Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

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Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Small Law Survivor »

I'm sharing this interesting/intriguing article:
https://crr.bc.edu/medicare-advantage-r ... s-medigap/

My wife and I buy Medigap. Why? We like being able to select our own doctor. My wife was diagnosed with a meningioma (a type of brain tumor) last year and we were able to see specialists at multiple hospitals in Boston. That's the primary reason, along with the fact that this is what my parents did, and I'm often inclined to follow my father's lead on things.

From the article:
Medigap buyers on average use $12,200 in medical care annually – $2,300 more than everyone else on Medicare . . .

Since Medigap buyers spend more, a logical supposition is that they are less healthy. But the researchers found that they are actually healthier than other retirees. Their incidence of diabetes and of cardiovascular disease are lower. They even spend more on healthcare than comparable retirees with the same health profiles. . . .

So, the question remains: why do Medigap buyers spend $2,300 more on healthcare? The researchers argue that since the various characteristics of the retirees themselves cannot explain this additional spending, their findings are consistent with “moral hazard.” Moral hazard, which is difficult to quantify, is a situation in which individuals who have Medigap spend more simply because they face lower out-of-pocket costs under these policies.

The researchers conclude that moral hazard “may lead these individuals to demand more [care] than those without Medigap.”

In other words, Medigap buyers are essentially getting more but paying less out-of-pocket for doctor’s appointments, medical care, and tests.
Many. interesting comments on the article. Here are a few:
I want to select my own providers and not be locked in to a plan group as I may not like the Dr they send me to. I don’t wait weeks for referrals to specialists. I can get multiple opinions. Comparing notes with friends, I get appointments faster than they do (with Advantage plans). I travel and need the go anywhere option. An employee waited about 3-4 months for gallbladder surgery (Advantage plan) and then only got 48 hrs notice. I had my surgery in a week.
I will repeat what I have seen often: “If you value your life, walk away from Advantage plans.”
Retirees who have multiple homes or a traveler’s lifestyle can’t get locked in to a Medicare Advantage program and its constraints. That is why we use Medigap.

Also, Medicare Advantage constrains your choice of providers. For wealthier people who want the best in medical care, that is a consideration. We will stay on Medigap for that reason, even after we stop doing the snowbird lifestyle.
There is a link to the study in the article.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by jebmke »

among other reasons, we buy Medigap because Advantage isn't available.

It appears they are treating this like buying processed food where knowledge of the product is available and one can easily make informed choices.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by bobn60014 »

There's certainly a lot of buyers remorse for some with MA, when s*** makes contact with the fan.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by supersharpie »

bobn60014 wrote: Sat Jul 06, 2024 8:40 am There's certainly a lot of buyers remorse for some with MA, when s*** makes contact with the fan.
I have heard FAR more complaints about MA. Why would you want to tie yourself to a network and be reliant on the doctors, rather than you, to direct your healthcare? It doesn't make sense IMO, unless you truly cannot afford the Medigap premiums.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Outer Marker »

I'm not there yet -- but I find the whole thing very complex and not transparent. Seems to me this comment is a more accurate representation of the overall situation:

I believe those constraints only exist for an Advantage HMO plan. PPO plans are also available through Medicare Advantage (obviously at a higher cost–but maybe not that much higher than Medigap?). With an Advantage PPO plan you can go to any provider that takes Medicare as I understand it.

I think the true comparison is [Traditional Medicare + Medigap] versus [Medicare Advantage PPO]
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by LCX2000 »

OP and those responding,
Which Medigap plans do you have? My DH has A, B, D and N. Seems like another good option is A, B, D and G, though more expensive.

Curious what others are doing for Medigap.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by jebmke »

LCX2000 wrote: Sat Jul 06, 2024 8:49 am OP and those responding,
Which Medigap plans do you have? My DH has A, B, D and N. Seems like another good option is A, B, D and G, though more expensive.

Curious what others are doing for Medigap.
Gap plan is G; also have Part D
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by JPH »

My former employer switched a couple of years ago from Medigap PPO to a Medicare Advantage PPO plan. I much prefer the new plan. I now deal only with BC/BS and receive one EOB. Customer service is outstanding. I have full choice of any provider I choose. I now pay no deductibles at all. I see no downside to the switch at all.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by LCX2000 »

jebmke wrote: Sat Jul 06, 2024 8:51 am
LCX2000 wrote: Sat Jul 06, 2024 8:49 am OP and those responding,
Which Medigap plans do you have? My DH has A, B, D and N. Seems like another good option is A, B, D and G, though more expensive.

Curious what others are doing for Medigap.
Gap plan is G; also have Part D
Interesting. And thank you. I Googled Medigap after reading the OP and did not understand that distinction. Sounds like N is the same as G only doesn't cover excess charges, but has a higher monthly premium.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by nedsaid »

For whatever this is worth, I recently went full Medicare and I chose Medicare A, B, D, and G High Deductible. I chose the Medigap option rather than the Medicare Advantage plans that are available in my area. Essentially Medicare Advantage is a regional coverage and you are restricted to their network of providers, this is what my Mom and Dad had and they received excellent care. My geographic area has excellent Medicare Advantage Plans but this is not true for all areas of the country. I chose Plan G as a Medigap plan for wider choice of providers and doctors.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Small Law Survivor »

I actually pay a consultant to help me chose the right plan. She's never mentioned the "PPO" option, but I'll be sure to ask her about it next year!
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by retiredude24 »

Live in New York City. I have B and UHC (AARP) supplemental plan G. Have D with Wellcare.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Conch55 »

Part B, Part D (Cigna/Express Scripts) and Plan G (UHC/AARP). We have been using this combination for 4 years and it's been great. The price has increased yearly but that was/is expected. In my mind the decision boils down to can one afford a medigap supplement with original Medicare. If not, then MA is the way to go.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Jack FFR1846 »

I have a Medigap plan and part D. I have watched most of the Medicare on Video segments. Both my mom and father in law were on Advantage plans but both of them had the plans paid by the city as former employees. In my mom's case, when she snowbirded to Florida in the winter, she would wait and have all of her doctor visits when she returned to Massachusetts, where the MA plan was located. This is not every MA plan but some are very localized and if you snowbird, you'll find that your closest in-plan doctor is 1000 miles away. I was on an HMO years ago and I remember their requirements. They had offices in one building and if I wanted to see my doctor, I'd make an appointment for that office and 6 months later, could see a doctor. I found that I mostly would see a nurse practitioner because then the wait was only 6 weeks. Any specialist visit required a pre-authorization and to get one, they required I first come in and have an appointment with a GP, and pay the appropriate co-pay. When my doctor left the HMO, I had to get on a wait list for a new doctor.

No thanks. With Medigap, I can go anywhere, see anyone and there are no pre-authorizations ever.

Will it somehow help me if you go with a Medigap plan.....and that's why I'm saying all this? No. I get nothing and really don't care. You can do what you find is best for you. If Fred Flintstone recommends the MA plan on TV, and he convinces you, fine, go with the biggest MA plan in Bedrock.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by diy60 »

Jack FFR1846 wrote: Sat Jul 06, 2024 9:42 amNo thanks. With Medigap, I can go anywhere, see anyone and there are no pre-authorizations ever.
I have Medigap and this is my sentiment as well. However, there are apparently MA PPO plans (I have this available to me thru MegaCorp I retired from) that allow going to any provider that accepts Medicare without any pre-approvals. What I don't know is if the "level" of benefits are the same as original Medicare w/Megigap. Also, something else to consider, assuming I live to the average life expectancy I estimate my monthly Medigap rates to be near $700/mo. I'm guessing this is why every elder person I know is on MA, but just a guess on my part. Good luck.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Kenkat »

One of the biggest issues with regular Medicare is that there is no out of pocket maximum. That leaves most people with then having to decide whether to go with Medicare Advantage or a Medigap policy.

I know people who have had a positive experience with Medicare Advantage but I will likely go with a Medigap policy, for all the reasons cited above, in a few years when I am eligible for Medicare assuming there are not major changes in the Medicare landscape between now and then.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by bertilak »

Medigap for me. Plan F.

Plan G is about the same.

Differences:
F pays the part B annual deductible, G does not. F costs a bit more (about the same as deductible amount it covers (?), but it has been a while since I compared). Last I looked, F was only available to those grandfathered in. G might be a tiny bit cheaper in the long run but I don't think I can switch without going through underwriting. Besides, by covering that part B deductible, I never have to wonder (early in the year) if a bill will come due.

Bottom line, G is probably the best choice.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by CloseEnough »

diy60 wrote: Sat Jul 06, 2024 9:50 am
Jack FFR1846 wrote: Sat Jul 06, 2024 9:42 amNo thanks. With Medigap, I can go anywhere, see anyone and there are no pre-authorizations ever.
I have Medigap and this is my sentiment as well. However, there are apparently MA PPO plans (I have this available to me thru MegaCorp I retired from) that allow going to any provider that accepts Medicare without any pre-approvals. What I don't know is if the "level" of benefits are the same as original Medicare w/Megigap. Also, something else to consider, assuming I live to the average life expectancy I estimate my monthly Medigap rates to be near $700/mo. I'm guessing this is why every elder person I know is on MA, but just a guess on my part. Good luck.
This is state specific, but is certainly true in Massachusetts where OP lives. A BC/BS PPO Medicare plan comes with a zero dollar monthly premium and many benefits not covered by original Medicare with supplement, such as dental, fitness allowance, pharmacy product allowance, etc..

Perhaps this is not a good option for someone with extensive health problems and medical needs, but I would think for many mostly healthy people this is a cost effective option. And, in Massachusetts I believe that switching to original Medicare can be done without health underwriting requirements, so if your health circumstances change to the point that original Medicare is the better option (which might be expected at some point for many people as they age), the switch to original Medicare can be done.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by SevenBridgesRoad »

Another of the endless perpetual debates here on BH (No international! Keep mortgage! 1.2783% withdrawal rate or it's cat food for you! Medicare Advantage is bad!)

We always seem to get back to: it's local and it's personal. My MA plan with United is outstanding here in DFW metro. Many thousands of network physicians and dozens of excellent hospitals. Of course, DFW is a huge metro area with excellent health care everywhere you look. Our United plan also has a huge national network. We had no problem taking a close relative, also on Medicare Advantage with United, to a "name brand", world-class geriatric memory clinic in another state with zero hassle and in-network co-pay.

We've had surgery. We've seen specialists. Prescriptions for zero out-of-pocket. We have easy access to primary care too. The telemedicine benefit is awesome. Physical therapy - yes. Optical - yes. Dental - yes.

MA pays for our gym memberships at name brand gyms. MA pays for over-the-counter products.

We pay zero premium for MA with United other than the same Medicare B premium everyone pays.

We are not stupid. We are not poor. We are not in perfect health. ( We hear "well, MA is ok if you're an idiot and can't afford Medicare and in perfect health")

I respect those who decide to go with regular Medicare. But the decision to go with Medicare Advantage can make perfect sense, too. Let's agree the decision is more nuanced than some would lead us to believe.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by CloseEnough »

SevenBridgesRoad wrote: Sat Jul 06, 2024 10:18 am

I respect those who decide to go with regular Medicare. But the decision to go with Medicare Advantage can make perfect sense, too. Let's agree the decision is more nuanced than some would lead us to believe.
Sure, I understand everything you wrote. But, isn't Medicare Advantage bad? :happy :happy :happy
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by SevenBridgesRoad »

CloseEnough wrote: Sat Jul 06, 2024 10:23 am
SevenBridgesRoad wrote: Sat Jul 06, 2024 10:18 am

I respect those who decide to go with regular Medicare. But the decision to go with Medicare Advantage can make perfect sense, too. Let's agree the decision is more nuanced than some would lead us to believe.
Sure, I understand everything you wrote. But, isn't Medicare Advantage bad? :happy :happy :happy
lol!!
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by MoreTaxes »

I am happy with Kaiser HMO, while working. Same day appointments, good urgent care, ER. No problems with referrals. Drug coverage. I've had surgeries, and they were scheduled and performed without hassle. I pay my co-pay, and that's it. There are no bills or other paperwork for me to fret over.

I see that Kaiser has a Medicare Advantage plan that lets me just continue on with Kaiser in the usual way. This is a no-brainer for me.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Rex66 »

The vast majority of my MA patients are happy. The biggest issue currently is centers dropping MA coverage. Hard to predict the future.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by SuzBanyan »

Not only is the choice personal, but it is also local.

For me, I pay about $50/month for Plan G HD and Part D, which (excluding drug costs, which are currently $0, but have no cap in 2024) means my maximum out of pocket is about $2700/year.

I have the option for MA PPO plan with UHC/AARP for $74/month with a max OOP of $4500/year in-network ($8550 in and out of network) (including drug costs).

I also the option for MA HMO plan with Kaiser with $0 premium with max OOP of $6000/year in network (including drug costs).

I’m happy with my choice of a MediGap plan. I am also happy that I have other reasonable choices, which I know is not true in every place.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by LookinAround »

I have Medigap. Always have. Always will. I think people are happy with MA until a major illness strikes. As I understand it, that's where MA may be problematic. You may want to see specialists who aren't in their network. Also, MA has their own pre-authorization rules and can put you through hoops that Medigap doesn't. Medigap also gives you coverage through out the US. Check on out of network costs for MA. Those are the differences I can recall. Maybe more.

I started with Medigap Plan F but switched to Plan G. If you're looking now you don't qualify for F.

My state (and a hand full of others) offer what's usually called Plan G+ but sometimes has a different name. The + is offered as an add-on by the insurance carrier. It provides extra benefits you typically get from an MA plan. As I recall, my G+ costs an extra $22/month. It provides
  • Silver Sneakers (gym membership),
  • Dental - 2 dental exams and cleanings + one set of Xrays evert 12 months. Discount on procedures. Check if your dentist is part of their network. I switched dentists and am very happy with my in-network choice
  • Vision - Free visit to a network optometrist every 12 months for an eye exam. Plus $130 towards buying glasses or contacts each 12 mo if in-network. $65 if out of network
  • Hearing aid discounts
I also have Plan D coverage. Up until 2024, Rx Out of Pocket ran a lot more if you took expensive brand drugs. That changed in 2024 with the Inflation Reduction Act. For 2024, you may read OOP is $8K but that includes the drug manufacturer contribution during the coverage gap phase. Effectively, OOP in 2024 with brand drugs should be $3,300 to $3,500.

Drug OOP limit drops in 2025 but there's speculation the premiums will be higher as a result. I haven't read speculation on the costs will be in 2025
Last edited by LookinAround on Sat Jul 06, 2024 12:40 pm, edited 3 times in total.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by baconavocado »

MoreTaxes wrote: Sat Jul 06, 2024 10:46 am I am happy with Kaiser HMO, while working. Same day appointments, good urgent care, ER. No problems with referrals. Drug coverage. I've had surgeries, and they were scheduled and performed without hassle. I pay my co-pay, and that's it. There are no bills or other paperwork for me to fret over.

I see that Kaiser has a Medicare Advantage plan that lets me just continue on with Kaiser in the usual way. This is a no-brainer for me.
Same.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by celia »

From the article:
Medigap buyers on average use $12,200 in medical care annually – $2,300 more than everyone else on Medicare . . .

Since Medigap buyers spend more, a logical supposition is that they are less healthy. But the researchers found that they are actually healthier than other retirees. Their incidence of diabetes and of cardiovascular disease are lower. They even spend more on healthcare than comparable retirees with the same health profiles. . . .

So, the question remains: why do Medigap buyers spend $2,300 more on healthcare? The researchers argue that since the various characteristics of the retirees themselves cannot explain this additional spending, . . .
Don't forget that these groups are self-selecting in that each person gets to decide which group to join. And the lower income folks don't really have a choice if they can't afford the Medigap premiums.

The answer why Medigap participants tend to spend more likely has to do with having more wealth and education than the average American. Just as Bogleheads aren't representative of the entire country, the same is probably true for Medigap participants. Besides usually having more income, some geographic areas don't have both options, as someone mentioned above.
The researchers conclude that moral hazard “may lead these individuals to demand more [care] than those without Medigap.”
I wouldn't say they "demand" more care but probably "expect" more. And doctors themselves will likely choose Medigap for themselves, when they retire. (How about a study of what retired doctors choose?)
In other words, Medigap buyers are essentially getting more but paying less out-of-pocket for doctor’s appointments, medical care, and tests.
I didn't read the article but this sounds contradictory to the beginning of the first quote. But I also count premiums as part of our health care costs.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by sgr000 »

We initially had Medigap coverage when I retired, through my employer's retiree program.

But the next year, my former employer forced everyone onto a Medicare Advantage program, because it saved them money. I hated the idea of yet more insurance supervision and the caregiver restricdtions, and chafed under the change. The retiree program was already kind of expensive, and I used it only because it was guaranteed issue for my spouse until she reached Medicare age.

So once we were both old enough, we dropped that and went to Original Medicare + a Medigap supplement. Pleasant surprise: in Massachusetts, there's never any underwriting required for switching from Medicare Advantage, and they've narrowed down the alphabet soup to just 2 plans (a bare-bones supplement and something like Plan G in other states).

Everything works fine so far, with the exception of hiccups in Part D. We're 6 months in, and doctors keep trying to prescribe using the old prescription plan, failing because we're not on it, and assuming we have no insurance. I've told them like 6 times about the new insurance, and I think they've finally gotten it straightened out. That's more an EMR system problem than an insurance problem, but as healthcare consumers we see *all* the problems.

Cost went down (slightly, since we got as gold-plated supplements as we could), service network went up, all seems well so far. No problems getting a minor surgery covered this spring.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by bertilak »

Yes, Medigap costs more. Those who can afford it are willing to pay the extra because it is preferrable. You have a wider choice of health care (go anywhere), that healthcare is less restrictive (e.g. re-approval not needed) and less of a hassle, in most cases not even billed to you.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Horologium »

I just turned 65 last week and recently finished navigating the Medicare enrollment swamp.

In doing my reading and research, one of the few constants I encountered was people referring to It as Medicare DISAdvantage.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by celia »

We've been on a Medigap plan since we started Medicare. We've even had a few specialists who aren't in any MA group give us referrals to more specialized specialists (at university hospitals).

The university hospital we chose says they don't accept MA patients since it takes them too long to finally get paid. Being able to get state-of-the-art care there was totally worth paying the extra in premiums.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by CrossOverGuy »

I read something that sort of sums up the feeling of many, and I paraphrase a bit: Many healthy older people swear BY Medicare Advantage, while many unhealthy older people swear AT Medicare Advantage.

At some point, the gyms and some other benefits offered by MA fade in importance vs. getting a doctor to see you fairly quickly and not having to deal with fighting while you're sick with an insurance company denying you the tests and procedures that your doctor says you need, among other problems.
Last edited by CrossOverGuy on Sat Jul 06, 2024 4:59 pm, edited 1 time in total.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Horologium »

LCX2000 wrote: Sat Jul 06, 2024 8:49 am
Curious what others are doing for Medigap.
As you probably know, everyone on Medicare has Parts A and B. I also got a Plan D plan for my Rxs.

I went back and forth between Medigap Plans G and N, but finally opted for G because I’ve got some health issues (knee and shoulder) I’ve been putting off seeing the doctor about until I had coverage (I’ve been without health insurance for the last 6 years :shock: ) and may end up needing one or more surgeries to fix my knee and shoulder.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by bertilak »

Horologium wrote: Sat Jul 06, 2024 4:56 pm
LCX2000 wrote: Sat Jul 06, 2024 8:49 am
Curious what others are doing for Medigap.
As you probably know, everyone on Medicare has Parts A and B. I also got a Plan D plan for my Rxs.

I went back and forth between Medigap Plans G and N, but finally opted for G because I’ve got some health issues (knee and shoulder) I’ve been putting off seeing the doctor about until I had coverage (I’ve been without health insurance for the last 6 years :shock: ) and may end up needing one or more surgeries to fix my knee and shoulder.
Smart move. I had N but it was a major hassle. All those little bills coming in for co-pays. Not only do you need to pay them, you feel the responsibility to verify them. I was able to switch to H without underwriting. Humana really wanted my business!
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by jebmke »

bertilak wrote: Sat Jul 06, 2024 5:02 pm
Horologium wrote: Sat Jul 06, 2024 4:56 pm
LCX2000 wrote: Sat Jul 06, 2024 8:49 am
Curious what others are doing for Medigap.
As you probably know, everyone on Medicare has Parts A and B. I also got a Plan D plan for my Rxs.

I went back and forth between Medigap Plans G and N, but finally opted for G because I’ve got some health issues (knee and shoulder) I’ve been putting off seeing the doctor about until I had coverage (I’ve been without health insurance for the last 6 years :shock: ) and may end up needing one or more surgeries to fix my knee and shoulder.
Smart move. I had N but it was a major hassle. All those little bills coming in for co-pays. Not only do you need to pay them, you feel the responsibility to verify them. I was able to switch to H without underwriting. Humana really wanted my business!
I went with G from start for similar reason. My wife was executor for two family members who had full boat Federal coverage. There are so many things to do in situations like that; the relief I saw every time she would sift through a stack of “zero due” medical papers (statements and EOBs) was enough for me to want to leave no mess behind if I go first.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by bogles the mind »

What are people paying for medigap and part D on average. A quick google said about $200. Sound about right?
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Horologium »

LookinAround wrote: Sat Jul 06, 2024 12:34 pm You may want to see specialists who aren't in their network.
At the risk of overstaying my welcome in this thread, I wanted to comment on this point.

I may be an outlier, but in my case just about every doctor I see is a “specialist”. By that I mean my wife is into non-traditional medicine. The doctors I see are small, independent “natural” health and “holistic” practitioners. (I have no idea what any of these distinctions are, but when you’ve been married 40 years, if you know what’s good for you, you do what you’re told :wink: ).

The docs I see aren’t part of networks or big practices. Luckily, two of them do take Medicare (one of them doesn’t, so I don’t know what we’re going to do about that). Consequently, Medicare Advantage wasn’t even an option for me, and I’d advise anyone with pre-existing relationships with doctors and/or facilities to ensure they’re in the Medicare Advantage network they’re considering.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by livesoft »

For those mentioned F and N plans: Are they even available anymore for people just becoming of Medicare age? Or are you grandfathered into them?
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by sgr000 »

bogles the mind wrote: Sat Jul 06, 2024 5:16 pmWhat are people paying for medigap and part D on average. A quick google said about $200. Sound about right?
Here are the costs for 2 people in Massachusetts, for plans that we picked out at the end of last year.

In retrospect, the choice of BCBS for Part D (line 5) was an error. I thought it would be convenient to have prescriptions and supplement insurance from the same company, to save back-and-forth with the inevitable arguments. I was willing to pay extra for that. But it turns out BCBS outsourced part D servicing to CVS/Caremark, and it would have been cheaper & just as effective to have an Express Scripts policy. Also, it took 6 months to get our providers to adapt their EMR to our new insurance.

Maybe next year we'll change the Part D, but otherwise it's been ok.

Emphasis: By our choice, this is insurance, not an investment; we're trying to reduce risk, not reduce costs. So I don't mind paying a premium price if the underlying insurance is solid and won't argue with me all the time about everything. Also, I insisted any plan had to support auto-pay so I couldn't forget a premium, ever.

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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Northern Flicker »

supersharpie wrote: Sat Jul 06, 2024 8:42 am
bobn60014 wrote: Sat Jul 06, 2024 8:40 am There's certainly a lot of buyers remorse for some with MA, when s*** makes contact with the fan.
I have heard FAR more complaints about MA. Why would you want to tie yourself to a network and be reliant on the doctors, rather than you, to direct your healthcare? It doesn't make sense IMO, unless you truly cannot afford the Medigap premiums.
I would lose coverage to see my current doctors if I chose medigap over advantage.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by talzara »

celia wrote: Sat Jul 06, 2024 4:11 pm Don't forget that these groups are self-selecting in that each person gets to decide which group to join. And the lower income folks don't really have a choice if they can't afford the Medigap premiums.

The answer why Medigap participants tend to spend more likely has to do with having more wealth and education than the average American. Just as Bogleheads aren't representative of the entire country, the same is probably true for Medigap participants. Besides usually having more income, some geographic areas don't have both options, as someone mentioned above.
Table 1 of the Arapakis paper shows that Medigap policyholders are:
  • Much less likely to be Black (0.03 instead of 0.21)
  • Much less likely to be Hispanic (0.01 instead of 0.09)
  • Much more educated (0.23 without high school diploma instead of 0.37)
  • Much wealthier (728k instead of 407k)
Table 1 also shows that total medical spending is $2,300 higher, but total Medicare spending is only $382 higher ($6,467 instead of $6,085).

People with a Medigap policy paid the Medigap premium. That's why their total spending is so much higher.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Northern Flicker »

livesoft wrote: Sat Jul 06, 2024 5:33 pm For those mentioned F and N plans: Are they even available anymore for people just becoming of Medicare age? Or are you grandfathered into them?
N is a newer plan type and is available if offered in your coverage area. F is no longer available for new enrollees.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by MiddleOfTheRoad »

If you are hospitalized or have surgery and need skilled nursing facility or acute rehab after your hospital stay, Medicare/medigap criteria and length of coverage is much much better and easier. The MA plans can and may deny you on that benefit, and they certainly will only authorize a shorter stay at rehab, even when you are not quite ready to go home. I am sure you have seen the uproar about MA and authorization shenanigans in the news in the past year.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Dregob »

supersharpie wrote: Sat Jul 06, 2024 8:42 am
bobn60014 wrote: Sat Jul 06, 2024 8:40 am There's certainly a lot of buyers remorse for some with MA, when s*** makes contact with the fan.
I have heard FAR more complaints about MA. Why would you want to tie yourself to a network and be reliant on the doctors, rather than you, to direct your healthcare? It doesn't make sense IMO, unless you truly cannot afford the Medigap premiums.
Depending where you live is a major factor if being tied to a network is an issue. I live near a major medical center with a cancer treatment center. That would be my choice, I have a MA plan, and it has been my in network doctor/hospital for the 40 years of my employment. I see no need to change. But yes, I am lucky to live in an area with a nationally known hospital.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by RationalWalk »

The only rational reason for having a Medicare Advantage plan is that you can't afford Medigap. You get what you pay for. Nobody ever has said the quality of medical care they receive is better in an MA plan. How many Bogleheads are so destitute that a MA plan is their only option? It's pretty simple -- case closed. There's nothing more to see here.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Doom&Gloom »

livesoft wrote: Sat Jul 06, 2024 5:33 pm For those mentioned F and N plans: Are they even available anymore for people just becoming of Medicare age? Or are you grandfathered into them?
Strandfathered in is more accurate.

I signed up for Plan F when I became eligible for Medicare. Once they decided to shelve Plan F, I inquired about transferring to Plan G or some other plan. My medigap provider declined to transfer me without underwriting and candidly told me that they would not accept me even with underwriting. Seems it's "'Til death do us part" with Plan F for them and me (and all the other Plan F folks with higher than average medical expenses).

I'd still rather have that than MA.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by diy60 »

Doom&Gloom wrote: Sat Jul 06, 2024 6:54 pm
livesoft wrote: Sat Jul 06, 2024 5:33 pm For those mentioned F and N plans: Are they even available anymore for people just becoming of Medicare age? Or are you grandfathered into them?
Strandfathered in is more accurate.

I signed up for Plan F when I became eligible for Medicare. Once they decided to shelve Plan F, I inquired about transferring to Plan G or some other plan. My medigap provider declined to transfer me without underwriting and candidly told me that they would not accept me even with underwriting. Seems it's "'Til death do us part" with Plan F for them and me (and all the other Plan F folks with higher than average medical expenses).

I'd still rather have that than MA.
Up to you, but I would not let some overseas call center rep tell me whether or not I could successfully change Medigap providers. Somewhere I read that 80% of folks can pass underwriting for Medigap. Requirements are significantly less rigorous than say life insurance.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Dregob »

RationalWalk wrote: Sat Jul 06, 2024 6:13 pm The only rational reason for having a Medicare Advantage plan is that you can't afford Medigap. You get what you pay for. Nobody ever has said the quality of medical care they receive is better in an MA plan. How many Bogleheads are so destitute that a MA plan is their only option? It's pretty simple -- case closed. There's nothing more to see here.
Some of us would disagree. I won't name the hospital/doctors in my MA plan but I worked there for years and was and is my network. We saw national politicians, international patients, famous coaches, celebrities, a murderer! (not OJ) and patients from every state on the East coast. Saying case closed does not make it true.
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Re: Medicare Advantage Reigns. So Who Still Buys Medigap? (from Center for Retirement Research, Boston College)

Post by Small Law Survivor »

RationalWalk wrote: Sat Jul 06, 2024 6:13 pm The only rational reason for having a Medicare Advantage plan is that you can't afford Medigap. You get what you pay for. Nobody ever has said the quality of medical care they receive is better in an MA plan. How many Bogleheads are so destitute that a MA plan is their only option? It's pretty simple -- case closed. There's nothing more to see here.
Interesting - I think this is what my MIT engineer-trained father concluded, so I've followed his lead.

Note that Massachusetts has a different systems from N and F and so forth ... plans.
How Medicare Supplement Insurance works in Massachusetts
In most states, there are 10 standard Medigap plan types, but Massachusetts uses its own different standardized system.

There are three plan types in Massachusetts. The Core Plan covers the basic benefits included in all Massachusetts Medicare Supplement Insurance plans, and the other two plans offer additional coverage on top of those basic benefits.
https://www.nerdwallet.com/p/best/insur ... medigap-ma

Don't know if this is a good thing or a bad thing.

Nerdwallet has some interesting statistics:
Massachusetts has more than 1.4 million Medicare beneficiaries. About 939,000 of those beneficiaries have Original Medicare (Part A and Part B).
But this doesn't tell us how many of that 939,000 people have purchased Medigap policies.
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