Medicare Plans

[Packman]

Since I will turn 65 next year, I'm paying more attention to the Medicare ads and the mail/email I am receiving. One thing I don't understand is why nearly every ad I see is for Medicare Advantage and very little for Medicare supplement plans. Is MA so much more profitable for insurance companies that they advertise so much? If so, how can that be when most charge no premiums and cover more medical needs (like dental, vision, etc.)?

I understand MA plans are mostly HMO's. But if you live in a large metro area and are not a snowbird or heavy traveler, MA seems like a better deal. Yet, recent stats show close to 65% of people choose original medicare. Why?

 

[CardsFan]

Since I will turn 65 next year, I'm paying more attention to the Medicare ads and the mail/email I am receiving. One thing I don't understand is why nearly every ad I see is for Medicare Advantage and very little for Medicare supplement plans. Is MA so much more profitable for insurance companies that they advertise so much? If so, how can that be when most charge no premiums and cover more medical needs (like dental, vision, etc.)?

I understand MA plans are mostly HMO's. But if you live in a large metro area and are not a snowbird or heavy traveler, MA seems like a better deal. Yet, recent stats show close to 65% of people choose original medicare. Why?

We just went through this for the first time this year.

Not wanting an HMO, or a restricted plan, we chose a plan G. Good anywhere Medicare is accepted. We hope to do some travelling in the future, so mobility is an issue.

FWIW, MC funds an HSA which covers about 85% of the cost (as of now), but we had decided on a plan G before I confirmed that benefit.

 

[Packman]

FWIW, MC funds an HSA which covers about 85% of the cost (as of now), but we had decided on a plan G before I confirmed that benefit.

I don't understand this statement, can you explain further?

 

[Bamaman]

We just went through this for the first time this year.

Not wanting an HMO, or a restricted plan, we chose a plan G. Good anywhere Medicare is accepted. We hope to do some travelling in the future, so mobility is an issue.

FWIW, MC funds an HSA which covers about 85% of the cost (as of now), but we had decided on a plan G before I confirmed that benefit.

I'm with you. My wife has had numerous surgeries the last 2 years, and Plan G may be expensive but it saved our pocketbooks.

My wife was able to choose the specialists, surgeons and hospitals she went to. Advantage plans may allow you to approve your main physician, but that's about it. Many Advantage patients have to got to other cities to specialists and hospitals--especially if they're living in small cities.

The huge hospital chain to the north of us has 1700 doctors and they've purchased hundreds of doctors' practices. And they control medicine in numerous states. They absolutely refuse to accept Medicare Advantage for a reason.

We just prefer to call our own shots when it comes to healthcare.

 

[Birdie Num Nums]

...
I understand MA plans are mostly HMO's. But if you live in a large metro area and are not a snowbird or heavy traveler, MA seems like a better deal. Yet, recent stats show close to 65% of people choose original medicare. Why?

I'm also comparing plans as a newbie to Medicare. In addition to the thick 2021 Medicare booklet I just got in the mail, I've been checking out various YouTube videos (take your pick!).

 

[REWahoo]

BoomerBenefits.com has a free mini-course on Medicare that many find helpful.

 

[Packman]

I think I understand the details of all of the plans. I just don't know why MA plans are not as popular as Medicare Supplement plans. So I heard one reason, and that is for those that use a lot of healthcare. In that case being able to go anywhere that accepts Medicare has value. And plan G pays for most everything.

 

[PaunchyPirate]

Insurance companies receive a specific amount of money for each Medicare Advantage subscriber they sign up. That amount isn’t directly based on the claims the have to pay out. So the more they can sign up, the larger the pool of money they have to start with. The companies then use economy of scale to provide services at lower costs that allow them to make profits. Even when they add in the free gym membership and dental, the government is paying enough money to still let it be profitable. Individual Gym memberships can be pretty cheap if you’re buying 200,000 of them.

HMO models are a way they can control the costs to eek out more profit.

 

[PaunchyPirate]

I am only 58, and I’m hoping Medicare is still largely the same as it is now when I can sign up for it. Assuming so, I plan on selecting Traditional Medicare plus a G Supplement plus Part D for meds.

I want full geographic freedom of coverage. I don’t want to track copays and out of pocket maxes more than I have to. I want full freedom to choose any PCP or specialist I want to see. Medicare has fewer hoops to go thru to get treatments.

To me, these things are worth the money.

This article has some light to shed on the topic. Take it for what it’s worth. I’m sure there are many happy MA customers out there.

https://justcareusa.org/most-people-choose-traditional-medicare-over-medicare-advantage/

 

[CRLLS]

I can't speak to Advantage plans. I never considered them at all. I do have 2 friends who do have Advantage plans and love them.

A couple of things to consider when comparing Supplement plans (Medigap): Do not look solely at the advertised premium for any supplement. Look at how that premium increases for different age groups. Some, if not many states' Dept. for the aging publish
this info. If you are lucky, you will be paying that older premium some day. 2nd is if you are happy with a more limited group of providers but like a particular plan letter, look at a "select" version of that plan. They are less cost.

Packman is right, Once the Medicare deductible is met, any Medicare approved service is 100% covered by Plan G. DW and I went thru this a short time ago. After a couple of years on a Plan F-HD, we both switched companies and plans this year. fortunately we passed the required underwriting. We are both now with AARP Plan G and do not look back. We liked that they are the only community rated plan in our state. After many years of very good health, this year I got hit with gallbladder surgery and then threw out my back (stenosis) requiring steroid shots and phys therapy. I'm not done yet. I'm glad I didn't have to pay for either of them. None of us are getting younger. What was, will not last forever.

 

[CardsFan]

FWIW, MC funds an HSA which covers about 85% of the cost (as of now), but we had decided on a plan G before I confirmed that benefit.

I don't understand this statement, can you explain further?

Former MegaCorp has a Health Savings Account that they fund as part of retiree healthcare. It currently funds about 85% of our Part G and D expenses, but it has no COLA, so eventually it will fund a smaller percentage. But I will take free money any day.

 

[NoMoreJob]

I think I understand the details of all of the plans. I just don't know why MA plans are not as popular as Medicare Supplement plans. So I heard one reason, and that is for those that use a lot of healthcare. In that case being able to go anywhere that accepts Medicare has value. And plan G pays for most everything.

Even if you don't currently use a lot of healthcare that doesn't mean that you won't eventually need to. As a matter of fact most of us will need more and often times much more healthcare. Knowing that as I age I will be able to access the (high quality) healthcare that I need with a cap on the out-of-pocket cost is very important to me.

In addition, for most if not all of of us mental capacity declines as we age. Given this fact I have been simplifying my life in as many ways as possible as I age with a particular focus on finances. I want to be able to handle my own affairs for as long as possible and with minimal stress so I can enjoy my later years as much as possible. Having a high quality traditional Medicare Plan like Plan G substantially reduces the administrative headaches of medical billings and record-keeping . I am more than willing to pay for that. The last thing I or my spouse needs when she or I are sick is to be burdened by medical billings and record-keeping (and possible badgering by medical billing departments and/or collection agencies).

 

[Dash man]

If you take the Advantage plan now and decide to switch to a supplement plan later, you have to pass medical underwriting. I’d rather start with a plan I’d want if my health turned south. I also like to be able to choose my own doctors.

 

[Chuckanut]

If you take the Advantage plan now and decide to switch to a supplement plan later, you have to pass medical underwriting. I’d rather start with a plan I’d want if my health turned south. I also like to be able to choose my own doctors.

+1

This is the main point. I know people who are in a MA Plan and suddenly found out they have some restrictions here and limits there, plus lots of copays all over the place. The copays have radically reduced the savings in their monthly payments. Because their health is not so good, they can't switch back to regular Medicare.

 

[wolf]

I think it depends on the MA, offered in your area.
Here in San Francisco, Bay area. California.
Kaiser, is a MA. Ranked very high. Many of my relatives are in.
I think for this year, $87 month premium. (don't quote me on this).

I have traditional Medicare. Pay, $ 167.67, plan G. Medigap. $ 13.20 Part D.
So, you can see, MA, is much cheaper.

 

[Gotadimple]

MA plans can be cheaper than Medigap + Plan D. Some of huge plans, like Aetna or United Health Care have $0 premium MA policies that include PPO options and HMO options, dental, vision, and drugs. PPO plans are hard to find - but if the provider network is broad and the insurer is nationwide and offers to cover any provider who accepts Medicare when you travel out of the service area, it can be an easy arrangement to deal with. Providers bill directly and get reimbursed directly (even some international hospitals).

But! You need to read and assess carefully. Most "Blue" plans provide nationwide access to doctors and hospitals, and some provide international coverage when you travel. Aetna does the same, and I'm starting to look and UHC - the AARP version to compare to my 'Blue' PPO plan. It is an annual exercise: compare network, coverage, copays and premiums for the best service. Same is true of Medigap and Part D plans.

My observation for MA plans is that when you are paying a premium, you are in essence buying 'down' the co-pays and deductibles and may be buying 'up' the level of coverage. You can compare the relative costs of buying up/down by comparing the summary of benefits brochures for the plans at one insurer, or among insurers.

Med Advantage is a risk plan: from the insurer's perspective they get a significant portion of the Part B premium and cannot go back to Medicare if their claim costs are more than the premium. Medigap is a health-qualified plan: you can switch annually but generally must meet underwriting requirements, some states insurance laws let you switch to another Medigap plan if you are already on one without going through the underwriting process. Part D only allows switching during open enrollment and there is no underwriting.

Boomer benefits is an agent that has good quality info on their site and can advise you for state specifics.

 

[Happyras]

If you take the Advantage plan now and decide to switch to a supplement plan later, you have to pass medical underwriting. I’d rather start with a plan I’d want if my health turned south. I also like to be able to choose my own doctors.

Be aware that some states, such as our more liberal state of WA, have statutes that allow you to change Medigap plans at any time for any reason without a medical underwriting. Most plans offered are community rated, a few are not. You can shop around for best rates and discounts. I can buy a community rated G plan for a range of +/- $30/mo, but some carriers offer 5 to 7% discount on premium if both spouses are covered.

I signed my wife up for the month of Dec to an HMO plan for $0 as she will be 65, but we are both switching to a Plan G effective Jan 1 with a discount.

 

[misanman]

A couple we know from Michigan spend the winters in Florida and the summers at a cabin up north. They have MA based on their Michigan residency and he has just been diagnosed with prostate cancer. He wants to take his treatment in Florida but his MA plan says "no dice". All these years he never realized this could happen. An additional problem is that the cabin up north is not insulated and it's unclear they could heat it adequately this winter. Not sure what they will do at this point because I don't think he will be able to switch plans.

 

[CardsFan]

A couple we know from Michigan spend the winters in Florida and the summers at a cabin up north. They have MA based on their Michigan residency and he has just been diagnosed with prostate cancer. He wants to take his treatment in Florida but his MA plan says "no dice". All these years he never realized this could happen. An additional problem is that the cabin up north is not insulated and it's unclear they could heat it adequately this winter. Not sure what they will do at this point because I don't think he will be able to switch plans.

Sounds like one choice would be to change residency to FL. Legally, with the required number of days, get a license, register to vote, etc.

Not sure if this can happen outside open enrollment, but since we are in that period, it seems something he should look at.

 

[Chuckanut]

On this subject..

I am currently Plan F which is closed to new subscribers.

Is there any good reason for me to switch to the newer Plan G?

 

[misanman]

Sounds like one choice would be to change residency to FL. Legally, with the required number of days, get a license, register to vote, etc.

Not sure if this can happen outside open enrollment, but since we are in that period, it seems something he should look at.

Once you're part of a MA plan I think its hard to switch out. If he were to switch to traditional Medicare with a supplement, he'd have to pass medical underwriting, which could be hard to do with a cancer diagnosis. I think he's pretty much stuck.

 

[CardsFan]

Once you're part of a MA plan I think its hard to switch out. If he were to switch to traditional Medicare with a supplement, he'd have to pass medical underwriting, which could be hard to do with a cancer diagnosis. I think he's pretty much stuck.

But I am talking about legally moving to FL, and getting a new MA plan in that area. At least he could be treated in FL, as he wants. May have to stay there longer each year than desired. Just a trade off.

 

[REWahoo]

On this subject..

I am currently Plan F which is closed to new subscribers.

Is there any good reason for me to switch to the newer Plan G?

Good question. Some believe since there will be no new (younger, healthier) insureds added to the F supplement the insurance companies will have to increase rates by a larger amount over time than for supplements like G that will continue to bring on younger people. By the time you find out if that's true you may not be healthy enough to pass underwriting to change to a new plan.

 

[MBSC]

Once you're part of a MA plan I think its hard to switch out. If he were to switch to traditional Medicare with a supplement, he'd have to pass medical underwriting, which could be hard to do with a cancer diagnosis. I think he's pretty much stuck.

When a Medicare Advantage enrollee moves out of the plan's service area, they have a Guaranteed Issue (GI) right to the lower preferred rate of certain Medigap plan letters. The minimum federal requirements are listed below but state law and carriers can include additional plan letters, such as Plan N.

There is a matching stand-alone Part D Special Enrollment Period (SEP).

Guaranteed issue rights (also called "Medigap protections") are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

* Must sell you a Medigap policy
* Must cover all your pre-existing health conditions
* Can't charge you more for a Medigap policy because of past or present health problems.

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

--You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You have the right to buy Medigap Plan A, B, C, F, F-HD, K, or L that’s sold by any insurance company in your state. [For those who become eligible in 2020+, plans A, B, D, G, G-HD, K, or L].

Reference: https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

This is what the UHC AARP Medigap application for Florida looks like. They don't sell high deductible Medigaps, so HD-F is not included.

Guaranteed Issue Situations:

2. Applicant is enrolled in a Medicare Advantage (MA) plan and: Applicant moves out of the service area.

A 65th birthday PRIOR to 1/1/2020: A, B, C, F, K, L, N or, if available in your area, Medicare Select N.

(page 67): https://www.aarpsupplementalhealth.com/content/dam/EAP/FL_AARP_Med_Supp_Enrollment_Kit_D.pdf

 

[Katsmeow]

Since I will turn 65 next year, I'm paying more attention to the Medicare ads and the mail/email I am receiving. One thing I don't understand is why nearly every ad I see is for Medicare Advantage and very little for Medicare supplement plans. Is MA so much more profitable for insurance companies that they advertise so much? If so, how can that be when most charge no premiums and cover more medical needs (like dental, vision, etc.)?

I understand MA plans are mostly HMO's. But if you live in a large metro area and are not a snowbird or heavy traveler, MA seems like a better deal. Yet, recent stats show close to 65% of people choose original medicare. Why?

I think I understand the details of all of the plans. I just don't know why MA plans are not as popular as Medicare Supplement plans. So I heard one reason, and that is for those that use a lot of healthcare. In that case being able to go anywhere that accepts Medicare has value. And plan G pays for most everything.

I looked at Medicare Advantage plan I would never select one that was an HMO. If I had to do a MA plan I would get one that was a PPO where you could go to out of network providers. Yes, many of the plans are $0 premium which is nice.

But there is no free lunch! MA plans have co-pays. The out of pocket maximum even for in network providers can be several thousand dollars. The out of network max is even higher.

I have traditional Medicare. I do pay for a supplement. But the cost of the supplement is far below the out of pocket maximum for a MA plan. I could pay for several years of my supplement for one year of a maxed out MA plan.

But, you might say. Well, I am healthy. I hardly ever go to the doctor. Me, too! But, people over 65 don't stay healthy. Eventually there will be a chronic condition, or a serious illness, etc. My mother died at 94. If she had had a MA plan she would have spent thousands every year. And she was mentally competent living alone until 2 months before she died. But, she had diabetes, heart failure and kidney disease. None of these started until she was in her 60s and most were not until her 70s.

And, had she had a Medicare Advantage plan she couldn't have gone back to Original medicare because she would not have been able to qualify for a supplement.

Of course you might say that you can qualify for a subsidy. Of course. The problem is that when you want to go back to traditional Medicare you may not be able to qualify.

On this subject..

I am currently Plan F which is closed to new subscribers.

Is there any good reason for me to switch to the newer Plan G?

There is a fear premiums will rise higher for people on Plan F because they are not getting new participants. Even if they don't you should compare the cost of Plan F to Plan G. DH is on Plan F (AARP UHC). I am on Plan G. I could have chosen F as it was right before they were phasing it out but by then AARP was offering it in our state and the cost of premiums was significantly different. But DH was kept F. He doesn't have what I would think are any significant health issues but I don't know what the standard is.