plans.

Medicare plans both Advantage and medigap plans across the country are in turmoil at this time.
Some Advantage plans are dropping service in different areas and many are cutting way back on their extra benefits.
Medigap plans all have at least one cost increase each year. Recently these increases have been in or near the double digit range.
Stand alone prescription drug plans have experienced massive premium increases over the last couple of years. If a beneficiary has a medigap plan he/she needs to get a prescription drug plan. Unless the individual only takes generic medicines they may find the least expensive plan has a large monthly premium.

Medigap policies in Florida are among the most expensive in the country.

Even though there are close to 40 G plans to choose from in Florida, 3 plans account for over 80% of the marketplace (beneficiaries in a plan).

Prior to selecting a plan take time to review the concept of "closing the book" on many similiar threads in this forum. There are also Youtube videos that discuss this insurance concept.

Many of the most prestigious medical institutions no longer accept beneficiaries with advantage plans.

If the cost a a medigap plan is uncomfortable to you and you have relatively low annual medical costs/needs consider a high deductible G plan. Again, there are several videos on Youtube that explain high deductible plans. The montly premiums on thes plans is low and an agent or broker may not want to sell you this plan. You can purchase the plan directly from the provider.

If you are considering a medigap plan please be cautious of the "el cheapo" alternative. Understand the closing the book concept mentioned above, ask how long the specific plan has been in the market and what the market share or number of enrollees is in the state.

Good luck

I was a SHIP volunteer in Illinois and was instructed to supply the facts about Medigap, Medicare Advantage, and Part D and let the person make their own decisions. I was instructed not to apply my own bias into the information I gave them. It must be different in Florida based on your post.

 

[teejayevans]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

Yes, well sort of.
Look for MA plans that are PPOs, not HMOs. And look for major companies (Aetna, UHC, Humana….).
Generally, you’ll be able to stay in network if you can find company plans in both states, BUT the plans won’t be the same because state insurance regulations, but you can check the provider networks to insure your doctors are in it.

 

[jet757f]

We have United Health care medigap. For both of us it costs $480 per month. We still end up getting bills all the time. At least with my company policy they had a family rate which was not that expensive. We started looking into Advantage plans but it seems like it could be risky since we don't know how we will age health wise.

 

[rk911]

Caution...you *may* not be able to switch back your Medigap plan without underwriting. For that reason alone (and fheir deceptive commercials) we have stayed with original Medicare + a supplement plan.

 

[winyaz]

Just remember Medicare DISadvantage. If you have the budget for original Medicare and Medigap, go with that. Medicare DISadvantage plans may make sense for those on fixed income with little money to budget for health care. Prior authorizations and denials are becoming more and more common as insurance companies strive to improve profits. I would say at their customers expense, but I worked for a large insurer, and they really saw CMS and the companies that purchased their plans for their employees as their customers, and not the people that actually used the insurance. Medigap plans don't have this issue. Generally if it's covered by Medicare, it's covered.

 

[ali]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

Stick with Medicare and forget about the Advantage plans. True the Advantage are much much cheaper but a good example is a friend of mine who like you does the snow bird thing and decided on the cheaper Advantage Florida plans. The about a year later she developed cancer and Florida Blue advantage plans denied her getting her treatments in her Up north state , therefore making her treatments difficult staying only in Florida. (and that was Florida Blue !)

 

[NoEZmoney]

We recently moved from CT to FL, for this coming year we will be spending time in both states while residing in FL. Do any Medicare Advantage plans have national coverage or should we just go with original Medicare?

I would avoid Advantage plans like the plague. They seem attractive at first thanks to zero or super low premiums and freebie coupons / food card bennies. Just don't get sick 'cuz claim managers will delay your approvals to see specialists or deny coverage or you get limited networks that will even be covered. And more docs & hospitals are not accepting Advantage plans due to lower to no reimbursements. I had two family members on Advantage and getting life-saving treatments was really difficult. One had delays in getting specialist referrals and their cancer spread so that by the time they could see a doc, the treatment options were limited and all they got was palailative care until they died 7 months later.
Get regular MC A/B, a drug plan and Plan G or N supplement. Premiums are more but unless you have a limited network of providers, you can see any doc that takes MC reimbursement.

 

[Flieger]

I hear a lot of "I have friends that had this issue..." statements from those vehemently opposed to MA. On the other hand, I hear people that are on MA that state good results.

Are/Is there anyone that actually was on MA, and has first hand experience of negative results? That would be helpful.

Flieger

 

[teejayevans]

All the negative comments are about HMO plans, MA PPO plans don’t require pre-authorization. They do have high MOOPs, especially if you go out of network. But you can go to any specialist you want.

The question remains whether you will occasionally need expensive treatments or if it will be a regular thing.

 

[Sarah S]

Perhaps the ppo plans in your area do not require pas but it is fairly common for them to do so including to see out of network providers.

 

[MBSC]

All the negative comments are about HMO plans, MA PPO plans don’t require pre-authorization. They do have high MOOPs, especially if you go out of network. But you can go to any specialist you want.

You are confusing the terminology. PPO plans do not require a "referral" from a PCP to see a specialist. Both HMO and PPO plans have prior authorization requirements (approval from the plan) before receiving certain expensive non-emergency services.

Do I need a referral from my doctor to use a specialist?
PPO: No
PFFS: No

Compare types of Medicare Advantage Plans

Compare types of Medicare Advantage Plans including HMO, PPO, MSA, PFFS and SNP.

www.medicare.gov

"Nearly all Medicare Advantage enrollees (99%) are in plans that require prior authorization for some services... Prior authorization is most often required for relatively expensive services, such as skilled nursing facility stays (99%), Part B drugs (98%), inpatient hospital stays (acute: 98%; psychiatric: 93%) and outpatient psychiatric services (82%)."

Reference: Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization | KFF

 

[anethum]

Are/Is there anyone that actually was on MA, and has first hand experience of negative results? That would be helpful.

You're unlikely to hear from people who died.

 

[Cayman]

Caution...you *may* not be able to switch back your Medigap plan without underwriting. For that reason alone (and fheir deceptive commercials) we have stayed with original Medicare + a supplement plan.

Very important consideration. Often over looked.

 

[walkinwood]

I already have a medigap plan, need it, and will continue to need it so it's the only option for me. My wife has an Advantage plan and the plan was to stick with it, she had cancer ten years ago and probably wouldn't get a G plan without an astronomical cost. My son who is knowledgable with insurance buy not this stuff in particular, said to just get the regular medicare and buy a drug plan. My head is spinning!

Regarding your wife getting back on traditional medicare with a medigap plan - call a few medigap insurers and fill out the underwriting questionaire and see what they say. I wouldn't skip this step. Maybe a broker can help you out.