Employer pushing retirees to Medicare Advantage

[FargoI]

Thank you - excellent insights. Have you experienced any "gatekeepers" questioning your board certified physician recommendations for PT, OT or advanced imaging studies verses traditional low cost x-rays.

 

[MissMolly]

Thank you - excellent insights. Have you experienced any "gatekeepers" questioning your board certified physician recommendations for PT, OT or advanced imaging studies verses traditional low cost x-rays.

If you are asking me, no, there were no issues. The doctors/PT got preapproval of course, but there was never any problem since approvals were given very quickly. X-rays don't always give the information you need. They work for diagnosing problems with bones, but not soft tissue. Our problems were not in our bones, but in tendons and nerves and whatnot. I also have problems with severe arthritis in my thumb. That was diagnosed with an x-ray. Dr has recommended joint replacement, but I have yet to make that decision. I don't anticipate any issues with the insurance should I decide to go forward with this. The arthritis/bone spurs/joint deformation is very evident on the x-rays.

 

[teej1985]

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.

Sure you can. You move to a state with open enrollment rights.

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.

It's secondary insurance, not medicare supplement. Your FEHB covers things that medicare does not cover, like physicals.

 

[Scratchy]

Once you go on a advantage plan you can’t go back to regular Medicare unless you pass medical underwriting.

You can go back to original medicare with no medical underwriting during enrollment periods or upon any one of a number of qualifying events.

https://www.medicareresources.org/medicare-eligibility-and-enrollment/how-do-i-change-my-medicare-coverage/

 

[youbet]

My DW is in a PPO MAP. I have traditional Medical plus a Plan F supplement. I've compared them in actual use over several years. It's pretty much a toss up if I toss out the premium supplement she gets from her pre-retirement employer partially covering her premium.

 

[Katsmeow]

I have a relative with a Medicare Advantage plan. A few years ago she needed to go to rehab (broken hip). She went to a couple of places that her family did not like at all. But, she was limited in her choices. My mom had traditional Medicare and supplement and at the same time needed to go to rehab. She could choose where to go based simply on whether they accepted Medicare. My family member was envious at the place my mom could go to because she had wanted it for the family member with Medicare Advantage but the insurer wouldn't approve it.

Look, the negatives of Medicare Advantage plans are largely common sense. The government pays a defined amount to insurance companies for each patient. MA plans are being pushed by insurance companies and many providers. Why? It is financially beneficial to them. It is not financially beneficial to patients.

Most of the people I know who like their MA plans fall within a couple of groups:

1. They are healthy and never hit anywhere close to their out of pocket max. That is fine and many who are fairly new to Medicare are quite healthy. But, people tend to get less healthy as time goes on. Those out of pocket maximums can easily later on far exceed what you pay under traditional Medicare and supplement. They also can't imagine that they might want to ever go back to traditional Medicare and assume they could pass underwriting if they needed to (but that isn't a given).

2. In addition to above, they are mentally sharp and easily able to navigate finding doctors in network and tracking co-payments, etc. When my mom was in her late 80s and early 90s that would have been beyond her (and she was relatively sharp for her age). Traditional Medicare with Supplement G was easy. She paid her premiums and paid her Part B deductible each year and then she was basically done on her medical care and payments and she didn't have to worry about networks.

3. Some people think a doctor is a doctor and a hospital is a hospital. That is, they assume that every provider is as good as any other provider and so they don't care if they can't go to the "best" provider. Other people want more choice. (Yes, I know PPO's exist but that may cost you and not really be an option).

If I was 100% sure I could switch back to traditional Medicare and could get a supplement and I didn't think I was likely to need care and the PPO was good then I could see trying Medicare Advantage. But I don't feel that certainty is there.

 

[youbet]

she didn't have to worry about networks.

It seems like many posters are not reading MichaelB's very helpful posts. MA plans are not all the same and when posters grab an anecdotal example of one particular plan and broaden it's benefits to all MA plans they're doing everyone a disservice. Many MA plans give you access to any doc and medical service which accepts traditional Medicare...... No network. They are frequently group MA plans associated with an employer or an union.

Kat, I have no problem with your account of your relative's experience with a particular MA plan other than you should have added something like "this was my relative's MA plan and others will differ."

 

[Telly]

You can go back to original medicare with no medical underwriting during enrollment periods or upon any one of a number of qualifying events.

https://www.medicareresources.org/m...ollment/how-do-i-change-my-medicare-coverage/

The issue isn't "going back to Original Medicare" per se, it's the passing medical underwriting to get a Medigap Plan. And a person may "pass" underwriting, but the plan's sponsor can chose medical issues to put the person in at a higher rate class. For a given geographical plan/rate area, insurance providers can have multiple rate classes. When I had a CSGActuarial login a few years ago, I was surprised to see all the different rate classes insurers had! I had wondered why there were so so many "Plans" for my area! Looking through them, I found out why...

In the link you attached, one needs to scroll way down to the heading "Changing Medigap Coverage" to see it. Ain't many choices! The bailing out during the first year MA "trial period" to me is of limited value. How many people in their first year of Medicare, going the MA route, know they made a mistake that soon? I wouldn't think that many. Yeah, there are a few states that don't allow underwriting, but I would think the piper has to be paid one way or another.

 

[Scratchy]

The issue isn't "going back to Original Medicare" per se, it's the passing medical underwriting to get a Medigap Plan. And a person may "pass" underwriting, but the plan's sponsor can chose medical issues to put the person in at a higher rate class. For a given geographical plan/rate area, insurance providers can have multiple rate classes. When I had a CSGActuarial login a few years ago, I was surprised to see all the different rate classes insurers had! I had wondered why there were so so many "Plans" for my area! Looking through them, I found out why...

In the link you attached, one needs to scroll way down to the heading "Changing Medigap Coverage" to see it. Ain't many choices! The bailing out during the first year MA "trial period" to me is of limited value. How many people in their first year of Medicare, going the MA route, know they made a mistake that soon? I wouldn't think that many. Yeah, there are a few states that don't allow underwriting, but I would think the piper has to be paid one way or another.

Thanks for this. I have a relative who is on an Advantage plan and may have to move to assisted living, as she has some medical issues affecting her ability to function independently. I was going to encourage her to switch to original Medicare. She is in California and my impression is that would give her greater choices in providers. However, if she had to go through medical underwriting to get a Medigap plan that would not be a good thing. Will have to look at this more carefully. Thanks for the heads up.

 

[braumeister]

FargoI, unless you quote the comment you're replying to, it's confusing to others reading this thread. Much better to hit the Quote button, then edit out all but the specific part you're responding to.

 

[eytonxav]

Medicare Advantage plans are heavily advertised which is not the case for gap supplements. What does that tell ya?

 

[FargoI]

MAP vs Medigap

"The issue isn't "going back to Original Medicare"

Thank you to all for sharing thoughts on Medicare Advantage.

Where there is 'guaranteed' issue and no medical underwriting to switch between company sponsored retiree Medigap and MAP in conjunction with the sponsor's open enrollment timeline, has anyone taken advantage of an employer's 'trial' run period ...enrolling and subsequently un- enrolling and possibly enrolling yet again over a course of years?

 

[Boose]

Anecdote: my mom (age 69) opted for a supplement/Medigap plan although she is quite frugal and had excellent health. Long story short, she was diagnosed with an unusual presentation of cancer and was able to transfer her care to Dana Farber after the local hospital screwed up her initial MRI. This wouldn't have been an option with the Advantage plans available in her area. Dana Farber's care plan was.more proactive than the local hospital's, and, three years layer, she has no evidence of cancer or disability. She wavers sometimes on continuing the Medigap plan due to the cost, but is keeping it during her "go-go" years.

 

[VanWinkle]

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.

Medicare Advantage has PPOs in my area and they are exactly like the work
plan I had for 40 years but only cost 29.00 per month. Not all MAPs are HMO.
I am very happy with my MAP.

 

[VanWinkle]

Medicare Advantage plans are heavily advertised which is not the case for gap supplements. What does that tell ya?

That there is little competition among gap supplements as the government requires specific coverage.

 

[VanWinkle]

I would have to max out my OOP max 7 times just to equal the premiums I would pay for a gap policy. 7 years of maxing OOP and I am likely deceased. People buy zero deductible car insurance for peace of mind. That doesn't make people with 1000 ded car insurance wrong.

 

[ncbill]

I have a relative with a Medicare Advantage plan. A few years ago she needed to go to rehab (broken hip). She went to a couple of places that her family did not like at all. But, she was limited in her choices. My mom had traditional Medicare and supplement and at the same time needed to go to rehab. She could choose where to go based simply on whether they accepted Medicare. My family member was envious at the place my mom could go to because she had wanted it for the family member with Medicare Advantage but the insurer wouldn't approve it.

Look, the negatives of Medicare Advantage plans are largely common sense. The government pays a defined amount to insurance companies for each patient. MA plans are being pushed by insurance companies and many providers. Why? It is financially beneficial to them. It is not financially beneficial to patients.

Most of the people I know who like their MA plans fall within a couple of groups:

1. They are healthy and never hit anywhere close to their out of pocket max. That is fine and many who are fairly new to Medicare are quite healthy. But, people tend to get less healthy as time goes on. Those out of pocket maximums can easily later on far exceed what you pay under traditional Medicare and supplement. They also can't imagine that they might want to ever go back to traditional Medicare and assume they could pass underwriting if they needed to (but that isn't a given).

2. In addition to above, they are mentally sharp and easily able to navigate finding doctors in network and tracking co-payments, etc. When my mom was in her late 80s and early 90s that would have been beyond her (and she was relatively sharp for her age). Traditional Medicare with Supplement G was easy. She paid her premiums and paid her Part B deductible each year and then she was basically done on her medical care and payments and she didn't have to worry about networks.

3. Some people think a doctor is a doctor and a hospital is a hospital. That is, they assume that every provider is as good as any other provider and so they don't care if they can't go to the "best" provider. Other people want more choice. (Yes, I know PPO's exist but that may cost you and not really be an option).

If I was 100% sure I could switch back to traditional Medicare and could get a supplement and I didn't think I was likely to need care and the PPO was good then I could see trying Medicare Advantage. But I don't feel that certainty is there.

4. they're poor enough (i.e. had to take SS at age 62 to survive) that they can't afford anything other than a $0 premium MAP that also covers all or part of their Part B premium plus offering drug coverage.

 

[The Cosmic Avenger]

A very smart friend of mine, who I have been friends with for decades, just posted this, and I trust his judgement on it:

If you haven't heard of this group, you need to. NYC has negotiated a plan with the MLC to eliminate the current zero cost plan for Medicare-eligible retirees and replace it with a Medicare Advantage plan. The negotiation process was VERY opaque and there are still questions about the plan, making it possible that this plan is a LOT worse than the current one (although it is not impossible that it is better).

Once it is in place, it would take a miracle to go back, so a group of motivated retirees formed this organization, which is a registered corporation under NYS law (rather than just a group with no rules), to hire an attorney and put a hold on the an while we get all the information we need to make an informed decision. They also share whatever they find out.

I strongly encourage you to join this group if you are a NYC retiree or plan to be someday, get the information, and consider donating the $25 they are asking for to cover the attorney's retainer. I did. I personally know some of the people on the board and they are definitely fighting for us, not jerking anyone around.

 

[Out of Steam]

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

'

Since it is several years away, we really haven't focused on Medicare yet, but the intensity of promotion of Medicare Advantage plans, including free lunches, also gives me pause.

 

[Katsmeow]

Kat, I have no problem with your account of your relative's experience with a particular MA plan other than you should have added something like "this was my relative's MA plan and others will differ."

Well, I did. I pointed out that I did know that PPO plans exist but may cost more and may not be an option. I was also talking more generally about MA.

 

[FargoI]

Nyc map

A very smart friend of mine, who I have been friends with for decades, just posted this, and I trust his judgement on it:

Thank you for thinking of me. Suffice to say I am 'well aware' of the group and their activities.


Your friend is welcome to contact me directly if you can figure out how you and I can private message one another in this app.

Thanks again.
M

 

[RetiredHappy]

CMS (Centers for Medicare and Medicaid Services) pays $12,000 a year per person who is in a Medicare Advantage plan to the insurer. The insurer will try to manage and control cost so that they don't lose money with every patient. Hence, MA plans are generally more restrictive, including the ones which are PPO. We have found many specialists here who refuse to accept MA PPO plans, both Aetna and Humana.

Unfortunately, we were with Kaiser back when my husband turned 65 and since that was all that we had experienced, we stayed with Kaiser, which was a MA plan and did not even think about Medigap plans. We moved out of state and we wanted to get him on a Medigap plan but my husband needed medical underwriting since he had passed the 2-year mark from 65 yo to get automatic qualification. Unfortunately he was put on a higher tier and the rate was significantly more and he passed on it. He went with United Health MA HMO for the first year and that was disastrous. He moved to Aetna MA PPO for 3 years and it worked out well initially and then all of a sudden at the end of last year, Aetna removed many specialists from the PPO network. To get any orthopedist, he had to go 100 miles to see one. We were alarmed and called their call center who confirmed that we no longer had orthopedic specialists in all of Las Vegas and Henderson in Nevada. We contacted Humana outside of open enrollment period and fortunately they were able to switch my husband over to their MA PPO plan. Since then, Aetna had re-added back orthopedists to their network here. But both Aetna and Humana MA PPO plans are problematic in that many top specialists here do not take their plans. We spoke to an insurance agent last month and we will try to get my husband to a Medigap plan if one would take him, even though it will cost more than than tier 1 rate.

The bottom line is go with Medigap/Medicare Supplement plan if you have a choice or when you turn 65.

 

[jollystomper]

Interesting and useful thread for us. DW will be enrolled in Medicare in less than a year, me in late 2022. At age 65 we are pushed off of Megacorp retiree insurance and have to make a choice between Medicare + supplement or Medicare Advantage. The information in this thread is helpful to our ongoing analysis.

 

[Katsmeow]

But both Aetna and Humana MA PPO plans are problematic in that many top specialists here do not take their plans. We spoke to an insurance agent last month and we will try to get my husband to a Medigap plan if one would take him, even though it will cost more than than tier 1 rate.

The bottom line is go with Medigap/Medicare Supplement plan if you have a choice or when you turn 65.

I am personally a fall of original Medicare with supplement. However, I have a question about the PPOs your husband has been in. I know many Medicare Advantage plans are basically HMOs where you have to use in network providers. I know there are also PPO plans that some people have available to them. I thought the point of the PPO plans was that you could go to out of network providers although your cost sharing might be higher. Are you saying that some out of network providers won't see you even so?

 

[RetiredHappy]

I am personally a fall of original Medicare with supplement. However, I have a question about the PPOs your husband has been in. I know many Medicare Advantage plans are basically HMOs where you have to use in network providers. I know there are also PPO plans that some people have available to them. I thought the point of the PPO plans was that you could go to out of network providers although your cost sharing might be higher. Are you saying that some out of network providers won't see you even so?

The Medicare Advantage plans have HMO and PPO versions. With PPO versions, there is a list of doctors. My husband had not gone to a specialist outside of the list of doctors on the PPO. We had gotten flat out rejection the phone when we tried to set an appointment up with these doctors. None of them had said that our share of cost would be higher, it was a flat out no.

This is the verbiage on Humana's website: Out-of-network/non-contracted providers are under no obligation to treat Humana plan members, except in emergency situations.