MediCare Advantage PPO’s

[Murf2]

I’m wondering if these newer PPO plans make the Advantage plan look any better for the average person.
I’m looking at the AARP Advantage PPO. It looks pretty good on paper. I wonder what I’m missing.
Are there any satisfied / dissatisfied users of the forum?

Thanks
Murf

 

[kevink]

This is as good a place as any to learn more about the underlying economics of Advantage plans vs. traditional Medicare + Medigap. "Follow the money" seems to always be a good starting point.

Not an easy decision IMHO because of course paying nothing out-of-pocket hard to resist. Until you have to travel out-of-state/out-of-network, want/need to see a doctor outside your PPO or come down with an illness that requires underwriting and can't get back onto a Medigap plan.

https://retireearlyhomepage.com/medicare2020.html

 

[Turbo29]

Not all PPOs are the same. I am on an Medicare Advantage PPO offered through the state retirement system. I can use any doctor that accepts Medicare (although I haven't run into any that don't accept the PPO).

 

[Dash man]

I’m wondering if these newer PPO plans make the Advantage plan look any better for the average person.
I’m looking at the AARP Advantage PPO. It looks pretty good on paper. I wonder what I’m missing.
Are there any satisfied / dissatisfied users of the forum?

Thanks
Murf

Check whether they pay for chemotherapy drugs, both in the office and at home drugs. That can get very expensive quickly if they don’t.

 

[MissMolly]

We have an Advantage PPO plan and it works just fine for us. Nationwide coverage so not an issue with "out of network". And anyway, it pays the same to out of network as it does to in-network, so... We've both had CAT scans, MRIs, surgeries, PT etc, etc. No problems with coverage. I have no complaints.

 

[Murf2]

Thanks all! I see most / all the Advantage PPO’s advertise nationwide coverage anywhere MediCare is accepted. I was curious if it really works as they claim. That would really help us with our planned travels.

I will have to find out about the chemo drugs. Would they policy just say “chemo drugs” or will I need to research names of these drugs.

Thanks so much for the input!
Murf

 

[ExFlyBoy5]

Be sure to CHECK YOUR ZIP CODE!

 

[Dash man]

Thanks all! I see most / all the Advantage PPO’s advertise nationwide coverage anywhere MediCare is accepted. I was curious if it really works as they claim. That would really help us with our planned travels.

I will have to find out about the chemo drugs. Would they policy just say “chemo drugs” or will I need to research names of these drugs.

Thanks so much for the input!
Murf

The specific thing to look for that I’ve heard people get into trouble with is what they say you are responsible for 20% of the cost of chemotherapy treatments or drugs. This not restricted by any promised out of pocket maximum and can add up quickly.

 

[pb4uski]

This is as good a place as any to learn more about the underlying economics of Advantage plans vs. traditional Medicare + Medigap. "Follow the money" seems to always be a good starting point.

Not an easy decision IMHO because of course paying nothing out-of-pocket hard to resist. Until you have to travel out-of-state/out-of-network, want/need to see a doctor outside your PPO or come down with an illness that requires underwriting and can't get back onto a Medigap plan.

https://retireearlyhomepage.com/medicare2020.html

The travel aspect is the hurdle that I have trouble getting over as we snowbird and spend 5 1/2 months up north.... I wouldn't want to change to a MA plan to save some $$$ and have some sort of medical event while up north and have to travel back to Florida in the summer to get treated.

 

[Venturer]

WE have the traditional Medicare + G supplement. My stepmom has a PPO plan that is good for her. She has $0 copay and $0 drugs. She has never did much traveling. I think thr longest trips for her from Ga. was once to Dallas Tx. when her daughter was living there and mabe 3 times to Fla. in her life. Her local Dr. are all in her plan and since she is not very likely to leave home town or home state she has a good deal. At 84 years old she probably won't be changing.

 

[Bamaman]

Hospitals are "consolidating" with other hospitals and doctors' practices everywhere are selling out to hospital chains. Physicians are now very often just hospital employees--or even independent contractors.

Not all hospitals accept Medicare Advantage plans, even if they may accept traditional Medicare coverage. Physicians groups owned by hospital chains also may not accept Advantage.

If your local hospital bows out of Advantage acceptance, that means you'll have to get new doctors and go to different hospitals. Patients may have to go another city or two away to be treated

We want to go to the hospital closest to our home, and we want to have a say so on who our doctors are. It's especially important to my wife who has numerous health issues. We're going with Plan F again--the most expensive but extensive plan.

 

[ShokWaveRider]

I found that in our area a Part G was way better than advantage. Having a $0 premium was not even a consideration as I considered it a Pay now or pay later issue. Plus I did not like all the nickel and diming when visiting a specialist and certainly was not interested in any type of referral for specialists, that is simply a waste of a trip to a GP.

Bottom line, the cost of my Part G is $178 a month ($2,336 a year) including the Medicare deductible that I added. Part G is $7.70 per month and not even worth discussing.

Most MA plans still require that one pays the Medicare part B payment, as one does with a supplement plan.

The equivalent PPO MA plan was $6,700 MAX OOP with a deductible and a lot of nickel and diming.

Simple choice for anyone who wants trouble free nationwide medical coverage (Including Mayo Clinic coverage) with no gotchas.

To me it was not worth worrying about the ~@$2500 PA cost, so insignificant in the grand scheme of things when it comes to comprehensive quality health coverage. My house insurance and other insurance costs is more than that.

 

[Irishgirlyc58]

Not all PPOs are the same. I am on an Medicare Advantage PPO offered through the state retirement system. I can use any doctor that accepts Medicare (although I haven't run into any that don't accept the PPO).

I’ve wondered if these plans from employers/ former employer are different.
I’m not Medicare age yet but looked into this during my retirement planning. The county I’m retiring from offers a MA PPO plan. Zero copays, coverage throughout US and international coverage. Prescriptions 0 cost.
It seems like a really good plan but then I have been reading that some MA plans are not what they seem. Although I could make that argument for most insurance.
I know it could change by the time I turn 65 in 2 years but I will give it serious consideration.

 

[Gotadimple]

Medicare Advantage Plans are great - if!
They are PPO plans with a broad network - not HMOs or PPOs with small networks
They have a provider network in/near your home zip code (some do not have coverage for a full state)
$0 premium and $0 copay plans - check carefully! They may have a limited provider network and high deductibles and max OOP (that's why they don't charge a premium)
There MAY BE some advantage to a MA sold by a local BlueCross/BlueShield plan, where if the plan is part of their Blue network you are covered anywhere in the BCBS network.

If you spend significant time out of their service area, you will find they won't provide coverage.

But you need to do the math - all of the math!
Annual MA Premium plus Deductibles and copays for common services compared to:
Annual Medigap Premium plus Part D premium plus any Part B/other deductibles and limits
Ignore Max OOP (that's the sum of deductibles and co-pays - the MA plan is betting you won't reach it and many people don't)

 

[CRLLS]

One thing that I haven't seen mentioned yet. Is it possible that the Advantage plan could change significantly or be just discontinued in future years? SO much that you want back on traditional Medicare? That thought bothers me. I have experienced a lot of that during the few years we were insured under ACA plans and didn't care for the annual reevaluating process. Each year our plan was discontinued and had to find a new one. I even had one insurer go broke mid-year and had to re-up. We had to start our deductible from scratch on that one. I feel that Traditional Medicare is a bit more stable from year to year with expected increases in premiums and deductible. I'm OK with that.

 

[Gotadimple]

I’ve wondered if these plans from employers/ former employer are different.

Yes they are because your employer is adding $ into the cost of the plan to provide $0 premium/co-pay/expanded coverage. Over time your employer may have to start charging the retirees a premium. When that happens you'll need to compare what your retiree plan offers to other commercial offerings.

I retired from a BCBS health plan and they offered a Retiree MA plan that initially was great because the copays were very low as was the premium. 4 years in and the claims experience for retirees wasn't that great, so the premiums went up but the deductibles and co-pays stayed low. I switched to their commercial offering (what the public buys) for lower premiums. Turns out the copays weren't a huge increase over what I had as a retiree, and, where they were large, I didn't have the health conditions to use the benefit.

You can't factor this into your retirement planning long-term, but do compare benefits to a similar product just to get a sense of what is available today.

 

[oldtimer]

We have decided to go the traditional medicare plus Plan G and Part D. We may pay more in a typical year vs an Advantage plan, but less things to track/pay and annually reevaluate coverage. We can spend the time saved to further enjoy our lives. Peace of mind - priceless!


We do consider Medicare Advantage plans our backup plan for healthcare insurance in case there is an unexpected impact to our finances in the future. No underwriting to change from original Medicare w/Medigap to MA plan. Even though one can switch from MA to original Medicare, the gotcha in most states is underwriting is required to get a Medigap plan outside the 6-month Medigap Open Enrollment Period - higher premium or rejection possible.


Talk with your local State Health Insurance assistance Program (SHIP) rep. They can help you understand the differences in your options. https://www.shiphelp.org/

 

[Venturer]

We have decided to go the traditional medicare plus Plan G and Part D. We may pay more in a typical year vs an Advantage plan, but less things to track/pay and annually reevaluate coverage. We can spend the time saved to further enjoy our lives. Peace of mind - priceless!


We do consider Medicare Advantage plans our backup plan for healthcare insurance in case there is an unexpected impact to our finances in the future. No underwriting to change from original Medicare w/Medigap to MA plan. Even though one can switch from MA to original Medicare, the gotcha in most states is underwriting is required to get a Medigap plan outside the 6-month Medigap Open Enrollment Period - higher premium or rejection possible.


Talk with your local State Health Insurance assistance Program (SHIP) rep. They can help you understand the differences in your options. https://www.shiphelp.org/

I didn't mention it in my previous post but this my thinking as well. I did initially talk with our Ship representative befor we made our decision. I had already spoken with a "Medicare expert"/insurance agent who was singing the "Advantage" praises. If in the future we need to switch we can, but I really like being able to go anywhere and see any Dr. who accepts Medicare. Just do your diligence in research before hand.

 

[Another Reader]

The SHIP person here was not very knowledgeable. She was on an Advantage plan herself but did not seem to fully understand them. She said most people that came for help chose Advantage plans. I did not bother to pursue the reasons.

Insurance agents have their best interests in mind, not yours. They make a lot more selling Advantage plans than they do selling supplements. Buyer beware...

 

[Car-Guy]

I have a Medicare Advantage plan thru my past employer.... I believe my previous mega corp is still subsidizing the plan but it's been impossible to find out by how much... I guess I shouldn't really care since it's not costing me anymore than regular Medicare... (Except for the added drug coverage)


The main things I like about my plan are, all doctors and hospitals in the US are in the plan "if they accept Medicare assignments". So far I haven't found any that won't. And I have an OOP annual maximum for both medical and drug so I'm not worried about breaking the bank if one of more serious conditions/events happen.

 

[DektolMan]

I have Plan G HD, $55 per month here in CT. I reason I did this is because being a cancer survivor you always wonder, what if...


Some top cancer hospitals accept medicare but do not accept Advantage plans and if I get cancer again I want to be able to go to the doctor and hospital I want no matter where they are in the country.

 

[VanWinkle]

I have the AARP Medicare Advantage PPO through UHC. It has nationwide coverage, modest out of pocket max, no deductible for health or prescriptions.
This is the same company that I was insured with for 40 years before retirement and I have always had good outcomes. I am above average on health and take no prescription meds so this plan works great for me. It may not work as well for someone at 65 with more than one chronic health concern.

VW

 

[ShokWaveRider]

I didn't mention it in my previous post but this my thinking as well. I did initially talk with our Ship representative before we made our decision. I had already spoken with a "Medicare expert"/insurance agent who was singing the "Advantage" praises. If in the future we need to switch we can, but I really like being able to go anywhere and see any Dr. who accepts Medicare. Just do your diligence in research before hand.

That is because it is the HIGHEST compensated plan for agents. That should ring bells wave red flags for a start. Health insurance is like anything, cheap is great until one REALLY needs it. Always check the small print, Deductibles, Copays and MOOP. From what we hear the AARP United HC MA is one of the best though.

Some areas do have great MA plans. Unfortunately, ours is not one of them, few cover the whole country in network.

 

[VanWinkle]

That is because it is the HIGHEST compensated plan for agents. That should ring bells wave red flags for a start. Health insurance is like anything, cheap is great until one REALLY needs it. Always check the small print, Deductibles, Copays and MOOP. From what we hear the AARP United HC MA is one of the best though.

Some areas do have great MA plans. Unfortunately, ours is not one of them, few cover the whole country in network.

There are no red flags, just choices based on each persons health and financial situation. SHIP representatives do not recommend Medigap over Medicare advantage. They give the good and bad sides of both, and let the person make their decision based on an educated view of both plans. That's like me saying Medigap is over priced for the coverage it makes available. It depends on your situation, not the cost. BTW, I am a SHIP counselor in Illinois and discuss this many times each day.

VW

 

[ShokWaveRider]

There are no red flags, just choices based on each persons health and financial situation. SHIP representatives do not recommend Medigap over Medicare advantage. They give the good and bad sides of both, and let the person make their decision based on an educated view of both plans. That's like me saying Medigap is over priced for the coverage it makes available. It depends on your situation, not the cost. BTW, I am a SHIP counselor in Illinois and discuss this many times each day. VW

I do not think I implied they did. Insurance Agents are the ones that pitch MA plans heavily.

When I first was reviewing Medicare, I went to a SHIP counselor to get educated, he did not recommend either. When I asked what plan he had, he did say "F" though. I also spoke to Boomer Benefits when selecting my plan and they recommended AARP Plan G for my personal situation. I had a Pacemaker replacement coming due in the next couple of years.