Medicare choices

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Julyguy754
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Re: Medicare choices

Post by Julyguy754 » Fri Mar 08, 2019 9:58 pm

I want to thank everyone who responded to my post! I have read and re-read your suggestions and may need to review again. My birthday is in July so I have time but it seems like so much to consider with the time left that will pass quickly. There are certain pros and cons with each. I have Anthem right now and will see what they have to offer with both plans. They have written my several times that signed up with them would be easier as they know my history, know what doctors I see, etc. This sounds reasonable, but as some have stated read all the plans, compare, and read the fine print. I have some information from AARP and United Health so will look at them. I am going to look into the Medicare for Dummies book as well. Hope it is a quick read.
I do have one additional question and didn't see anyone mention using a Medicare Broker service. I saw one at Boomerbenefits.com . Does anyone have any experience or knowledge if these type of services are worth it? Boomer said theirs is free and they hook you up with possible plans.
Thanks so much to all of you BH's. I appreciate the BH Community!
Julyguy

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GerryL
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Re: Medicare choices

Post by GerryL » Fri Mar 08, 2019 10:31 pm

Re Medicare Brokers: Understand that they do not work will ALL providers and plans. If you are considering going with traditional Medicare and an F high-deductible supplement, (or G-HD, if it becomes available), you probably won't hear about it from them.

I've talked to a couple of brokers and asked whether they could advise about F-HD plans and they have both declared that "people don't like dealing with all the paperwork involved with those plans." Take that to mean, "No. We don't earn a commission on HD plans." (I've been on F-HD for several years and have not found the paperwork to be at all onerous.)

Topic Author
Julyguy754
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Re: Medicare choices

Post by Julyguy754 » Sat Mar 09, 2019 9:26 am

Ok, thanks for sharing your helpful information. If I had to choose right now I would go with reg med FHD, but want to take all this in before deciding.
Julyguy

FBN2014
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Re: Medicare choices

Post by FBN2014 » Sat Mar 09, 2019 11:48 am

Julyguy754 wrote:
Fri Mar 08, 2019 9:58 pm
I want to thank everyone who responded to my post! I have read and re-read your suggestions and may need to review again. My birthday is in July so I have time but it seems like so much to consider with the time left that will pass quickly. There are certain pros and cons with each. I have Anthem right now and will see what they have to offer with both plans. They have written my several times that signed up with them would be easier as they know my history, know what doctors I see, etc. This sounds reasonable, but as some have stated read all the plans, compare, and read the fine print. I have some information from AARP and United Health so will look at them. I am going to look into the Medicare for Dummies book as well. Hope it is a quick read.
I do have one additional question and didn't see anyone mention using a Medicare Broker service. I saw one at Boomerbenefits.com . Does anyone have any experience or knowledge if these type of services are worth it? Boomer said theirs is free and they hook you up with possible plans.
Thanks so much to all of you BH's. I appreciate the BH Community!
Julyguy
I can tell you what swayed my decision to go with a supplement plan. My daughter is a physical therapist who works at a skilled nursing facility. She has many patients who are recovering from hip or knee replacements or more serious illnesses. Her patients who have a Medicare Advantage plan are limited in the amount of therapy that the insurance carrier will authorize. They are in the business to make money and deny benefits, the patient be damned. She tells me that most patients who have an MA plan cannot get the therapy they need in order to become functional again. Those patients with a supplement plan don't get the pushback from the insurance carrier as long as she documents the medical need for therapy. Needless to say the MA patient's families are very unhappy that their mom or dad are not receiving the services that they thought they had and constantly complain to my daughter, "Why aren't you giving my mom the therapy sessions that she needs" My daughter's hands are tied and she feels horrible when this happens but has to explain to them that their insurance carrier will not authorize treatment. Whatever you do, I would recommend that you seek out an experienced independent Medicare insurance agent who can represent all companies and can give you unbiased advice since the commission is the same no matter which company they write the policy with. All Medicare supplement plans are standardized so no matter which company you go with the coverage benefits are the same by law. Medicare Advantage is not standardized and they can decide to change the benefits at any time so you have to have a knowledgeable agent guiding you to make a good choice. I used a great agent that I found who is licensed in all 50 states. Send me a message if you want his contact information.
"October is one of the peculiarly dangerous months to speculate in stocks. The others are July, January, September, April, November, May March, June, December, August and February." - M. Twain

azianbob
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Re: Medicare choices

Post by azianbob » Sat Mar 09, 2019 1:59 pm

My parents went with Medicare Advantage because there is no extra charge for it, but they handle everything A B D for them. Also they got some free dental out of it too. Standard Medicare would have been more of a hassle.

Most importantly, the doctor they have been going to for over 10 years takes it, so they did it.

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dm200
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Re: Medicare choices

Post by dm200 » Sat Mar 09, 2019 2:07 pm

orlandoman wrote:
Fri Mar 08, 2019 6:17 pm

Medicare Advantage:
- MA plans are available as HMO’s & PPO’s
- each insurance carrier may offer HMO’s or PPO’s at their choice
- there is no required standardization of HMO or PPO plans
- each carrier may offer multiple HMO or PPO plans in the same area, each with different benefits
- many/most MA plans include Part D drug benefits
- benefits may include limited vision & dental benefits & free gym memberships & benefits may change on an annual basis
- HMO’s & PPO’s normally have copays or deductibles & an out of pocket maximum
- HMO’s have a network & normally only emergency care is offered out of network
- PPO’s have a network & out of network services are available with a higher copay or deductible
- PPO’s services out of network, you need to get services from any provider that either participates in Medicare or accepts assignments (same as supplements) & accepts you as a new out of network patient
Yes - very good summary. let me add:

1. These also apply to the similar Medicare Cost plans (much like advantage with a few twists). Our Kaiser medicare plan is a cost plan
2. MA HMOs come in two very different types. One type (Kaiser, for example) of HMO has its own fully dedicated facilities, physicians and providers. The other type is a network of participating providers who provide services from their own offices and facilities.
3. While there is no required "standardization" of MA plans, there are many required services and minimum types of things provided by Medicare
4. Over the decades when we had network HMO or PPO coverage, we never found the HMO requirements to be a problem. At worst, it was a very minor inconvenience to get specialist referrals from our PCPs.

One, of many, reasons we are happy with our Kaiser Medicare plan is the combination of convenience, flexibility and no/low hassle of getting medical care - including access by phone, email, smart phone or in person. Specialists are always available quickly and, often, depending on the specialty - my PCP can get the necessary information/guidance from the specialist without my seeing the specialist in person. Some friends and acquaintances (on original Medicare) take weeks to find and get an appointment with a specialist. Close to zero "hassle" for us.

FBN2014
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Re: Medicare choices

Post by FBN2014 » Sun Mar 10, 2019 9:51 pm

Something to think about if you have MA.

https://www.aafp.org/news/government-me ... rauth.html
"October is one of the peculiarly dangerous months to speculate in stocks. The others are July, January, September, April, November, May March, June, December, August and February." - M. Twain

averagedude
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Re: Medicare choices

Post by averagedude » Sun Mar 10, 2019 10:29 pm

I know little about this topic, but i do know that every state has a free program to provide one - on- one medicare counseling that can help you make the most informed decision. You can even bring in a list of your prescriptions and they will show what each plan will pay. I suggest you do a google search and find the agency in your state that does this, and set up an appointment with them. These people are knowledgeable and it is totally free. They helped a family member of mine and they were pleased.

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Mon Mar 11, 2019 1:02 am

GerryL wrote:
Fri Mar 08, 2019 10:31 pm
Re Medicare Brokers: Understand that they do not work will ALL providers and plans. If you are considering going with traditional Medicare and an F high-deductible supplement, (or G-HD, if it becomes available), you probably won't hear about it from them.

I've talked to a couple of brokers and asked whether they could advise about F-HD plans and they have both declared that "people don't like dealing with all the paperwork involved with those plans." Take that to mean, "No. We don't earn a commission on HD plans." (I've been on F-HD for several years and have not found the paperwork to be at all onerous.)
I did not use a broker but one popped up on my radar screen yesterday. On my Facebook feed, actually. Anyway, I checked out his blog and was intrigued. We had a brief email back and forth. He is quite positive about Plan F HD and I may very well use him if and when I switch from MA to traditional Medicare with a Supplement. (In my state, I already knew I could do that once a year, but thanks to him I learned about a free state program that I can sign up for that will, among other things, give me a special enrollment period to switch out of my MA midyear if that should become desirable at any future point for some reason.) He has a blog and seems astute and helpful, but also low key and low pressure. He represents several MA providers and several supplement providers, including the lowest cost Plan F HD available in our area.

For me the calculus goes as follows:

in very good health/ no drugs currently and hope to stay that way for some years to come. Have a $0 premium MA PPO plan that includes prescription drug coverage plus hearing aid benefits, some vision/dental and Silver Sneakers. Network is very comprehensive and includes all the hospitals in upstate NY and VT and just about all the docs too. It certainly includes every doc I have ever considered going to. MA rating is 4.5 stars, tied for top in my state and nationally high ranked. Copays are very reasonable, even out of network. I do not need a gatekeeper or referral to see a specialist, whether in or out of network. OOP max is $6,700 in network and $10K combined in/out. I am psychologically as well as financially prepared to deal with possibility of hitting OOP max. Financially prepared thanks to $40k balance in HSA. Psychologically prepared because I previously had an ACA Bronze HD policy and hit the (much larger at $13K) OOP max on that one year. So I believe I can be philosophical if that happens with my current plan.

Switching to trad Medicare plus Supplement F HD would cost me $58/month plus I would need to spend $17/month for the cheapest Part D, and I would lose the hearing aid, vision/dental, and Silver Sneakers.

One more thing my MA plan provides that trad Medicare plus supplement does not: 24/7 video online access to telemedicine doctors if I want to discuss an urgent issue without physically traveling anywhere.

bob60014
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Re: Medicare choices

Post by bob60014 » Mon Mar 11, 2019 7:10 am

If I recall and someone correct me if I'm wrong, as the F plan will not be open to new enrollees next year, the insured pool will begin to shrink and rates will rise. Something to consider when shopping.

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dm200
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Re: Medicare choices

Post by dm200 » Mon Mar 11, 2019 8:17 am

FBN2014 wrote:
Sun Mar 10, 2019 9:51 pm
Something to think about if you have MA.
https://www.aafp.org/news/government-me ... rauth.html
Interesting. Thanks.

My wife and I have each had some potentially serious issues while on our Kaiser Medicare plan. Neither of us has ever experienced any delay in needed treatment for "prior authorization".

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dm200
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Re: Medicare choices

Post by dm200 » Mon Mar 11, 2019 8:21 am

in very good health/ no drugs currently and hope to stay that way for some years to come. Have a $0 premium MA PPO plan that includes prescription drug coverage plus hearing aid benefits, some vision/dental and Silver Sneakers. Network is very comprehensive and includes all the hospitals in upstate NY and VT and just about all the docs too. It certainly includes every doc I have ever considered going to. MA rating is 4.5 stars, tied for top in my state and nationally high ranked. Copays are very reasonable, even out of network. I do not need a gatekeeper or referral to see a specialist, whether in or out of network. OOP max is $6,700 in network and $10K combined in/out. I am psychologically as well as financially prepared to deal with possibility of hitting OOP max. Financially prepared thanks to $40k balance in HSA. Psychologically prepared because I previously had an ACA Bronze HD policy and hit the (much larger at $13K) OOP max on that one year. So I believe I can be philosophical if that happens with my current plan.
Great for you. I hope it continues. The lower annual expenses should offset the chance that you will have the up to $6,700 out of pocket.

Our plan also has a $6,700 annual out of pocket max.

It seems that this max out of pocket tends to go up every year.

DrGoogle2017
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Re: Medicare choices

Post by DrGoogle2017 » Mon Mar 11, 2019 10:49 am

FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
This is what my sister was told by her doctor too. I wanted to make sure she understands this point before she picks her options this year.

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dm200
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Re: Medicare choices

Post by dm200 » Mon Mar 11, 2019 10:56 am

DrGoogle2017 wrote:
Mon Mar 11, 2019 10:49 am
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
This is what my sister was told by her doctor too. I wanted to make sure she understands this point before she picks her options this year.
BUT - only if:

1. The specialist/provider accepts Original Medicare; AND
2. You can get an appointment to be seen

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munemaker
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Re: Medicare choices

Post by munemaker » Mon Mar 11, 2019 12:52 pm

Shallowpockets wrote:
Tue Feb 26, 2019 2:08 pm
The big issue for most people is if they can keep their doctor or not. That is, if you had a doc you really liked before medicare.
Other reasons.
I don't want any constraints on who I go to see. Such as in an HMO, PPO.
I want to be covered everywhere (in the world too)
I don't want to have to have a referral to see a specialist.

These reasons are all personal.

A good proportion of people look down on Advantage Plans in the same way that people who have "my guy" who manages their money and you are a BH. Also they pay up for that in the same fashion.

All medicare recipients pay the base $135 a month. What else you pay depends on what plan, either Advantage or supplemental you decide upon. All the way through to Plan F.

And once again, let me say, go and buy the book medicare for dummies.
Counterpoint: I am about the ultimate in do-it-yourself everything rather than having a "my guy" and I went with the Advantage Plan. It really comes down to what is available in your area. I live in Western PA where UPMC is the dominant health care provider, and they also operate their own insurance company. Using the UPMC Advantage Plan gives me economical access to any UPMC facility or doctor, plus a number of non-UPMC facilities. The cost of my plan is only $40/month, and it includes gym membership (my choice), annual vision exams and preventive dental coverage. This plan also includes out-of-the country coverage (just got back from the islands) and snowbird coverage in most states between PA and Florida.

It does seem like a lot of Bogleheads look negatively on the Advantage Plans. This is unfortunate and I don't know why. When any other kind of insurance is discussed, the advice is always to avoid extended warranties, buy only the coverage you need, etc. But for some reason, people have a different view when it comes to health insurance.

I agree on the "Medicare for Dummies book." Very helpful.

DrGoogle2017
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Re: Medicare choices

Post by DrGoogle2017 » Mon Mar 11, 2019 1:07 pm

dm200 wrote:
Mon Mar 11, 2019 10:56 am
DrGoogle2017 wrote:
Mon Mar 11, 2019 10:49 am
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
This is what my sister was told by her doctor too. I wanted to make sure she understands this point before she picks her options this year.
BUT - only if:

1. The specialist/provider accepts Original Medicare; AND
2. You can get an appointment to be seen
She has lots of health issues, she might not pass the medical test to get back to Medicare.

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Mon Mar 11, 2019 1:27 pm

DrGoogle2017 wrote:
Mon Mar 11, 2019 10:49 am
FBN2014 wrote:
Wed Feb 27, 2019 12:59 pm
I like the option of going to anyone in the country if I need treatment for a disease. Medicare Advantage will not give you that. IMO its not worth saving a few dollars unless you are really strapped for income. Remember once you have MA and then decide you want traditional Medicare Supplement you will have to be medically underwritten and you will have a surcharge on part B. Not worth the risk IMO.
This is what my sister was told by her doctor too. I wanted to make sure she understands this point before she picks her options this year.
Dr. Google and FBN2014, no choice will give you the option of ¨going to anyone in the country¨ since there are docs who do not take traditional Medicare. That said, my Medicare Advantage Plan is a PPO which will cover any doctor who takes traditional Medicare as well as in network doctors. (The only difference is slightly higher copay out-of-network and higher OOP max out of network.)

FBN2014, as far as needing to be medically underwritten to switch to a Supplement, that depends on your state. I am fortunate to be in one of the best states, NY, which guarantees acceptance without medical underwriting if and when I want to switch. Of course our Supplement premiums are higher in this state (especially since there is no age rating, it is pure community rating for premiums) but that is all the more reason to stay with Medicare Advantage low cost program while I am in a period of my life without much need for medical expenses. So your mileage may vary. There are a few other very flexible states that allow flexibility in switching.

quantAndHold
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Re: Medicare choices

Post by quantAndHold » Mon Mar 11, 2019 2:04 pm

My wife is on a MA plan. It's the exact same large network she was in when she was working, except now it's cheaper and she gets a free gym membership.

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dm200
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Re: Medicare choices

Post by dm200 » Mon Mar 11, 2019 2:21 pm

munemaker wrote:
Mon Mar 11, 2019 12:52 pm
Shallowpockets wrote:
Tue Feb 26, 2019 2:08 pm
The big issue for most people is if they can keep their doctor or not. That is, if you had a doc you really liked before medicare.
Other reasons.
I don't want any constraints on who I go to see. Such as in an HMO, PPO.
I want to be covered everywhere (in the world too)
I don't want to have to have a referral to see a specialist.
These reasons are all personal.
A good proportion of people look down on Advantage Plans in the same way that people who have "my guy" who manages their money and you are a BH. Also they pay up for that in the same fashion.
All medicare recipients pay the base $135 a month. What else you pay depends on what plan, either Advantage or supplemental you decide upon. All the way through to Plan F.
And once again, let me say, go and buy the book medicare for dummies.
Counterpoint: I am about the ultimate in do-it-yourself everything rather than having a "my guy" and I went with the Advantage Plan. It really comes down to what is available in your area. I live in Western PA where UPMC is the dominant health care provider, and they also operate their own insurance company. Using the UPMC Advantage Plan gives me economical access to any UPMC facility or doctor, plus a number of non-UPMC facilities. The cost of my plan is only $40/month, and it includes gym membership (my choice), annual vision exams and preventive dental coverage. This plan also includes out-of-the country coverage (just got back from the islands) and snowbird coverage in most states between PA and Florida.
It does seem like a lot of Bogleheads look negatively on the Advantage Plans. This is unfortunate and I don't know why. When any other kind of insurance is discussed, the advice is always to avoid extended warranties, buy only the coverage you need, etc. But for some reason, people have a different view when it comes to health insurance.
I agree on the "Medicare for Dummies book." Very helpful.
Yes - somewhat puzzles me as well - although I often see the points raised.

My experience is that the stated (policy and fine print) constraints in practice have not presented any problems whatsoever.

I have NO medical credentials or competence - just a well informed patient. Some friends and acquaintances I chat with from time to time have terrible things to say about the same Kaiser Medicare plan that DW and I are very happy with. My opinion/conclusion about their "unhappiness" may be the result of several factors:

1. They have unreasonable or unrealistic expectations about what Physicians can accomplish - no matter the type of insurance or coverage
2. They are very ill informed about ways to get good care and/or refuse to use the features available to them
3. They seem to not understand some of the normal processes and procedural steps in getting optimum care

While there may also be differences between some Physicians, one friend had the same PCP as I have had - and the friend's perception of this Physician was completely different than mine. The friend thought the Physician was terrible and I believe she is top notch and especially responsive - both in time and content - to any and all issues I have experienced.

I often feel like there should be a "Guide" to being an informed patient - how to receive the best care from your available Physicians and the lowest cost to you. While I cannot prove it "objectively", I am also convinced that certain types of patient "behavior" can result in "better" results from your Physician. The one situation that absolutely amazed me was when I had some continuing low/moderate pain in my lower left abdomen. I made an online appointment on a Thursday afternoon to see my PCP on a the next day (a Friday) - very late in the day. I put a sentence or two in the description about what I needed to see her about. She tried to call me on the phone at the end of her day on Thursday - but did not make the connection with me. She also sent an email - and she called me Friday morning to suggest that I see her at 2 pm - instead of late in the day because the lab would be closed late in the day. If I saw her at 2 pm, she would/could order lab tests and see them before she left on Friday. I saw her at 2 pm, had the lab tests run right after I saw her. After she got home on late Friday afternoon, she checked the lab results and got back to me by email that there was nothing identified in the lab tests.
Last edited by dm200 on Mon Mar 11, 2019 2:47 pm, edited 1 time in total.

Morgan Dollar 1921
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Re: Medicare choices

Post by Morgan Dollar 1921 » Mon Mar 11, 2019 2:46 pm

averagedude wrote:
Sun Mar 10, 2019 10:29 pm
I know little about this topic, but i do know that every state has a free program to provide one - on- one medicare counseling that can help you make the most informed decision. You can even bring in a list of your prescriptions and they will show what each plan will pay. I suggest you do a google search and find the agency in your state that does this, and set up an appointment with them. These people are knowledgeable and it is totally free. They helped a family member of mine and they were pleased.
+1
For Ohio residents it is "OSHIIP Coordinator"
From the ODI website, Find an OSHIIP volunteer coordinator and OSHIIP counseling site near you. An OSHIIP site can be a facility such as a senior center, hospital, retirement community, local library, etc. that agrees to support and facilitate OSHIIP’s outreach effort in its community. Staff at the site are knowledgeable about OSHIIP, can provide OSHIIP publications and may have a resident OSHIIP volunteer who can counsel a person with Medicare.
I got non-biased info and options, from a person who has seen both sides of the ledger, seniors with experiences both pro and con, it was an eye opening meeting.

I agree on the "Medicare for Dummies" book, also and will add two more, "The Traps Within Medicare--2019 Edition: How to Spot Them, How to Avoid Them" & "Medigap vs Medicare Advantage"

drawpoker
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Re: Medicare choices

Post by drawpoker » Mon Mar 11, 2019 7:11 pm

FBN2014 wrote:
Sat Mar 09, 2019 11:48 am
Julyguy754 wrote:
Fri Mar 08, 2019 9:58 pm
.......one additional question and didn't see anyone mention using a Medicare Broker service.... anyone have any experience or knowledge if these type of services are worth it.......
..... I would recommend that you seek out an experienced independent Medicare insurance agent who can represent all companies and can give you unbiased advice since the commission is the same no matter which company they write the policy with. All Medicare supplement plans are standardized so no matter which company you go with the coverage benefits are the same by law..........
This is incorrect. Sales commissions vary widely among the companies selling Medicare supplement plans. Just because the plans themselves are "standardized" by law, (coverage and benefits must be the same) amounts of commissions earned by brokers are most definitely not.

Why would they be? Premiums are most definitely not standardized, they can vary enormously based on where you live.
A 65-year old buying Plan F in some Midwest states, TX and a few other places might pay less than $140 a month for Plan F; in NYC that 65-year old might pay $500 or more a month for Plan F.

Very rarely is there actual need to utilize a broker, anyone with a computer and internet access can easily research which companies are offering which Plans at what premium cost for their area.

Also, keep in mind, the best value in Medicare supplements is buying one (during open enrollment) based on issue age rating method; not attained age or community. Most of the few out there that are issue-age rated are offered thru the benevolent associations thru their own agents. An indep broker is not going to be inclined to tell you about something where he/she isn't going to make a commission off it.

orlandoman
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Re: Medicare choices

Post by orlandoman » Mon Mar 11, 2019 7:38 pm

When using brokers keep in mind that they receive a commission on policies sold. Do you think a broker makes more on a $100-$200 monthly premium supplement and possibly a second Plan D drug policy or a $0 premium Medicare Advantage Plan?
"Don't Believe Everything You Think"

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Tue Mar 12, 2019 12:55 am

orlandoman wrote:
Mon Mar 11, 2019 7:38 pm
When using brokers keep in mind that they receive a commission on policies sold. Do you think a broker makes more on a $100-$200 monthly premium supplement and possibly a second Plan D drug policy or a $0 premium Medicare Advantage Plan?
The answer is not at all obvious. The $0 premium MA plan might well be more profitable for the insurance provider depending on the capitation fee the provider will receive from Medicare relative to the cost of the coverage they will need to provide in exchange.

One insurance company in our area sells supplement (Medigap) plans, Plan D drug policies, and several MA plans including a $0 option.

That company spends a ton of money advertising and promoting the MA plan (and their ads barely seem to mention their Medigap plans.) I assume the MA plan must be very profitable.

In general, I see far more ads and promotion for MA plans than for supplement plans, so I assume the MA plans must be financially more rewarding for their sponsors than the supplements.

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Tue Mar 12, 2019 1:09 am

orlandoman wrote:
Mon Mar 11, 2019 7:38 pm
When using brokers keep in mind that they receive a commission on policies sold. Do you think a broker makes more on a $100-$200 monthly premium supplement and possibly a second Plan D drug policy or a $0 premium Medicare Advantage Plan?
A further thought: the broker I recently connected with via email seemed to be a big fan of Plan F high deductible (both in his emails and on his blog). It is the cheapest Medigap in the state ($58/month). Other Medigap plans have much higher premiums, many of them over $300/month or more. (Note that all plans in our state are community rated. Age-rated or issue-age rating is not allowed in NY.)

But the cheap Plan F-HD may be far more profitable than other higher premium plans costing hundreds of dollars per month because the folks who select it are likely extremely healthy and very unlikely to run up more than $2000 of out of pocket costs beyond Medicare reimbursement. (Keep in mind that as soon as they become unhealthy, they are allowed to switch to another Medigap plan from the same or a different provider under our state´s rules!) So the $58/month for Plan F-HD may be close to pure profit other than marketing costs and bookkeeping, paperwork management.

Edited to add: in fact, it is worth noting that the company that sells the cheapest Plan F-HD for $58/month is not the lowest cost Plan F provider. It seems as if the carrier *wants* their Plan F-HD subscribers to go elsewhere (to a different carrier) once they reach the point of deciding to switch to Plan F because they have become less healthy. (Note also that our state health department has a great website that makes it easy to compare the costs of all the plans available to them.)

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munemaker
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Re: Medicare choices

Post by munemaker » Tue Mar 12, 2019 7:04 am

quantAndHold wrote:
Mon Mar 11, 2019 2:04 pm
My wife is on a MA plan... and she gets a free gym membership.
I suggest the gym membership is not free and is included in the cost of the MA plan.

orlandoman
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Re: Medicare choices

Post by orlandoman » Tue Mar 12, 2019 7:34 am

munemaker wrote:
Tue Mar 12, 2019 7:04 am
quantAndHold wrote:
Mon Mar 11, 2019 2:04 pm
My wife is on a MA plan... and she gets a free gym membership.
I suggest the gym membership is not free and is included in the cost of the MA plan.
Or, it might be that people who go to the gym are healthier & offering no cost gym memberships are preventitive medicine, which lowers future costs. In that case MA plans offer additional preventitive benefits that supplements do not.
"Don't Believe Everything You Think"

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dm200
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Re: Medicare choices

Post by dm200 » Tue Mar 12, 2019 8:25 am

orlandoman wrote:
Tue Mar 12, 2019 7:34 am
munemaker wrote:
Tue Mar 12, 2019 7:04 am
quantAndHold wrote:
Mon Mar 11, 2019 2:04 pm
My wife is on a MA plan... and she gets a free gym membership.
I suggest the gym membership is not free and is included in the cost of the MA plan.
Or, it might be that people who go to the gym are healthier & offering no cost gym memberships are preventitive medicine, which lowers future costs. In that case MA plans offer additional preventitive benefits that supplements do not.
Yes - I would describe it as "a feature in the MA plan for which there is no charge to utilize".

Interesting why MA plans might choose to include? Perhaps:
- the MA plan believes that increased use of gyms will keep folks healthier and have lower medical costs
- the MA plan believes that adding this feature will be popular and attract and retain more enrolees
- the MA plan is able to negotiate a very low cost with the gyms - either because few folks use them and/or the gyms can "sell" added services.
- might there be (do not know) Medicare incentives for MA plans to offer this
- any ideas about what goes on in this gym membership and MA plans?

In our case, in 2019 our plan added "Silver Fit" at no charge. I enrolled at Gold's gym. I will use this very infrequently because we have a very low cost (and a bit more convenient) County rec center membership. The rec centers have more holidays than Gold's and somewhat shorter hours. At the cunty rec centers, I get a towel at each visit - but at Gold's I either take my own or pay a monthly fee for towel service.

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munemaker
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Re: Medicare choices

Post by munemaker » Tue Mar 12, 2019 8:32 am

quantAndHold wrote:
Mon Mar 11, 2019 2:04 pm
My wife is on a MA plan. It's the exact same large network she was in when she was working, except now it's cheaper and she gets a free gym membership.
Medicare Advantage Plans are very similar to common employer provided plans and to many ObamaCare silver plans, in my experience.

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Tue Mar 12, 2019 8:41 am

dm200 wrote:
Tue Mar 12, 2019 8:25 am
orlandoman wrote:
Tue Mar 12, 2019 7:34 am
munemaker wrote:
Tue Mar 12, 2019 7:04 am
quantAndHold wrote:
Mon Mar 11, 2019 2:04 pm
My wife is on a MA plan... and she gets a free gym membership.
I suggest the gym membership is not free and is included in the cost of the MA plan.
Or, it might be that people who go to the gym are healthier & offering no cost gym memberships are preventitive medicine, which lowers future costs. In that case MA plans offer additional preventitive benefits that supplements do not.
Yes - I would describe it as "a feature in the MA plan for which there is no charge to utilize".

Interesting why MA plans might choose to include? Perhaps:
- the MA plan believes that increased use of gyms will keep folks healthier and have lower medical costs
- the MA plan believes that adding this feature will be popular and differentially attract and retain relatively more healthy enrolees
- the MA plan is able to negotiate a very low cost with the gyms - either because few folks use them and/or the gyms can "sell" added services.
- might there be (do not know) Medicare incentives for MA plans to offer this
- any ideas about what goes on in this gym membership and MA plans?
The words I added above in red are what I think are going on. MA plans get paid capitation fees by HHS based on a crude formula that does not fully adjust for risk and anything insurance companies can do to improve their customer mix risk profile within that schema helps their bottom line. Many (most?) MA plans thrive by cherrypicking healthier patients. There is is some interesting game theory going on with the players being the various MA providers and the designers of the reimbursement system and the customers.

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dm200
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Re: Medicare choices

Post by dm200 » Tue Mar 12, 2019 9:12 am

The words I added above in red are what I think are going on. MA plans get paid capitation fees by HHS based on a crude formula that does not fully adjust for risk and anything insurance companies can do to improve their customer mix risk profile within that schema helps their bottom line. Many (most?) MA plans thrive by cherrypicking healthier patients. There is is some interesting game theory going on with the players being the various MA providers and the designers of the reimbursement system and the customers.
I have often seen this "cherry picking" allegation against MA plans for many years. Probably we all have some kind of anecdotal experiences - either supporting this or discrediting it. I tend to not believe such "cherry picking" is a big factor - but that is anecdotal as well.

While, probably, I am a bit healthier than the "average" Medicare participant of my age and sex, I do have several conditions that need monitoring, testing and regular specialist visits. I have also had outpatient surgery last year. Based on my eight years of being on Medicare (all of it in an MA type plan), I believe that I would continue to be satisfied with my plan if I had a lot of health/medical problems - and was "sicker" than the average patient of my age and sex.

It seems to me that most of the "conclusions" about this "cherry picking" are from organizations or folks with some kind of bias - one way or the other.

Someone told me (not sure if true or not) that in my Medicare plan (Kaiser) - there is a financial incentive for Kaiser to classify and document as many participants as possible with as many conditions/ailments as can be documented. The claim is that, then, Kaiser will get more money from Medicare.

2015
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Re: Medicare choices

Post by 2015 » Tue Mar 12, 2019 12:26 pm

dm200 wrote:
Tue Mar 12, 2019 9:12 am
The words I added above in red are what I think are going on. MA plans get paid capitation fees by HHS based on a crude formula that does not fully adjust for risk and anything insurance companies can do to improve their customer mix risk profile within that schema helps their bottom line. Many (most?) MA plans thrive by cherrypicking healthier patients. There is is some interesting game theory going on with the players being the various MA providers and the designers of the reimbursement system and the customers.
...
It seems to me that most of the "conclusions" about this "cherry picking" are from organizations or folks with some kind of bias - one way or the other.
...
Yes. It seems to me the "cherrypicking" allegations are speculative at best. Putting such allegations in with the same context as game theory does not give them credence. I can't think of a single business to which game theory cannot be applied.

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dodecahedron
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Re: Medicare choices

Post by dodecahedron » Tue Mar 12, 2019 12:44 pm

dm200 wrote:
Tue Mar 12, 2019 9:12 am
The words I added above in red are what I think are going on. MA plans get paid capitation fees by HHS based on a crude formula that does not fully adjust for risk and anything insurance companies can do to improve their customer mix risk profile within that schema helps their bottom line. Many (most?) MA plans thrive by cherrypicking healthier patients. There is is some interesting game theory going on with the players being the various MA providers and the designers of the reimbursement system and the customers.
I have often seen this "cherry picking" allegation against MA plans for many years. Probably we all have some kind of anecdotal experiences - either supporting this or discrediting it. I tend to not believe such "cherry picking" is a big factor - but that is anecdotal as well.

While, probably, I am a bit healthier than the "average" Medicare participant of my age and sex, I do have several conditions that need monitoring, testing and regular specialist visits. I have also had outpatient surgery last year. Based on my eight years of being on Medicare (all of it in an MA type plan), I believe that I would continue to be satisfied with my plan if I had a lot of health/medical problems - and was "sicker" than the average patient of my age and sex.

It seems to me that most of the "conclusions" about this "cherry picking" are from organizations or folks with some kind of bias - one way or the other.

Someone told me (not sure if true or not) that in my Medicare plan (Kaiser) - there is a financial incentive for Kaiser to classify and document as many participants as possible with as many conditions/ailments as can be documented. The claim is that, then, Kaiser will get more money from Medicare.
I was careful to say ¨many (most)¨ rather than ¨all.¨ Kaiser and some other nonprofits may well be exceptions but here is a New England Journal of Medicine article reporting research that suggests that cherrypicking is a real phenomenon at many insurers.

And cherrypicking is all relative to your officially rated rick category. Kaiser likely gets a bigger capitation payment for you with all your documented conditions that need monitoring and management than they would for someone with no observable documented risk factors.

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dm200
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Re: Medicare choices

Post by dm200 » Tue Mar 12, 2019 12:59 pm

I was careful to say ¨many (most)¨ rather than ¨all.¨ Kaiser and some other nonprofits may well be exceptions but here is a New England Journal of Medicine article reporting research that suggests that cherrypicking is a real phenomenon at many insurers.
And cherrypicking is all relative to your officially rated rick category. Kaiser likely gets a bigger capitation payment for you with all your documented conditions that need monitoring and management than they would for someone with no observable documented risk factors
.

Interesting. Like so many "statistical" issues, this is complex.

One aspect that occurs to me, but was not mentioned in this article directly is the knowledge/sophistication of the Medicare recipient and the coices made.

Another question, even if there is "cherry picking", how large an effect it has.

While my sample is small and "anecdotal", in discussions with friends and acquaintances who are enrolled in several different Advantage plans, such folks have not ever expressed the view or conclusion that their Advantage plan has or would "cut corners" on needed services or care.

An interesting issue (my opinion) to follow and study.

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