Medicare Plan F High Deductible vs Advantage

[Nico08]

Hi all, I've been trying to helping my dad decide on a medicare plan that best meets his needs and have been looking at the medicare advantage, plan f high deductible and regular plan f. From what I have read and heard, plan F is the cadillac of plans but it comes with a hefty price tag so we want to consider alternatives that may work just as well and potentially cost less. I've talked to a few brokers and have been getting mixed feedback so I'm hoping for some additional input and/or offer feedback from those who have a plan F HD or advantage plan and aren't looking to make a profit.

Where we live, AARP/UHC plan F costs$166, BCBS Plan F $196 and F HD is $55 per month. My dad is fairly healthy and typically only sees the doctor for the occasional illness or checkup. He does takes several medications (blood pressure, cholesterol, and a heart (for mitral valve).

Has anyone had issues with MA and getting referrals or receiving crappy service? What limitations if any have you run into? Does a doctor who accepts medicare automatically accept medicare advantage?


For those who have medigap plan f or just understand it better than I do:
Do "excess charges" count towards your deductible? I have read that the maximum you would pay out of pocket is the premium + the $2070 deductible but then I have also read that you could end up paying much more than $2070 because of "excess charges." Which is correct? Also, if you are on a medigap plan, is there a yearly enrollment period where you can switch companies and plans without going through underwriting or are you essentially stuck with the same plan (we live in MO)? The HD plan does not seem to be very popular but I'm not sure why (unless I am misunderstanding the coverage).

I'd love to hear any and all feedback about the MA and F HD plans!

[TN_INVEST]

1. Does a doctor who accepts medicare automatically accept medicare advantage?
2. Do "excess charges" count towards your deductible?
3. Also, if you are on a medigap plan, is there a yearly enrollment period where you can switch companies and plans without going through underwriting or are you essentially stuck with the same plan

1. No. Most advantage plans operate with "networks" that are based on corporate contracts. Some doctors, hospitals and doctor groups choose to not accept certain advantage insurance. Every region is different, so do your homework.
2. I don't think so
3. One of the most commonly held misconceptions about Medicare and Medigap plans is that there is an annual enrollment period for Medigap plans. This misconception holds that you can change plans only during this period, and you do not have to answer medical questions or “qualify” to do so. Put simply, that is just not the case. On the contrary, there is NO annual enrollment period – you can change plans at any time. Whenever you change Medigap plans, you DO have to answer medical questions (in most states).

[SpringMan]

Also consider Blue Cross Legacy Plan C, here in Michigan it has been running $122/month per person. It has covered everything so far for us, not much different than plan F.

[johnep]

My wife enrolled in plan F with BCBS 5 years ago. She is on the regular plan F. I do not believe the high deductible option existed at that time. Even though her health is only fair, I think we would have come out ahead on the high deductible plan. Unless someone is hospitalized or has major issues I would think the high deductible works best but that is really a crapshoot and stuff happens to us old folks. Her plan F, aside from the high premium, has been great. She has had very little, if any, out of pocket costs for medical care.

I considered Advantage plans at the time, but there seemed to be issues with some of those so we opted for plan F.

[kaneohe]

Another thing to keep in mind is that (my impression anyway) it is easier to migrate "downward" in level from a
comprehensive medigap plan to a less comprehensive one and then to a MA plan that to migrate upwards. If you had any uncertainty, it might be better to start high knowing that you could "always" migrate lower in future yrs rather than the other way around.

You might also want to investigate the networks of MA plans. DW and I go to the same large/high quality clinic which has many local branches. She has MA and I have Plan F. Basically we have access to the same doctors (at least for now since networks can change) but I pay quite a bit more . She has to go thru the gatekeeper personal physician before seeing a specialist.
I don't. She is restricted to in-network care (for the most part) while I'm not. However for all practical purposes, the end results are the same (in terms of care) except for the costs. Does it make sense to pay more for the medigap? ??????
but that's where I started for the reason in the first paragraph.

[soaring]

This is the link where you begin to study Medicare Advantage plans (MA). I started here several years ago and spent many many days reading about plans in my area. What State and County determines what plans are available. The process is time consuming. There are MA plans with drugs included or without.

http://www.medicare.gov/sign-up-change- ... plans.html

https://www.medicare.gov/find-a-plan/qu ... /home.aspx

I don’t know your area so this is just an example
We have been in an HMO Preferred Care Partners, MA, overall rating is 4 of 5 and includes drugs. Preferred was bought by United Health Care in 2012. We are very satisfied and have remained with Preferred Care in 2013.

http://www.medicare.gov/find-a-plan/res ... &sgmntid=0

When you find a plan of interest click on the plan name to read about it. The first page shows BOTH the Part B premium you pay to the govt and the extra premium you pay to the plan.

As an example, I copied this from our plan. This info is on the first page of the plan info when you click on a plan.

Monthly Premiums
Part B Premium $5.00
Plan Premium $0.00

There are very few plans that actually pay your Medicare part B premium but Preferred Care pays $99.90 of your part B premium and there is no plan premium you pay to the plan.

So in the case of Preferred Care they pay direct to Medicare $99.90 of your Medicare premium and I pay $5.00. I pay nothing to the plan.
The doctors we use are in the plan and the drugs we take are tier 1 and cost nothing. Primary care visits cost zero. Local gyms in town included, $300 toward eye glasses annually included, Some dental included, hearing aid assistance included + more.

Some folks desire a certain doctor for medical or personal reasons and won’t change to save so in their case saving isn’t an option if their doctor isn’t in a certain plan.

Good luck

[plannerman]

There are a variety of MA plans including PPO, PFFS, HMO and POS plans. So you really need to understand the differences before deciding which plan to choose.

I have been very happy with my MA PPO plan. In my case, all the doctors I see, as well as the hospitals I would use if necessary, are all "in plan". Moreover, my specific MA plan allows me to see any doctor that accepts Medicare.

Most of the local doctor's practices here are being bought up by one local hospital in particular. So most of the time, I'm dealing with one provider--at least as far as billing goes.
It does cross my mind, however, that once this particular hospital corners the market on medical services, that they could attempt to negotiate higher reimbursement rates with my insurer, and who knows where that might lead.

plannerman

[Abe]

My wife and I have Medi-Pak Advantage MA (PFFS) with Blue Cross Blue Shield. Our doctors accept it, and so far we have been satisfied with it. We pay zero premium except BCBS gets the Medicare part B premium which we would be paying anyway.

Medicare pays 80% of health care cost and I pay 20%. That would be fine with me except that 20% I pay could be enormous. That is the main reason I have Advantage because it limits the amount I pay to $6,700.00 per year out of pocket for Medicare covered services, plus there are a few additional benefits.

[donall]

I would also consider F plan, just for the convenience, i.e Medicare and the supplemental insurance pay for everything; so far after 20 years. When one is over 80 it may become difficult to monitor health bills without help. I wish the drug plans would be as simple, but they were not part of original Medicare.

[mur44]

Since your are interested in saving on premiums,
you may want to look at Medigap Plan 'N'.
Plan 'N' could work for people with lower
health care needs. One should use Health
and Wealth factors to make the decision.

Your best bet is to visit County SHIP
(State Health Insurance assistance Program)
counselor. Telephone number is listed in the
Medicare & You handbook.

Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

[Nico08]

First off, thank you everyone for your responses!

1. Does a doctor who accepts medicare automatically accept medicare advantage?
2. Do "excess charges" count towards your deductible?
3. Also, if you are on a medigap plan, is there a yearly enrollment period where you can switch companies and plans without going through underwriting or are you essentially stuck with the same plan

1. No. Most advantage plans operate with "networks" that are based on corporate contracts. Some doctors, hospitals and doctor groups choose to not accept certain advantage insurance. Every region is different, so do your homework.
2. I don't think so
3. One of the most commonly held misconceptions about Medicare and Medigap plans is that there is an annual enrollment period for Medigap plans. This misconception holds that you can change plans only during this period, and you do not have to answer medical questions or “qualify” to do so. Put simply, that is just not the case. On the contrary, there is NO annual enrollment period – you can change plans at any time. Whenever you change Medigap plans, you DO have to answer medical questions (in most states).

#2 is what has me concerned. Two of the brokers I have talked to said that excess charges count towards our deductible and our max out of pocket is capped at $2070 (this year) but I have read mixed responses about that here. Does anyone know for sure?

[Nico08]

Also consider Blue Cross Legacy Plan C, here in Michigan it has been running $122/month per person. It has covered everything so far for us, not much different than plan F.

I just checked Plan C again and the only difference is that is that part b excess is not covered or capped. It is also only a $3 less than plan F in our area so it was not really an option for us. I am glad to hear this plan works for you that you have not had to pay any excess charges !

[Nico08]

My wife enrolled in plan F with BCBS 5 years ago. She is on the regular plan F. I do not believe the high deductible option existed at that time. Even though her health is only fair, I think we would have come out ahead on the high deductible plan. Unless someone is hospitalized or has major issues I would think the high deductible works best but that is really a crapshoot and stuff happens to us old folks. Her plan F, aside from the high premium, has been great. She has had very little, if any, out of pocket costs for medical care.

I considered Advantage plans at the time, but there seemed to be issues with some of those so we opted for plan F.

Thank you for your feedback! Plan F definitely sounds ideal aside from the high premiums. Have you been happy with BCBS in general? Any issues?

[midareff]

I took the AARP United Plan F as my choice when I retired and could no longer keep medical coverage from my former employer. It is my understanding from a friend ho has it and recently moved upstate that pricing is geographically determined. While I am fortunate in many ways besides health I think you have to look at the coverage from a worst case scenario ..... like a major medical event; broken hip, major cardiac event, pnemonia or a car wreck requiring an extended stay, or from whatever cause and what medical insurance coverage protection do you have. I don't think I've been healthy is the right way to look at this once retired. .. just my 2 cents.

[Nico08]

Another thing to keep in mind is that (my impression anyway) it is easier to migrate "downward" in level from a
comprehensive medigap plan to a less comprehensive one and then to a MA plan that to migrate upwards. If you had any uncertainty, it might be better to start high knowing that you could "always" migrate lower in future yrs rather than the other way around.

You might also want to investigate the networks of MA plans. DW and I go to the same large/high quality clinic which has many local branches. She has MA and I have Plan F. Basically we have access to the same doctors (at least for now since networks can change) but I pay quite a bit more . She has to go thru the gatekeeper personal physician before seeing a specialist.
I don't. She is restricted to in-network care (for the most part) while I'm not. However for all practical purposes, the end results are the same (in terms of care) except for the costs. Does it make sense to pay more for the medigap? ??????
but that's where I started for the reason in the first paragraph.

So you have not had any issues finding doctors? I have read and heard that while doctors show they accept medicare, that does not necessarily mean they will accept an MA plan.

Do you still go through underwriting to change to a lower medigap plan? that is another thing I am getting mixed answers on. One broker says you have the option to switch companies/plans with out having to apply during your anniversary month and the other says, once you are outside your open enrollment, you will always have to apply and wait to be approved.

[Steelersfan]

As has been mentioned a few times, plans differ a lot by the area you're in so what's good in one area may not be not in another, and may not even be generally available.

When I was deciding which plan to choose I talked to a State Health Insurance Advisory Program (SHIP) councilor, a health insurance broker recommended by some friends, and my physician. Since I'm in good health and financially able to cover the deductible if needed, they all recommended a High Deductible Medicare Advantage PPO. My first year premiums were $0 and this year they went up to $16 a month. It covers medical and drugs and limited eye care. I've been happy so far.

I don't think I could have figured out the best plan all on my own. That's why I went to multiple local resources who know what plans are available here. They were unanimous, so my choice was easy. You may or may not be so lucky.

[bettykayWAAZ]

I started out with a MA plan that cost $0, but it didn't cover me in the winter when I was in Arizona.
So I changed to another MA plan. I was the same group of doctors in both plans, and was very happy.

Then my chronic disease flared up and my doctor recommended a treatment that cost $6000 every two months. I was to pay 20% of that. At that point I changed to Plan F and have bee very happy with it.

The insurance agent said that if you sign up when you are 65 there are no questions asked. If you want to switch into Plan F they have a series of health questions. At that time Crohn's disease was not on the the list questions, but he suggested that it would be soon.

I just spend 4 days in the hospital and haven't gotten the OEB yet. So I don't know how much it cost. I expect to pay nothing.

I think that over my life time the higher premiums on Plan F will prove to be to my advantage. And if not, I have peace of mind.

Bettykay

[dbr]

I think people should be very careful to consider the implications of not enrolling in the Medigap plan one really wants at age 65.

I will admit to not being completely certain of all of that myself, but I have proceeded as if the choice at age 65 is going to be the final and only choice. In particular I chose to avoid my retiree health plan as "supplemental," which was a good thing as they pulled the plan effective 2014.

[dm200]

Regarding Medicare Advantage (MA):

1. These MA plans vary a lot. Whether a MA plan is a good fit depends primarily, IMO, on the plans available in your area.

2. As best I understand (could be wrong), physicians accept do not "accept MA" or not, but rather accept the MA plan(s) in which they are participants. I do not think there is any correlation between accepting standard Medicare and being part of a MA plan.

3. I live in the Washington DC area and enrolled in Kaiser Permanente Medicare Advantage plan 2 years ago when I became Medicare eligible. I love it. Originally I paid Kaiser about $100 per month for the "high option", but on further analysis, after the first year, I pay Kaiser nothing extra. This Kaiser plan (some areas of the country have different kaiser MA plans) allows use of standard Medicare with participating physicians (at least that is what the Kaiser documentation says). I have not used that, and have no specific plans to use it, but that seems a nice feature to have, especially if someone spends some period of time away from Kaiser. With Kaiser, my experience is that referrals to specialists are not a problem at all. The records are computerized and perhaps about half of the health/medical issues that come up can be handled by email (with perhaps teats being ordered).

4. A friend of mine has the Humana Medicare Advantage plan (uses network of participating physicians). He is very happy with the Humana plan.

[kaneohe]

Another thing to keep in mind is that (my impression anyway) it is easier to migrate "downward" in level from a
comprehensive medigap plan to a less comprehensive one and then to a MA plan that to migrate upwards. If you had any uncertainty, it might be better to start high knowing that you could "always" migrate lower in future yrs rather than the other way around.

You might also want to investigate the networks of MA plans. DW and I go to the same large/high quality clinic which has many local branches. She has MA and I have Plan F. Basically we have access to the same doctors (at least for now since networks can change) but I pay quite a bit more . She has to go thru the gatekeeper personal physician before seeing a specialist.
I don't. She is restricted to in-network care (for the most part) while I'm not. However for all practical purposes, the end results are the same (in terms of care) except for the costs. Does it make sense to pay more for the medigap? ??????
but that's where I started for the reason in the first paragraph.

So you have not had any issues finding doctors? I have read and heard that while doctors show they accept medicare, that does not necessarily mean they will accept an MA plan.

Do you still go through underwriting to change to a lower medigap plan? that is another thing I am getting mixed answers on. One broker says you have the option to switch companies/plans with out having to apply during your anniversary month and the other says, once you are outside your open enrollment, you will always have to apply and wait to be approved.

I assume you are asking about my DW who has the MA plan...........as I previously mentioned , we both go to the same large,
multi-location clinic and have not had issues about finding doctors. If the MA plan were to drop the clinic from their network, DW would either have to find other docs still in the network or change plans. I don't know if you have to go thru underwriting if "downgrading" but I got the impression it's a lot easier than going the other way. In CA, they have a "birthday" rule that allows a parallel or downward move in medigap plans once a yr w/o underwriting. My impression is that is not common in other states.

[nisiprius]

One thing we did which I think is absolutely basic-basic to a decision, even though of course the lists could change in future.

Begin by making a comprehensive list of the names of all the doctors your dad goes go to today or can remember going to within the last five years or so, or has thought of going to.

Then go to the medicare.gov provider website and see if they all take Medicare assignment. In our case (my wife's and mine) the answer was "yes" for every one.

Then go to the insurer's Medicare Advantage website and see if all the doctors are within the plan's network. In our case, again, the answer was "yes."

An important factor is: does your dad travel within the U.S.? That is, does he have a summer place or a winter place at which he makes extended stays? HMOs, including Medicare Advantage plans, do have rules regarding coverage in such situations but you want to read the fine print. Medicare's "network" is national.

P.S. All I want to say about costs is that it's not a slam dunk. We looked long and hard at this, and there are so many unknowns in the package of extra out-of-pocket costs you need to pay with Medicare Advantage that it's hard to tell. It was not the case that Medicare Advantage was much cheaper. It might have been 10% cheaper, total, but even that wasn't certain.

[jeffyscott]

Has anyone had issues with MA and getting referrals or receiving crappy service? What limitations if any have you run into? Does a doctor who accepts medicare automatically accept medicare advantage?

No significant problems. My mom is in poor health and in assisted living, the only minor issue is things like their in-house therapy is not in-network. But when I was talking to UHC/AARP about this issue, they said that in this situation the provider could ask for an exception and be considered in network on a temporary basis. The provider was unwilling to do this, so I found another provider that does "house calls" for therapy.

Do "excess charges" count towards your deductible? I have read that the maximum you would pay out of pocket is the premium + the $2070 deductible but then I have also read that you could end up paying much more than $2070 because of "excess charges." Which is correct?

I don't know, but I think if the doctor accepts Medicare assignment, there will be no excess charges.

The HD plan does not seem to be very popular but I'm not sure why (unless I am misunderstanding the coverage)

I would guess it is the $2070, which to me is not really a "high deductible" these days, but I guess a lot of people would rather have the certainty of a higher monthly premium and lower out of pocket??? To me the best options seemed to be the high deductible supplement or a MA plan.

Even with my mom's poor health, my estimates did not show much difference. Whatever route she went her total costs would be about the same. With the high deductible, were she even accepted (which she would not be) she'd be capped at about $3300 per year in out of pocket plus premiums, with MA her plan's max is a bit higher ($3950), but if she happened to not need a lot of services her costs would be lower than with the supplement.

[jimkinny]

I just enrolled in Medicare's Plan F, High Deductible.

Nothing I read indicated that excess charges were excluded from coverage. My understanding is the HD Plan F is identical to Plan F except for the 2070/ year deductible. The deductible will increase, with time due to inflation, just as the premiums will go up, with time.

There are myriad of flavors of advantage plan. I think there is a lot marketing, with some real differences. One of the things that should be considered is the maximum out of pocket expenses. As I recall, in my area, all advantage plans had about $6,000 per year as the maximum. There may have been one advantage plan with a 4K maximum.

This was the determining factor for me, the maximum out of pocket expenses, 2K with plan F HD or 6K with an advantage plan. Most of these advantage plans had some form of freebies added such as some limited dental and or eye care. They of course had a lot of co-pays that would count towards the maximum out of pocket expense.

For me, the freebies, although appealing, were not enticing enough to draw me away from what I wanted to buy and that is health insurance.

Medical expenses can be very high and the value of the freebies was small relative to the potential 6K per year out of pocket expenses. I am not sure about this: what would happen if one reached the maximum in November or December, then had to have a re-admission in January to a hospital. Would you now be facing a potential 12K expense in 3 months? I made the assumption that this would be the case. All health cares plans I have been in have operated on a yearly basis.

jim

[dm200]

There are myriad of flavors of advantage plan. I think there is a lot marketing, with some real differences.

Absolutely! Another "twist" in (I think) all of the Medicare plans (I know this is true of MA), is that some retirees continue to get some degree of benefits for medical insurance. Just as an example, I pay only the approx $100 to Medicare for my Kaister MA plan (nothing extra per month to Kaiser), but I have, typically, $30 or $40 copays when I see the doctor. Some of my friends and acquaintences, who are retired under the federal employee system, pay zero copays. In the private sector, especially, such returee benefits are disappearling rapidly.

[jeffyscott]

This was the determining factor for me, the maximum out of pocket expenses, 2K with plan F HD or 6K with an advantage plan.

But you also must include the premiums in the out of pocket costs, add up plan F premiums, part D premiums and the deductible to get your total maximum out of pocket costs. Then compare that to same costs for any acceptable MA plans.

In my mom's case a plan F amounted to the certainty of paying about $1200 extra in annual premiums, to avoid a potential extra out of pocket cost of up to $700 more. Her cost with the MA selected could vary from a minimum of maybe $300 to a max of $3950, while plan F would range from maybe $1500 to $3300 for the year.

[Nico08]

Thanks for all the feedback everyone! I think he is going to go with the plan f HD over MA. If he's not happy, he should at least be able to go to an MA easier than if he were on MA and wanted to move to medigap.

if anyone else has feedback, please continue to share! It's very helpful to read about situations/experiences from people who are not looking to make commission off of you.