Employer pushing retirees to Medicare Advantage

[FargoI]

Hello. The City of New York is aggressively working to transition municipal retirees away from an employeer sponsored Medigap supplemental plan to a group Medicare Advantage plan Administered primarily by a BCBS affiliate know as Empire BCBS.

1- looking for insights into folks who were "promised" traditional supplemental plan and later "transitioned" as cost savings into retiree medicare group Advantage plan.

2- looking for insights into the love hate relationship with medicare advantage plans. Do you love your MAP or hate it and why?

Thanks
Stay safe and well

 

[RobbieB]

Love it.

 

[W2R]

Hello. The City of New York is aggressively working to transition municipal retirees away from an employeer sponsored Medigap supplemental plan to a group Medicare Advantage plan Administered primarily by a BCBS affiliate know as Empire BCBS.

1- looking for insights into folks who were "promised" traditional supplemental plan and later "transitioned" as cost savings into retiree medicare group Advantage plan.

2- looking for insights into the love hate relationship with medicare advantage plans. Do you love your MAP or hate it and why?

Thanks
Stay safe and well

I don't have a Medicare Advantage plan, but my boyfriend does. He loves it! It pays reasonably well for his medical care, and also pays for his Medicare Part B, plus free gym fees and around $40/month (or is that every 3 months? I forgot) of free OTC medical purchases of his choice. He does have to pay a percentage of his prescription drug costs. In his case, all his doctors, labs, and hospitals were already included in the Medicare Advantage plan.

I think that most Medicare Advantage plans are not that good, though. Many people do not like them. But here, we are lucky enough to have the one he chose. I'd say that of the middle class retirees that we know who didn't have a plan from work, about 80% chose this same M.A. plan. It's very popular here. I think that it is just local only, and if we moved away (which we do not plan to do) he might have to find another plan.

In my case, I am sticking with my federal employee/retiree health insurance plan which I like, and it converted to a Medicare supplement when I turned 65. It is not Medicare Advantage.

 

[Scuba]

Medicare Advantage is like an HMO. Cheaper than traditional Medicare plus supplemental plans, but less choices of providers. I’m all about choice so I will avoid Medicare Advantage unless I cannot afford other options.

 

[Bamaman]

The way I read it, the primary physician gets paid $X per month no matter how many times per year he sees you.

And the paybacks to specialists are very low--which means independent physicians may not accept you as a patient. In many communities, Advantage members may have to see doctors that come from med schools in other countries.

One of two dominant hospital chains close to me refuses to accept Medicare Advantage patients in their hospitals, clinics and they don't allow their 1,700 physicians in their employ to take it either. That means many patients in small towns are having to leave home to go to new doctors and to other hospitals--50 to 100 miles away.

Advantage plans are being advertised heavily on television and by direct phone marketers. That alone makes me question whether it's good for everyone.

I'm diabetic on an insulin pump and glucose monitor, and my supplies are quite expensive. My wife has terrible arthritis and a very bad back. She's had 7 surgeries in 3 years and is under pain management. We have chosen Plan F for our supplement, which includes 100% coverage on durable goods (for me.) And we haven't seen any substantial bills for years.

We choose to do business with the best local hospital and specialist physicians in our community.

 

[Teacher Terry]

Once you go on a advantage plan you can’t go back to regular Medicare unless you pass medical underwriting. Also if you have a disease they can make you go through steps one by one to see if it helps. By the time you get to the treatment you need it may be too late. It’s called step therapy. They save money by not spending it on you.

 

[Bryan Barnfellow]

Reading the negative comments gave me a shiver today. Yikes!

-BB

 

[Dtail]

My DGF is on a Medicare Advantage plan and it is accepted by all her preferred doctors here.
Since she has been on it and is on disability, I think at age 65, she could go back to regular medicare, but not sure.

 

[MichaelB]

My DM’s retirement health plan was changed from an employer paid Medigap and Plan D to Medicare Advantage without prior notification. A decade later, the net effect of the change is not easy to measure. There really has been no change for her.

There are many varieties of Medicare Advantage plan. Some offer networks that include all providers enrolled in Medicare. Others are small HMOs. To properly understand the impact to the OP we would need to see the specific plans offered.

 

[FargoI]

In this nyc municipal employee plan annual transfer between plans without medical underwriting will be permissible.

The network is Anthem Blue national provider network + any Medicare participating facility/ provider who accepts Medicare assignment or accepts Medicare reimbursement at the elevated 115% rate. Non participating Medicare providers are not covered.

Zero premium
$1450 MOOP.
$15 specialist copay
$15 lab, imaging copay
NYC reimburses Part B + as applicable IRMAA...unless one opts totally out of their sponsored plans and purchases from free market* (e.g. AARP).




*Note: at first blush, free market supplement plan are significantly less expensive than the NYC community rated supplement plan. That said, part B reimbursement with IRMAA reimbursement more than levels the field...especially for the upper income folks. And spousal part B is permissible.




I worked FT in Healthcare for 40+ years as didvmy wife. I've been brainwash ( not quite) to NEVER enroll in any Advantage Medicare program. Yet we have friends and neighbors including retired physicians who love their GMA plans.

The initial, inaugural year, new premium to remain in a ~ Plan F will be ~$200@ ( retiree and spouse). Deductibles as indicated above are being added for first time. There is no MOOP with original Medicare supplemental plan. The supplemental plan has no perks but historically pays or works very well as a COB with parts A and B. Prescription Drug plan is separate plan with added costs and administered by Express Scripts. Absolutely no way to easily compare the Prescription drug plan as one can not predict the medications they will need in the future only current state and in the past

For those familiar with Advantage plans, and forgetting about the CMS poorly run STAR rating program...what are people hearing or experiencing with Anthem Blue Cross Blue Shield affiliated Advantage programs? Are the media promoted pre authorizations for expensive treatments and testing literally one off episodes or are they the means by which Advantage plan executive garner their multi million dollar salaries...on the backs of unsuspecting subscribers? Thank you to all for weighing in. I'm happy to peel the onion as far bsck as folks in this community have interest/tolerance. Stay safe stay well. Regards from South Central PA

 

[FargoI]

BTW...they are doing exactly that...moving everyone from Medigap to Advantage unless one manually opts out and agrees to pay a new premium for the employer sponsored functional equivalent of plan F. I researched this and absolutely CMS allows for this conversation methodology. As people learn about these tricks of the trade it only makes them more suspicious and angry with the DC politicians on both sides of the isle.

 

[MRG]

My DGF is on a Medicare Advantage plan and it is accepted by all her preferred doctors here.
Since she has been on it and is on disability, I think at age 65, she could go back to regular medicare, but not sure.

+1

DW is on disability and gets Medicare with it. You can pay for a supplement but it's very expensive pre 65. At 65 she can convert to a reasonably priced supplement or stay on advantage. We'll opt for a supplement.

 

[MichaelB]

All Medicare Advantage plans are required to offer the same coverage as traditional Medicare.

If this Advantage plan is a PPO there is no requirement for pre-authorization, and network is all providers that accept Medicare.

The two big differences between this Medicare Advantage and traditional Medicare + Medigap are 1) the MA plan has more cost sharing and total out of pocket, and 2) The MA plan also covers prescription drug, while the traditional Medicare / MediGap requires a separate Plan D drug plan.

The cost impact of the drug coverage may be substantial but differs for each individual.

In this case, from a distance it looks like the biggest impact is not coverage, it’s greater cost sharing.

 

[athena53]

BTW...they are doing exactly that...moving everyone from Medigap to Advantage unless one manually opts out and agrees to pay a new premium for the employer sponsored functional equivalent of plan F. I researched this and absolutely CMS allows for this conversation methodology. As people learn about these tricks of the trade it only makes them more suspicious and angry with the DC politicians on both sides of the aisle.

Well, you're better off than my brother who ER'd and was informed in late 2017 that retiree health insurance was no longer provided as of 1/1/2018. He and my DSIL were 61. They're FINALLY Medicare-eligible but their premiums for ACA in 2018 totalled $22,000 and they didn't qualify for subsidies.

Anyway- my BF works for a hot line for Medicare beneficiaries and he's dead set against Advantage Plans. He's gotten too many calls from people upset with the limited networks and the step therapy. My Dad was aggressively sold a Medicare Advantage and despite BF's admonitions he switched. Fortunately there was a trial period during which he could change back and he did.

 

[FargoI]

Thanks. With a MOOP max of $1450 /year, on the surface that offers a good stop loss for the subscriber.

 

[FargoI]

For those that "love it" without disclosing sensitive personal information has the MA plan met or exceeded expectations when faced with serious injury, or medical condition diagnosed or during rule out phase of assessment?

There is no shortage of people who love products including or especially autos until the test drive is complete.

 

[FargoI]

Thank you. Sorry your loved ones have experience...this wave is sweeping the country.

Insightful information on MA plans. Appreciate your sharing

 

[MissMolly]

For those that "love it" without disclosing sensitive personal information has the MA plan met or exceeded expectations when faced with serious injury, or medical condition diagnosed or during rule out phase of assessment?

There is no shortage of people who love products including or especially autos until the test drive is complete.

We have an employer provided retiree MA PPO plan. We have a $1,200 MOOP/per person. Last year my husband had x-rays, MRI, rotator cuff surgery and months of PT. Once we hit the MOOP we didn't have to pay another penny. This year I had x-rays, MRI, CT myelogram, carpal tunnel revision surgery, PT as well as some other misc. doctor appointments with the dermatologist and a visit to the Express Clinic for a UTI. I have not yet hit the MOOP of $1,200. My coverage is free under our retirement system. My husband's coverage costs $77/month. Our plan also covers prescription drugs, Silver Sneakers, 2 visits to the dentist for routine cleanings and some sort of coverage for fillings (not real sure about this without looking it up). So yes, I'm satisfied with our MA plan.

 

[Jerry1]

I’ve always understood one of the disadvantages to an advantage plan is for those who travel - especially snow birds. Advantage plans have agreements with local providers. I’m not sure how they handle out of state issues. Especially if they are non-emergency.

I’m not there yet, but if I was being pushed into Medicare advantage, I’d look into what it would cost to stay on Medicare and pay for a supplemental plan. Maybe it would still be employer sponsored/subsidized but just at a lower level. I think I’d be okay with that.

On thing is for certain, the employer is not pushing to get you on an advantage plan to benefit you. Definitely something to study carefully before you change. I’m not sure if what TT said is correct (probably is), but if it wasn’t automatic to be able to go back on Medicare, I’d be very reluctant to get off regular Medicare in the first place.

 

[MichaelB]

I’ve always understood one of the disadvantages to an advantage plan is for those who travel - especially snow birds. Advantage plans have agreements with local providers. I’m not sure how they handle out of state issues. Especially if they are non-emergency.

Medicare Advantage plans can be either HMO or PPO. Major insurers, such as United Healthcare, offer MA PPO plans that have the same nationwide networks as traditional Medicare and require no preauthorization.

They also offer HMOs with limited local networks and preauthorization requirements.

 

[sengsational]

As my parents aged, they had things to address, and, being from Minnesota, and my mom working at the Mayo Clinic, they'd just do a trip there and have a full work-up on the medical issue at hand. I believe if you want to do something like that without paying for it all yourself, you need to have traditional Medicare. I'm willing and able to pay for flexibility, so that's the direction I'm headed, when the time comes.

 

[FargoI]

Thanks. I worked FT in Healthcare so yes, I'm researching from every conceivable angle including this fabulous group.

The Anthem network is literally nationwide and the plan offers international emergency and urgent care.

The big downside to any or many GMA plans is they move authorizations to the front of the cycle whereas CMS Medicare reserves the right to audit retrospectively and claw back money from providers. All comments and insights are greatly appreciated. Would be especially interested in hearing about Anthem. BCBS, Highmark or interrelated brother and sisters insurance companies

 

[txtig]

My former company offered reimbursement to its retirees Goethe costs of their Medigap plans. This benefit was one of the most favored ones for retirees. When Megacorp sought to reduce their health insurance costs, they didn’t settle for trying to push us into cheaper MA plans. They pulled the rug out from under us by cutting out all reimbursement for health costs. Zero!

 

[Crewer]

I didn't think my retiree medical plan was guaranteed (didn't think any were) and wasn't surprised when they transitioned to the Advantage plan. Better they save money than cancel completely. The Advantage plan is administered by Aetna.
We haven't noticed a difference but we do still pay something for it and our copays and I think MOOP are lower than for my brother and sister-in-law's Aetna plan. We can go where Medicare is taken and don't need preauthorizations. DH makes appointments with specialists without seeing the PCP first, for example. We do have to use Express Scripts mail order pharmacy after our first prescription for something but the first Rx can be filled locally. I live in Ohio but needed emergency services when I broke a bone in AZ and all that was paid directly by insurance except for the copay, of course. The plan will still cover some emergency stuff overseas but we do buy an extra plan that includes medical evacuation when we travel overseas. I don't see any loss of flexibility with the Advantage plan. I hope my former employer keeps the retiree coverage and we plan to stay with whatever they subsidize even if subsidies decrease.

I said we haven't noticed a difference but I think Aetna may be taking over what the doc's office used to do. I figure it's more cost savings. I got an unsolicited colon cancer screening kit, for example. My PCP didn't have it in his records.

 

[FargoI]

That's horrible. Unethical, immoral capitalism is out of control.