Medigap or Advantage? Lots of info/Lots of questions.

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Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Mon Jul 15, 2013 9:40 pm

apologies, in advance, for the long post…

I live in NY, and am considering plans F or High Deductible F for my husband, who turns 65 in October.
He has fortunately been extremely healthy thus far.
He does not like going to the doctor and if he is fortunate and his good health continues, he will go to the doctor only once per year, for annual preventative checkups.

Best prices:
Plan F: $257/month - $3,084/year (United).

Plan F High Deductible: $79/month - $948/year if deductible not used or $3,058 if deductible fully used. (Blue Cross).

Plan N: $173/month - $2,076/year (United).
$2,484 (F) - $2,076 (N) = $408 difference per year.
Although I am not concerned about the $147 Part B deductible, I am concerned about the 5% excess charge.
I don’t like unknowns when it comes to insurance and plan N has no limit on the out of pocket expense.

* * * * *

I don’t mind spending $79 a month (or even $257 if I have to) (plus, of course, $43 per month for Part D) for a Medigap plan, but if it’s not necessary I’d rather keep it in my pocket and use those same funds when the actual need arises.

I should note that the Advantage plans have a maximum out-of-pocket max of either $3,400 or $3,900, depending on carrier, which is only $1,000 or $1,500 more per year than Medigap plan F (I would have no problem paying it, if it came to that).

I had phoned several very highly rated specialists, and most were in one of the Advantage plans I was considering.
Unfortunately, Sloan Kettering (cancer specialists) & Hospital for Special Surgery do not participate in any Advantage networks, but being NYC, Columbia Presbyterian or NYU Hospitals are equally excellent substitutes.

* * * * *

My Medigap concerns:
- The ‘new patient’ quotas worry me. Can a doctor participating In an Advantage plan turn you away or make you wait an excessively long time, as they can in a Medigap plan?
- Being in such a large city as New York, will we have trouble getting appointments with a Medigap policy?
- Do doctors use ‘quotas’ as a way to exclude Medicare patients because they get paid less?
- Being frugal, and knowing that my husband will not be visiting the doctor unless a crisis arises, I am veering away from the Medigap plans because …why pay for something you might not use. Again, the Advantage plans have an out-of-pocket max of either $3,400 or $3,900, depending on carrier …only $1,00 more than the Medigap annual premium.

My Advantage concerns:
I want all options and the best care available, should the need arise.

* * * * *

Finally, he will be having a colonoscopy immediately after coverage begins. On his last one, he had polyps removed. Because of this, I was considering starting on the regular F plan in October, and then switching him in November to the F High Deductible plan if he has a clean bill of health.

As one can downgrade a Medigap plan whenever they choose (upgrades must wait 12 months), I figure the worst that could happen is that we have to fulfill the Plan F $2,100 deductible.

is this a good idea? Any negatives?
Last edited by conky11 on Tue Jul 16, 2013 3:55 pm, edited 1 time in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby dm200 » Mon Jul 15, 2013 9:57 pm

The Medicare Advantage plans vary a lot. In my opinion, before choosing an advantage plan, check out the details to see if it works for you. I have been on the Kaiser MA plan for almost 3 years and am very happy - good care, VERY convenient and low costs. I pay nothing (premiums per month) beyond the approx. $100 per month regular Medicare charge deducted from my Social Security. I pay modest prescription charges, and $20 copay for primary car Dr and $30 for specialist. A friend of mine is on the, very different, Humana plan and he is very happy.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby nisiprius » Mon Jul 15, 2013 10:18 pm

I can't speak to New York. In my area, whose reputation for medical care is a) good but b) high cost, I have been on traditional Medicare and Medigap for about two years, after about twenty years in several of the big local HMO plans. I have noticed no differences whatsoever in doctors' availability or anything else. Before going on Medicare I made a list of every single doctor I could remember seeing and checking to see whether they took Medicare assignment, and--f those who were still in practice--every single one of them did.

I recently had to change doctors because the PCP I've been seeing for fifteen years retired. The practice I currently go to--a giant group practice that is qualified as a "patient centered medical home"--accepts Medicare assignment across the board. Their website simply shows which doctors are accepting new patients--it doesn't distinguish between Medicare and any other form of payment. The last two times I needed to see a doctor for an unscheduled visit, I got appointments promptly.

The only difference I've experienced compared the HMO plans are, of course, different billing structure, and no office co-pays.

I can't say that there is no discrimination against Medicare/Medigap patients anywhere, all I can say is that I've seen no evidence of it whatsoever. That includes at least one practice that seemed to me to be, how shall I say, very attentive to the business aspects of the practice, and one oral surgeon whose office seemed to be sort of unfamiliar with Medicare.
Last edited by nisiprius on Mon Jul 15, 2013 10:20 pm, edited 1 time in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby 1530jesup » Mon Jul 15, 2013 10:19 pm

There is no doubt that the Advantage plans save money - up to several thousands a year for each spouse.

1) Doctor choice is restricted to their 'preferred' providers as is the hospital you may use. With Traditional Medicare you just go to another doc or another facility.
2) From experience in Florida with a relative we help, appointments are not too easy to get and you may not see the same doc from visit to visit. Appointments and crowded waiting rooms do not seem to be an issue with TM
3) Should you want to change docs or see a specialist you need approval. With TM, you just make the move.
4) I know from experience that certain tests, procedures and meds can be excluded - or challenged - if the Advantage Plan feels they are not needed. Should TM question a procedure, your doc has an interest in being your advocate. That may not happen with the advantage plan because the doc works for the plan and is restricted by the plan's decisions.
5) In good health today, seeing few or no docs; sadly does not mean that 5 years later there could be challenges that make the above important.

With that said, TM with Medigap & Plan D does not get you eye glasses, hearing aids and dental work.
And some day the flexibility of TM may not outweigh our need to get an extra $5,000 back into our budget.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby rixer » Tue Jul 16, 2013 9:20 am

I just signed on for Plan F Hi-D. One thing to remember is that while you do have a $2100 deductible, medicare part b pays 80% of your bill. You pay only 20% until you're $2100 is fulfilled so it's not so bad. Quite often about the same as a co-pay in a MA plan. Another advantage of Plan F Hi-D is you can go to any doctor or hospital that accepts medicare patients. You're not restricted to a certain group like MA plans are.

The rates you're quoting in NY are much higher than what I'm paying in Ca. My Plan F Hi-D is $450 annually or about $38 per month. Worse case out of pocket is $2550. Less than the Advantage Plans I've seen.
They offer these lower rates because they figure that people won't go running to the doctor for every little hangnail problem but if you need medical care, you're covered and it's affordable to you.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby dm200 » Tue Jul 16, 2013 10:17 am

1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 10:55 am

having researched this last year and selecting Medicare Advantage plan.

found out how many stars medicare has assigned to this advantage plan(yes there is a rating system). Also go on line and read the info about each advantage plan you are interested in.also look at the drug formulary for the advantage plan.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Rob5TCP » Tue Jul 16, 2013 11:02 am

i did a comparison for a friend to help her narrow down the choices. Her primary doctor took Medicare but not the "advantage" plans. I ultimately reviewed all the options (reading here and elsewhere) with her and she went with Plan F, not the high deductible (though that may change next year). She goes on in September and I am now prepared for what I will be looking at in a number of years. It was a good learning experience.
Here the main choice was easy - medigap. Looking through all the plans was more time consuming. In NYC, Manhattan, Plan F was $257 and she ultimately chose AARP. The high deductible may be a good option, but for the first year she plans to do everything that she has put off (or never done).
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 11:07 am

dm200 wrote:1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.



this is incorrect. when you select medicare advantage plan all part B coverage is in the Advantage plan. you cannot use regular medicare.,
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Irishheart » Tue Jul 16, 2013 11:19 am

I am in a similar situation, but I need to find a suitable plan for both myself and my husband. In thinking about Plan F or Plan F HD, I am considering the possibility of investing the difference in cost (something low risk that might return something to offset the increase in premium price in the future), because my husband and I are relatively healthy at this point. Every year we could do this would add to the medical fund for future deductibles. In other words, I would bank the premium cost of Plan F instead of paying it to the company every year. Of course, if something happens that we need it right away, this might not be a great idea. I just am not sure what to do.
I have completely rejected Advantage plans, which seem too restrictive.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby orlandoman » Tue Jul 16, 2013 11:31 am

A lot of the comments above about MA plans are correct for their MA plan, but not all MA plans. In FL I have a MA plan, but the provider I use has both a HMO & PPO MA option. With the PPO MA plan, which I have, I can use any Dr. that accepts Medicare & don't need prior appoval to see them. The plan deducatables & per visit fee is different depending on whether I choose a Dr. in their MA plan or a DR. that accepts Medicare that is not in their plan ... so, YOU need to compare YOUR options ... and use all the comments as points of reference to check in the plans that are available to you.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby dm200 » Tue Jul 16, 2013 11:42 am

gerrym51 wrote:
dm200 wrote:1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.



this is incorrect. when you select medicare advantage plan all part B coverage is in the Advantage plan. you cannot use regular medicare.,


No, YOU are the one who is INCORRECT. I am CORRECT. I am absolutely sure that MY PLAN allows exactly what I said it does. I agree that it is neither the norm, nor is it common, BUT that is my plan (Kaiser Medicare Plus (Cost)).
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Steelersfan » Tue Jul 16, 2013 11:49 am

orlandoman wrote:A lot of the comments above about MA plans are correct for their MA plan, but not all MA plans. In FL I have a MA plan, but the provider I use has both a HMO & PPO MA option. With the PPO MA plan, which I have, I can use any Dr. that accepts Medicare & don't need prior appoval to see them. The plan deducatables & per visit fee is different depending on whether I choose a Dr. in their MA plan or a DR. that accepts Medicare that is not in their plan ... so, YOU need to compare YOUR options ... and use all the comments as points of reference to check in the plans that are available to you.


That true in my area as well.

There are no universal truths about comparisons of Medicare Advantage plans as compared to regular Medicare plans. It varies by area and by insurance provider.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby frugaltype » Tue Jul 16, 2013 12:02 pm

Medicare Advantage costs the taxpayer 14% more for the same services as Medigap. It used to be 17% more, but Obamacare has narrowed the gap somewhat and I think is phasing in more narrowing. It is probably against the rules of this board to explain why it costs taxpayers more, but contemplating why Medicare Plan D is forbidden to negotiate drug prices with pharmaceutical companies like regular insurance companies can will give you a clue.

For that reason alone, I wouldn't touch it. However, it also means you are letting a traditional insurance company run ALL your medical care. If you have no problems with that, you have had different experiences pre-Medicare age than me.

Medigap, on the other hand, sits behind Medicare, which is not run by the rules of traditional insurance companies but which actually aims to provide decent medical care. And anything Medicare pays for (it pays partly), Medigap is required to cover.

Either of these reasons rules out Medicare Advantage as far as I am concerned. It's been night and day in terms of the ease of getting proper and speedy medical care for me since I went on Medicare plus Medigap vs. my previous employer's standard insurance run by United Healthcare.

In the several years I'm been on this combo, I have had to see a number of specialists. I think one's staff when I phoned for an appointment said they don't take Medicare. Otherwise I have had no problem, and I see specialists at two of the highest rated hospitals in the country. If I have something seriously wrong, I don't want to wait forever for an insurance company to decide to authorize a test, nor do I want to have to shop around when I'm sick in hopes of finding a doctor who is both a good doctor for that problem and acceptable to them.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby dm200 » Tue Jul 16, 2013 12:38 pm

frugaltype wrote:Medicare Advantage costs the taxpayer 14% more for the same services as Medigap. It used to be 17% more, but Obamacare has narrowed the gap somewhat and I think is phasing in more narrowing. It is probably against the rules of this board to explain why it costs taxpayers more, but contemplating why Medicare Plan D is forbidden to negotiate drug prices with pharmaceutical companies like regular insurance companies can will give you a clue.

For that reason alone, I wouldn't touch it. However, it also means you are letting a traditional insurance company run ALL your medical care. If you have no problems with that, you have had different experiences pre-Medicare age than me.

Medigap, on the other hand, sits behind Medicare, which is not run by the rules of traditional insurance companies but which actually aims to provide decent medical care. And anything Medicare pays for (it pays partly), Medigap is required to cover.

Either of these reasons rules out Medicare Advantage as far as I am concerned. It's been night and day in terms of the ease of getting proper and speedy medical care for me since I went on Medicare plus Medigap vs. my previous employer's standard insurance run by United Healthcare.

In the several years I'm been on this combo, I have had to see a number of specialists. I think one's staff when I phoned for an appointment said they don't take Medicare. Otherwise I have had no problem, and I see specialists at two of the highest rated hospitals in the country. If I have something seriously wrong, I don't want to wait forever for an insurance company to decide to authorize a test, nor do I want to have to shop around when I'm sick in hopes of finding a doctor who is both a good doctor for that problem and acceptable to them.


While Medicare Advantage Plans have a degree of flexibility, nonetheless I believe they must provide coverage and benefits that are required for Medicare plans.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 12:39 pm

dm200 wrote:
gerrym51 wrote:
dm200 wrote:1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.



this is incorrect. when you select medicare advantage plan all part B coverage is in the Advantage plan. you cannot use regular medicare.,


No, YOU are the one who is INCORRECT. I am CORRECT. I am absolutely sure that MY PLAN allows exactly what I said it does. I agree that it is neither the norm, nor is it common, BUT that is my plan (Kaiser Medicare Plus (Cost)).



actually you agree with me. all medicare b coverage is assigned to the Medicare advantage plan and you selected one that gives you other options.it is still the medicare advantage plan that is giving the options. If you went to a provider and did not mention you had advantage plan and used the medicare part b when they processed electronically oit would reject saying you had a medicare advantage plan. i work for a medical provider(pharmacy) and this is what happens with medicare advantage patienst.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby dm200 » Tue Jul 16, 2013 12:54 pm

gerrym51 wrote:
dm200 wrote:
gerrym51 wrote:
dm200 wrote:1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.



this is incorrect. when you select medicare advantage plan all part B coverage is in the Advantage plan. you cannot use regular medicare.,


No, YOU are the one who is INCORRECT. I am CORRECT. I am absolutely sure that MY PLAN allows exactly what I said it does. I agree that it is neither the norm, nor is it common, BUT that is my plan (Kaiser Medicare Plus (Cost)).



actually you agree with me. all medicare b coverage is assigned to the Medicare advantage plan and you selected one that gives you other options.it is still the medicare advantage plan that is giving the options. If you went to a provider and did not mention you had advantage plan and used the medicare part b when they processed electronically oit would reject saying you had a medicare advantage plan. i work for a medical provider(pharmacy) and this is what happens with medicare advantage patienst.


No, I do not agree with you (as it pertains to my plan). It may work, the way you describe, for most MA plans. According to the details of my plan, although I have not done this, I could (if I so chose) go to a provider that accepted Traditional Medicare, and receive services just as though I was not in a MA plan.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 1:07 pm

dm200 wrote:
gerrym51 wrote:
dm200 wrote:
gerrym51 wrote:
dm200 wrote:1. Several friends and acquaintances in this area (Virginia suburbs of Washington DC) have told me that it can be somewhat of a challenge to find a primary care physician (Internal medicine, family practice or general practice) who will accept NEW Medicare patients. One of them had a Doctor in solo, single physician practice for a long time. She saw him and was happy with him for a long time. Then, he retired and she had a challenging time finding a new physician because she found that most would not accept NEW patients on Medicare. Her conclusion (and advice) is to see physicians in a group practice so that if/when your Doctor leaves/retires, you can stay with the practice and see another physician. From what I see from other who post here, this situation is different in different locations. What seems odd to me that this is an area where, it seems anyway, there are a lot of Doctors.

2. Some Medicare Advantage plans have some degree of coverage or discounts on Dental and Vision, that are not covered at all under traditional Medicare.

3. I do not know how many Medicare Advantage plans do this, but mine does - In the Kaiser MA plan I have it is called "Medicare Plus (Cost)". The term 'COST' means that I am not completely restricted to the MA plan, but can use Traditional Medicare with a participating TM provider if I need to or choose to. This sounds like having your cake and eating it. I have not done this, nor do I plan to do so, so I can't speak about how it works.



this is incorrect. when you select medicare advantage plan all part B coverage is in the Advantage plan. you cannot use regular medicare.,


No, YOU are the one who is INCORRECT. I am CORRECT. I am absolutely sure that MY PLAN allows exactly what I said it does. I agree that it is neither the norm, nor is it common, BUT that is my plan (Kaiser Medicare Plus (Cost)).



actually you agree with me. all medicare b coverage is assigned to the Medicare advantage plan and you selected one that gives you other options.it is still the medicare advantage plan that is giving the options. If you went to a provider and did not mention you had advantage plan and used the medicare part b when they processed electronically oit would reject saying you had a medicare advantage plan. i work for a medical provider(pharmacy) and this is what happens with medicare advantage patienst.


No, I do not agree with you (as it pertains to my plan). It may work, the way you describe, for most MA plans. According to the details of my plan, although I have not done this, I could (if I so chose) go to a provider that accepted Traditional Medicare, and receive services just as though I was not in a MA plan.


you don't have to believe me.Try it yourself. your medicare part B rights have been assigned to the medicare advantage plan. if a provider attempts to use strait medicare part B they will get a message saying part b rights assigned to the medicare advantage plan. if what you say is true then the medicare advantage plan does not have to be used. Medicare is the one that assigns the class b rights. is it possible you are actually talking about"out of network providers". my wife pays an extra fee to her medicare advantage plan for that right. it is still decided by the medicare advantage plan.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby frugaltype » Tue Jul 16, 2013 1:10 pm

dm200 wrote:While Medicare Advantage Plans have a degree of flexibility, nonetheless I believe they must provide coverage and benefits that are required for Medicare plans.


More than once I've been in a doctor's office, and the staff has said, we'll have to check with the insurance company and get approval for that test, it will probably take a few days at least, and I've said no, I have Medigap, not Medicare Advantage, and they've said oh, and gone right ahead and scheduled the test. No one could confuse me with someone of below Medicare age.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 1:19 pm

frugaltype wrote:
dm200 wrote:While Medicare Advantage Plans have a degree of flexibility, nonetheless I believe they must provide coverage and benefits that are required for Medicare plans.


More than once I've been in a doctor's office, and the staff has said, we'll have to check with the insurance company and get approval for that test, it will probably take a few days at least, and I've said no, I have Medigap, not Medicare Advantage, and they've said oh, and gone right ahead and scheduled the test. No one could confuse me with someone of below Medicare age.



medicare advantage plans cover everything regular medicare covers plus other extras. howver they work like HMO's and PPO's and have their own networks and plan rules-however they do cover everthing medicare does.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby 1530jesup » Tue Jul 16, 2013 1:20 pm

frugaltype wrote:Medicare Advantage costs the taxpayer 14% more for the same services as Medigap. It used to be 17% more, but Obamacare has narrowed the gap somewhat and I think is phasing in more narrowing. It is probably against the rules of this board to explain why it costs taxpayers more, but contemplating why Medicare Plan D is forbidden to negotiate drug prices with pharmaceutical companies like regular insurance companies can will give you a clue.

For that reason alone, I wouldn't touch it. However, it also means you are letting a traditional insurance company run ALL your medical care. If you have no problems with that, you have had different experiences pre-Medicare age than me.

Medigap, on the other hand, sits behind Medicare, which is not run by the rules of traditional insurance companies but which actually aims to provide decent medical care. And anything Medicare pays for (it pays partly), Medigap is required to cover.

Either of these reasons rules out Medicare Advantage as far as I am concerned. It's been night and day in terms of the ease of getting proper and speedy medical care for me since I went on Medicare plus Medigap vs. my previous employer's standard insurance run by United Healthcare.

In the several years I'm been on this combo, I have had to see a number of specialists. I think one's staff when I phoned for an appointment said they don't take Medicare. Otherwise I have had no problem, and I see specialists at two of the highest rated hospitals in the country. If I have something seriously wrong, I don't want to wait forever for an insurance company to decide to authorize a test, nor do I want to have to shop around when I'm sick in hopes of finding a doctor who is both a good doctor for that problem and acceptable to them.


:thumbsup before this get locked - totally agree with all of the above
efficiency is not all its cracked up to be, do you want to live your life in half the time it takes the average person? Rhymes With Orange | Rich
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 1:29 pm

all i can say is this . my wife and i in our medicare advantage plan are using the same company we used for 20 years with my former employer insurance. we use health new England in western massachusettes and has a 5 star medicare advantage rating.

my wife and i never had a problem in using HNE for the 20 years i was on a HNE employer plan and i don't anticipate much of a difference in using the HNE medicare advantage plan. to each his own.


also if you want drug coverage if you are using medigap you still need a Part d plan.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby rixer » Tue Jul 16, 2013 1:47 pm

gerrym51 wrote:all i can say is this . my wife and i in our medicare advantage plan are using the same company we used for 20 years with my former employer insurance. we use health new England in western massachusettes and has a 5 star medicare advantage rating.

my wife and i never had a problem in using HNE for the 20 years i was on a HNE employer plan and i don't anticipate much of a difference in using the HNE medicare advantage plan. to each his own.


also if you want drug coverage if you are using medigap you still need a Part d plan.


What is your maximum yearly out of pocket expense with this MA plan?
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 1:56 pm

delete
Last edited by conky11 on Tue Jul 16, 2013 3:23 pm, edited 1 time in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 2:01 pm

rixer,

i'm providing a link to the one we purchase. it's a little more because it easily allows outside providers. in network on left out of network on right


https://www.healthnewengland.com/medica ... reedom.htm
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 2:03 pm

we've gone totally off topic.
Help still needed in regards to original questions, please :)
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Rob5TCP » Tue Jul 16, 2013 2:05 pm

" conky11 wrote
"hi Rob,
fyi: EMBLEM has the EXACT same Plan F for $207 in New York. That was one of my questions...if people thought that the carrier (Emblem) was something to be concerned about."




I looked over the listings - the cheapest was AARP. Emblem did not show up. I just double checked under her zipcode (she lives on my floor).
Emblem is not one of the options. After Conseco comes Empire. Perhaps Emblem is not available in Manhattan (10009).
I would feel terrible if I could have saved her $600+ per year.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Rob5TCP » Tue Jul 16, 2013 2:10 pm

Going back to your original question:

She rarely goes to the doctor. Part of the reason, she is super healthy. But, the other part, her current employer's insurance has fairly high deductable and co-pays. We (I) did several spreadsheets and determined that if she plans on getting many tests, plus vaccinations (pneumonia/tetanus) plus other routine screenings done, a low deductible would be better for the first year. Plus, she would not hesitate to do something because of the costs (she is somewhat Bogleish in her ways).

If after 6 months ,you find you are rarely going to the doctor and have done the "super" physicals when you first get your new coverage, you can then go to a high deductible plan. This is something I will revisit with her around Feb/March of next year.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby gerrym51 » Tue Jul 16, 2013 2:14 pm

conky11 wrote:we've gone totally off topic.
Help still needed in regards to original questions, please :)



have you tried googling medigap plans and your zipcode

and Medicare advantage plans and your zip code
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 4:05 pm

Rob5TCP wrote:" conky11 wrote
"hi Rob,
fyi: EMBLEM has the EXACT same Plan F for $207 in New York. That was one of my questions...if people thought that the carrier (Emblem) was something to be concerned about."




I looked over the listings - the cheapest was AARP. Emblem did not show up. I just double checked under her zipcode (she lives on my floor).
Emblem is not one of the options. After Conseco comes Empire. Perhaps Emblem is not available in Manhattan (10009).
I would feel terrible if I could have saved her $600+ per year.


you are right, rob. i just double checked. i deleted that from my above post as i was incorrect. you did well for your friend.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Rob5TCP » Tue Jul 16, 2013 6:31 pm

conky11 wrote:
Rob5TCP wrote:" conky11 wrote
"hi Rob,
fyi: EMBLEM has the EXACT same Plan F for $207 in New York. That was one of my questions...if people thought that the carrier (Emblem) was something to be concerned about."




I looked over the listings - the cheapest was AARP. Emblem did not show up. I just double checked under her zipcode (she lives on my floor).
Emblem is not one of the options. After Conseco comes Empire. Perhaps Emblem is not available in Manhattan (10009).
I would feel terrible if I could have saved her $600+ per year.


you are right, rob. i just double checked. i deleted that from my above post as i was incorrect. you did well for your friend.


No good deed goes unpunished. Her sister in law has to decide by March of next year and is already concerned. Guess who she might ask.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby mur44 » Tue Jul 16, 2013 7:37 pm

You are lucky to be living in one of the two states in
the country (New York and Connecticut) where you have the
right to buy a Medigap plan at any time.
Three states (MA, MN and WI) have also rights.
Rest of us in the 45 states do not have the same right.

Therefore, if your health is good, it is OK to stay
on a Medicare Advantage with Prescription Drug (MAPD)
as long as your health care needs are met.

As soon as your health care needs require a Medigap
plan, you can buy one anytime with an effective date
of the first the following month.

It is worth calling local HIICAP (Health Insurance Information
and Counseling Program - same as SHIP) counselor for
unbiased, objective and free advice.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ
Last edited by mur44 on Wed Jul 17, 2013 3:38 pm, edited 1 time in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Jetpack » Tue Jul 16, 2013 8:04 pm

mur44 wrote:You are lucky to be living in one of the two states in
the country (New York and Connecticut) where you have the
right to buy a Medigap plan at any time. Rest of us in the 48 states
do not have the same right.

Therefore, if your health is good, it is OK to stay
on a Medicare Advantage with Prescription Drug (MAPD)
as long as your health care needs are met.

As soon as your health care needs require a Medigap
plan, you can buy one anytime with an effective date
of the first the following month.

It is worth calling local HIICAP (Health Insurance Information
and Counseling Program - same as SHIP) counselor for
unbiased, objective and free advice.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ


+1

Each state has a version of SHIP and because they receive funding from the federal govt they will not endorse a private sector company and will provide unbiased, real world numbers so that you can make an informed decision based upon your individual needs. Here in Ohio our is called OSHIIP, housed under the Ohio Dept. of Insurance, and this is exactly where I refer everyone shopping for Medicare Advantage or Supplement plans.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Steelersfan » Tue Jul 16, 2013 8:55 pm

mur44 wrote:
It is worth calling local HIICAP (Health Insurance Information
and Counseling Program - same as SHIP) counselor for
unbiased, objective and free advice.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ


+1

When I was facing the Medicare Supplement vs Medicare Advantage decision with multiple options from both types of plans, I scheduled a session with a SHIP counselor. They were very good. I also talked to my PCP and a well regarded health care insurance broker.

In my case, with my healthy status and financial situation, they all recommended a high deductible Medicare Advantage plan from a single company in my area.

That won't be true for all people in all areas, and could even change over time in my area, but seeking opinions from those three sources is (IMHO) more valuable than trying to get advice from people not in your area and not familiar with the plans there.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 10:40 pm

1530jesup wrote:There is no doubt that the Advantage plans save money - up to several thousands a year for each spouse.

1) Doctor choice is restricted to their 'preferred' providers as is the hospital you may use. With Traditional Medicare you just go to another doc or another facility.
2) From experience in Florida with a relative we help, appointments are not too easy to get and you may not see the same doc from visit to visit. Appointments and crowded waiting rooms do not seem to be an issue with TM
3) Should you want to change docs or see a specialist you need approval. With TM, you just make the move.
4) I know from experience that certain tests, procedures and meds can be excluded - or challenged - if the Advantage Plan feels they are not needed. Should TM question a procedure, your doc has an interest in being your advocate. That may not happen with the advantage plan because the doc works for the plan and is restricted by the plan's decisions.
5) In good health today, seeing few or no docs; sadly does not mean that 5 years later there could be challenges that make the above important.

With that said, TM with Medigap & Plan D does not get you eye glasses, hearing aids and dental work.
And some day the flexibility of TM may not outweigh our need to get an extra $5,000 back into our budget.
Be well, Rich



5 EXCELLENT POINTS. Leaning towards Medigap. Time to read on...
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 10:59 pm

rixer wrote:I just signed on for Plan F Hi-D. One thing to remember is that while you do have a $2100 deductible, medicare part b pays 80% of your bill. You pay only 20% until you're $2100 is fulfilled so it's not so bad. Quite often about the same as a co-pay in a MA plan. Another advantage of Plan F Hi-D is you can go to any doctor or hospital that accepts medicare patients. You're not restricted to a certain group like MA plans are.

The rates you're quoting in NY are much higher than what I'm paying in Ca. My Plan F Hi-D is $450 annually or about $38 per month. Worse case out of pocket is $2550. Less than the Advantage Plans I've seen.
They offer these lower rates because they figure that people won't go running to the doctor for every little hangnail problem but if you need medical care, you're covered and it's affordable to you.


YES YES YES!
at first, I thought I pay the first $2,100 OF ALL BILLS, but in reality Original Medicare picks up 80% and I pick up only 20%.

So in order to reach the full $2,100 deductible, the year’s TOTAL BILLS would have to be $50,000.
$50,000 - 80% = $10,000 x 20% = $2,000 (deductible).

if I had $50,000 worth of bills, I am more than happy to pay $2,100.
do i have this right?

finally, for those New Yorkers out there, when taking into account all premiums plus the $2,100, the F High Deductible plan $79 per month/$948 per year + $2,100 = $3,058) is actually $30 cheaper per year than the F plan ($257 per month/$3,084 per year).

MEDIGAP IT IS !!! (but, will keep reading) :)
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 11:20 pm

Rob5TCP wrote:i did a comparison for a friend to help her narrow down the choices. Her primary doctor took Medicare but not the "advantage" plans. I ultimately reviewed all the options (reading here and elsewhere) with her and she went with Plan F, not the high deductible (though that may change next year). She goes on in September and I am now prepared for what I will be looking at in a number of years. It was a good learning experience.

Here the main choice was easy - medigap. Looking through all the plans was more time consuming. In NYC, Manhattan, Plan F was $257 and she ultimately chose AARP. The high deductible may be a good option, but for the first year she plans to do everything that she has put off (or never done).


I’m considering starting on Plan F, going for all sorts of preventative work (including colonoscopy), and if there’s a clean bill of health, switching the following month to the High Deductible F. i was told that one can downgrade plans at any time.

the tricky part is that i wanted to start on United F ($257), and then switch to Blue Cross High Deductible F (United doesnt have a HD F). if it's less of a hassle to NOT switch companies, i will just start with Blue Cross F...at the higher rate of $323 and simply switch plans.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 11:29 pm

Irishheart wrote:I am in a similar situation, but I need to find a suitable plan for both myself and my husband. In thinking about Plan F or Plan F HD, I am considering the possibility of investing the difference in cost (something low risk that might return something to offset the increase in premium price in the future), because my husband and I are relatively healthy at this point. Every year we could do this would add to the medical fund for future deductibles. In other words, I would bank the premium cost of Plan F instead of paying it to the company every year. Of course, if something happens that we need it right away, this might not be a great idea. I just am not sure what to do.
I have completely rejected Advantage plans, which seem too restrictive.


in my opinion, this could be VERY dangerous.
1) one NEVER knows what will happen in the stock market. it could crash and you could lose all your money or it could take 10 years to come back and if you needed funds, you would have to sell at a loss. having money to pay for medical care is a necessity. this is not money to gamble with.
2) just as the stock market, you never know what the future will bring when it comes to one’s health. that is the purpose of insurance. to insure against the risk of something happening.

above…you, yourself, said this would not be a good idea, so i think you’re trying to save money (as we all are), but down deep you know that medigap is the way to go. Go for the HD F…it’s fully comprehensive coverage at only $79 a month (max $3,084 per year if you incur the deductible).

it seems I’m now advocating FOR MEDIGAP. this forum has been a blessing! thanks, everyone!!!
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby lethean46 » Tue Jul 16, 2013 11:38 pm

Conky

Here's how I looked at Plan F vs HD Plan F. I'll use my husband as the example. He is 72.

Plan F = $2535.81 yearly.

HD Plan F = $896.83 yearly.

Premium savings = $1638.98. Using HD Plan F, you can spend those "savings" on healthcare costs and BE (breakeven) vs using Plan F.

What's the downside risk? It's $2110 (the deductible) - $1639 (the premium savings) = $471 in the worst case. Worst case may happen some years. Other years, there will be savings going with HD Plan F.

It so happens I just finished a spreadsheet of medical bills for husband resulting from an emergency room visit and 3 day hospital stay.

Total billed amount = $24,669.

Medicare approved = $2770. Yes. That's right. Unreal!!!

Medicare paid = $2014.

HD Plan F deductible = $692.

Balance due = $692. That's what I'll pay.

That includes everything. Many, many bills. Hospital, docs, labs, etc. Now. Look back up to the top of my post. And see where the $692 fits into my calculations. There's still a LONG way to go - to spill over into the "worst case" of downside risk $471.

I hope that is helpful and makes some sense.

ML

ps I think your calculations above using $50,000 example are off, by a lot. For one thing. That's the BILLED amount. Look at what Medicare actually approved vs billing in my husbands case. Overall, the Medicare "approved amount" was roughly 10% of the billed amount. Medicare pays 80% of the "approved amount" and I pay roughly 20% of "approved amount". Forget the "billed amount". It's almost irrelevant - unless you are uninsured.
Last edited by lethean46 on Tue Jul 16, 2013 11:59 pm, edited 3 times in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby Browser » Tue Jul 16, 2013 11:41 pm

Let me say that I'm a cancer survivor who, when I was employed and on a company PPO, found that I could not receive the only effective treatment (surgery) where I lived at the time - Louisville. Thanks to my wonderful oncologist at the time, I was referred to Memorial Sloan Kettering in NY and somehow slipped through the cracks and Humana pre-approved treatment there. A decision I'm sure they regretted after the bills started flooding in. I'm alive today because of the multiple surgeries that were performed. After I returned to work, the insurance company had changed to Anthem Blue Cross and their rules for out of network coverage clearly would have restricted me from receiving treatment at MSKCC and I wouldn't have survived the type of cancer that I had. Ditto for Humana. I knew I'd dodged a bullet. My treatment would have been limited to what was available in-network in the Louisville area, and that would have been chemotherapy. I learned that chemotherapy would not have been effective with my cancer, but that's what I would have gotten because that's what the network doctors would have approved. There were simply no surgical oncologists in the entire area skilled in the complex surgery that was required. I would NEVER lock myself into restricted HMO/PPO coverage if there was any way to avoid it. If you choose an Advantage plan you are done with traditional Medicare forever - that's a one-way street. Think long and hard before you make that choice is the best advice I can give anyone. Hope for the best, but prepare for the worst.
If we have data, let’s look at data. If all we have are opinions, let’s go with mine. – Jim Barksdale
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 11:46 pm

frugaltype wrote:Medicare Advantage costs the taxpayer 14% more for the same services as Medigap. It used to be 17% more, but Obamacare has narrowed the gap somewhat and I think is phasing in more narrowing. It is probably against the rules of this board to explain why it costs taxpayers more, but contemplating why Medicare Plan D is forbidden to negotiate drug prices with pharmaceutical companies like regular insurance companies can will give you a clue.

For that reason alone, I wouldn't touch it. However, it also means you are letting a traditional insurance company run ALL your medical care. If you have no problems with that, you have had different experiences pre-Medicare age than me.

Medigap, on the other hand, sits behind Medicare, which is not run by the rules of traditional insurance companies but which actually aims to provide decent medical care. And anything Medicare pays for (it pays partly), Medigap is required to cover.

Either of these reasons rules out Medicare Advantage as far as I am concerned. It's been night and day in terms of the ease of getting proper and speedy medical care for me since I went on Medicare plus Medigap vs. my previous employer's standard insurance run by United Healthcare.

In the several years I'm been on this combo, I have had to see a number of specialists. I think one's staff when I phoned for an appointment said they don't take Medicare. Otherwise I have had no problem, and I see specialists at two of the highest rated hospitals in the country. If I have something seriously wrong, I don't want to wait forever for an insurance company to decide to authorize a test, nor do I want to have to shop around when I'm sick in hopes of finding a doctor who is both a good doctor for that problem and acceptable to them.


I’m having trouble figuring out how Medicare Part D, being forbidden to negotiate drug prices with big pharma, as regular insurance companies can do, makes Advantage plans more costly for the taxpayer (and I’m curious). can you elaborate?

I’ve never had issues with my previous HMOs, but I do like what you say about Medicare aiming to provide decent care. Even if that’s not true (I’m hoping it is), the system is not out to screw the consumer, as insurance companies typically are.

Most important points you’ve made:
If I have something seriously wrong, I don't want to wait forever for an insurance company to decide to authorize a test, nor do I want to have to shop around when I'm sick in hopes of finding a doctor who is both a good doctor for that problem and acceptable to them.

Looks like MEDIGAP for me!
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Tue Jul 16, 2013 11:54 pm

frugaltype wrote:
dm200 wrote:While Medicare Advantage Plans have a degree of flexibility, nonetheless I believe they must provide coverage and benefits that are required for Medicare plans.


More than once I've been in a doctor's office, and the staff has said, we'll have to check with the insurance company and get approval for that test, it will probably take a few days at least, and I've said no, I have Medigap, not Medicare Advantage, and they've said oh, and gone right ahead and scheduled the test. No one could confuse me with someone of below Medicare age.


The security that a Medigap plan brings, certainly makes it worth the money! With this, i can sleep at night!
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 12:02 am

gerrym51 wrote:all i can say is this . my wife and i in our medicare advantage plan are using the same company we used for 20 years with my former employer insurance. we use health new England in western massachusettes and has a 5 star medicare advantage rating.

my wife and i never had a problem in using HNE for the 20 years i was on a HNE employer plan and i don't anticipate much of a difference in using the HNE medicare advantage plan. to each his own.

also if you want drug coverage if you are using medigap you still need a Part d plan.



the magic words...5 star plans. i checked out the link. looks like an AMAZING plan!
unfortunately, nothing like that in NY.
Last edited by conky11 on Wed Jul 17, 2013 12:05 am, edited 1 time in total.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby lethean46 » Wed Jul 17, 2013 12:03 am

Conky

Please look at my post above before it gets buried.

ML
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 12:54 am

Rob5TCP wrote:No good deed goes unpunished. Her sister in law has to decide by March of next year and is already concerned. Guess who she might ask.


just think of all that karma you're inheriting!
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 12:56 am

gerrym51 wrote:have you tried googling medigap plans and your zipcode
and Medicare advantage plans and your zip code


yes, of course, gerry. i'm so knowledgeable about medicare that i could work for the medicare rights group.
i just cant make up my mind. (but this forum has finally convinced me that Medigap is without a doubt the way to go).
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 1:10 am

Steelersfan wrote:
mur44 wrote:
It is worth calling local HIICAP (Health Insurance Information
and Counseling Program - same as SHIP) counselor for
unbiased, objective and free advice.

Disclosure: I am a Certified Volunteer Medicare Counselor from NJ


+1

When I was facing the Medicare Supplement vs Medicare Advantage decision with multiple options from both types of plans, I scheduled a session with a SHIP counselor. They were very good. I also talked to my PCP and a well regarded health care insurance broker.

In my case, with my healthy status and financial situation, they all recommended a high deductible Medicare Advantage plan from a single company in my area.

That won't be true for all people in all areas, and could even change over time in my area, but seeking opinions from those three sources is (IMHO) more valuable than trying to get advice from people not in your area and not familiar with the plans there.



being neurotic, I called NY’s Medicare Rights Center (which is the same as HIICap (Health Insurance Information Counseling and Assistance Program), the Dept of Aging, and SHIP. I called 3 times and spoke with 3 different people and each one had a different ‘opinion’.

Even though they are supposed to be objective, when I pushed and asked ‘what would you do?’, one rep highly recommended Advantage, one suggested Medigap F and the 3rd rep felt Medigap N was the way to go.

And this is why I’m overwhelmed. Everyone had their own personal bias. So i figured I'd come here, get lots of insight from people who think like me (bogleheads), and then sort it all out...which i have finally done (YAY!). Medigap F for month 1 / Medigap F HD month 2 and forward.
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 1:40 am

Here's how I looked at Plan F vs HD Plan F. I'll use my husband as the example. He is 72.

Plan F = $2535.81 yearly.
HD Plan F = $896.83 yearly.
Premium savings = $1638.98.
Using HD Plan F, you can spend those "savings" on healthcare costs and BE (breakeven) vs using Plan F. YES YES YES

What's the downside risk? It's $2110 (the deductible) - $1639 (the premium savings) = $471 in the worst case. Worst case may happen some years. Other years, there will be savings going with HD Plan F.

It so happens I just finished a spreadsheet of medical bills for husband resulting from an emergency room visit and 3 day hospital stay.
Total billed amount = $24,669. unbelievable (3 days)!
Medicare approved = $2770. Yes. That's right. Unreal!!! OMG!
Medicare paid = $2014.
HD Plan F deductible = $692.
Balance due = $692. That's what I'll pay. that’s AMAZING.
so on a $25,000 hospital bill, the out of pocket cost to you (that goes towards the $2,110 deductible) is $692. EXCELLENT!

this is SOOOOOO incredibly helpful.

so then, I am correct in what I posted earlier?
in order to reach the full $2,100 deductible…the MEDICARE APPROVED AMOUNT of the year’s TOTAL BILLS would have to be $50,000 (which would make the ACTUAL doctor’s bill close to $500,000).
$50,000 - 80% (medicare covers) = $10,000 x 20% (my cost) = $2,000 (which is the HD F deductible).


That includes everything. Many, many bills. Hospital, docs, labs, etc. Now. Look back up to the top of my post. And see where the $692 fits into my calculations. There's still a LONG way to go - to spill over into the "worst case" of downside risk $471. I still don’t understand why this is a ‘risk’. you are still $471 AHEAD of what the regular F plan premium would cost, no?

I hope that is helpful and makes some sense. you have NO idea! BEST POST EVER!!!!
you boggleheads ROCK! (can I say that, I’m over 50, lol)

ML

ps I think your calculations above using $50,000 example are off, by a lot. For one thing. That's the BILLED amount. Look at what Medicare actually approved vs billing in my husbands case. Overall, the Medicare "approved amount" was roughly 10% of the billed amount. Medicare pays 80% of the "approved amount" and I pay roughly 20% of "approved amount". Forget the "billed amount". It's almost irrelevant - unless you are uninsured. yes, I JUST caught that with your post. that’s why your post was so great! love the breakdown. :happy
conky11
 
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Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 1:47 am

Browser wrote:Let me say that I'm a cancer survivor who, when I was employed and on a company PPO, found that I could not receive the only effective treatment (surgery) where I lived at the time - Louisville. Thanks to my wonderful oncologist at the time, I was referred to Memorial Sloan Kettering in NY and somehow slipped through the cracks and Humana pre-approved treatment there. A decision I'm sure they regretted after the bills started flooding in. I'm alive today because of the multiple surgeries that were performed. After I returned to work, the insurance company had changed to Anthem Blue Cross and their rules for out of network coverage clearly would have restricted me from receiving treatment at MSKCC and I wouldn't have survived the type of cancer that I had. Ditto for Humana. I knew I'd dodged a bullet. My treatment would have been limited to what was available in-network in the Louisville area, and that would have been chemotherapy. I learned that chemotherapy would not have been effective with my cancer, but that's what I would have gotten because that's what the network doctors would have approved. There were simply no surgical oncologists in the entire area skilled in the complex surgery that was required. I would NEVER lock myself into restricted HMO/PPO coverage if there was any way to avoid it. If you choose an Advantage plan you are done with traditional Medicare forever - that's a one-way street. Think long and hard before you make that choice is the best advice I can give anyone. Hope for the best, but prepare for the worst.


Hope for the best, but prepare for the worst. WORDS TO LIVE BY!
As I mentioned above, Sloan Kettering is not on ANY Advantage plans. I greatly appreciate your post.
conky11
 
Posts: 33
Joined: Fri Jul 05, 2013 10:39 pm

Re: Medigap or Advantage? Lots of info/Lots of questions.

Postby conky11 » Wed Jul 17, 2013 1:57 am

conky11 wrote:
Browser wrote:Let me say that I'm a cancer survivor who, when I was employed and on a company PPO, found that I could not receive the only effective treatment (surgery) where I lived at the time - Louisville. Thanks to my wonderful oncologist at the time, I was referred to Memorial Sloan Kettering in NY and somehow slipped through the cracks and Humana pre-approved treatment there. A decision I'm sure they regretted after the bills started flooding in. I'm alive today because of the multiple surgeries that were performed. After I returned to work, the insurance company had changed to Anthem Blue Cross and their rules for out of network coverage clearly would have restricted me from receiving treatment at MSKCC and I wouldn't have survived the type of cancer that I had. Ditto for Humana. I knew I'd dodged a bullet. My treatment would have been limited to what was available in-network in the Louisville area, and that would have been chemotherapy. I learned that chemotherapy would not have been effective with my cancer, but that's what I would have gotten because that's what the network doctors would have approved. There were simply no surgical oncologists in the entire area skilled in the complex surgery that was required. I would NEVER lock myself into restricted HMO/PPO coverage if there was any way to avoid it. If you choose an Advantage plan you are done with traditional Medicare forever - that's a one-way street. Think long and hard before you make that choice is the best advice I can give anyone. Hope for the best, but prepare for the worst.


Hope for the best, but prepare for the worst. WORDS TO LIVE BY!
also, EXPECT THE UNEXPECTED!

As I mentioned above, Sloan Kettering is not on ANY Advantage plans. I greatly appreciate your post.
conky11
 
Posts: 33
Joined: Fri Jul 05, 2013 10:39 pm

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