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

[Teacher Terry]

I know a couple of people that are only still alive today because they could seek medical care anywhere in this country. Even before my SS was greatly increased and I was on a pretty tight budget the last thing I was going to give up was regular Medicare with the supplement.

I have known people that have no money problems at all and had no idea about many of the common issues with Medicare advantage plans. They switched to Medicare advantage not really understanding some of the disadvantages. For something as important as healthcare I was surprised that some intelligent people hadn’t done more research.

60 minutes actually did a segment on Medicare advantage plans and the problems people may have. They told a couple of peoples personal stories. What I’ve come to realize from reading on forums is that people that have a Medicare advantage plan sponsored by their employer as a retirement benefit tend to have much better advantage plans than the general public.

 

[Pluperfect]

For accepting risk, the [Advantage] insurance company gets a significant portion of the Part B premium plus they can charge a premium for coverage.

They aren't given a portion of each member's $185 Part B monthly, and then can add their own premium.

The government pays them about $1,000 per month per member. And they can add their own premium to that.

 

[Pluperfect]

Part B drugs are not subject to the $2000 Part D MOOP. You would pay the plan's 20% coinsurance until you hit the $6700 MOOP for covered Part A/B services. See page 60 of the Evidence of Coverage for Humana FFS plan H8145-069 below.

Thank you!

It's troubling that someone who really looked into how his Advantage plans pay for healthcare expenses missed the coinsurance (not copay) for cancer treatment. And then made an assumption about how the chemotherapy drugs would be covered that turned out to be wrong.

That's no way to make an informed decision.

Apparently the OP can afford the $6,700 he would undoubtedly owe if he had cancer treatment, but it could be devastating to people who can't afford it, and don't realize it's even a possibility.

And I'll add that people saying, "I've had X amount of surgeries and never even come close to my OOP max" doesn't help because, like with the OP, they seem to think surgeries are the most expensive things that are covered.

 

[Pluperfect]

One big "advantage" to MA to me seems to be avoiding the possibility of "closed book" issues with supplement plans.

I don't agree. Avoiding the possibility of a supplement's closed book isn't a valid reason for enrolling in an Advantage plan.

First of all, not all supplements end up in a closed book.

And even if they do, you might be in a state where you can switch without underwriting, or you might pass underwriting. That's a lot of "if"s.

And even if you can't switch your supplement away from a closed book that is resulting in premiums you can't afford, you can switch to an Advantage plan during open enrollment.

Maybe you'll resent having paid supplement premiums for those years just to end up in an Advantage plan anyway. But even that's not a given. Maybe when you had a supplement you got treatment from providers who wouldn't have been in an Advantage plan. Or maybe your treatment might have been subject to step therapy under Advantage, and you avoided that.

 

[aja8888]

I don't agree. Avoiding the possibility of a supplement's closed book isn't a valid reason for enrolling in an Advantage plan.

First of all, not all supplements end up in a closed book.

And even if they do, you might be in a state where you can switch without underwriting, or you might pass underwriting. That's a lot of "if"s.

And even if you can't switch your supplement away from a closed book that is resulting in premiums you can't afford, you can switch to an Advantage plan during open enrollment.

Maybe you'll resent having paid supplement premiums for those years just to end up in an Advantage plan anyway. But even that's not a given. Maybe when you had a supplement you got treatment from providers who wouldn't have been in an Advantage plan. Or maybe your treatment might have been subject to step therapy under Advantage, and you avoided that.

I'm pretty sure if your Supplement provider closes up, you can switch to another without medical underwriting.

 

[Pluperfect]

I wonder--do you have links to where fans of traditional Medicare admitted people on Advantage plans are dumb or poor?

Dumb and poor is kind of harsh, but...

"Beneficiaries in traditional Medicare with Medigap and employer-sponsored insurance had higher incomes, were in relatively good health, had more years of education, and were less likely to be under age 65 with disabilities than all traditional Medicare beneficiaries."

"Medicare Advantage enrollees were more likely to be Black or Hispanic, self-report relatively poor health, have incomes below $20,000 per person, and have lower levels of education, compared to traditional Medicare beneficiaries in 2022."

kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries/

 

[Pluperfect]

I'm pretty sure if your Supplement provider closes up, you can switch to another without medical underwriting.

We're talking about closing the book on a plan (i.e. not accepting new enrollees but the people already in the plan stay in the plan). That's different from a company going under or getting out of the supplement business entirely.

 

[aja8888]

We're talking about closing the book on a plan (i.e. not accepting new enrollees but the people already in the plan stay in the plan). That's different from a company going under or getting out of the supplement business entirely.

Thanks, I misunderstood.

 

[Pluperfect]

Some identified issues that may cause you to fail [medical underwriting for a supplement] are COPD, Cancer, and being diabetic. There may be others. Once you are rejected, I believe that it's forever.

It's not forever. It's not uncommon, for example, for supplement providers to accept people who have had cancer but have been cancer-free for a certain number of years.

Plus, each insurance company has its own underwriting guidelines, and some are known to be more lenient than others. So Company A might reject you, but Company B might take you.

And it's not necessarily pass/fail. Insurers can issue you a supplement if you have certain health conditions, as long as you agree to pay a higher premium than you'd pay if you didn't have those health conditions.

 

[aja8888]

It's not forever. It's not uncommon, for example, for supplement providers to accept people who have had cancer but have been cancer-free for a certain number of years.

Plus, each insurance company has its own underwriting guidelines, and some are known to be more lenient than others. So Company A might reject you, but Company B might take you.

And it's not necessarily pass/fail. Insurers can issue you a supplement if you have certain health conditions, as long as you agree to pay a higher premium than you'd pay if you didn't have those health conditions.

Getting a Sup plan with those issues is great if you can pull it off, but I will bet it's not very common.

I am only locally familiar with Humana as one of my friends sells MA plans. I am sure there are exceptions, as there are with open enrollment period being closed and still being able to switch plan issuers. But with respect to the illnesses I mentioned, if one has one of those, it will be a tough ride getting into a sup plan. I have personal (family member) experience with that after being on Medicare for 17 years now.

I have family members on MA plans and they tried to qualify for a sup, but couldn't pass underwriting, and they tried several insurers.

 

[CindyBlue]

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!

I, too, have Kaiser Medicare Advantage. So did my folks. While I have had no major health problems (though my knees are beginning to be painful and will probably require replacing sometime in the future), both my folks had some major issues, mom with ulcerative colitis and dad with a couple of operations. Kaiser came through for them in a big way. I have no way of knowing if a different Medicare plan would have been better or worse...all I know is that from what I could tell, Kaiser bent over backwards to serve them.

I have friends who were sent by Kaiser to a non-Kaiser hospital in the San Francisco Bay Area with non-Kaiser doctors when the situation warranted, so I know they will send, and cover, patients out of network if need be.

Their policy is that you can go to a non-Kaiser facility if a Kaiser facility isn't within a certain mileage range of where you are (can't remember what that distance is, will have to look it up) so if I'm traveling I will be covered. I had to use it once when I was traveling and got a very severe case of poison oak, and was fully covered. But you can go to any close hospital, Kaiser or not, if it is an emergency, and you will be covered.

They fully covered my mom's non-Kaiser hospital expenses when she had the final ulcerative colitis collapse that eventually killed her a week later. She was too fragile to be transported to the closest Kaiser hospital 25 miles from home but had to be rushed to our local non-Kaiser hospital 5 miles from home, even though technically she was within the Kaiser transport range according to policy.

We al make decisions based on personal experience, the experience of those we talk to, and our research. Each of us has to make the decision based on the information we have. I will never know if choosing Kaiser MA was the right decision because hindsight is 20/20, right? But it was the right decision at the time, and, from personal experience, continues to be, for me.

 

[RetiredHappy]

@CindyBlue I had Kaiser in Northern California ever since I moved there and until I moved out of state, so basically I was with Kaiser for 18 years. I had incompetent specialists, bad specialists, rude specialists and specialists who refused to see me despite referrals from my PCP. I have a health condition that was so bad that I was almost suicidal, where I really wished I did not wake up in the morning. Since Kaiser health system was all that I had known, I never realized that I had other health care options.

We moved out of state and there is no Kaiser presence here. I had to have a new PCP. He referred me to the best in class specialists, and one such specialist saved my life, literally. He stopped the 4 types of medications and each type that was quadruple dosed from FDA recommendation, that Kaiser had put me on for my health condition. None of the medications worked but it was all that I could rely on. He replaced the medications with 1 drug and my misery stopped immediately. I had never lived a normal life until then. My husband asked this specialist why did Kaiser not put me on that one drug. His answer was very simple, they just didn't know.

Since I have been on both sides, I will never go back to a HMO system if I can help it.

 

[Pluperfect]

This is a good document to look at to see what underwriting involves, for Medico Insurance Company, anyway. On page 6 they have "declinable conditions" and "possible declinable conditions." There are a lot of them.

But under declinable, it says "Radiation or chemotherapy treatments within the past two years."

mic.gomedico.com/webres/File/Supplies/Forms/General%20Forms/24-115-4036-0116-US.pdf

A document I found for Farm Bureau says, "Applicants will not be sold a supplement if they have been treated for any of these conditions within the last five years" and lists things like cancer and heart attack.

fbhealthplans.com/blog-posts/what-should-i-know-about-the-medicare-supplement-underwriting-process/

This is a situation where it can be helpful to consult an independent agent because they'll have experience with how various companies look at specific conditions when it comes to underwriting.

 

[harllee]

Regarding underwriting to be able to switch traditional Medicare Supplements my DH could not switch to another insurance company because he has an autoimmune disease. DH used Boomer Benefits and they could not find any insurance company that would take him. I assume the same would have been true if he were on an Advantage plan and wanted to come back to traditional Medicare with a supplement. DH does have to take medication for his autoimmune disease but otherwise is very healthy.

 

[steelpony10]

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

Flieger

In your research call and talk to a real person at AARP. The whole process can be pretty seamless and less confusing. Four million plus retirees get their insurance from them. Everyone (so far) accepts their supplement. It’s good in all states not not just a regional plan if one is a snowbird. We have overseas coverage also which if you plan to travel you should consider. We’re duo Canadian/American citizens and used to travel a lot.

In retirement food, a residence and health care are ones biggest expenses. Personally my comfort and health are my biggest priorities as I age. What the heck did I save all this money for? I can “cheap out” everywhere else.

Problem solved.

 

[ncbill]

Also remember the maximum OOP is $9,350 for MA plans in 2025.

While they may charge less this year, OP's MA plan (& any other) could switch to charging the maximum OOP every year, starting in 2026.

 

[Flieger]

In your research call and talk to a real person at AARP. The whole process can be pretty seamless and less confusing. Four million plus retirees get their insurance from them. Everyone (so far) accepts their supplement. It’s good in all states not not just a regional plan if one is a snowbird. We have overseas coverage also which if you plan to travel you should consider. We’re duo Canadian/American citizens and used to travel a lot.

In retirement food, a residence and health care are ones biggest expenses. Personally my comfort and health are my biggest priorities as I age. What the heck did I save all this money for? I can “cheap out” everywhere else.

Problem solved.

Thanks steel pony! I was hoping to get a response from MBSC or one of the others from SC as to different options and choices and their experiences as well, but will definitely take your advice. DW will start before me (just over 2 years) so still some time. Unfortunately, ACA hit next year is going to impact our plans for the next couple of years. I need to REALLY understand and monitor the income cliff.

Flieger

 

[Bigbass]

Also remember the maximum OOP is $9,350 for MA plans in 2025.

Not for all MA plans, mine has a $900 maximum OOP for both in network and out of network.

 

[steelpony10]

Thanks steel pony! I was hoping to get a response from MBSC or one of the others from SC as to different options and choices and their experiences as well, but will definitely take your advice. DW will start before me (just over 2 years) so still some time. Unfortunately, ACA hit next year is going to impact our plans for the next couple of years. I need to REALLY understand and monitor the income cliff.

Flieger

My info is over 10 years old that’s why I said call which would save research and they’ll direct you to what you need to know. All these responses twists and turns made my head hurt. Posters agonize over investments so they apply the same process but miss the big picture.

As a fellow high income investor this is another benefit, more freedom of choice and ease. You’re already trained to view the big picture.

I paid about 30k for my wife until she reached 65. Guess what no spend down just more CEF income, adapting as situations arise. Financial Darwinism, lol.

 

[sengsational]

If I were trying to save money on healthcare premiums, and I had no pre-existing conditions, I might go with Medicare Part C, but only if I had solid plans to move states (change residence) in a few years. You have 11 months to switch without underwriting anyway. And then if you had a health issue that wasn't handled in a world-class way, you move (run the planned residence switch), and get traditional Medicare with a supplement plan without underwriting. You do get guaranteed issue if you move out of your Part C's geography, right?

By the way, I think "Part C" is the best way to refer to these plans. It's more accurate to think of the plans as getting a "C" grade, than saying they hold an "Advantage" over traditional Medicare

 

[mf15]

Had wife in Aetna MA say 15 years ago. Well they closed the plan,then I had to put her on a supplement plan. Of course Aetna opened with new MA plans,right away. Then we were both on a supplement plan with the same company 2019. Well they closed the plan,so had to find another company. Good thing when this happens you have guaranteed underwriting. Not talking about closing the book. Will stick with a supplement plan.
oldmike

 

[CindyBlue]

@CindyBlue I had Kaiser in Northern California ever since I moved there and until I moved out of state, so basically I was with Kaiser for 18 years. I had incompetent specialists, bad specialists, rude specialists and specialists who refused to see me despite referrals from my PCP. I have a health condition that was so bad that I was almost suicidal, where I really wished I did not wake up in the morning. Since Kaiser health system was all that I had known, I never realized that I had other health care options.

We moved out of state and there is no Kaiser presence here. I had to have a new PCP. He referred me to the best in class specialists, and one such specialist saved my life, literally. He stopped the 4 types of medications and each type that was quadruple dosed from FDA recommendation, that Kaiser had put me on for my health condition. None of the medications worked but it was all that I could rely on. He replaced the medications with 1 drug and my misery stopped immediately. I had never lived a normal life until then. My husband asked this specialist why did Kaiser not put me on that one drug. His answer was very simple, they just didn't know.

Since I have been on both sides, I will never go back to a HMO system if I can help it.

This is valuable information, thank you, RetiredHappy. And I'm so glad your new doctor found the medication that made such a difference in your life!

 

[Koolau]

@CindyBlue I had Kaiser in Northern California ever since I moved there and until I moved out of state, so basically I was with Kaiser for 18 years. I had incompetent specialists, bad specialists, rude specialists and specialists who refused to see me despite referrals from my PCP. I have a health condition that was so bad that I was almost suicidal, where I really wished I did not wake up in the morning. Since Kaiser health system was all that I had known, I never realized that I had other health care options.

We moved out of state and there is no Kaiser presence here. I had to have a new PCP. He referred me to the best in class specialists, and one such specialist saved my life, literally. He stopped the 4 types of medications and each type that was quadruple dosed from FDA recommendation, that Kaiser had put me on for my health condition. None of the medications worked but it was all that I could rely on. He replaced the medications with 1 drug and my misery stopped immediately. I had never lived a normal life until then. My husband asked this specialist why did Kaiser not put me on that one drug. His answer was very simple, they just didn't know.

Since I have been on both sides, I will never go back to a HMO system if I can help it.

Right.

Save money on Cell plans and Streaming services and eating out. Don't save it on health care.

 

[youbet]

I assume...........

Probably not a wise thing to do, especially in this case.

 

[RunningBum]

My parents had/have Medicare Advantage. My brother and sister have dealt with everything for them for many years, from appointments to billing. I asked if they ran into problems because of MA and they said no. But, my brother and sister are both on original Medicare + supplemental plans.