Medicare Advantage more common that I expected

[SumDay]

The USA has the most complicated form of medical care/insurance for [-]old[/-] people in the world.
Medicare Advantage provides a simpler (less complicated) version.

Fixed it for you.

 

[MichaelB]

California's Birthday Rule (no underwriting) is for switching between Medigap plans of equal or lessor benefits. Switching from Advantage to Medigap in CA requires underwriting unless there is a qualifying event for guaranteed issue.

CT, MA, and NY are the year round Medigap guaranteed issue states.

An important detail, thanks.

 

[ivinsfan]

But again, not all Advantage Plans are the same. Mine is $500 deductible, $1,200 MOOP, and includes drug coverage with NO deductible and NO dough nut hole. And it's a PPO and almost universally accepted by doctors and hospitals where I live. In fact, I don't know of any that don't accept it.

How much is it and where do you live, I might need to move!!!

 

[youbet]

The USA has the most complicated form of medical care/insurance for old people in the world.
Medicare Advantage provides a simpler (less complicated) version.

Simplification is one reason that I like it.
Another reason, for me, is one stop shopping. All my records in one place.

And, so far, I have not encountered (in 5 years) any cost cutting annoyances. In fact, one of my Kaiser docs recommended an MRI after my chemo and I said no. It would be waste of money. I have never felt rushed in any of doc/PA encounters.

Medicare Advantage plans are frequently discussed here as though they are all the same. They aren't.

Like you, my DW is going through a bout of cancer while covered by a Medicare Advantage plan. There have been no coverage issues. The plan allows her to see any doc or use any resource that accepts regular Medicare. And, so far, she has not encountered any provider that accepts regular Medicare that won't accept her plan. As far as I can tell, she's done exactly what she would have done if she was on regular Medicare with a type F supplement (like me).

Having said that, I freely admit I wish she had gone with regular Medicare and a supplement since now that she's a cancer patient she'll likely never pass underwriting to go back to Medicare + supplement. Everything has been fine so far, but I worry there might be changes to her plan making it less flexible in the future. Hopefully I'm worrying about nothing.

 

[ivinsfan]

Medicare Advantage plans are frequently discussed here as though they are all the same. They aren't.

Like you, my DW is going through a bout of cancer while covered by a Medicare Advantage plan. There have been no coverage issues. The plan allows her to see any doc or use any resource that accepts regular Medicare. And, so far, she has not encountered any provider that accepts regular Medicare that won't accept her plan. As far as I can tell, she's done exactly what she would have done if she was on regular Medicare with a type F supplement (like me).

Having said that, I freely admit I wish she had gone with regular Medicare and a supplement since now that she's a cancer patient she'll likely never pass underwriting to go back to Medicare + supplement. Everything has been fine so far, but I worry there might be changes to her plan making it less flexible in the future. Hopefully I'm worrying about nothing.

This is good to read and I hope things go well for both of you....it's my understanding that you can move freely between Advantage plans without underwriting during open enrollment. So you would be able to look for a better plan is necessary. Why did your DW go with an Advantage plan in the first place?

 

[Gotadimple]

This is good to read and I hope things go well for both of you....it's my understanding that you can move freely between Advantage plans without underwriting during open enrollment. So you would be able to look for a better plan is necessary. Why did your DW go with an Advantage plan in the first place?

You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available.


Most MA plans are HMO's and that does limit choices of doctors and hospitals with no out of plan coverage. If one can find a MA plan that is a PPO you aren't locked to their network, but you will pay a higher percentage of the costs as it is out of network. Most $0 premium plans are HMO's.


As someone else said, the details matter because they tell you why the premium is the way it is. A low premium plan usually has a restricted network, high deductibles, and high co-pays. A high premium plan can have a restricted network with a lower set of deductibles and co-pays. It all depends on how much you want to pay up-front to get the services later on at a higher/lower cost.


- Rita

 

[youbet]

Why did your DW go with an Advantage plan in the first place?

She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the Medicare Advantage premium deducted from her pension check and the fed gov't bills her for the Part B premium.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement.

I would have had her go with regular Medicare and a supplement but it was her choice. Thankfully, it's a PPO style Medicare Advantage plan (not HMO style) and despite utilizing a lot of providers and specialists this past couple of years due to her cancer, there have been no issues, no restrictions, no refusal of providers to accept the coverage and no surprises.

Other than the absence of the infamous "donut hole" in her drug coverage and the minor perk of Silver Sneakers paying for her health club membership, I haven't seen any advantages over regular Medicare + supplement. But, OTOH, I haven't seen any disadvantages beyond me needing to know the ins and outs of two different programs.

Inexplicably, customer service has been extraordinarily good. Far superior to my BCBS type F plan where phone trees and long waiting times are the norm.

 

[MichaelB]

She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the premium deducted from her pension check.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement.

My mum is also retired from Illinois and has a UHC PPO Advantage. Her original benefit was a MediGap, but she was automatically enrolled in MA after they changed plans a couple of years ago. We haven’t had any problems either, even after she moved to S Fla.

I’m sure some MA plans, such as this one, are adequate and offer a valuable option for lower income seniors. Personally, I’ve chosen to pay more for MediGap coverage.

 

[ivinsfan]

You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available.


Most MA plans are HMO's and that does limit choices of doctors and hospitals with no out of plan coverage. If one can find a MA plan that is a PPO you aren't locked to their network, but you will pay a higher percentage of the costs as it is out of network. Most $0 premium plans are HMO's.


As someone else said, the details matter because they tell you why the premium is the way it is. A low premium plan usually has a restricted network, high deductibles, and high co-pays. A high premium plan can have a restricted network with a lower set of deductibles and co-pays. It all depends on how much you want to pay up-front to get the services later on at a higher/lower cost.


- Rita

I did say you could move between Advantage Plans....that's all I was referring to.

 

[ShokWaveRider]

She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized.

From what I can tell, these MA plans are far better than those available to Joe Public. My neighbor has one that was sponsored by his union, it is fine for the most part.

I have another who purchased his from an agent on the open market at 65, his is a disaster.

Unfortunately most of us do not have a preferred option.

 

[ivinsfan]

She is a retired teacher in Illinois. Illinois eliminated post-65 coverage for retired teachers several years ago offering a non-subsidized Medicare Advantage plan in its place. The Medicare Advantage plan is a United Health Care group PPO plan with features negotiated by the state on behalf of the group, but not subsidized. (DW has the Medicare Advantage premium deducted from her pension check and the fed gov't bills her for the Part B premium.) Her alternative was that or simply walk away and go with traditional Medicare and a supplement.

I would have had her go with regular Medicare and a supplement but it was her choice. Thankfully, it's a PPO style Medicare Advantage plan (not HMO style) and despite utilizing a lot of providers and specialists this past couple of years due to her cancer, there have been no issues, no restrictions, no refusal of providers to accept the coverage and no surprises.

Other than the absence of the infamous "donut hole" in her drug coverage and the minor perk of Silver Sneakers paying for her health club membership, I haven't seen any advantages over regular Medicare + supplement. But, OTOH, I haven't seen any disadvantages beyond me needing to know the ins and outs of two different programs.

Inexplicably, customer service has been extraordinarily good. Far superior to my BCBS type F plan where phone trees and long waiting times are the norm.

Your story leads me to think we are inevitably but slowly moving to MA plans..I'll be paying close attention to what happens in my state now that all the cost plans for over 350K people have been eliminated. We have access to fantastic medical care in this state but premiums reflect that.

 

[haha]

You can move wherever you want during open enrollment, including returning to Traditional Medicare from MA or even dropping Medigap. But. If you have been on MA and decide you want to go to Medigap you MAY BE subject to Medical Underwriting - with only a few exceptions - most relating to the MA plan no longer being available.

Does this mean that if one has Kaiser Medicare Advantage and she moves to an area with no Kaiser she can switch to original Medicare and a Medigap without underwriting?

Also, how is an area with no Kaiser defined? One's city, county, or entire state has to have no Kaiser? I guess if someone really hated a Medicare Advantage choice, might not be too bad to move to Ct or Mass or NY for a period to get a redo. I could easily stand another year in Back Bay, or maybe Brookline. I have trad Medicare and Medigap, but my GF has Kaiser. So far it seems fine for her.

Ha

 

[youbet]

My mum is also retired from Illinois and has a UHC PPO Advantage. Her original benefit was a MediGap, but she was automatically enrolled in MA after they changed plans a couple of years ago. We haven’t had any problems either, even after she moved to S Fla.

I’m sure some MA plans, such as this one, are adequate and offer a valuable option for lower income seniors. Personally, I’ve chosen to pay more for MediGap coverage.

Actually, there is very little cost advantage to DW's UHC PPO Advantage plan over my BCBS type F plan and Humana Part D plan. For BCBS medical service coverage, I pay higher premiums and have zero deductibles. She pays lower premiums and has higher deductibles. If you use enough medical services to pay your full deductible, the two are in the ball park of the same annual cost.

DW's prescription coverage does have some advantages over my Part D coverage (no donut hole, lower deductibles, lower co-pays), but that might just be the result of the Part D plan I chose. Maybe I just wasn't a good shopper during the annual enrollment period.

I agree with you regarding the traditional Medicare + supplement route and that's what I do. But, so far, results have been substantially identical for her compared to mine on most fronts: cost, convenience, coverage. She has a strong edge regarding customer service.

DW did have a choice between an UHC Advantage PPO plan and an UHC Advantage HMO plan, as I'm sure your DM did. One fear we have is that they'll stop offering the PPO plan and we would definitely not like her going to an HMO situation. Fortunately, according to BCBS, if UHC dropped her PPO plan, only offering the HMO plan, that would be a "qualifying event" and DW could then switch to a traditional supplement plan, like mine, without underwriting and that's what she'd do.

 

[Dtail]

But it is a Pay now or pay later. If one has pre-existing conditions too, switching can be problematic.

My Plan G is $2k per year No deductible (Other than Medicare $185). The closest advantage plan was $0 + $6.4k MOOP. If I had an issue it would cost me $4k more. I made a calculated guess that the $2k was a reasonable insurance. Remember also one has to pay the Medicare premium regardless.

That goes back to my original question. My DGF has an MA plan at 57 y.o. due to disability. So being that she has pre existing conditions, can she switch at age 65 to Medigap without issues?

 

[MissMolly]

How much is it and where do you live, I might need to move!!!

Actually is part of my pension benefits so it’s free.

 

[mamadogmamacat]

Your story leads me to think we are inevitably but slowly moving to MA plans..I'll be paying close attention to what happens in my state now that all the cost plans for over 350K people have been eliminated. We have access to fantastic medical care in this state but premiums reflect that.

This was part of my reason for starting this thread, as I think the same. Also, my surprise that 40% of medicare recipients are already on MA was the other reason for the thread. Not sure if anyone read the article i started with or not, but the 40% number was from it.

Also starting 2019 MA plans will be allowed to implement "fail first" for drugs and I assume treatments as well. A few articles and opinion pieces out there on that. Here is one:

https://www.sandiegouniontribune.com/news/health/sd-no-step-therapy20180814-story.html

In my pre 65 mega corp retiree plan, they are already doing this. So far, I do not much like it. Would be truly horrible if I had to go through fail first for say cancer treatment, rather than just the arthritis I'm dealing with now.

The referenced article does say there is an appeal process included, after a 72 hr wait anyway.

 

[REWahoo]

That goes back to my original question. My DGF has an MA plan at 57 y.o. due to disability. So being that she has pre existing conditions, can she switch at age 65 to Medigap without issues?

MBSC's response to your question is worth repeating. His knowledge of Medicare rules has always been spot-on:

No penalty. Everything is reset during the age 65 open enrollment period. Under current rules, she will be able to purchase a Medigap plan at the preferred rate just like everyone else.

 

[ShokWaveRider]

That goes back to my original question. My DGF has an MA plan at 57 y.o. due to disability. So being that she has pre existing conditions, can she switch at age 65 to Medigap without issues?

Honestly, I do not know, other than what is posted above. Call United Health Care, they are pretty efficient.

 

[Dtail]

MBSC's response to your question is worth repeating. His knowledge of Medicare rules has always been spot-on:

I took his response only relating to financial delay penalties of delayed Medicare enrollment applying it to the original MA choice when disabled, but didn't apply the pre existing condition free pass aspect.

Ok great then.

 

[REWahoo]

I took his response only relating to financial delay penalties of delayed Medicare enrollment applying it to the original MA choice when disabled, but didn't apply the pre existing condition free pass aspect.

Ok great then.

Perhaps I misinterpreted his "everything is reset" response, so we need to ask MBSC if he will clarify it for us.

 

[MBSC]

That goes back to my original question. My DGF has an MA plan at 57 y.o. due to disability. So being that she has pre existing conditions, can she switch at age 65 to Medigap without issues?

As long as she enrolls in the Medigap plan during her age 65 Medigap Open Enrollment Period (OEP), she cannot be denied coverage, cannot be charged a higher premium, and cannot have pre-existing conditions excluded. She will be treated like everyone else going through OEP.

The Upside for Medicare Disabled Under 65

Fortunately, when you turn 65, you will get a SECOND Medicare supplement open enrollment period to allow you to switch into a Medigap plan without health questions. At that time you can enroll in any Medigap plan you like. Rates will be far more stable long-term because now you are lumped in with everyone else over 65. This is better than being in the under-65 group, which insurance companies view as high risk.

Reference: https://boomerbenefits.com/medigap-under-age-65/

 

[Dtail]

As long as she enrolls in the Medigap plan during her age 65 Medigap Open Enrollment Period (OEP), she cannot be denied coverage, cannot be charged a higher premium, and cannot have pre-existing conditions excluded. She will be treated like everyone else going through OEP.

Like REWahoo stated, you are the expert. Excellent news, even though everything is relatively fine right now.

Edit - nice article. Now it makes more sense why DGF has an MA plan vs. Medigap under 65 y.o.

 

[athena53]

She explained MA is the cheapest solution for a reason. Some of her customers do insist on it because of that. She is also compensated more on it.

Ah. This would explain why my 87-year old Dad got the hard sell from insurance agents and decided to switch to Medicare Advantage. Follow the money. I'd forwarded a long note with caveats against MA from a friend who works a SHIP hotline and handles inquiries from people about SS and Medicare, so he's heard the stories.

Dad doesn't have any major issues, just a lot of chronic ones of the type you get when you live beyond the useful age of many of your body parts. I can see that the area where you live makes a big difference in the quality of plans available- it will be interesting to see how this works out.

 

[gerntz]

Hubby (69) likes to spend a lot of time (at least some time up there 3 days a week) on the roof blowing off the leaves and cleaning leaves out of the gutters.

 

[simple girl]

When I worked in outpatient rehab about a decade ago, the Medicare Advantage plans were problematic. Many had a limited number of visits for PT per year (or per condition per year, which was somewhat better). That's a real problem for seniors, who need rehab much more than any other age group.

I'm not sure if this is still the case.