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

[John Galt III]

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

The attraction of 'N' for me is that even though it doesn't pay excess charges for Part B, which would be 20% of the allowable amount, my state (Pa) does not allow the patient to be billed the 20% excess charges anyway, so no worries. I could be wrong, but I read that somewhere.

 

[bmcgonig]

Considering the price of Medigap insurance I would choose it. There's a possibility that we all will someday want the "best surgeon/specialist available". And our advantage plan will probably not cover that. In my own case I have AFib. At some stage I probably will need an ablation. This can be a simple surgery or a complex one. The outcomes and complications vary considerably according to the experience of the EP doing the job. I don't want a guy who had done 100 of these when I can use a guy that had done 10000 for the same price. Why be limited when the cost is so little (relatively) yet the opportunity cost so high?

 

[John Galt III]

My gf and my parents are/were on advantage plans, for the lower premiums. My father and my gf ended up with high out of pocket expenses some years (nearing but not reaching the $6,700 annual deductible), so would have been better of with a supplement, right? Would a supplement say, Plan G, have saved them those out of pocket expenses?

 

[REWahoo]

The attraction of 'N' for me is that even though it doesn't pay excess charges for Part B, which would be 20% of the allowable amount, my state (Pa) does not allow the patient to be billed the 20% excess charges anyway, so no worries. I could be wrong, but I read that somewhere.

The excess charge limit is 15%, not 20% but you are correct about Pennsylvania. They are one of several states that prohibit excess charges for part B:

Connecticut.
Massachusetts.
Minnesota.
New York.
Ohio.
Pennsylvania.
Rhode Island.
Vermont.

Anyone living in one of those states should seriously consider Plan N.

Even where allowed, excess charges are relatively rare.

 

[H2ODude]

Plan N because we travel and have heard too many horror stories of getting gigged by out of network services, one by my primary care p when he had a heart attack out of town. We don't use much healthcare thankfully but have been hit with a few of those excess charges (NC). We just pay whatever comes in on a second notice and assume it's legit. Trying to understand all the paper they send on this stuff is more difficult than analyzing taxes and when to take SS. So I don't do either.

 

[ivinsfan]

When trying to decide Medigap or Advantage ask yourself why Advantage has no underwriting for health conditions. If you have end stage renal disease you can't enroll but anyone can enroll without underwriting.


During open enrollment you can go from a Medigap to Advantage at will but not the other way around. This tells me the insurance WANTS you in an Advantage plan. Did you know the Fed government gives the Advantage company a monthly payment for insuring you and not using original Medicare in the state of MN they pay something like 660 a month per person to the insurance company.. you might like your Advantage network now but the company can change the network at will and then you are stuck.

 

[Fedup]

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.

Thank you for your post. I didn’t know one has to go through underwriting for the supplement. If my sister already has lots of health issues, I think I should at least mention this to her. The low premium from the Advantage plan can be misleading.

 

[ivinsfan]

Thank you for your post. I didn’t know one has to go through underwriting for the supplement. If my sister already has lots of health issues, I think I should at least mention this to her. The low premium from the Advantage plan can be misleading.

IMO this is what makes the initial signup for a supplement so difficult...you have 6 months from your turning 65 or going on Medicare age to pick anything but you could have a lifetime of second guessing if you make the wrong choice.

 

[Huston55]

TriCare now.

Medicare + TriCare @ 65.

 

[Texas Proud]

I am still a few years away from having to decide, but went to look at Humana as that is what my sister and mom have...


Funny thing is when you click on the link to show supplemental plans they show 12 plans and NONE are supplemental!! They have HMO, SNP, POS, PPO and PFFS plans. I do not know what all these letter mean. Cost is mostly zero... with most PPO costing a bit and the PFFS costing over $100 per month...


If you want a supplement you have to call...



So far the HMO plan has been pretty good for my mom... she has used a lot of care this year and her copays etc. have not been out of hand...

 

[ivinsfan]

They can offer some plans for zero because they have a big pool and are getting a monthly payment for each individual from the government. In my state the Humana PPO was 98 a month...it can make the decision harder when you get Advantage for nothing ..in a PPO Humana has a huge nationwide network that you can use when you travel for in network prices

 

[REWahoo]

IMO this is what makes the initial signup for a supplement so difficult...you have 6 months from your turning 65 or going on Medicare age to pick anything but you could have a lifetime of second guessing if you make the wrong choice.

+1

Going with an Advantage Plan may lock you in to that choice for the rest of your life. Choosing a Medigap Plan offers you the flexibility of switching to an Advantage Plan at some later date should you feel the need to do so.

 

[Texas Proud]

They can offer some plans for zero because they have a big pool and are getting a monthly payment for each individual from the government. In my state the Humana PPO was 98 a month...it can make the decision harder when you get Advantage for nothing ..in a PPO Humana has a huge nationwide network that you can use when you travel for in network prices

Interesting... the PPO plans here are $15, $45, and $87. Looking at the comparison I do not see any big advantage to the higher price plans... maybe the networks are bigger, but that is not shown in the comparisons...




Here is a link to something I saw on AARP that had a quick table about the plans... very informative IMO as I do not know what all the letters are for...





https://dhwyucd0wi8y4.cloudfront.net/pdf/aarp-plan-comparison-guide/WB25918TX (07-16)_yMVF.pdf

 

[Fedup]

Interesting, I did read the Medicare book page to page and I don’t recall it mentions anything like this, otherwise I would know. I did remember it states, it only pays 80%, we have to pay 20%. So that’s why I’m glad we have BCBS from the Federal government as a supplement. And this second insurance also covers us when we travel, so no travel insurance.

 

[ivinsfan]

HMO are very restrictive I couldn't really recommend them to anyone that has the money for a different plan

 

[Katsmeow]

Interesting, I did read the Medicare book page to page and I don’t recall it mentions anything like this, otherwise I would know. I did remember it states, it only pays 80%, we have to pay 20%. So that’s why I’m glad we have BCBS from the Federal government as a supplement. And this second insurance also covers us when we travel, so no travel insurance.

The 20% co payment and things like that are why people get a supplement. Different supplements cover different amounts.

Look at this link:

https://www.medicare.gov/supplement...can-i-buy-medigap/when-can-i-buy-medigap.html

"The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more."

Note that you don't have to go through underwriting for the supplement if you do it during the initial enrollment period (or at any of the times when an exception applied. From the link above:

"If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below."

 

[MichaelB]

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?

I had decided on UHC/AARP G, with the intention of changing to G Hi-D when announced. UHC recently announced they no longer will allow these changes to the Medicare Supplemental plans without underwriting. http://www.early-retirement.org/forums/f38/aarp-uhc-medigap-plans-f-g-87496.html#post2100462

Update: UHC/AARP is revising their internal policy of allowing existing members to downgrade from Medigap plan F to G without underwriting. It looks like courtesy downgrades to Plan N will still be allowed.

Starting October 1, 2018, members currently enrolled in an AARP® Medicare Supplement Insurance Plan, including Medicare Select Plans, insured by UnitedHealthcare® Insurance Company, residing in all states and territories EXCEPT CA, CT, FL, GU, MA, ME, MN, MP, NY, OR, VI, VT, WA, and WI who wish to change to Plan G will now need to complete a new application and answer all medical underwriting questions to determine a premium rate. This new underwriting policy is in response to UnitedHealthcare’s efforts to maintain stable Plan G premium rates and product competiveness.

Reference: Alert: New Underwriting Policy for AARP Medicare Supplement Insurance Plan G

Back to the drawing board for me. Will probably go for either UHC or BCBS G plan.

 

[audreyh1]

I had decided on UHC/AARP G, with the intention of changing to G Hi-D when announced. UHC recently announced they no longer will allow these changes to the Medicare Supplemental plans without underwriting. http://www.early-retirement.org/forums/f38/aarp-uhc-medigap-plans-f-g-87496.html#post2100462


Back to the drawing board for me. Will probably go for either UHC or BCBS G plan.

Would you go through AARP or directly with UHC for their plan?

 

[ShokWaveRider]

I had decided on UHC/AARP G, with the intention of changing to G Hi-D when announced. UHC recently announced they no longer will allow these changes to the Medicare Supplemental plans without underwriting. http://www.early-retirement.org/forums/f38/aarp-uhc-medigap-plans-f-g-87496.html#post2100462


Back to the drawing board for me. Will probably go for either UHC or BCBS G plan.

"Starting October 1, 2018, members currently enrolled in an AARP® Medicare Supplement Insurance Plan, including Medicare Select Plans, insured by UnitedHealthcare® Insurance Company, residing in all states and territories EXCEPT CA, CT, FL, GU, MA, ME, MN, MP, NY, OR, VI, VT, WA, and WI who wish to change to Plan G will now need to complete a new application and answer all medical underwriting questions to determine a premium rate. This new underwriting policy is in response to UnitedHealthcare’s efforts to maintain stable Plan G premium rates and product competiveness."


Does this statement mean that Florida does not have to have underwriting for the change? As mentioned before when I called them 3 weeks ago it was OK. So Confusing.....

 

[MichaelB]

Would you go through AARP or directly with UHC for their plan?

Great question. I don’t know what the difference is between the AARP/UHC https://www.aarpmedicareplans.com and UHC Medicare https://www.uhc.com/medicare. By law, the plans are the same, and at least in the State of Florida, they appear as UHC in the State Medicare info website The UHC Medicare website uses the same policy name

AARP® Medicare Supplement Insurance Plans Insured by UnitedHealthcare Insurance Company (UnitedHealthcare)

When signing my brother to the UHC/AARP plan D, I recall issues setting up autopay.

 

[MichaelB]

Does this statement mean that Florida does not have to have underwriting for the change? As mentioned before when I called them 3 weeks ago it was OK. So Confusing.....

Yes, it is confusing. The only info I have on this is from the thread I linked. Because of that, I am not counting on being able to change policies without underwriting once I enroll. In pre-ACA Florida I was denied insurance by both BCBS and UHC due to preexistíng conditions, so I expect the same outcome in the future if a plan requires underwriting.

Based on some Medicare threads here, I am also looking at MediGap N. The price difference is $50 per month, or $6K over 10 years.

 

[audreyh1]

Great question. I don’t know what the difference is between the AARP/UHC https://www.aarpmedicareplans.com and UHC Medicare https://www.uhc.com/medicare. By law, the plans are the same, and at least in the State of Florida, they appear as UHC in the State Medicare info website The UHC Medicare website uses the same policy name

When signing my brother to the UHC/AARP plan D, I recall issues setting up autopay.

I just wondered if there was any benefit to signing up through AARP rather than directly, as I am not a member of AARP.

 

[Katiek]

Has anyone purchased supplemental insurance through a private exchange from their employer? My megacorp gives employees a certain amount in a nominal account that you can use to purchase insurance either from megacorp (prior to medicare eligibility) or from a private exchange after medicare eligibility.


My concern is that I don't know much about the exchange, and if I sign up for a supplemental plan with them, and then don't like it, I won't be able to change plans without medical underwriting.

 

[Another Reader]

Has anyone purchased supplemental insurance through a private exchange from their employer? My megacorp gives employees a certain amount in a nominal account that you can use to purchase insurance either from megacorp (prior to medicare eligibility) or from a private exchange after medicare eligibility.


My concern is that I don't know much about the exchange, and if I sign up for a supplemental plan with them, and then don't like it, I won't be able to change plans without medical underwriting.

Lots of companies and agencies use Via Benefits/One Exchange. They offer some to all of the plans offered in your state. My agency apparently offers a fairly broad variety of plans and I am probably going to sign up for the UHC/AARP Plan F through them. The price is the same as on the AARP plan page of the UHC website. Look at what they offer before you decide.

 

[ShokWaveRider]

I called UHC today. Things are changing. They used to allow changing between plans (In Florida and some other states). They WILL do Underwriting in the future when changing Medigap Plans, especially when Plan F is discontinued in 2020 and folk want to go to plan G. (Even though it says not so on the website for Florida and some other states).

There is an exception, If one chooses a Medicare Advantage Plan for the FIRST year one is on Medicare (in the 6 month enrollment period) one gets 1 year trial, again this is ONLY for Advantage plans, then if after a year (10 - 11 months actually) one does not like it, one can change to a Medigap plan (Plan G for example) without underwriting providing one notifies UHC of the decision 60 days prior to changing.

That is what I understood at least. The rep said anything can change from one year to the next, but that it what is current.