Satisfied Socal/LA area Kaiser user approaching 65 - can i do kaiser (advantage?) but switch later if i think maybe conventional plan G is better ?

mh

mh

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subject says it all Satisfied Socal/LA area Kaiser user approaching 65 - can i do kaiser (advantage?) but switch later if i think maybe conventional plan G is better ?

to elaborate a bit i've had kaiser as my job health care and via ACA when i retired early. was always very healthy till i got bladder cancer a couple years ago.
i got very good care with some non trivial surgery and chemo, (they removed my bladder and put in a reconstructed neo bladder from intestine) and now i'm currently
back to my old self for the most part. maybe that's too much information but you get what level of non trivial i'm talking about at least :)

anyways... i'm feeling maybe i should stick with Kaiser and my existing urology care in my post 65 / medicare XXX pathway i turn 65.
one thing i'm not clear about is weather i could switch to something like humana medicare G / etc... supplement which my mom had and was pretty reasonable
for her if i though later on maybe that wasn't the best way for me to go. i am guessing the answer is no ( it seems to be dependent on the state ? or ?? )

any comments / knowledge by anyone has on the subject would be appreciated. don't worry about 100% accuracy. i'll double check any anecdotal info
 
I was thinking that you can switch from Advantage back to regular Medicare BUT you may have to undergo underwriting if you want Gap insurance.

Yes, do please check further. This is not may area of expertise.
 
I think you cannot change from MA to MediGap without underwriting, even in California.

California has a guaranteed issue birthday rule, but it only applies when you already have an existing Medidap policy and want to change insurers or downgrade to less MediGap coverage.
 
You can only switch to a Medigap plan before you turn 67, basically you can ride an Advantage plan for up to a maximum of 2 years and not need underwriting. With past cancer, I would not want to wait out to go on a Medigap plan. It is unlikely that any Medigap insurer would take you with underwriting.
 
If you choose Medicare Advantage at 65, federal regulations give you a 12-month "trial right". You can switch to original Medicare and choose any Medigap plan at the preferred rate without medical underwriting. You also choose any Part D drug plan. After the trial right ends, you can still switch back to original Medicare BUT have to pass underwriting in CA to get a Medigap plan. Otherwise, there are a few Special Enrollment Periods (SEPs) that allow you to get a Medigap, such as moving out of the MA plan's service area or if Kaiser stops offering the MA plan.

California has a Medigap Birthday Rule. It allows you to change Medigap plans annually without underwriting as long as the new one doesn't have more benefits. Some people mistakenly believe it lets you drop MA. It does not. State Farm and USAA (no military affiliation required) usually have the lowest Plan G Medigap rates in most of CA. There is no reason to pay more in birthday rule states.

Guaranteed issue rights or “Medigap protections” are your rights to buy certain Medigap policies in limited situations outside of your Medigap Open Enrollment Period. 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 if...(Trial right) You joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

You have the right to buy any Medigap policy that’s sold by an insurance company in your state.

CMS Guide to Choosing a Medigap (pages 21-23): https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
Click to expand...
 
It sounds like you have had a positive experience so far with Kaiser. If you think that will continue, and presuming they offer an equivalent MA plan, and it's cheaper and if being cheaper makes a difference, then that might be fine ( a lot of "and" items in that sentence). The point of the post, though, is, if you go with plan G or similar, you can see any doctor that takes Medicare. I presume your current medical team takes Medicare?
 
sengsational said:
It sounds like you have had a positive experience so far with Kaiser. If you think that will continue, and presuming they offer an equivalent MA plan, and it's cheaper and if being cheaper makes a difference, then that might be fine ( a lot of "and" items in that sentence). The point of the post, though, is, if you go with plan G or similar, you can see any doctor that takes Medicare. I presume your current medical team takes Medicare?
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Kaiser being a HMO, only takes their specific Medicare Advantage plan and not Medigap plans. We were both with Kaiser the whole time we lived in California and had the best PCPs and OBGYN. Most of the specialists were horrible. When my husband turned 65, he continued with Kaiser since we didn't know better. It was simple and everything was under one roof.

When we left California, my husband was 68 yo and we tried to get him on a Medicare Supplement plan and was subjected to underwriting which he "failed". He was offered 3X regular Supplement rates (I think back then it was called Tier 3 pricing) and was cost prohibitive. He then went on Medicare Advantage PPO for 3 years and then applied again through the same insurer (Humana). This time he passed underwriting because the insurer could see all the claims for the past few years. Then last year during the birthday rule, we switched him to a less expensive Plan F insurer.

We do have superior specialists compared with ours at Kaiser's. We both get better prescription drugs - something that actually work, and better specialists who want to see us as opposed to declining to see us after our PCPs referred us to them at Kaiser. We did not know better when we were with Kaiser, and now we do.
 
If you are happy with Kaiser, why not stay with it? I agree with others about needing underwriting to switch, especially after the age 67.
We tried Kaiser for two years before retirement, as my work offered MODA or Kaiser. We liked that it was so easy, all under one roof, so to speak. No problems getting referrals, easy online medical records, etc. The only down side is getting same day urgent appt with our PCP, but they have urgent care clinics all over, urgent online appts and same day providers available, just not with our primary doc. But I experienced that the last couple years with MODA too.
So we stayed with it for medicare and chose Advantage plan. Remain happy with it so far.
I even recently needed emergent care while on vacation in Hawaii. Went to Kaiser hospital, no problems.
 
MBSC said:
If you choose Medicare Advantage at 65, federal regulations give you a 12-month "trial right". You can switch to original Medicare and choose any Medigap plan at the preferred rate without medical underwriting. You also choose any Part D drug plan. After the trial right ends, you can still switch back to original Medicare BUT have to pass underwriting in CA to get a Medigap plan. Otherwise, there are a few Special Enrollment Periods (SEPs) that allow you to get a Medigap, such as moving out of the MA plan's service area or if Kaiser stops offering the MA plan.

California has a Medigap Birthday Rule. It allows you to change Medigap plans annually without underwriting as long as the new one doesn't have more benefits. Some people mistakenly believe it lets you drop MA. It does not. State Farm and USAA (no military affiliation required) usually have the lowest Plan G Medigap rates in most of CA. There is no reason to pay more in birthday rule states.
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Good job MBSC Correct answer.
But, as a Kaiser member you get addition option during AEP because they do not sell a Medicare supplement.
You enrolled in a Medicare Advantage Plan and that plan either:
• Reduced any of its benefits;
• Increased the amount of cost-sharing or premium; or;
• Discontinued (for other than quality of care) a contract with a provider currently furnishing
services to you.
In addition, no Medicare Supplement plan is available from that issuer, a subsidiary of the parent company of the issuer, or a network that contracts with the parent company of the issuer.

Not the correct answer: There is no reason to pay more in birthday rule states.
You need to look at more than rates, Example: no Gym memberships included with those companies you mentioned (important to me), I do not think they offer High deducible plans. I do not think they offer discounted dental plans, vision or single annual payment. I am willing to pay more for service from the company and local insurance agent fighting for me. When I have an issue such as reinstate for failure to pay or international claims issues cheapest is not always the best. Drive the cheapest car? Clothing at Walmart? Food at Aldi? Cheapest Vodka or Beer? Not that those are bad, just saying my option is do a deeper dive than cheapest.
 
I'm a longtime socal Kaiser person. I hit in Medicare in 2 years and will be switching away to a plan G. My sister is on Medicare and has Kaiser through her retiree teacher plan and loves it.

The reason I plan to switch is better coverage on places like Central California (big hole in the state with no Kaiser), ability to see specialists of my choosing without the gatekeeper of the PCP or Kaiser network.

My parents had Kaiser and were very happy with their care, including oncologists... But I'm looking forward to being able to seek out doctors outside the Kaiser umbrella. I also know as I get older more things will go wrong with my body... Right now I only use Kaiser for the annual checkup and inoculations.

So my advice is to consider if you want more coverage than you currently have, as you age, or if you think your needs might increase as you age, beyond what Kaiser will provide.
 
I was with Kaiser for 40+ years and have been very happy with them. Unfortunately, my PCP got a promotion just right before I turned 65. So I decided to give the outside world a try since I have to find a new PCP anyways. Only advice I have to offer is to look for a new PCP months before you plan to leave Kaiser. My first welcome to Medicare appt with my new PCP is on Feb 14th, 2025. I made that appt back in June, two months before I turned 65. Of course I could've been seen by many other Drs before Feb, but I didn't just want to go with the earliest available Dr.
 
I grew up near where Kaiser originated. They paid so much less than other employers, their doctors at the beginning were of questionable quality. The ONLY reason they exist today is they convinced the generally left leaning faculty at UC Berkeley to use them as the main provider.

When I was in elementary school, one of my friends got a bad stomach flu. Her professor parents were out of the country, so although my mother took her to the ER, we had to wait for the grandparents to show so she could be treated. Nothing like the basement of Kaiser Oakland at midnight.

And then there was my friend in junior high who got an abdominal cancer. Since this was very unusual, the cancer diagnosis was made very late. Appropriate testing was delayed. When it was found, the tumor was surgically removed. The surgery was damaging, and she died in her early 30's, if I recall.

The witch doctors of Kaiser, as they have always been known by the astute medical consumers in that area...
 
Another Reader said:
I grew up near where Kaiser originated. They paid so much less than other employers, their doctors at the beginning were of questionable quality. The ONLY reason they exist today is they convinced the generally left leaning faculty at UC Berkeley to use them as the main provider.

When I was in elementary school, one of my friends got a bad stomach flu. Her professor parents were out of the country, so although my mother took her to the ER, we had to wait for the grandparents to show so she could be treated. Nothing like the basement of Kaiser Oakland at midnight.

And then there was my friend in junior high who got an abdominal cancer. Since this was very unusual, the cancer diagnosis was made very late. Appropriate testing was delayed. When it was found, the tumor was surgically removed. The surgery was damaging, and she died in her early 30's, if I recall.

The witch doctors of Kaiser, as they have always been known by the astute medical consumers in that area...
Click to expand...
Kaiser has a decent reputation in the Islands though I prefer Queens.
 
Kaiser is great for convenience and not having major health issues, and for those who don't want to navigate provider options in getting the best specialists out there.
 
Another Reader said:
I grew up near where Kaiser originated. They paid so much less than other employers, their doctors at the beginning were of questionable quality. The ONLY reason they exist today is they convinced the generally left leaning faculty at UC Berkeley to use them as the main provider.

When I was in elementary school, one of my friends got a bad stomach flu. Her professor parents were out of the country, so although my mother took her to the ER, we had to wait for the grandparents to show so she could be treated. Nothing like the basement of Kaiser Oakland at midnight.

And then there was my friend in junior high who got an abdominal cancer. Since this was very unusual, the cancer diagnosis was made very late. Appropriate testing was delayed. When it was found, the tumor was surgically removed. The surgery was damaging, and she died in her early 30's, if I recall.

The witch doctors of Kaiser, as they have always been known by the astute medical consumers in that area...
Click to expand...
 
Those “ witch doctors” are a thing of the past. At least at northern CA Bay Area Kaiser. My wife is a physician ( pediatrics) there. I know a bunch of the doctors and listen/ goto a bunch of shareholder events. They are highly qualified, best schools and care utmost about the patient. Like any megacorp, there will be some issues. FYI. Kaiser is the health care plan. The physicians are The permanente medical group. The group is nearly possessed about giving the best care possible. Kaiser, the hospital/ health care plan is what some get disenchanted with at times.
 
thanks for the responses so far. the main reason for me to think about staying with kaiser is that the urology specialist that i had at kaiser was really good. the oncologist was also good. my health was very good prior to that so i don’t have much else to go on. the few basic interactions i had with kaiser prior to that were also good.

so… i guess i’m finding it a little hard to move away from the 2 specialists at i have had good experiences with. there’s very little chance i will move anywhere else in my lifetime, but i want to try to keep options open if possible. for example, if the specialist moves on. my main reason for staying goes away.. although the whole dept seemed good with the few interactions i had with them.
 
A radical cystectomy with ileal conduit is probably the most major surgery a urologist performs. If you’ve been pleased with the care you received by both your urologist and your oncologist at Kaiser, it seems reasonable to stay with Kaiser. I’m not sure of the time limit, but I had heard the window for changing from a Medicare Advantage plan to traditional Medicare with a medigap plan in California was 6 months rather than the 12 months someone else mentioned earlier. But that was anecdotal information I read in the local paper, not an official healthcare website.
 
dak2018 said:
I'll let my Kaiser physicians know that they are witch doctors, or I would if that comment was not borderline racist.
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I think he means the Kaiser doctors suck, if they were any good they would be at Hoag, UCLA or City of hope
 
jw72 said:
I think he means the Kaiser doctors suck, if they were any good they would be at Hoag, UCLA or City of hope
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Actually, Kaiser is now the best paymaster. Doctors and nurses make more and have much more generous pensions than other hospital systems in California. The issue is that the PCPs are the gatekeepers and even when they do refer you to their specialists, the specialists can decline to see you or be totally rude to you and tell you that you are wasting their time and close your referral. You have no recourse. It happened to me. Then there is the issue of incompetent specialists. I can go on...
 
I call BS, "Doctors and nurses make more and have much more generous pensions than other hospital systems in California."
Please check the UC hospital pension. Sate employees
 
Joseph said:
Those “ witch doctors” are a thing of the past. At least at northern CA Bay Area Kaiser. My wife is a physician ( pediatrics) there. I know a bunch of the doctors and listen/ goto a bunch of shareholder events. They are highly qualified, best schools and care utmost about the patient. Like any megacorp, there will be some issues. FYI. Kaiser is the health care plan. The physicians are The permanente medical group. The group is nearly possessed about giving the best care possible. Kaiser, the hospital/ health care plan is what some get disenchanted with at times.
Click to expand...
I have friends currently dealing with them who would vehemently disagree. I do know one person dealing with breast cancer in the East Bay who is medically sophisticated and good at organizing and controlling processes. She is pleased with her care.
 
Kaiser has done an awful job with Covid, especially Long Covid. Because there are so many presentations and complications, the referral process is extremely difficult to navigate. I have a younger friend that has received very little help in four plus years with what is a serious chronic disease.
 
jw72 said:
I call BS, "Doctors and nurses make more and have much more generous pensions than other hospital systems in California."
Please check the UC hospital pension. Sate employees
Click to expand...
I call BS on you. I have several friends, registered nurses, PCP and OBGYN working in Kaiser and know what they make and the pensions that they get. It is out of this world great.

This is from AI with google search about compensation between UC and Kaiser:
1726323992234.png
 
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