Why I use Medicare Advantage, and I'm happy.

[Qs Laptop]

Maybe it is, but I am not Medicare age yet and am researching. Thanks.

Flieger

Like a lot of others here, I chose Medicare gap coverage (Plan N) for this exact reason. I wanted the ability to go to ANY doctor ANYWHERE and not be tied down to the selection of doctors only within the PPO network of the Medicare Advantage plan. Another factor was not having to worry about whether or not I had coverage while traveling anywhere in the United States. Oh, and avoiding the annual Advantage plan renewal shopping ritual.

 

[REWahoo]

Like a lot of others here, I chose Medicare gap coverage (Plan N) for this exact reason. I wanted the ability to go to ANY doctor ANYWHERE and not be tied down to the selection of doctors only within the PPO network of the Medicare Advantage plan. Another factor was not having to worry about whether or not I had coverage while traveling anywhere in the United States. Oh, and avoiding the annual Advantage plan renewal shopping ritual.

Same here. One additional reason we went with Medigap rather than Advantage: Medigap pays when Medicare pays. Period.

Advantage plans are run by for profit insurance companies who improve their bottom line by limiting/restricting coverage - not that they would do that of course...

 

[harllee]

This is down the road for me, but I’m interested in the topic.

If you enroll in MA for a year and don’t like it, is there anything that prevents you from going back to traditional Medicare the following year?

In most states you would have to pass health underwriting to get a traditional Medicare supplement the following year and almost any health condition can make you fail underwriting. So if you want traditional Medicare and a supplement you need to start off with traditional.

 

[MichaelB]

Is it 100% known they would not have been able to get the treatment if on MA? Just curious how one would know?

Flieger

We can know for sure what traditional Medicare and Supplemental covers, because the coverage, by regulation, is exactly the same across all insurers and around the country. The decision to pay for a service is made solely by Medicare and the Supplement insurers have no choice and are obligated to pay,

We cannot say the same about MA, It is certain MA covers the same things Medicare A and B cover, but the networks will not be the same, and the MA insurer may interpret a situation as outside their coverage and decline to pay, or just make it difficult.

An MA insurer can also change the network and drop providers without prior notification.

 

[aja8888]

It's like my Dad used to say..."In the end, you get what you pay for".

 

[marko]

OK, but a question: If one is on MA, can't they switch back to Medicare plus a Supplement at the end of each year? A problem if you get a serious issue in April, but you're not locked in forever are you?

 

[aja8888]

OK, but a question: If one is on MA, can't they switch back to Medicare plus a Supplement at the end of each year? A problem if you get a serious issue in April, but you're not locked in forever are you?

Some states require a medical evaluation (medical underwriting) to switch from a MA plan to Medicare with a supplemental plan. Some identified issues that may cause you to fail the test are COPD, Cancer, and being diabetic. There may be others. Once you are rejected, I believe that it's forever.

 

[marko]

Some states require a medical evaluation (medical underwriting) to switch from a MA plan to Medicare with a supplemental plan. Some identified issues that may cause you to fail the test are COPD, Cancer, and being diabetic. There may be others. Once you are rejected, I believe that it's forever.

Ouch!!!! (and, holy crap!)

 

[MBSC]

This is down the road for me, but I’m interested in the topic.

If you enroll in MA for a year and don’t like it, is there anything that prevents you from going back to traditional Medicare the following year?

In most states you would have to pass health underwriting to get a traditional Medicare supplement the following year and almost any health condition can make you fail underwriting. So if you want traditional Medicare and a supplement you need to start off with traditional.

If you enroll in a MA plan at 65, you get a 12-month "trial right" to test drive the MA plan. Anytime during that period, you can switch to original Medicare and choose any Medigap plan without underwriting plus a stand-alone Part D drug plan. @harllee is correct once the 12 months are up.

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. (Trial right #1)

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

Note: Your rights may last for an extra 12 months under certain circumstances. Check with your State Insurance Department.

Page 19: https://www.medicare.gov/publicatio...health-insurance-for-people-with-medicare.pdf

 

[sengsational]

I retired early and went on ACA plans for 10 years. Those plans are similar to how Medicare Advantage plans operate: with defined networks. And the rules about who you can treat you "in-network" and where you can go "in-network" can change at any point. In most businesses, if you "change the deal" the customer can walk, get their money back, and find another provider. But not in the case of health insurance.

I started the first year the PPACA plans went active, and I watched over the years how the insurance companies kept changing the rules. I get it. They needed to save money to compete. But I got fed-up with that process and want to avoid anything like it, if I can. And I can, by avoiding Medicare Advantage.

Here's one example... I traveled to another state to see a world-class doctor and it was covered. A few months later, but the next year, with "the same insurance" they denied the claim. They pointed me to an 80 page PDF and expected me to notice that a paragraph had been REMOVED from the document year to year! Oh, and, by the way, that document was not available to me until AFTER I purchased the insurance on healthcare.gov! I fought that and won.

Another example I ran into is "stacked deductible", which got outlawed, but I got hit with. This where if you get two individual policies for husband and wife, the insurance kicks in at, say $5K, but if you buy the exact same coverage with both of you on one policy, the insurance doesn't kick in until $10K. I fought that and lost. And later they outlawed the practice, so the judge in my case was wrong...probably didn't want to get appealed.

The insurance company would see where they were spending "too much" and set it up next year so it was harder or impossible for customers to consume resources in a certain way. Insurance companies see their customers as ants to honey...they spray "Raid" on the biggest trails.

Besides those reasons, as a matter of principle, I don't buy things that involve a "hard sell."

 

[latexman]

Advantage plans are run by for profit insurance companies who improve their bottom line by limiting/restricting coverage - not that they would do that of course...

My Medicare Advantage plan is furnished and subsidized by the MegaCorp I retired from.

 

[RetiredAt55.5]

We can know for sure what traditional Medicare and Supplemental covers, because the coverage, by regulation, is exactly the same across all insurers and around the country. The decision to pay for a service is made solely by Medicare and the Supplement insurers have no choice and are obligated to pay,

We cannot say the same about MA, It is certain MA covers the same things Medicare A and B cover, but the networks will not be the same, and the MA insurer may interpret a situation as outside their coverage and decline to pay, or just make it difficult.

An MA insurer can also change the network and drop providers without prior notification.

+1

When we investigated MA, one big drawback IMO is that the details of a MA plan can change every single year, so that would necessitate reviewing the plan every open enrollment to see what coverage details have changed, and investigating other MA plans and their details if one wanted to switch. Ugh, yearly homework.

Those MA dental, vision, gym add-ons aren't guaranteed so those savings can disappear if the insurer chooses.

It's great if one has the option of a good MA PPO plan in their area. There's no guarantee that PPO plan will still be available 5 years from now if the insurer decides to stop offering that plan or decides to get out of the MA business altogether, or just makes major changes to the plan or network. I'm not sure those scenarios would allow someone to switch to a original Medicare plan without underwriting (in every state). So, one could end up in a not so good HMO MA plan if that's all that's available.

 

[pacergal]

We have Kaiser Medicare Advantage. We have never had a referral declined, our PCP has placed referrals for anything we have requested, or referrals from ER visits by the Drs.
I have used it out of state for an emergency without problem at another Kaiser network. They also have a number to call for travel if you wish to know where to go ahead of time, especially if a Kaiser facility is not nearby.
Both my husband and I have had hospitalizations, one with surgery, for health issues and received high quality care (I am a very good judge on that, and being an RN, I am very picky about my medical care)
We can schedule appointments for chiropractor, PT, acupuncture without referral. They have a list of places we can call and go to.

So far, I am pleased with Kaiser system. we switched over prior to going off my work insurance to try out Kaiser before medicare. We chose to stick with it. Kaiser is pretty big on the west coast.

Everyone needs to do their own research and make the choice that is best for them, for the area they live in. And research alternative care needs that may also be covered or not.

People mention the need to research every year because "MA plans change".
I believe that could happen, and does, with any insurance plan.
I research all Medicare plans every year to make sure I want to stay on Kaiser.
We live in a state where we can change every year if we desire.

May good health be with you all!

 

[Qs Laptop]

We have Kaiser Medicare Advantage.
I have used it out of state for an emergency without problem at another Kaiser network. They also have a number to call for travel if you wish to know where to go ahead of time, especially if a Kaiser facility is not nearby.

It was a good thing that when you were out of state they had another Kaiser network available in an emergency. Of course they have a number to call when traveling to see if there is a Kaiser facility nearby, but this is not very useful in an emergency.

People mention the need to research every year because "MA plans change".
I believe that could happen, and does, with any insurance plan.
I research all Medicare plans every year to make sure I want to stay on Kaiser.
We live in a state where we can change every year if we desire.

May good health be with you all!

The only thing that could potentially change with my Medigap plan is Part D, the pharmaceutical coverage. I remember when my mom was alive and on Advantage plans she had a broker that would advise her every year on which plan was changing coverage in what area and tell her which plan she should switch over to. No thank you, I don't want to deal with this.

 

[Yipper]

If you enroll in a MA plan at 65, you get a 12-month "trial right" to test drive the MA plan. Anytime during that period, you can switch to original Medicare and choose any Medigap plan without underwriting plus a stand-alone Part D drug plan. @harllee is correct once the 12 months are up.

You are also able to return to original Medicare + your previous supplement plan if you decided at any time in the future to "try out" MA. You can only do this one time and you have 1 year to return to OM+Supplement.

 

[pacergal]

I won't post their Medicare travel care booklet, but
You can get care anywhere in a life threatening emergency, especially if you are in a non Kaiser area.
There is a travel number to call for referral to urgent care facility, if you have time (for non life threatening urgent medical needs)
And we call the number ahead of time when we travel to get info, just in case.

There is a number and process for payment Orr eimbursement, just as with any insurance company.

Kaiser works for us, may not for many.

 

[Flieger]

If you enroll in a MA plan at 65, you get a 12-month "trial right" to test drive the MA plan. Anytime during that period, you can switch to original Medicare and choose any Medigap plan without underwriting plus a stand-alone Part D drug plan. @harllee is correct once the 12 months are up.

MBSC, you're in SC like me, are you on Medicare? If so, which way did you go?

Flieger

 

[RetiredAt55.5]

You are also able to return to original Medicare + your previous supplement plan if you decided at any time in the future to "try out" MA. You can only do this one time and you have 1 year to return to OM+Supplement.

An issue with doing that is that you might not be able to return to the same OM + Supplement plan.

E.g., if you were originally in a plan N, you might not be able to get back into a plan N. I think you could pick a plan G. Not sure about a G-HD. But suffice to say, there's some restrictions.

 

[Focus]

Kaiser works for us, may not for many.

I had them as my provider for a few of my ACA years and was initially happy to do so, since I agreed with what they claimed to be their philosophy of care. Upon their entry in Washington state, they offered "loss leader" premiums that beat all the competition, and then they rapidly jacked them up in subsequent years once they were established.

They claim to be actively preventive, but I found them purely reactive in practice. In fact, the annual preventive exam covered under the ACA was simply a 10-minute chat and nothing more; they never did a blood test. A former boss of mine was a big Kaiser advocate for many years, but then his wife got cancer, and after going through their treatment process, he said he'd never recommend Kaiser to anyone again.

 

[ncbill]

If you can afford to pay for rehab out-of-pocket & understand that your MA provider will insist you start out with the cheapest treatment protocol for your potentially terminal whatever then a zero premium MA might be fine for you.

 

[marko]

If you can afford to pay for rehab out-of-pocket & understand that your MA provider will insist you start out with the cheapest treatment protocol for your potentially terminal whatever then a zero premium MA might be fine for you.

You can pay now or pay (more) later.

 

[Pluperfect]

1) The people on OM always tell you that OM is the best choice. It's not true.

OM + a Plan G supplement is undoubtedly the best insurance. And I'd say it's the best choice if you can afford it and especially if you want to avoid billing hassles.

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.

It's not surgeries that cause people to hit the OOP max on Advantage plans--it's cancer. In a lot of Advantage plans, cancer treatment is covered by the member paying 20% coinsurance instead of a copay. Those people can meet their max OOP with a quickness.

The benefit summary you posted doesn't address cancer treatment (chemotherapy/radiation), and maybe it depends on whether it's inpatient or outpatient or maybe under the prescription drug coverage. I'm blessedly ignorant on how cancer treatment is billed.

But I have a friend whose husband was on an Advantage plan, much to her chagrin because they're rich. He had cancer and he hit his OOP max every year, paying more than what OM + supplement would have cost.

That's why it's important to know exactly how cancer treatment is covered under an Advantage plan.

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.

In every state you can switch from Advantage to Original Medicare during the Medicare open enrollment period at the end of the year and during the Advantage open enrollment period at the beginning of the year.

What you might not be able to do is buy a supplement to cover the 20% OM doesn't cover--that will depend on your state and your health status.

 

[RetMD21]

Most people on MA plans are satisfied but there could be pre-approval and limitations in care even in "good" plans. An individual's experience isn't a guide to the possibilities. Some people who choose MA plans get very defensive over the choice.

 

[GoodWishes]

DH and I took care of his parents for a couple years before they passed. We were in close contact with all their health care providers. Several providers (rehab, skilled nursing, PT, OT) told us that it is difficult to deal with MA to get what they believe are best for the patients. They said it is much easier to deal with OM.

 

[kevink]

This is down the road for me, but I’m interested in the topic.

If you enroll in MA for a year and don’t like it, is there anything that prevents you from going back to traditional Medicare the

You may be required to go through medical underwriting in order to get a supplemental plan.