Any reason not to go on (Boeing provided) Medicare Advantage for a year?

[stepford]

I turn 65 in a few months (and just got my Medicare Card, yay). In any case, as a former employee of the now reviled Boeing I have a pretty decent employer sponsored Medicare Advantage plan available to me. As a California resident I know I can switch out of an Advantage Plan into a standard Medicare Supplement Plan (presumably a part G) one year later. I actually have three questions.

1. Is there any reason I shouldn't save some money immediately and go on Boeing's Advantage plan on the 1st day of my birth month this summer and plan to switch to a Part G plan next year? In particular, is there any reason why I might want to preserve this option for some later year down the line?

2. Since this is an employer sponsored plan I've heard that it may be possible to switch into a Medicare Supplement Plan at *any* time without underwriting. This seems too good to be true and I can't find anything indicating this is the case on the medicare.gov site. In any case, can any of the experts here verify that this indeed false (or perhaps, by some miracle, true).

3. Finally, many of my colleagues seem happy as clams staying on the Boeing supplied Advantage plan, and it does have pretty good benefits and low costs. Does anyone here have any direct experience with it? Recommendations and advice would be welcome.

 

[rk911]

Since this is an employer sponsored plan I've heard that it may be possible to switch into a Medicare Supplement Plan at *any* time without underwriting. This seems too good to be true and I can't find anything indicating this is the case on the medicare.gov site. In any case, can any of the experts here verify that this indeed false (or perhaps, by some miracle, true)...

You're wise to be skptical. A call to your choice of Medicare Supplement Plan providers would be approprIate. Good luck?

 

[Texas Proud]

It does make a difference in who is sponsoring the plan... I would bet that Boeing has a really robust plan and if you can stay on it forever it might be cheaper and just as good as a gap plan...

I have two sisters on the Texas Teacher retirement plan, which is also an Advantage plan, and she has zero problem with getting any of her healthcare needs done...

It just matters if you have to leave it sometime in the future... does it allow you to have it an all 50 states?

 

[CaptTom]

My MegaCorp offered post-65 retirees a "new" advantage plan. It kinda sucked. I went with an outside Medigap plan, instead. Maybe Boeing isn't like this, but I strongly suspect our company signed up for this new plan not to help the retirees, but to save themselves a ton of money. YMMV.

 

[zl55lz]

I turn 65 in a few months (and just got my Medicare Card, yay). In any case, as a former employee of the now reviled Boeing I have a pretty decent employer sponsored Medicare Advantage plan available to me. As a California resident I know I can switch out of an Advantage Plan into a standard Medicare Supplement Plan (presumably a part G) one year later. I actually have three questions.

1. Is there any reason I shouldn't save some money immediately and go on Boeing's Advantage plan on the 1st day of my birth month this summer and plan to switch to a Part G plan next year? In particular, is there any reason why I might want to preserve this option for some later year down the line?

2. Since this is an employer sponsored plan I've heard that it may be possible to switch into a Medicare Supplement Plan at *any* time without underwriting. This seems too good to be true and I can't find anything indicating this is the case on the medicare.gov site. In any case, can any of the experts here verify that this indeed false (or perhaps, by some miracle, true).

3. Finally, many of my colleagues seem happy as clams staying on the Boeing supplied Advantage plan, and it does have pretty good benefits and low costs. Does anyone here have any direct experience with it? Recommendations and advice would be welcome.

It sounds like this might be an Employer Group Waiver Plan (EGWP), which are often designed for the specific employer health plan and from what I have read tend to be more robust than the Medicare Advantage plans offered to the general public.

I would find out if it is a PPO or an HMO, and what the in-network availability is.

I would also find out for sure what the rules are about switching to a Medigap plan in the future, even years hence. I know a person who retired in AZ with an EGWP offered very cheaply by their employer and then a couple years later they greatly increased the price on the PPO offering, meaning pay much more of a premium or switch to the HMO offering, thus greatly limiting provider options. Unfortunately, by this time the person likely wouldn't be able to pass underwriting to switch to a Medigap plan.

From what I have seen so far, Medicare Advantage EGWP plans can change rapidly in specifics such as premiums, out of pocket max, network providers, etc., but often have very good Rx coverage. Many Medigap plans are a great secondary to Original Medicare, but one has to usually enroll in a Part D Rx plan too to have prescription coverage.

I also wonder what happens to health coverage if an employer goes through bankruptcy, even a Chapter 11. Would it then be too late to get underwriting for Medigap? I suppose then the alternative would be a publicly offered Medicare Advantage plan?

 

[MBSC]

2. Since this is an employer sponsored plan I've heard that it may be possible to switch into a Medicare Supplement Plan at *any* time without underwriting. This seems too good to be true and I can't find anything indicating this is the case on the medicare.gov site.

See California GI rights #14 & 17 in the link below, but substitute Boeing's MA plan for "Blue Shield" MA. If the MA plan reduces its benefits, increases premium or copays 15% or more, or drops a provider you're seeing from the network, then you have a Medigap GI right.

Once you have a Medigap plan, the CA Birthday Rule lets you switch to another Medigap with equal or lesser benefits annually without underwriting.

https://www.blueshieldca.com/content/dam/bsca/en/medicare/docs/MedSupp-GAguide-EN.pdf

 

[becca]

We've been on the AT&T Medicare Advantage Plan for 2 years now. We were nervous about this but so far it's been fine. We have had no major illnesses but some testing done ie, MRI, colonoscopy, ultrasound, plus routine physicals/blood work/vaccines. We do have copays for office visits but we pay nothing for the insurance and it has a $900.00 per year maximum out of pocket. We also take advantage of the free gym membership for which we were previously paying $100 per month. My sense is the employee sponsored Medicare Advantage Plans are better than those offered on the open market.

 

[flyoverstate]

I ran into some neighbors recently who are on a state retirement fund sponsored Medicare Advantage plan. My spouse would be eligible for the same plan, but there is *no* way we are biting on that bait. We live in a rural area. There are basically one set of doctors, and one hospital. There is *no* guarantee the state Medicare Advantage plan will sign contracts with the local providers the next time contract time comes around. An insurance company<->hospital system dispute last year already hung thousands of people out to dry in Durango, CO. Additionally, there is no guarantee *any* Medicare Advantage plan will even continue to be offered. The moment a Medicare Advantage plan is costing the insurer "too much", it can be withdrawn, throwing subscribers into underwriting to get back onto Medigap. This is way too big of a risk, IMHO. Even if you are in perfect health today, that could change tomorrow, and it you have to go through underwriting to get Medigap, you could be absolutely broken by having to cover 20%+ of an expensive treatment.

YMMV, etc.

 

[MBSC]

... Additionally, there is no guarantee *any* Medicare Advantage plan will even continue to be offered. The moment a Medicare Advantage plan is costing the insurer "too much", it can be withdrawn, throwing subscribers into underwriting to get back onto Medigap...

Loss of a group/individual Medicare Advantage plan through no fault of your own creates a federal Medigap guarantee issue right. While the federal regulations do not include Plan N, a few states and carriers are more consumer friendly and include N on their GI lists.

Guaranteed issue rights or “Medigap protections” are your rights to buy certain Medigap policies in limited situations outside of your Medigap Open Enrollment Period. In these situations, an insurance company:
• Must sell you a Medigap policy.
• Must cover all your pre‑existing health conditions.
• Can’t charge you more for a Medigap policy because of past or present health problems.

You have a guaranteed issue right if...You have a Medicare Advantage Plan, and:
• Your plan is leaving Medicare
• Stops giving care in your area, or
• You move out of the plan’s service area.

You have the right to buy Medigap Plan A, B, C/D, F/G, K, or L that’s sold by an insurance company in your state.

Pages 21-23: https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf

 

[MichaelB]

See California GI rights #14 & 17 in the link below, but substitute Boeing's MA plan for "Blue Shield" MA. If the MA plan reduces its benefits, increases premium or copays 15% or more, or drops a provider you're seeing from the network, then you have a Medigap GI right.

Once you have a Medigap plan, the CA Birthday Rule lets you switch to another Medigap with equal or lesser benefits annually without underwriting.

https://www.blueshieldca.com/content/dam/bsca/en/medicare/docs/MedSupp-GAguide-EN.pdf

Loss of a group/individual Medicare Advantage plan through no fault of your own creates a federal Medigap guarantee issue right. While the federal regulations do not include Plan N, a few states and carriers are more consumer friendly and include N on their GI lists.This substantially reduces the risk OP faces.

These are solid protections against the employer reducing the benefits or shifting cost onto the employee.

Does the California birthday rule allow MA policyholders guaranteed access to a MediGap plan?

 

[MBSC]

Does the California birthday rule allow MA policyholders guaranteed access to a MediGap plan?

No. The birthday rule only applies to switching between Medigap plans.

 

[flyoverstate]

Loss of a group/individual Medicare Advantage plan through no fault of your own creates a federal Medigap guarantee issue right. While the federal regulations do not include Plan N, a few states and carriers are more consumer friendly and include N on their GI lists.

That is interesting. If you google around, you'll see that there are many, many MA plans being discontinued across the country. The wording is ambiguous enough that if a provider ends the plan you like, but still offers a different MA plan that is not good, can you be pushed to the "not good" plan? And what is "your area"? Our medical center is 20 minutes away, with an associated clinic closer. If the MA plan pulls out of that system, but is still allowing care an hour away, are we forced to go an hour? After seeing what happened in Durango, CO last year, where the only local hospital had a fight with the largest insurer in the area, I'm am very aware of the shenanigans these entities are willing to pull. People were without coverage for three weeks.

MA plans seem to be aimed at urban areas. Unfortunately, my wife's state pension quit providing Medigap subsidies, so you use the *one* MA plan available in our area, or you get nothing. We are going on our own. MA plans are a trap.

 

[MBSC]

If you google around, you'll see that there are many, many MA plans being discontinued across the country. ... And what is "your area"? Our medical center is 20 minutes away...

The plan "stops giving care in your area" means the plan itself is no longer available in your county. The articles you found probably mention Humana pulling out of some areas. That falls under this category since they didn't leave the entire MA program (first bullet).

The wording is ambiguous enough that if a provider ends the plan you like, but still offers a different MA plan that is not good, can you be pushed to the "not good" plan?

An example may be Humana (or a former employer) dropping a PPO plan and keeping their HMO plan.
The PPO members receive a notice of plan termination with an explanation of their Medigap GI rights. It may say they will put you in the HMO unless you take action. The key is receiving a notice of MA plan termination that you can provide to the Medigap carrier.

If a carrier has two PPO plans using the same provider network, they may consolidate them during annual enrollment. You could receive a "crosswalk" letter instead of a termination letter. You may think certain parts of the new plan are worse, but CMS thought they were close enough to approve the crosswalk. You can switch to any other MA plan during annual enrollment.

 

[gauss]

I turn 65 in a few months...

3. Finally, many of my colleagues seem happy as clams staying on the Boeing supplied Advantage plan, and it does have pretty good benefits and low costs. Does anyone here have any direct experience with it? Recommendations and advice would be welcome.

The problem with this line of reasoning is that young folks (ie age 65-70) tend to be healthier and thus benefit from the relatively small perks offered by MA plans.

As one enters end of life and large medical charges start to incur, MA plans tend to ramp up their delay/deny tactics to ration care and create the "savings".

I saw this first hand with my late mother when her employer provided MA plan denied her in-house rehab after prescribing 24-hour oxygen treatment. The hospital health care team did not support this and resubmitted documentation to insurance company a second time. A second denial came quickly.

She was on the dementia path already so this did not work out so well and she was dead within a month after leaving the hospital.

FWIW she was happy with her MA plan in the early years.

You have to look at the full life-cycle of MA plans to properly assess.

-gauss

 

[flyoverstate]

The plan "stops giving care in your area" means the plan itself is no longer available in your county. The articles you found probably mention Humana pulling out of some areas. That falls under this category since they didn't leave the entire MA program (first bullet).

An example may be Humana (or a former employer) dropping a PPO plan and keeping their HMO plan.
The PPO members receive a notice of plan termination with an explanation of their Medigap GI rights. It may say they will put you in the HMO unless you take action. The key is receiving a notice of MA plan termination that you can provide to the Medigap carrier.

If a carrier has two PPO plans using the same provider network, they may consolidate them during annual enrollment. You could receive a "crosswalk" letter instead of a termination letter. You may think certain parts of the new plan are worse, but CMS thought they were close enough to approve the crosswalk. You can switch to any other MA plan during annual enrollment.

What I was referring to was this: ‘Very angry’ patients await resolution of Mercy, Anthem dispute

Blue Cross, and the *only* medical system in Durango, CO, had a dispute over their contract, and hung thousands of people out to dry for three weeks. They eventually came to terms, but imagine you were in that situation?

As you confirmed, they can force you into another plan if they bribe or coerce the administrators to deem the new plan as "equivalent", but certainly they aren't, since the insurance company wouldn't be withdrawing a plan and forcing people into a different one for no reason. I have heard of people signing up for MA plans because they got health club memberships, dental, etc., and then those little bennies were removed.

I think the bloom is off the rose of MA plans.

 

[Out of Steam]

Blue Cross, and the *only* medical system in Durango, CO, had a dispute over their contract, and hung thousands of people out to dry for three weeks. They eventually came to terms, but imagine you were in that situation?

One of the things we like about where we moved at retirement is that it is big enough to have three different medical systems. Both my wife and I have at least one doctor affiliated with each.

 

[Crewer]

My retiree medical benefit switched to an Advantage plan about 4 or 5 years ago. I pay one bit and my former employer pays two bits for it. I live in a metro area with at least 3 separate large, high-quality hospital systems and DH and I have not had any problem accessing any care. Also all our meds are covered with fairly low copays. DH had at least 5 MRIs during a hospitalization a couple of years ago including a high res one and it was all covered. Our out of pocket max isn't as low as AT&Ts but is only $2k and that's all we paid that year. I understand that I can opt out of the Advantage plan during an enrollment period but once I go out I cannot go back in during a later enrollment period. Before you enroll can't you see what docs and hospital systems (and meds) will be covered in the Boeing plan?

I agree the Advantage plans probably cherry pick toward younger enrollees.

 

[RetiredHappy]

We've been on the AT&T Medicare Advantage Plan for 2 years now. We were nervous about this but so far it's been fine. We have had no major illnesses but some testing done ie, MRI, colonoscopy, ultrasound, plus routine physicals/blood work/vaccines. We do have copays for office visits but we pay nothing for the insurance and it has a $900.00 per year maximum out of pocket. We also take advantage of the free gym membership for which we were previously paying $100 per month. My sense is the employee sponsored Medicare Advantage Plans are better than those offered on the open market.

The key is you have had no major illnesses, yet. As long as I can afford to pay for Medigap plans, I would not go on Advantage plans.