Medicare(regular) versus Medicare Advantage

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Kersten
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Medicare(regular) versus Medicare Advantage

Post by Kersten » Tue Oct 01, 2013 4:38 am

I have been recently been told that Medicare Advantage is better than regular Medicare because it is less costly.
I would like some input as to how you made your decision to go with one or the other. Thank you for your help

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windhog
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Re: Medicare(regular) versus Medicare Advantage

Post by windhog » Tue Oct 01, 2013 12:34 pm

Let me start this reply by declaring my bias. I recently retired from a thirty year career in medicine, and ran a solo medical practice (with plenty of help from my better half) for the last fourteen years. I think the most disturbing part of the Medicare Advantage option is the fact that it is managed care. This means that the company can change the terms of what they cover and how they cover it at least annually, and effectively at any time. I have seen this happen and changes are always made in favor of the carrier, which means that patients lose.

My second concern is that these plans tempt one to purchase the coverage that they need now, with no consideration of their future needs. Let's face it, getting older means new problems will appear and that's what insurance should be about.

In 15 months when I sign up for Medicare, I will shop for the best Medigap policy I can find. Anyone selling a MedAdvantage plan can take a hike. Good luck.

Paul

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 1:10 pm

Kersten wrote:I have been recently been told that Medicare Advantage is better than regular Medicare because it is less costly.
I would like some input as to how you made your decision to go with one or the other. Thank you for your help
There have been many discussions of this, with varying experiences, opinions and views. For the most part, these have helped me understand.

The short answer is that "it depends". There are large and significant differences in MA plans - even between ones from the same issuer in different locations. To get the "best" plan for you, evaluate the MA plans available to you AND (if at all possible) speak with friends and acquaintances who use those plans.

I also recently learned (reading the Medicare Book from the Government) that there is a distinction between a "Medicare Advantage" plan and a "Medicare Cost" plan. My plan, as I figured out, is actually a "Medicare Cost" plan. In general, the Medicare Advantage and Medicare Cost plans are very similar and my experience is probably valid for both (BUT check out details).

My plan (Kaiser Permanente Medicare Plus (Cost)) in the Washington DC area is fantastic, both the benefits/care and the cost. In 2013 I paid zero beyond the Medicare charge, and I have prescription drug coverage as well. Primary care office visits are $20; specialist are $30. In 2014, this will have a $15 per month charge to Kaiser.

With a MA plan, you do not purchase a Medicare supplement.

With MA plans, there are some actual or potential restrictions on getting a supplemental policy IF you move to traditional Medicare. We can speculate and debate about this, and only time will tell, but there are changes set to reduce (to some degree) the cost and benefits of MA plans compared with Traditional Medicare.

Where do you live? Perhaps some folks here have knowledge/experience with plans in that area.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 1:14 pm

windhog wrote:Let me start this reply by declaring my bias. I recently retired from a thirty year career in medicine, and ran a solo medical practice (with plenty of help from my better half) for the last fourteen years. I think the most disturbing part of the Medicare Advantage option is the fact that it is managed care. This means that the company can change the terms of what they cover and how they cover it at least annually, and effectively at any time. I have seen this happen and changes are always made in favor of the carrier, which means that patients lose.

My second concern is that these plans tempt one to purchase the coverage that they need now, with no consideration of their future needs. Let's face it, getting older means new problems will appear and that's what insurance should be about.

In 15 months when I sign up for Medicare, I will shop for the best Medigap policy I can find. Anyone selling a MedAdvantage plan can take a hike. Good luck.

Paul
When I evaluate my plan, I also look at "what ifs" in the future. I am convinced that my plan would be just as favorable vs. traditional medicare under almost any change in health/medical circumstances.

While the companies can make changes (many of them significant) to the MA plans, there are certain basic services/costs that all MA plans must comply with.

obgraham
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Re: Medicare(regular) versus Medicare Advantage

Post by obgraham » Tue Oct 01, 2013 1:38 pm

Like most of the docs I know, I agree completely with what windbag (sp) said.

MA plans are most successful in larger areas, where they provide enogh docs, hospitals, labs, and pharmacies (either their own or contracted) so that the patient has good access and adequate choice.

And as has been stated herein a number of times, they are all different, and the state regs are different. You have to evaluate what is best for you and your specific situation.

For me, it's a Blue Plan supplement with the widest choices available. That puts me in the most expensive plans. So be it.

gerrym51
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Re: Medicare(regular) versus Medicare Advantage

Post by gerrym51 » Tue Oct 01, 2013 2:03 pm

in some areas medicare advantage is a good deal-in others not so much.

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Steelersfan
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Re: Medicare(regular) versus Medicare Advantage

Post by Steelersfan » Tue Oct 01, 2013 2:10 pm

As the previous posters said, MA plans vary a lot from area to area.

I talked to three different sources to make up my mind.

1. State Health Insurance Assistance Program (SHIP) counselor

2. A well respected health care insurance broker

3. My GP physician.

All of those were free consultations.

For a person in my (healthy) condition and with the plans sold in my area, they all recommended a particular MA plan available in my area.

That does not mean that's the right choice for you in your area.

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jjustice
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Re: Medicare(regular) versus Medicare Advantage

Post by jjustice » Tue Oct 01, 2013 2:14 pm

I live in a small town (77,000) with a Medicare Advantage plan which is a PPO that seems to include every healthcare provider of any sort in the area. I pay $0/month premium with modest copays, $450 deductible, and $6,700 out-of-pocket limit. I'm quite happy with it. I'm very happy not to choose and pay for a medicare supplement. But I think that those who say "it depends" are right. You have to check out what is available to you where you live.
John

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 2:34 pm

One factor (may work both ways) is the availability of providers who accept the plan/choices you choose.

In this area (Virginia suburb of Washington DC), many friends and acquaintances tell me that a lot of primary care physicians (Internal Medicine, Family Practice, general practice) do not accept new Medicare patients. Most will accept Medicare from existing patients who newly enroll in Traditional Medicare. Because I chose a MA plan immediately, I did not face the issue or have any first hand knowledge. The multiple people who tell me that issue or challenge are people that I tend to believe. It is true, I suppose, that some primary care physician in the area takes on new Medicare patients, but the ones that do may have other disadvantages.

While it is true that a MA plan can stop doing business, leaving enrollees to search for another plan or other physicians and providers, a plan offering service in an area must have a supply of participating providers. In that sense, if you are in a MA plan, you have assurance that you can receive covered care.

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Steelersfan
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Re: Medicare(regular) versus Medicare Advantage

Post by Steelersfan » Tue Oct 01, 2013 3:53 pm

dm200 wrote:One factor (may work both ways) is the availability of providers who accept the plan/choices you choose.



While it is true that a MA plan can stop doing business, leaving enrollees to search for another plan or other physicians and providers, a plan offering service in an area must have a supply of participating providers. In that sense, if you are in a MA plan, you have assurance that you can receive covered care.
One disadvantage to enrolling in a MA plan, in most states (there's that qualifier again), you aren't guaranteed to be able to switch back and get into a regular Medicare supplement plan, even if it would be advantageous to do so.

But if your MA plan goes out of business in your area (a mixed blessing I suspect) you can switch back.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 3:56 pm

Steelersfan wrote:
dm200 wrote:One factor (may work both ways) is the availability of providers who accept the plan/choices you choose.



While it is true that a MA plan can stop doing business, leaving enrollees to search for another plan or other physicians and providers, a plan offering service in an area must have a supply of participating providers. In that sense, if you are in a MA plan, you have assurance that you can receive covered care.
One disadvantage to enrolling in a MA plan, in most states (there's that qualifier again), you aren't guaranteed to be able to switch back and get into a regular Medicare supplement plan, even if it would be advantageous to do so.

But if your MA plan goes out of business in your area (a mixed blessing I suspect) you can switch back.
That's true. As far as I know, you can always switch to another MA plan. For those plans that are rated "Five Star", you can signup/switch to any time during the year.

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windhog
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Re: Medicare(regular) versus Medicare Advantage

Post by windhog » Tue Oct 01, 2013 4:01 pm

While the companies can make changes (many of them significant) to the MA plans, there are certain basic services/costs that all MA plans must comply with.
Once upon a time I believed this was true also. One of my patients with an MA plan found that a treatment covered fully by their plan made a change with no real warning. The treatment was still covered, but coverage meant the patient had a 10% co-insurance capped at $1500/yr, and was pushed to $2500 the next year. This was hardly trivial and I generated a protest through CMS. The person charged with making sure that west coast MA plans followed the legal requirements wrote me back and said the carrier was within it's rights to change this benefit.

Based on this experience, it is entirely possible that any treatment (including cancer chemotherapy) could go from first-dollar coverage to several thousands of dollars in out-of-pocket costs annually. Whatever plan you have now, there is a real good chance it will be different next year. Just hope you don't get the disease that gets targeted for disease management by your carrier.

Paul

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 4:34 pm

windhog wrote:
While the companies can make changes (many of them significant) to the MA plans, there are certain basic services/costs that all MA plans must comply with.
Once upon a time I believed this was true also. One of my patients with an MA plan found that a treatment covered fully by their plan made a change with no real warning. The treatment was still covered, but coverage meant the patient had a 10% co-insurance capped at $1500/yr, and was pushed to $2500 the next year. This was hardly trivial and I generated a protest through CMS. The person charged with making sure that west coast MA plans followed the legal requirements wrote me back and said the carrier was within it's rights to change this benefit.

Based on this experience, it is entirely possible that any treatment (including cancer chemotherapy) could go from first-dollar coverage to several thousands of dollars in out-of-pocket costs annually. Whatever plan you have now, there is a real good chance it will be different next year. Just hope you don't get the disease that gets targeted for disease management by your carrier.

Paul
I strongly suspect that this change (capped at $1,500 one year and $2,500 the next) was in the "Evidence of Coverage" or other notice the insured received in the fall of the year before the change took effect. I don't know if you call that "no real warning" or not. With the fall notice, insured can choose to make a change that would go into effect on January 1. I made no statement that this kind of change was not allowed'; there are still some features of a MA plan, though, that are required by Medicare. The plans almost always have changes each year. My plan has many changes. I learned that reading the notice each year about this time is very important. Two years ago, my plan dropped the drug coverage on me, due to a clerical error on my part. Since I did not have many prescription drugs at that time, I just noticed it earlier this year with a new, expensive drug being prescribed. The good news is that, since it was their error, I was retroactively enrolled in the MA drug program and got a refund for overcharges.

mur44
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Re: Medicare(regular) versus Medicare Advantage

Post by mur44 » Tue Oct 01, 2013 6:11 pm

When you are eligible for Medicare, your best option is to
take an appointment at your county SHIP (State Health Insurance
Assistance Program) and discuss your needs with a Medicare
counselor, who can provide unbiased, free and objective
assistance.

You can obtain (800) number from the site
by choosing state:

https://shipnpr.shiptalk.org/shipprofile.aspx

If you want gold standard, go with Original Medicare
(Parts A and B), add a Medigap plan (such as plan C or F)
and a drug plan (Part D).

If your medical needs are very low, you can consider
a Medicare Advantage plan.


Note: I am a Certified Volunteer Medicare Counselor from NJ
and advisor for Affordable Care Act (Obamacare) health insurance

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fandango
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Re: Medicare(regular) versus Medicare Advantage

Post by fandango » Tue Oct 01, 2013 6:31 pm

I chose a Medigap plan. I want the freedom to choose my medical provider.

My neighbor has a Medicare Advantage plan. He sustained a knee injury that required surgery. He had to wait three weeks to get the surgery scheduled on an approved orthopedic surgeon's calendar and then had to drive 60 miles each way to the surgery center.

Where we live, several major orthopedic surgery centers are within 25 miles. With my Medigap policy, I have a choice of 25 orthopedic surgeons.

That's why I chose a Medigap plan.
Last edited by fandango on Tue Oct 01, 2013 6:31 pm, edited 1 time in total.

obgraham
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Re: Medicare(regular) versus Medicare Advantage

Post by obgraham » Tue Oct 01, 2013 6:31 pm

I think Mur44 has hit the nail on the head here.

There are counselors, and even health insurance sales people (gasp!) who are very up to date in each specific locale and what is available there.

However, here's the main caution: Don't EVER expect the system and its explanations to be clear, simple, and logical. It just isn't, and it won't get any better. I practised medicine for almost 40 years, and was the doc in my group who did most of the legwork in dealing with insurance companies, welfare, medicare, etc. So I eventually became pretty familiar with the rules and pitfalls of our healthcare payment system. However, now that I am myself on Medicare, it takes me very close attention and a lot of teethgnashing to understand Medicare, its coverage, the claims process, the drug coverage issues, and the complex paperwork issued by everyone involved. I surely don't envy any of our older folks trying to decipher what is going on with their Medicare. The Apollo Missions were likely less complicated!

That said, and I hate to admit it, Medicare's website is pretty informative and helpful in investigating your claims and your policies.

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JMacDonald
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Re: Medicare(regular) versus Medicare Advantage

Post by JMacDonald » Tue Oct 01, 2013 6:39 pm

It is interesting that there have been some negative comments about Medicare Advantage plans from very knowledgeable persons. I have Kaiser Medicare Advantage, and I wonder if those individuals have any experience with this plan. As of now, I am very happy with Kaiser and would not change to any other plan.
Best Wishes, | Joe

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 7:56 pm

JMacDonald wrote:It is interesting that there have been some negative comments about Medicare Advantage plans from very knowledgeable persons. I have Kaiser Medicare Advantage, and I wonder if those individuals have any experience with this plan. As of now, I am very happy with Kaiser and would not change to any other plan.
Yes, as I have posted in other threads here, I am a very satisfied Kaiser "Medicare Plus (Cost)" participant. The premiums are low (zero additional 2011-2013, and $15/mo on 2014) and the benefits excellent. There are actually dozens of Kaiser MA plans - often multiple ones in the same state (such as CA and CO). As I recently figured out, my plan (technically) is not a "Medicare Advantage" plan, but the very similar "Medicare Cost" plan. Wit the "Cost" plan, I can use Traditional Medicare if I ever wanted to do so (I have no plans to do that). What also may not be readily apparent to someone just reading the comparison tables is that the cost to the participants may be less than other plans for several possible reasons (in my experience): 1. A great deal of what you would normally have to see the doctor (in person) for and pay the copay - can be done via email to the doctor. No charge and very convenient; 2. In some cases, where email doesn't get the job done, Kaiser offers telephone appointments - again convenient and no charge; 3. In some cases where, in the classic 'referral to a specialist' is needed, your primary care Kaiser physician can just check with a specialist to see if an actual visit with the specialist is needed. That can save time and money.

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Re: Medicare(regular) versus Medicare Advantage

Post by LadyGeek » Tue Oct 01, 2013 8:03 pm

This thread is now in the Personal Finance (Not Investing) forum (insurance).
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

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Re: Medicare(regular) versus Medicare Advantage

Post by john94549 » Tue Oct 01, 2013 9:05 pm

I selected Kaiser Senior Advantage (Kaiser's MA). As noted in other threads, my main concerns were (1) availability of service, and (2) proximity. My main issues with "regular" Medicare were the obvious. It benefits you little to have coverage if you can't get through the door.

My only experience with Kaiser's Senior Advantage since signing up were a few prescriptions from my dentist. He called them in, I called the automated phone service to see if they were ready for pick-up (they were), I drove over, parked for free in their gargantuan garage (Walnut Creek), and picked them up. My co-pays were quite low (I was actually shocked at how low). I think I waited in line five minutes (max) both times, in the pharmacy.
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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Tue Oct 01, 2013 9:19 pm

john94549 wrote:I selected Kaiser Senior Advantage (Kaiser's MA). As noted in other threads, my main concerns were (1) availability of service, and (2) proximity. My main issues with "regular" Medicare were the obvious. It benefits you little to have coverage if you can't get through the door.
"Senior Advantage" is one of the different flavors of Kaiser plans. My primary motivation (at the time) when I became eligible for Medicare for going to Kaiser was that we had been with Kaiser much of the past 35 years and I wanted to get back to Kaiser because I really liked the care/service/etc. I never would have left Kaiser except for employment insurance coverage. Then,, when we had to scramble for health insurance a few years ago, Kaiser would not accept us because we were not in near-perfect health. If you have a Kaiser plan available to you under Medicare, I think asking regular Kaiser participants (whether Medicare or not) about how Kaiser works for them can be very helpful. From my nearly 3 years with Kaiser under Medicare, I see absolutely no difference in how a Medicare participant is treated than a non-Medicate participant. [Of course, I pay the Medicare fees/copays/charges that are different]. If you like Kaiser before medicare, I think you will like it with medicare; if you dislike Kaiser before Medicare, then I suspect you will not like it under Medicare. What I find very interesting/curious about Kaiser now is that Kaiser, in this area at least, no longer has any Nurse Practioners in Primary care. They hire more physicians and you only see an actual MD (in a few cases it might be a DO).

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Re: Medicare(regular) versus Medicare Advantage

Post by john94549 » Tue Oct 01, 2013 9:25 pm

dm200, interesting observation. I suspect my affinity for Kaiser dates back to my days in the Navy. To me, Kaiser is the epitome of efficient medical care, and I liken it to a Naval Hospital. Get in, get out, go back to your ship.

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Steelersfan
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Re: Medicare(regular) versus Medicare Advantage

Post by Steelersfan » Tue Oct 01, 2013 9:27 pm

obgraham wrote:I think Mur44 has hit the nail on the head here.

There are counselors, and even health insurance sales people (gasp!) who are very up to date in each specific locale and what is available there.

However, here's the main caution: Don't EVER expect the system and its explanations to be clear, simple, and logical. It just isn't, and it won't get any better.
i agree that working your way through the options available in conjunction with Medicare is challenging. I supported some very complex computer systems in support of some of the most complicated businesses there are so I have the ability to approach complex situations and figure my way through them. The Medicare maze is as complex as there is and I was lost. That's why I utilized multiple experienced sources (noted above) to make my decision.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Wed Oct 02, 2013 9:38 am

john94549 wrote:dm200, interesting observation. I suspect my affinity for Kaiser dates back to my days in the Navy. To me, Kaiser is the epitome of efficient medical care, and I liken it to a Naval Hospital. Get in, get out, go back to your ship.
While I was in the Navy many decades ago, I never was on a ship and I had only minimal health/medical issues at that time - so I don't see the parallel. One of the constant criticisms of HMOs (like Kaiser) is that an HMO shortchanges patients on expensive treatments and procedures. I have been with 3 different HMOs over the decades, as well as being on the old-fashioned full fee for service insurance and PPOs. The only HMO I have had for long periods is Kaiser. With Kaiser, I have never felt that any treatment/procedure necessary was disallowed. Neither have I been prohibited from seeing a specialist when I made a request. Almost 3 years ago, when I went back to Kaiser, I made a point of asking for a referral from my Primary care Kaiser physician to see two specialists. She readily agreed and I saw both specialists within a few days. About 25 years ago, while with Kaiser, I had significant surgery (went well) and that issue required certain followup over the years. Comparing the followup at Kaiser with (a few years) continuing followup outside Kaiser (one was full fee for service and another a PPO as I recall), the Kaiser followup was actually a bit more "expensive". Again, I believe I am a very informed user of medical/health care, and I continue to be puzzled by accusations that Kaiser shortchanges treatment. I just have never seen it.

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Re: Medicare(regular) versus Medicare Advantage

Post by rixer » Wed Oct 02, 2013 10:13 am

I chose Medigap High Deductible Plan F. It's just the same as regular Plan F but there is a 2100 deductible. Btw, medicare part b pays 80% of that. Total out of pocket expense is $2100 plus Plan F HD rate of $450 per year equals $2,550. Much less than the $6,500 for kaiser.
Another thing that worried me is if I wanted to go back to Medigap from MA, I'd likely have to go through underwriting and there's no guaranty I could switch back.

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Re: Medicare(regular) versus Medicare Advantage

Post by obgraham » Wed Oct 02, 2013 10:50 am

I think Kaiser is the prototype for a well run HMO. They have been at it for a very long time. They aren't everywhere, but if they have a large presence in your community, they are not a bad choice.

In my area, a similar outfit is Group Health (though without the great reputation of Kaiser). The docs there are all on salary, not paid by the procedure. Some years ago we had a "how satisfied are you with your life" survey of docs in my specialty. Overall, about 30% claimed to be "very satisfied". But despite earning a little over 50% of what independent docs made, Group Health docs' rate was 80%, and most had been there all their career.

Overall docs are happier when you remove bureaucracy and paperwork from their life and just let them see patients. Even if they take a pay cut. If your HMO (i.e. MA plan) allows the docs to make their decisions, you'll likely get good care.

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frugaltype
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Re: Medicare(regular) versus Medicare Advantage

Post by frugaltype » Wed Oct 02, 2013 10:56 am

I'm on my way out the door, so have not read the replies.

My understanding is that Medicare advantage plans cost the taxpayer (that's us) more by about 14% than Medicare + Medigap plans.

Also, you have to struggle to get coverage approved. A couple of times when my doctor wanted me to have imaging, the staff prepared to go head to head with United (No)Healthcare for approval until I reminded them I had an AARP Medigap plan that was just administered by UHC, then they realized they didn't need preapproval when Medicare was the primary.

Also with my Medigap plan I can see any doctor who takes it. I see some at Mass General and no one there has ever refused me as a patient.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Wed Oct 02, 2013 11:57 am

rixer wrote:I chose Medigap High Deductible Plan F. It's just the same as regular Plan F but there is a 2100 deductible. Btw, medicare part b pays 80% of that. Total out of pocket expense is $2100 plus Plan F HD rate of $450 per year equals $2,550. Much less than the $6,500 for kaiser.
Another thing that worried me is if I wanted to go back to Medigap from MA, I'd likely have to go through underwriting and there's no guaranty I could switch back.
As I have stated, there are many Kaiser Medicare plans (different states and different areas of the same state). My Kaiser plan, for example, has a total "out of pocket" cap for covered Parts A and B services of only $3,400. I agree that some Kaiser plans have a higher "out of pocket" cap.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Wed Oct 02, 2013 12:06 pm

frugaltype wrote:I'm on my way out the door, so have not read the replies.

My understanding is that Medicare advantage plans cost the taxpayer (that's us) more by about 14% than Medicare + Medigap plans.

Also, you have to struggle to get coverage approved. A couple of times when my doctor wanted me to have imaging, the staff prepared to go head to head with United (No)Healthcare for approval until I reminded them I had an AARP Medigap plan that was just administered by UHC, then they realized they didn't need preapproval when Medicare was the primary.

Also with my Medigap plan I can see any doctor who takes it. I see some at Mass General and no one there has ever refused me as a patient.
Yes, there is (not sure which years) this alleged 14% gap of the "cost" to the Medicare system between MA plans and Traditional Medicare. Existing law (and associated regulations) are phasing in changes to close that gap. I do not think anyone can accurately predict how any particular MA plan will deal with those phased in changes. There are also those who maintain that this 14% is either incorrect or misleading. I have no opinion on that, but note that a motivation of the MA plans was to have lower cost to the Medicare system. The blanket statement
"Also, you have to struggle to get coverage approved"
is not true. That all depends on the particular MA plan. I have not had that experience at all.

Also, perhaps a "fine point" - As best I understand, Medicare is funded - not by general taxpayers, but rather Medicare "taxes" and fees. Those "taxes" and fees fall differently than other taxes.

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Re: Medicare(regular) versus Medicare Advantage

Post by kaneohe » Wed Oct 02, 2013 4:17 pm

rixer wrote:I chose Medigap High Deductible Plan F. It's just the same as regular Plan F but there is a 2100 deductible. Btw, medicare part b pays 80% of that. Total out of pocket expense is $2100 plus Plan F HD rate of $450 per year equals $2,550.
I don't understand how Medicare B can pay 80% of that (that = 2100 deductible?). ..........Medicare B pays first so it knows nothing about the 2100 deductible when it pays. Also if you are incuding the 2100 as out of pocket expense, that seems inconsistent w/ the statement that Medicare B pays 80% of that.

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Re: Medicare(regular) versus Medicare Advantage

Post by frugaltype » Wed Oct 02, 2013 4:32 pm

dm200 wrote: I have no opinion on that, but note that a motivation of the MA plans was to have lower cost to the Medicare system.
[OT comment removed by admin LadyGeek]

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Re: Medicare(regular) versus Medicare Advantage

Post by robjer » Wed Oct 02, 2013 4:49 pm

I'm a handful of years from making this decision.
Here's our situation: Wife and I expect to still be traveling throughout the U.S. and overseas even after we have chosen either Medicare or an Advantage Plan. If we were sticking around home more, there is excellent medical services in all specialties in the town (Springfield, MO) and I would not hesitate to enroll in a Medicare Advantage plan.

Traveling as much as we do and want to, I am afraid out-of-network costs will kill us if something untoward happens.

Are there M.C. Advantage plans that have a wider or nationwide network.
Somebody mentioned Kaiser, is there Advantage plan a nationwide network?

rixer
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Re: Medicare(regular) versus Medicare Advantage

Post by rixer » Wed Oct 02, 2013 4:51 pm

kaneohe wrote:
rixer wrote:I chose Medigap High Deductible Plan F. It's just the same as regular Plan F but there is a 2100 deductible. Btw, medicare part b pays 80% of that. Total out of pocket expense is $2100 plus Plan F HD rate of $450 per year equals $2,550.
I don't understand how Medicare B can pay 80% of that (that = 2100 deductible?). ..........Medicare B pays first so it knows nothing about the 2100 deductible when it pays. Also if you are incuding the 2100 as out of pocket expense, that seems inconsistent w/ the statement that Medicare B pays 80% of that.
I'm sorry, I did say that wrong. What I meant to say was that although you have a 2100 deductible, medicare part b is still paying 80% of the medical expense. You're only going to pay 20% of the bill until you reach your ded. then plan hi-f takes over. Also, annual check-ups are n/c as well as some lab tests.

nonnie
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Re: Medicare(regular) versus Medicare Advantage

Post by nonnie » Wed Oct 02, 2013 6:15 pm

mur44 wrote:If you want gold standard, go with Original Medicare
(Parts A and B), add a Medigap plan (such as plan C or F)
and a drug plan (Part D).
Don't forget to include the new Plan G for comparison-- it generally compares very well.
This post may be monitored for quality assurance purposes.

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frugaltype
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Re: Medicare(regular) versus Medicare Advantage

Post by frugaltype » Wed Oct 02, 2013 6:28 pm

dm200 wrote: I have no opinion on that, but note that a motivation of the MA plans was to have lower cost to the Medicare system.
I believe this is not correct, but when I said what I understood the motive to be, it got deleted. I just don't want to have the impression left that what you are saying is correct, as far as I know, since some people may base financial decisions on it.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Wed Oct 02, 2013 7:29 pm

frugaltype wrote:
dm200 wrote: I have no opinion on that, but note that a motivation of the MA plans was to have lower cost to the Medicare system.
I believe this is not correct, but when I said what I understood the motive to be, it got deleted. I just don't want to have the impression left that what you are saying is correct, as far as I know, since some people may base financial decisions on it.
I can't locate anything now to back my understanding. I am quite sure I read that in something about Medicare advantage plans. MA plans were started in 1997: The Medicare+Choice program – now known as Medicare Advantage – was enacted. Perhaps I might clarify/modify my statement to say that it is my understanding that proponents of this offering, now known as Medicare Advantage claimed that it would have lower costs to the Medicare system. It is, unfortunately, the case that proponents of all sorts of things make predictions and projections that do not an out. Certainly MA (and similar) plans give a bigger role to health insurance companies/organizations as well as managed care providers, such as HMOs and PPOs. Many of those pointing to the alleged 14% extra being paid for MA subscribers claim the providers/insurers have somehow "gamed" the system to make more money. I have no opinion - one way or the other. I do tend to believe, though, that an HMO like Kaiser, that is both insurer and provider has lower administrative costs because everything is together.

I also know that the MA (and related) plans are lobbying and encouraging MA participants to lobby against increased charges and/or fewer services schedule to be phased in that will, allegedly, close this 14% gap. Again, I have no opinion on whether there is or is not a gap, or what should or should not be done. I do know that I am very happy with what I have and hope it continues to be an excellent plan.

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Steelersfan
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Re: Medicare(regular) versus Medicare Advantage

Post by Steelersfan » Wed Oct 02, 2013 8:13 pm

This article seems to have a good summary of the historical and current (as of 2012) situation.

http://www.washingtonpost.com/blogs/won ... cost-more/

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Re: Medicare(regular) versus Medicare Advantage

Post by Kersten » Thu Oct 03, 2013 7:17 am

All of the input is very much appreciated. I plan to read through everything suggested carefully, have made an appointment with a SHIP counselor and am going to a seminar on Medicare changes for 2014 at a local hospital (I live in Florida) Plus access the government Medicare site and seen what information I can glean.

Medicare is a quagmire of confusion. I do wonder what people do who are very elderly and have to make a decision every year about which plan they will enroll in. Depend upon a friend or relative, I guess.
Staying healthy and keeping up jogging seems to be the best way to avoid high medical costs, no matter what
ones plan is. I have 37 years into jogging and don't plan on quitting any time soon(although I run a lot slower than I did when younger!) Thank you again for everyone that has taken the time to address the Medicare/MA issue. Bogleheads forums are such a great place to share information with other people who want to make intelligent choices.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Thu Oct 03, 2013 9:03 am

Kersten wrote:All of the input is very much appreciated. I plan to read through everything suggested carefully, have made an appointment with a SHIP counselor and am going to a seminar on Medicare changes for 2014 at a local hospital (I live in Florida) Plus access the government Medicare site and seen what information I can glean.

Medicare is a quagmire of confusion. I do wonder what people do who are very elderly and have to make a decision every year about which plan they will enroll in. Depend upon a friend or relative, I guess.
Staying healthy and keeping up jogging seems to be the best way to avoid high medical costs, no matter what
ones plan is. I have 37 years into jogging and don't plan on quitting any time soon(although I run a lot slower than I did when younger!) Thank you again for everyone that has taken the time to address the Medicare/MA issue. Bogleheads forums are such a great place to share information with other people who want to make intelligent choices.
I agree. VERY complicated and often confusing. Once you figure it out, things change. I will say that enrolling in Medicare and signing up for receipt of Social Security benefits (I did the Medicare first - then SS retirement about a year later) was a very smooth, efficient and error-free process. I did it all either by phone of internet. It seems that the Medicare folks think just printing the Medicare books and materials in large print is all that is needed for the "elderly" to figure it all out. You will also find that you will be (if not already) bombarded with folks and companies trying to sell you something, whether it is a Medigap plan or one of the MA plans. There is money to be made, and they all want some of it from you and me. AARP, for example, really has a big pitch for all kinds of insurance. Whether the best interests of the individual members is a priority - I am not sure. The politicians get involved too. Depending on where they are in the political spectrum, they may (in my opinion) either resort to unjustified scare tactics or unjustified assurances that everything Is just wonderful and perfect.

I guess the folks who live in rural areas with no choices may have it the simplest. (but not the best).

The annual Medicare book (from the government) is good in listing the various plans available, but (as I posted earlier) may not (probably does not) tell the full story. In my case (Kaiser Medicare Cost Plan) - the listings understate the benefits and the cost savings. Because I can do so much by email, internet and telephone with my physicians (and some other providers) - all at ZERO cost, I pay considerably less than someone who must make an appointment each and every time for every matter (and pay the copay or share of office visit). It saves a lot of time as well.

I agree that doing everything to stay healthy is the best strategy. Make up for low utilization of health benefits each year -- by living t0 100+. That's my current plan. One of the BEST pieces of information I ever received on this discussion list was in 2011 when I started (again) regular exercise. I asked about getting a heart rate monitor, and someone posted two books - "Younger Next Year" that makes the point that the effects of aging are mostly "optional" to the 80's and probably into the 90's. The other book was Sally Jenkins' Heart Rate Monitor Guide on how to use such a monitor. I got one and it is critical to me, so I do enough to get the exercise benefits, but do not overdo it -- and have to stop or cut back

Good Luck -- and keep on jogging (at an age appropriate pace and intensity) until you are 100+. One of my low-priority goals, if I get in good enough shape and don't have any problems, is to do a 10k again. I did a few about 30 years ago, but slipped back into being sedentary.

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Re: Medicare(regular) versus Medicare Advantage

Post by BolderBoy » Thu Oct 03, 2013 4:17 pm

john94549 wrote:dm200, interesting observation. I suspect my affinity for Kaiser dates back to my days in the Navy. To me, Kaiser is the epitome of efficient medical care, and I liken it to a Naval Hospital. Get in, get out, go back to your ship.
I did my anesthesia training at Geisinger which is an HMO in Pennsylvania. It sold me completely on the true HMO concept (Geisinger, Kaiser, Mayo..._). When the opportunity was neigh, I enrolled in HMO plans throughout my life. I've had Kaiser for 8 of the last 10 years and plan to continue with Kaiser when it is Medicare time.

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Steelersfan
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Re: Medicare(regular) versus Medicare Advantage

Post by Steelersfan » Thu Oct 03, 2013 5:36 pm

dm200 wrote:
I agree. VERY complicated and often confusing.

One of the BEST pieces of information I ever received on this discussion list was in 2011 when I started (again) regular exercise. I asked about getting a heart rate monitor, and someone posted two books - "Younger Next Year" that makes the point that the effects of aging are mostly "optional" to the 80's and probably into the 90's.
+1 on "Medicare" being complicated and confusing; not so much the Medicare part but all the private insurance options most people (myself included) can add onto it.

+10 on "Younger Next Year". I've always been physically active but that book got me really motivated to keep it up and ramp it up. The combination of science, training advice, and pure motivation make for a compelling and life changing read.

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dm200
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Re: Medicare(regular) versus Medicare Advantage

Post by dm200 » Thu Oct 03, 2013 8:41 pm

Steelersfan wrote:
dm200 wrote:
I agree. VERY complicated and often confusing.

One of the BEST pieces of information I ever received on this discussion list was in 2011 when I started (again) regular exercise. I asked about getting a heart rate monitor, and someone posted two books - "Younger Next Year" that makes the point that the effects of aging are mostly "optional" to the 80's and probably into the 90's.
+1 on "Medicare" being complicated and confusing; not so much the Medicare part but all the private insurance options most people (myself included) can add onto it.

+10 on "Younger Next Year". I've always been physically active but that book got me really motivated to keep it up and ramp it up. The combination of science, training advice, and pure motivation make for a compelling and life changing read.
The aspect of "YNY" that motivated me, and continues to motivate me, is the use of our human history/evolution to explain how our bodies work - what makes them tick. Our ancestors evolved having to spend long, slow periods tracking that animal - then a sudden burst to catch and kill it. Those who couldn't do that starved and those that could lived and became our ancestors. The same with how when we cut back severely on food - our evolved bodies think winter is coming with no food, so it shuts down and conserves energy/calories. The follow-on book, with lots of detail in exercise and nutrition is great "Thinner This year".

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joe8d
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Re: Medicare(regular) versus Medicare Advantage

Post by joe8d » Thu Oct 03, 2013 9:22 pm

My understanding is that Medicare advantage plans cost the taxpayer (that's us) more by about 14% than Medicare + Medigap plans.
My understanding is the the "Fraud Costs" occur in the Traditional Medicare, not MA Plans.
All the Best, | Joe

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