Evaluating Medicare Advantage Plans

[Pellice]

I will be applying for Medicare next month, and I have read through *some* of the many forum threads on Medicare Advantage and Medicare Supplement plans. I understand that the big rap on MA plans is a more limited access to providers. And that is a big rap. (Although the plan I am being offered allows out-of-network providers at no extra cost, the providers must accept the Aetna plan).

That said, I am being offered an MA PPO plan for retired employees of the state that seems pretty good. But it isn't easy to evaluate! What should I be looking for? I have no current health conditions, so it's all based on thinking about the future - although if I live long enough, I'll come down with something serious, most likely.

I know the star rating of my plan, 4.5, but that seems to be based on a narrow range of issues. I know all the usual metrics - moop costs, co-pays, nationwide coverage. But, going beyond these ... I tried looking up two types of special coverage, cancer institutes and acute rehabilitation (stroke) facilities in my area, and I was satisfied that some top-rated facilities were in-network.

Is there any other way to research my MA plan?

 

[MissMolly]

I wish I had a good answer for you. I also have a MA PPO plan through my state's retirement system. I guess we are about to find out how well it works. My husband fell off the ladder about 8 weeks ago and hurt his shoulder. His arm is pretty much useless now. After 2 doctor appointments, x-rays and an MRI he is scheduled for surgery for a large rotator cuff tear next Tuesday. So far, expenses were $25 for each of the 2 doctor visits. X-rays were free. MRI was $25. The surgeon is "in network" but is the same surgeon we have used in the past even before we went on Medicare. So I guess we will find out how all the billings work out on this. Fingers crossed.

 

[Teacher Terry]

Once you go on a MA plan you can’t go back to traditional without passing medical underwriting.

 

[MissMolly]

Once you go on a MA plan you can’t go back to traditional without passing medical underwriting.

I can.

 

[REWahoo]

I can.

Please share how so we can learn.

 

[Pellice]

Once you go on a MA plan you can’t go back to traditional without passing medical underwriting.

Yes, and I understand that the big reason you might want traditional is the choice of providers (individuals and facilities). And I am considering that, but am also trying to take into consideration that the MA plan I am being offered appears to be quite good. I am just trying to evaluate a little further, for example, the offer of a care coordinator. I just looked up audiologists, something I will take advantage of, and found many in-network with good ratings.

 

[CardsFan]

OP, Is this the only plan being offered? Or do you have Supplements available as well?

The trouble with evaluating MA plans, is that there is no standard. They are all different. Supplements are standardized, so if I have plan G with UHC (which I will in August) it is the same as every other plan G out there.

I have several friends with MA plans, and their satisfaction ranges from very happy, to ticked-off every time they pay a co-pay, or are directed to an office they don't care for.

I have one friend who was a teacher. She is on a subsidized plan similar to what you are considering. She is very happy. All her doctors are in network. BUT, she has not had a problem out of the area, and the network can change in any given year. That is the risk.

If you travel outside your area, I would carefully look at the MA coverage out of network. Some are pretty good, some are awful.

Good luck.

 

[davebarnes]

I like Kaiser

I have Medicare Advantage with Kaiser.
The plan is the cheapest one. I only pay my basic Medicare premium.

0. I chose this plan because I like Kaiser based upon previous experience and because my entire medical history between ages 22-64.99 was a kidney stone.
1. I am very happy.
2. I do not plan to travel in the USA. So, I don't worry about geographic coverage.
3. I "tested" the plan with colon cancer surgery and chemotherapy at age 65. Total cost to me was $2500.
4. I tested the plan again with a perianal abscess requiring 3 surgeries. Total cost was $500.

 

[MissMolly]

Please share how so we can learn.

It's all part of our state's retirement system plan. They offer both MA policies and Supplements. We can switch back and forth each year.

 

[Pellice]

OP, Is this the only plan being offered? Or do you have Supplements available as well?

...
If you travel outside your area, I would carefully look at the MA coverage out of network. Some are pretty good, some are awful.

Good luck.

Several supplement plans are being offered, but I can't tell if they are "true" supplement plans (even though they are specifically labelled "supplement plans) because they have in-network and out-of-network categories. The best appears to be *slightly* less generous than the MA plan, for example, requiring precertification for post-hospital skilled nursing care. The MA plan does not require that.

 

[OldShooter]

We have been fortunate to have excellent independent insurance agents to figure all this stuff out for us. We tell them what's important, like international coverage when we're traveling, and they recommend what we should buy. This is not an area where my usual inclination to DIY is the right strategy for us. Too hard.

 

[Packman]

We have been fortunate to have excellent independent insurance agents to figure all this stuff out for us. We tell them what's important, like international coverage when we're traveling, and they recommend what we should buy. This is not an area where my usual inclination to DIY is the right strategy for us. Too hard.

I am about a year from Medicare, so I am interested in this thread. As far as taking the advice of an insurance agent, I'm okay with that, but they are salespeople and it seems to me like one should do some DIY research as well. It is complicated and an expert can be helpful. However, aren't they paid commissions by Medicare? If so, wouldn't there be a conflict of interest?

 

[OldShooter]

I am about a year from Medicare, so I am interested in this thread. As far as taking the advice of an insurance agent, I'm okay with that, but they are salespeople and it seems to me like one should do some DIY research as well. It is complicated and an expert can be helpful. However, aren't they paid commissions by Medicare? If so, wouldn't there be a conflict of interest?

Underline the word independent when you say "agent." Independent agents get paid by the insurance companies but it is in their best interest to represent their client. This is in contrast to "tied" agents like State Farm, etc. where the agent is totally dependent on the insurance company that they represent. I avoid tied agents for any insurance business that I may have, including MA.

Certainly it's possible that an independent agent could be swayed by different commission structures but when we sit down and go over table of alternative plans, carriers, and costs I think we would be able to tell if we were getting manipulated.

Getting educated as a consumer is always A Good Thing.

 

[CardsFan]

Several supplement plans are being offered, but I can't tell if they are "true" supplement plans (even though they are specifically labelled "supplement plans) because they have in-network and out-of-network categories. The best appears to be *slightly* less generous than the MA plan, for example, requiring precertification for post-hospital skilled nursing care. The MA plan does not require that.

That does not sound like a Supplement. It should clear state it is plan G, N, or a variety of others. A true supplement will be honored by anyone taking Medicare.

Sounds like an employer secondary plan, and they vary all over the map, as well.

I am assuming the State is subsidizing the plan, so your options are limited, unless you just go on the open market, which could be a bit (or a LOT) more expensive.

I would look at all the plans offered, and evaluate the pros and cons of each.

Keep the big picture in mind. This is insurance, not a health care plan, despite what they call it. A few bucks here or there is nothing if you are assured a major calamity will be covered.

 

[Telly]

.......That said, I am being offered an MA PPO plan for retired employees of the state that seems pretty good. But it isn't easy to evaluate! What should I be looking for? I have no current health conditions, so it's all based on thinking about the future - although if I live long enough, I'll come down with something serious, most likely.

DW will be eligible for a state-wide special MA plan when she retires, if I can ever get her to do so! It's been $138 a month for the last few years, and we will have to evaluate it versus a Part B Medigap plan + Part D drug plan, which is what I have.

Her MA plan has a $500 deductible, no network, seems to have a lot of good points, but we will need to dig into it to see if we can find any big negatives. There are a lot of people in it, and more add on each year... and of course some die. Any gigantic increase in premiums would cause many people to light a fire under their state reps, and descend on the state legislature. The MA plan has been running for 4 or 5 years now, it replaced unsustainable plans that they had before, which were too good to be true... back then, I could have been added on for just $25 a month! It was heading for a major crash, the state entity kept saying so, hired consultants to show it, and the legislature still did nothing, till the clock was about to run out, then they, along with the entity reworked it totally. It requires the retiree to kick in the monthly premium, but there are still state $ going in for part of it. It is now the entity's only retirement medical plan for anyone who is Medicare-able, i.e., that paid into Part A when working, and eligible for Part B.

Personally, I usually wouldn't touch an MA plan, but this one deserves serious consideration. I'm interested in anything you figure out on yours, as it may give us something to check. We have plenty of time, so it seems, to check it out

 

[Teacher Terry]

MA plans are also allowed to use step therapy. You could be dead before you get to the step you need.

 

[MissMolly]

Regular Medicare with a Part D drug plan can also require step therapy, so....

You just need to understand what you have. You may or may not be required to do step therapy whether you are on regular Medicare or on an Advantage Plan. Advantage Plans are not evil as some want to make them out to be.

 

[nwsteve]

Regular Medicare with a Part D drug plan can also require step therapy, so....

You just need to understand what you have. You may or may not be required to do step therapy whether you are on regular Medicare or on an Advantage Plan. Advantage Plans are not evil as some want to make them out to be.

Miss Molly please share circumstances when Traditional Medicare requires step therapy.
One of the advantages of Trad Medicare is no-one but you decide which docs you see and in what order. If I want to see a particular specialist, I get an appointment. Now, it is certainly true that some specialists require a referral but is that really step therapy?

 

[REWahoo]

Here is a short thread that explains how/when step therapy may apply to traditional Medicare. See post #6. https://www.early-retirement.org/fo...ing-with-a-medicare-advantage-plan-94513.html

 

[MissMolly]

Miss Molly please share circumstances when Traditional Medicare requires step therapy.
One of the advantages of Trad Medicare is no-one but you decide which docs you see and in what order. If I want to see a particular specialist, I get an appointment. Now, it is certainly true that some specialists require a referral but is that really step therapy?

Step therapy relates to drugs, not doctors. Some drug plans and some Advantage plans require you to try Drug A before you can try Drug B. That is step therapy. And it's not Medicare per se that would require the step therapy, it's your Part D drug plan.

 

[W2R]

Frank is very happy with his Medicare Advantage plan that he transitioned to a year ago when he turned 65. It includes all of his doctors, labs, hospitals, and other providers so that is not an issue for him. Also it pays his gym fees and for some of his OTC meds. His monthly payments are low enough that he feels like he got a nice raise, compared with the monthly payments for his megacorps retiree insurance that he had before reaching Medicare age. All of his retired friends over 65 are on this same local Medicare Advantage plan, and none have reported any problems to him. It is a very popular plan here.

Personally I have federal government retiree insurance which I plan to keep forever, so I never looked into Medicare Advantage. If I knew more I would comment more intelligently on this thread.

 

[nwsteve]

Step therapy relates to drugs, not doctors. Some drug plans and some Advantage plans require you to try Drug A before you can try Drug B. That is step therapy. And it's not Medicare per se that would require the step therapy, it's your Part D drug plan.

Thanks to you & REWahoo for the clarification. Outside of having a MA plan with drugs, unfortunately no good options for Plan D. Fortunately neither DW or I take any drugs.

 

[CRLLS]

OP, Is this the only plan being offered? Or do you have Supplements available as well?

The trouble with evaluating MA plans, is that there is no standard. They are all different. Supplements are standardized, so if I have plan G with UHC (which I will in August) it is the same as every other plan G out there.

I have several friends with MA plans, and their satisfaction ranges from very happy, to ticked-off every time they pay a co-pay, or are directed to an office they don't care for.

I have one friend who was a teacher. She is on a subsidized plan similar to what you are considering. She is very happy. All her doctors are in network. BUT, she has not had a problem out of the area, and the network can change in any given year. That is the risk.

If you travel outside your area, I would carefully look at the MA coverage out of network. Some are pretty good, some are awful.

Good luck.

FYI, "AARP" Medigap Plan G includes "Renew Active", a gym membership. This is an added benefit above and beyond many other Plan G offerings and not required by Medicare to be included. Medicare dictates what the Medigap plans "must include", not the entire offering of various providers.

I have Medicare Advantage with Kaiser.
The plan is the cheapest one. I only pay my basic Medicare premium.

0. I chose this plan because I like Kaiser based upon previous experience and because my entire medical history between ages 22-64.99 was a kidney stone.
1. I am very happy.
2. I do not plan to travel in the USA. So, I don't worry about geographic coverage.
3. I "tested" the plan with colon cancer surgery and chemotherapy at age 65. Total cost to me was $2500.
4. I tested the plan again with a perianal abscess requiring 3 surgeries. Total cost was $500.

I tested the Plan G Supplement last month with a combined Gallbladder removal surgery (DaVinci robot plus Firefly) and a colonoscopy. After the Part B annual deductible of $198, which I had previously met with the ER visit. When all the bills are finalized, I will pay $0 including the various pre-surgery office visits for the ~$72,000+ billed amount. I'm not saying that Plan G is better than your MA plan. I'm just giving a comparison for the OP to consider.

 

[Teacher Terry]

We pay a fourth of our gross income for insurance but I wouldn’t go on a MA plan. There’s a reason they are cheap.

 

[RobbieB]

I like my Kaiser Senior Advantage plan, $18/mo. I like the whole system. I've had no problems getting referred to specialists either.

5 stars!