Medicare versus Medicare Advantage for 2018

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1pk3mks
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Medicare versus Medicare Advantage for 2018

Post by 1pk3mks » Fri Oct 06, 2017 6:41 pm

I will reach Medicare age next year. So many options! I live in GA - should I go with a Medigap plan or a less expensive Medicare Advantage plan?

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GerryL
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Re: Medicare versus Medicare Advantage for 2018

Post by GerryL » Fri Oct 06, 2017 8:21 pm

There is no single "best" option for everyone. It will depend on your circumstances. I always recommend the book Medicare for Dummies for help in navigating the complexity of Medicare. Borrow a copy of the book from the library. (I liked it so much I bought my own copy.) Then when you understand enough to ask the right questions, contact your state SHIP office to get personal help if you need it.

In my case I opted to go with traditional Medicare because I could always switch to an Advantage plan in the future. The opportunity to switch from Medicare Advantage to traditional Medicare is very limited when it's even possible. I chose a Medigap F high-deductible plan because I don't use a lot of healthcare services, so I benefit from the very low premium. As a result, when fall rolls around, the only plan I have to revisit is my Part D drug plan. (If you choose to go with an Advantage plan, you will want to revisit the options every year.)

123
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Re: Medicare versus Medicare Advantage for 2018

Post by 123 » Fri Oct 06, 2017 8:24 pm

If you have an established relationship with a doctor and you wish to try to keep it you should see what plans he participates in and consider your choices from that aspect. If you don't need to keep the same doctor you will have more options. A primary thing to consider is whether any existing healthplan you participate in has a Medigap/Medicare Advantage version and whether that option would work for you. For some people it's difficult to start their healthcare options from scratch again, for others it doesn't matter.
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Kidneydoc
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Re: Medicare versus Medicare Advantage for 2018

Post by Kidneydoc » Sat Oct 07, 2017 8:34 am

As a physician, I would not recommend Medicare Advantage, unless you are of good health and do not anticipate using the healthcare system frequently (an unlikely scenario as you age). The upfront costs of traditional Medigap plan pale compared to the deductible and coinsurance costs of a Medicare (dis)Advantage, aka Medicare (in)Complete plans, if you have a chronic disease and anticipate seeing multiple physicians. The administrative costs of Medicare Advantage are much higher than traditional Medicare, as they are run by for-profit insurance companies, whose sole purpose is to cut cuts at the expense of patient and reimbursement of the physician for their profit margins. Traditional Medicare is non-profit but is also not easy with upcoming government mandates and changes in payment system in the near future.

Ask any physician that treats Medicare age population, what plan they prefer: most would say traditional Medicare with Medigap plan. Granted we get often paid more with traditional Medicare, but the headaches of dealing with Medicare Advantage (basically an HMO) is not appreciated by the healthcare consumer because of the lower or no premiums (you get what you pay for). If you want specialty care at renowned cancer center, need an "in-network" physician, or do not need roadblocks to subacute rehabilitation/potential costly care, then it's hard to beat traditional Medicare.

The average Boglehead probably has considerable higher net worth than the average Joe. According the latest study at Fidelity, you need to anticipate healthcare costs during retirement to be around $275,000 per couple. If you afford that nut, I would take traditional Medicare. If not, I would take Medicare Advantage and choose a well-regarded hospital and multispecialty group to get your care that is in-network.

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JMacDonald
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Re: Medicare versus Medicare Advantage for 2018

Post by JMacDonald » Sat Oct 07, 2017 9:08 am

Kidneydoc wrote:
Sat Oct 07, 2017 8:34 am
As a physician, I would not recommend Medicare Advantage
Medical care plans are confusing. However I am happy that I have the Kaiser Senior Advantage Plan. Before I retired I was with another medical plan, and it did not serve me well. After I moved to Kaiser, I am receiving much better care. Maybe those other Senior Advantage Plans are problematic, not Kaiser, at least for me.
Best Wishes, | Joe

2015
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Re: Medicare versus Medicare Advantage for 2018

Post by 2015 » Sat Oct 07, 2017 9:32 am

GerryL wrote:
Fri Oct 06, 2017 8:21 pm
There is no single "best" option for everyone. It will depend on your circumstances. I always recommend the book Medicare for Dummies for help in navigating the complexity of Medicare. Borrow a copy of the book from the library. (I liked it so much I bought my own copy.) Then when you understand enough to ask the right questions, contact your state SHIP office to get personal help if you need it.

In my case I opted to go with traditional Medicare because I could always switch to an Advantage plan in the future. The opportunity to switch from Medicare Advantage to traditional Medicare is very limited when it's even possible. I chose a Medigap F high-deductible plan because I don't use a lot of healthcare services, so I benefit from the very low premium. As a result, when fall rolls around, the only plan I have to revisit is my Part D drug plan. (If you choose to go with an Advantage plan, you will want to revisit the options every year.)
+1
I'm not on Medicare yet, but had planned on simply starting with an MA plan after reading Medicare for Dummies. After reading this article yesterday, I'm thinking I will "test drive" a traditional plan coupled with Medigap Plan F for the first year.

http://squaredawayblog.bc.edu/squared-a ... -10-rules/
First-time Medicare enrollees might want to be strategic, Mills said. Sixty-five-year-olds who want to play it safe could choose a Medigap supplement initially, because they cannot be refused coverage by Medigap during the first six months after they first sign up for Part B. Medigap isn’t always available to people who’ve already been enrolled in an Advantage plan, because Medigap can deny coverage based on pre-existing conditions. Perhaps enroll in Medigap the first year to “play out the scenario and learn how it works,” she said. Enrollees can easily switch from Medigap to an Advantage plan during the next open enrollment period, which is always Oct. 15 through Dec. 7. The plans become effective Jan. 1.

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Raybo
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Re: Medicare versus Medicare Advantage for 2018

Post by Raybo » Sat Oct 07, 2017 10:23 am

I joined Medicare last May. I have been a satisfied SF Kaiser member for over 30 years. In checking here and other places, I was satisfied that SF Kaiser Medicare Advantage would provide me with the care I'd come to expect. So, that is what I chose.

I just got my 2018 annual renewal notice and Kaiser has raised the out-of-pocket maximum from $4400 to $6700, an increase of over 50%! In the past, Kaiser raised its rates 10% a year. This moderated with Obamacare.

I asked about 2017 and the OOP went from $3500 to $4400. In 2018, it is going up to $6700. That is close to 100% in 2 years! It says to me that Kaiser doesn't have a handle on its Medicare Advantage expenses and it will keep raising them until some outside force intervenes.

I am seriously considering switching to regular Medicare, as I am now in good (enough) health and believe I could pass underwriting, which is now required for me to switch back to Medicare.

Frankly, this whole episode reminds me of the Long-Term Care fiasco.
No matter how long the hill, if you keep pedaling you'll eventually get up to the top.

orlandoman
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Re: Medicare versus Medicare Advantage for 2018

Post by orlandoman » Sat Oct 07, 2017 10:34 am

Kidneydoc wrote:
Sat Oct 07, 2017 8:34 am
As a physician, I would not recommend Medicare Advantage, unless you are of good health and do not anticipate using the healthcare system frequently (an unlikely scenario as you age). The upfront costs of traditional Medigap plan pale compared to the deductible and coinsurance costs of a Medicare (dis)Advantage, aka Medicare (in)Complete plans, if you have a chronic disease and anticipate seeing multiple physicians. The administrative costs of Medicare Advantage are much higher than traditional Medicare, as they are run by for-profit insurance companies, whose sole purpose is to cut cuts at the expense of patient and reimbursement of the physician for their profit margins. Traditional Medicare is non-profit but is also not easy with upcoming government mandates and changes in payment system in the near future.

Ask any physician that treats Medicare age population, what plan they prefer: most would say traditional Medicare with Medigap plan. Granted we get often paid more with traditional Medicare, but the headaches of dealing with Medicare Advantage (basically an HMO) is not appreciated by the healthcare consumer because of the lower or no premiums (you get what you pay for). If you want specialty care at renowned cancer center, need an "in-network" physician, or do not need roadblocks to subacute rehabilitation/potential costly care, then it's hard to beat traditional Medicare.

The average Boglehead probably has considerable higher net worth than the average Joe. According the latest study at Fidelity, you need to anticipate healthcare costs during retirement to be around $275,000 per couple. If you afford that nut, I would take traditional Medicare. If not, I would take Medicare Advantage and choose a well-regarded hospital and multispecialty group to get your care that is in-network.
As a 3 year MA plan user, I wish to make the following points:
- MA plans tend to be better for those in good health
- MA plans vary by state & area, you need to compare to what is available in your area
- Yes, in many area's MA plans are HMO's ... but, in Central FL where I live PPO options are available. In fact 2 of 3 MA PPO plans, AARP United Healthcare & Humana are $0 monthly premium, BC/BS is $41 a month
- My MA PPO charges $15 to see my personal physican, $50 for an in-network specialist & $70 for an out of network specialist
- My MA plan actually pays me (retail gift cards) to take preventive health steps & tests
- In my case I considered my health, $0 monthly premium, what I might spend on Dr's & meds (included w/MA) versus the monthly cost of a med supplement & a drug supplement & a MA was the right choice for me
- Do your own evaluation
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1pk3mks
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Re: Medicare versus Medicare Advantage for 2018

Post by 1pk3mks » Sat Oct 07, 2017 2:46 pm

Thank you for the replies - does anyone know of someone who was on Medicare Advantage and then tried to switch back to Medigap and they were not eligible for Medigap policy?

orlandoman
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Re: Medicare versus Medicare Advantage for 2018

Post by orlandoman » Sat Oct 07, 2017 3:23 pm

1pk3mks wrote:
Sat Oct 07, 2017 2:46 pm
Thank you for the replies - does anyone know of someone who was on Medicare Advantage and then tried to switch back to Medigap and they were not eligible for Medigap policy?
Medical underwriting would apply ... so, it would depend on your health condition/history & the underwriting requirements of the medical supplement carrier you apply too, each may have different requirements.

Here's an article about medical underwriting with some general comments https://boomerbenefits.com/medigap-underwriting/.

Also, here's Blue Shield of California's underwriting guidelines (just google'd med supp med underwriting), starting on page 19, it lists what it will/maynot/won't take ... this should give you some idea of guidelines, http://www.consumerwatchdog.org/resourc ... riting.pdf.
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1pk3mks
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Re: Medicare versus Medicare Advantage for 2018

Post by 1pk3mks » Sat Oct 07, 2017 4:34 pm

Medical underwriting would apply ... so, it would depend on your health condition/history & the underwriting requirements of the medical supplement carrier you apply too, each may have different requirements.

Here's an article about medical underwriting with some general comments https://boomerbenefits.com/medigap-underwriting/.

Also, here's Blue Shield of California's underwriting guidelines (just google'd med supp med underwriting), starting on page 19, it lists what it will/maynot/won't take ... this should give you some idea of guidelines, http://www.consumerwatchdog.org/resourc ... riting.pdf.

Very helpful, thanks!

montanagirl
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Re: Medicare versus Medicare Advantage for 2018

Post by montanagirl » Sat Oct 07, 2017 9:51 pm

I "strategically" started with MA my first year when I was on unemployment and waiting to file spousal at 66. Cost 30/mo and was a godsend.

The company has since been run out of business by Blue Cross, which is now dropping its MA plan. Mission accomplished.

Anyway, the switch to traditional Medicare was guaranteed after a year on MA, as I recall. No underwriting. :)

JohnF
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Re: Medicare versus Medicare Advantage for 2018

Post by JohnF » Sun Oct 08, 2017 1:37 pm

Also in Georgia, wife and I have been on a zero premium Medicare Advantage PPO plan for several years. The plan has paid for an outpatient surgery (me) and a four day hospital stay (wife) with minimal charges to us. And we’ve yet to come across a provider that does not accept our coverage. So far we’re more than satisfied.

1pk3mks
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Re: Medicare versus Medicare Advantage for 2018

Post by 1pk3mks » Sun Oct 08, 2017 1:59 pm

Who is your provider for the MA?

JohnF
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Re: Medicare versus Medicare Advantage for 2018

Post by JohnF » Sun Oct 08, 2017 7:35 pm

Aetna

cashmoney
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Re: Medicare versus Medicare Advantage for 2018

Post by cashmoney » Sun Oct 08, 2017 8:29 pm

Raybo wrote:
Sat Oct 07, 2017 10:23 am
I joined Medicare last May. I have been a satisfied SF Kaiser member for over 30 years. In checking here and other places, I was satisfied that SF Kaiser Medicare Advantage would provide me with the care I'd come to expect. So, that is what I chose.

I just got my 2018 annual renewal notice and Kaiser has raised the out-of-pocket maximum from $4400 to $6700, an increase of over 50%! In the past, Kaiser raised its rates 10% a year. This moderated with Obamacare.

I asked about 2017 and the OOP went from $3500 to $4400. In 2018, it is going up to $6700. That is close to 100% in 2 years! It says to me that Kaiser doesn't have a handle on its Medicare Advantage expenses and it will keep raising them until some outside force intervenes.

I am seriously considering switching to regular Medicare, as I am now in good (enough) health and believe I could pass underwriting, which is now required for me to switch back to Medicare.

Frankly, this whole episode reminds me of the Long-Term Care fiasco.


6,700 is the maximum allowed for any medicare advantage plan and is also the most common MOOP you will see with MA so anything below that is good.The good news is that probably less than 1 % of medicare beneficiaries ever hit the MOOP on medicare advantage plan.If you switch back to a med supp/PDP combo you are then looking at a minimum out of pocket of 3000.00 in premiums give or take 1000.00 depending on age, location,health etc..

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Watty
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Re: Medicare versus Medicare Advantage for 2018

Post by Watty » Sun Oct 08, 2017 10:25 pm

GerryL wrote:
Fri Oct 06, 2017 8:21 pm
There is no single "best" option for everyone. It will depend on your circumstances. I always recommend the book Medicare for Dummies for help in navigating the complexity of Medicare. Borrow a copy of the book from the library. (I liked it so much I bought my own copy.) Then when you understand enough to ask the right questions, contact your state SHIP office to get personal help if you need it.
+1 on that book.

Be sure you are looking at the most current edition if you get it from a library since there have been lots of changes.

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Sheepdog
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Re: Medicare versus Medicare Advantage for 2018

Post by Sheepdog » Mon Oct 09, 2017 12:04 am

Research diligently your various in-retirement medical insurance options, and there are many. And, to be sure you are continuing to have good economic and/or basic insurance coverage over the years, review annually. Times change, insurance policies change, rates change. This is our continuing 19 year in-retirement history.

I was insured through Medicare and possibly 4 or more different Medigap policies from 1998 at age 65 until 2014. Changes were because of increasing insurance premiums. (Part D prescription plans also when they became available.) The Medigap premium rates were increasing dramatically as I aged especially past age 75. I began a research of Advantage plans. I was hesitant. I didn't like the restrictions on HMO type Advantage plans. (Basically, I did not want to ask for permission to do certain medical procedures). PPO (preferred physician) plans, I thought, were less restrictive. (In research of Advantage plans, be diligent of what is covered and what isn't, and any restrictions which you may not like.) I did decide on a PPO plan (Anthem BCBS) and have been very satisfied. It not only covers my normal medical needs, but also includes some dental and vision benefits, and hearing coverage for up to $3000 on aid purchases a year, the latter of which I took advantage of this year. It also covers, of course, prescription needs. My experience on coverage has been very good, for example, I had bladder cancer surgery in 2015 with periodic quarterly (now annual) bladder exams since. (staying clean, by the way :D ) I obtained hearing aids costing $3000 this year and were fully covered. The physicians available in the network has been good. The dental coverage has not been very good so far. I have saved over $2000 per year in insurance premiums since,plus I gained those extra mentioned benefits.

Now, let's look at my wife's insurance. Because of my experience, she decided to move away from Medicare/Medigap plans to a Medicare Advantage PPO plan in 2016, one of Humana's, which worked okay (also saving over $2000 a year in premiums) until September of this year (2017) when Humana advised her by mail that her regular primary care physician was leaving her network at the end of this year and she would have to find another one for 2018. They even gave her the name and address of a doctor to contact. (She asked her doctor why and he said it was because he didn't like how they treated patients needing extended care and suggested that she change her insurance provider.) She did not like having to change her doctor, as you can imagine. She is expecting to change to my BCBS coverage as her physician is still in my network. (A side note, as we reviewed insurance programs for 2018 on the Medicare web site I find that next year my primary care physician also dropped out of Humana's PPO listing...I don't know why, but I guess it may have been for the same reasons as they are friends and neighbors.)
People should not say everything they think. They should think about everything they say.

orlandoman
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Re: Medicare versus Medicare Advantage for 2018

Post by orlandoman » Mon Oct 09, 2017 7:34 am

Sheepdog wrote:
Mon Oct 09, 2017 12:04 am
" .... her regular primary care physician was leaving her network at the end of this year ..." & "I find that next year my primary care physician also dropped out of Humana's PPO listing"
Since these are PPO plans, you can see the doctors as out of network, it may be the difference between a $0-$15 and a $35-$50 copay (for a primary care physician, don't know your specific plan). I see an out of network specialist & pay a $70 copay instead of $50 for in network ... because it's the dr. I want to see. If it's only a couple of times a year, the $ amt may not mean too much.
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Sheepdog
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Re: Medicare versus Medicare Advantage for 2018

Post by Sheepdog » Mon Oct 09, 2017 8:22 am

orlandoman wrote:
Mon Oct 09, 2017 7:34 am
Sheepdog wrote:
Mon Oct 09, 2017 12:04 am
" .... her regular primary care physician was leaving her network at the end of this year ..." & "I find that next year my primary care physician also dropped out of Humana's PPO listing"
Since these are PPO plans, you can see the doctors as out of network, it may be the difference between a $0-$15 and a $35-$50 copay (for a primary care physician, don't know your specific plan). I see an out of network specialist & pay a $70 copay instead of $50 for in network ... because it's the dr. I want to see. If it's only a couple of times a year, the $ amt may not mean too much.
Yes, but even out of network, her doctor told her that he will not file any claim with Humana!! He told her that she should change insurance. He appeared to be very upset with them, she said. Because of medical issues, she has already seen him 11 times this year so her bills would not be so low.
People should not say everything they think. They should think about everything they say.

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