(OM) Original Medicare is a great option for many people. I have plenty of money and decided to explore (MA) Medicare Advantage by myself. Finding details is a very complex subject because the "experts" are mostly unprofessional, massage the truth, and many times don't know themselves.
In my zip code, metro Atlanta, there are over 60 MA options. Only several meet my criteria, which is to be able to see all the best doctors and go to the best facilities. In my case, only Aetna and Humana can do it.
I selected OM in the first 7 months at age 65, then switched the next year to MA.
The first MA was with Aetna. Aetna canceled it after one years. This allowed me to go on OM without tests, but I selected a new MA, Humana Gold Choice H8145-069 (PFFS). I have saved at least $6K per year compared to OM.
Premium of OM supplement + Part D = $3000. MA = 0
Prescriptions: I have a tier 3 drug that I had to pay about $1900 + others under OM = $2000. Under MA is about $100-200.
Dental $2500
Vision eye check + glasses/contacts are about $500. I used it in 2025
Free LA Fitness(Silver Sneakers) = $360
Over-the-Counter (OTC) $250 per quarter = $1000. I used it to buy many things, including the latest Fitbit.
If you add the above, it comes easily to over $6-7K.
This means that the above money is invested, as I do with all my money.
Let's use $5K savings * 20 years at a modest performance of 6% = $200K
My max out-of-pocket at in/out of network is $6700. This looks scary, but in the real world it isn't when I used it.
Two years ago, I had a $35K surgery. I paid the deductible of just $370.
Two months ago, I had another surgery at $40K, and I paid only $415. This time the surgeon and the hospital were out of network, but my deductible is the same. It means I can go to other states too.
In big metro areas, MA can be a very good choice if you select the right one. In most cases it's not an HMO, although I read that Kaiser is a good choice. Several friends in Kaiser can't use the best doctors and specialists in my area. PPO should be your choice. In my case, PFFS (Private Fee-For-Service) is even better with more flexibility to use other states, a low same deductible for in/out of network, and much lower out-of-pocket costs.
From what I read, I found out that:
1) The people on OM always tell you that OM is the best choice. It's not true.
2) Most MA are below par IMO, but several of them are excellent if they are available in your zip code.
3) They also scare you with MA; you may be in trouble and have to pay thousands out-ot-pocket, my 2 surgeries proved it wrong.
4) Another scare is that if you are sick, you can't join OM. That's true in some cases but not all. Several states let you change to OM every year regardless. In my case, cancellation of my MA, allowed me to join OM without tests.
5) Many people who have enough select the easy OM choice. That's fine. I have plenty, but I'm a number guy; in my case it is clear to me that my choice is going to save me thousands over the years. I discuss my MA with a local broker that have used these type of MA, he has almost 1000 clients for about 20 years, some with multiple complicated and expensive surgeries, and the most that anyone paid was $1500 annually out of pocket. I have several friends that have used him for over 15 years.
6) I also found out you can buy stand-alone coverage for certain deductibles. In my case, if I stay in the hospital, I will pay $390 daily for the first 5 days, then zero for the rest. I could buy insurance that will pay me $500 per day for 5 days at about $40 per month. I passed on that. There are insurances that will cover your max-out-of pocket for $55-70 monthly. They are all much cheaper when you look at the total picture.
In my zip code, metro Atlanta, there are over 60 MA options. Only several meet my criteria, which is to be able to see all the best doctors and go to the best facilities. In my case, only Aetna and Humana can do it.
I selected OM in the first 7 months at age 65, then switched the next year to MA.
The first MA was with Aetna. Aetna canceled it after one years. This allowed me to go on OM without tests, but I selected a new MA, Humana Gold Choice H8145-069 (PFFS). I have saved at least $6K per year compared to OM.
Premium of OM supplement + Part D = $3000. MA = 0
Prescriptions: I have a tier 3 drug that I had to pay about $1900 + others under OM = $2000. Under MA is about $100-200.
Dental $2500
Vision eye check + glasses/contacts are about $500. I used it in 2025
Free LA Fitness(Silver Sneakers) = $360
Over-the-Counter (OTC) $250 per quarter = $1000. I used it to buy many things, including the latest Fitbit.
If you add the above, it comes easily to over $6-7K.
This means that the above money is invested, as I do with all my money.
Let's use $5K savings * 20 years at a modest performance of 6% = $200K
My max out-of-pocket at in/out of network is $6700. This looks scary, but in the real world it isn't when I used it.
Two years ago, I had a $35K surgery. I paid the deductible of just $370.
Two months ago, I had another surgery at $40K, and I paid only $415. This time the surgeon and the hospital were out of network, but my deductible is the same. It means I can go to other states too.
In big metro areas, MA can be a very good choice if you select the right one. In most cases it's not an HMO, although I read that Kaiser is a good choice. Several friends in Kaiser can't use the best doctors and specialists in my area. PPO should be your choice. In my case, PFFS (Private Fee-For-Service) is even better with more flexibility to use other states, a low same deductible for in/out of network, and much lower out-of-pocket costs.
From what I read, I found out that:
1) The people on OM always tell you that OM is the best choice. It's not true.
2) Most MA are below par IMO, but several of them are excellent if they are available in your zip code.
3) They also scare you with MA; you may be in trouble and have to pay thousands out-ot-pocket, my 2 surgeries proved it wrong.
4) Another scare is that if you are sick, you can't join OM. That's true in some cases but not all. Several states let you change to OM every year regardless. In my case, cancellation of my MA, allowed me to join OM without tests.
5) Many people who have enough select the easy OM choice. That's fine. I have plenty, but I'm a number guy; in my case it is clear to me that my choice is going to save me thousands over the years. I discuss my MA with a local broker that have used these type of MA, he has almost 1000 clients for about 20 years, some with multiple complicated and expensive surgeries, and the most that anyone paid was $1500 annually out of pocket. I have several friends that have used him for over 15 years.
6) I also found out you can buy stand-alone coverage for certain deductibles. In my case, if I stay in the hospital, I will pay $390 daily for the first 5 days, then zero for the rest. I could buy insurance that will pay me $500 per day for 5 days at about $40 per month. I passed on that. There are insurances that will cover your max-out-of pocket for $55-70 monthly. They are all much cheaper when you look at the total picture.
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