Evaluating Medicare Advantage Plans

[Pellice]

I am about a year from Medicare, so I am interested in this thread.

Packman, from what I can tell, choosing MA or a Supplement is a process with two parts. First is the evaluation of MA plans, and that is difficult if you are not making much use of doctors. Looking up some facilities for specific conditions (I checked stroke and cancer facilities) was helpful, but, as pointed out above, these can change. Still, considering that I am in a health-facility-rich area, I think I can be confident that this state employee retiree plan will include some top facilities.

Second, though is the simple decision: a MA plan will not include any facility anywhere that accepts Medicare, though it might include some. You can't just say to yourself, "I'm going to the Mayo Clinic," and be confident that you can do it. Nor can you necessarily choose the most convenient skilled nursing facility, although, again, in an area inundated with health care, you probably can find something convenient and good. Balanced against that is the substantially lower cost and possibly more extensive benefits of an MA plan.

I'm supposed to talk soon to several people who are pretty much dead set against MA plans because of spousal experiences, and one of my angles will be to find out whether they had "good" MA plans or not.

 

[bizlady]

4. I tested the plan again with a perianal abscess requiring 3 surgeries. Total cost was $500.

DH hits 65 early next year. How do you "test" the plan? That might be helpful as we evaluate.

 

[Gotadimple]

The thing with MA plans is that the majority are HMO plans with limited networks, and a restriction on out of network use. That's what HMO's do, that is why they are inexpensive.

However, there are some MA plans that are PPO plans (Aetna for one). The real key in selection is to find the plan with the broadest network of providers and ideally, a PPO plan with the BlueCross BlueShield Association. Why? because if it is a branded PPO MA plan with BCBS logo, you can see providers in other states because there is a pricing exchange agreement among the BCBS plans.

So broad provider network. PPO plan, no HMO. BCBS logo on the product, with a confirmed sharing arrangement with other BCBS plans. Bonus: in some states the BCBS travel insurance program is also available for additional costs (called GeoBlue).