Medicare Advantage vs. Supplemental

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RustyShackleford
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Medicare Advantage vs. Supplemental

Post by RustyShackleford » Thu Oct 12, 2017 6:23 pm

So I'm at the age where I have to make these decisions. Lord, it's complicated. I thought our health "care" delivery system was, as David Brooks said, "created by an evil genius", but I had no idea until now :-)

Anyhow, the first-order decision is whether to go with the Medicare Advantage (aka. Part C) or Medicare Supplemental (aka. medigap). I retired early and already have retiree health insurance through a former employer, but they require me to become Medicare primary at age 65. They are pushing hard for me to go with a Medicare Advantage plan (which they subsidize), through United Healthcare Group. But, they will also allow to keep my current plan (which is free, pretty lousy, a 70/30 BCBS plan), but with it becoming secondary to Medicare; in that event, I almost certainly want to go with some medigap, probably Plan F or G.

I am more concerned with getting the best coverage possible, and less concerned with cost. My secondary concern is probably simplicity. The Advantage is extremely simple, as UHC would handle everything, including prescriptions. It seems like the 70/30 + medigap would provide better coverage for less than $1000/year additional premium (which I'd probably save, certainly if out-of-pocket max kicked in), but it also seems like it could be ferociously complicated, since I'd be dealing with 4 insurance policies (Medicare, BCBS 70/30, Plan F or Plan G, and Part D prescription drug). So my main question, for those who've gone this route: how complicated is having this Frankenstein-like coverage going to be, versus Medicare Advantage ?

Thanks. And I'd welcome any other thoughts on this decision too.

blmarsha123
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Re: Medicare Advantage vs. Supplemental

Post by blmarsha123 » Thu Oct 12, 2017 9:23 pm

RustyShackleford wrote:
Thu Oct 12, 2017 6:23 pm
So I'm at the age where I have to make these decisions. Lord, it's complicated. I thought our health "care" delivery system was, as David Brooks said, "created by an evil genius", but I had no idea until now :-)

Anyhow, the first-order decision is whether to go with the Medicare Advantage (aka. Part C) or Medicare Supplemental (aka. medigap). I retired early and already have retiree health insurance through a former employer, but they require me to become Medicare primary at age 65. They are pushing hard for me to go with a Medicare Advantage plan (which they subsidize), through United Healthcare Group. But, they will also allow to keep my current plan (which is free, pretty lousy, a 70/30 BCBS plan), but with it becoming secondary to Medicare; in that event, I almost certainly want to go with some medigap, probably Plan F or G.

I am more concerned with getting the best coverage possible, and less concerned with cost. My secondary concern is probably simplicity. The Advantage is extremely simple, as UHC would handle everything, including prescriptions. It seems like the 70/30 + medigap would provide better coverage for less than $1000/year additional premium (which I'd probably save, certainly if out-of-pocket max kicked in), but it also seems like it could be ferociously complicated, since I'd be dealing with 4 insurance policies (Medicare, BCBS 70/30, Plan F or Plan G, and Part D prescription drug). So my main question, for those who've gone this route: how complicated is having this Frankenstein-like coverage going to be, versus Medicare Advantage ?

Thanks. And I'd welcome any other thoughts on this decision too.
I could be wrong, but I think that what your company is saying is that either the UHC MA plan or the BCBS 70/30 plan would become secondary to Medicare. If the BCBS plan does not include drug coverage, then you would need a Part D plan. There would be no "fourth" policy or provider.

I think that many choose a MA plan because:

(1) They have used such a plan in the past and are happy with the medical coverage and services, and the cost. If you have not used a MA plan before, you should try to find out how well people in your coverage area like the MA plan, as opposed to, say, people in Washington, D.C. or Southern California.

(2) As you pointed out, prescription coverage is included as part of the MA plan.

(3) In many cases, MA plans include some (basic) dental, vision and possibly hearing coverage and services.

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Watty
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Re: Medicare Advantage vs. Supplemental

Post by Watty » Thu Oct 12, 2017 9:56 pm

When I first started looking into this I found the "Medicare for Dummies" book to be very good despite it's title and I would highly recommend it. Be sure you are looking at the most recent edition if you get it.

I have not started Medicare yet but for my wife the initial decision was daunting but we went with a traditional plan and a Plan G supplement along with a part D drug plan. Once that was done the yearly mechanics are easy for us since the only thing we need to do is to look at the part d drug plan each year.

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Re: Medicare Advantage vs. Supplemental

Post by neilpilot » Fri Oct 13, 2017 6:41 am

Since you are "more concerned with getting the best coverage possible" be sure to determine if the Part C MA option is an HMO, I.e. Will it cover you at the provider of your choice? We selected Medigap G for maximum flexibility over our MA options.

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Re: Medicare Advantage vs. Supplemental

Post by jcpct » Fri Oct 13, 2017 7:52 am

I'm in the same boat as you, just entering Medicare territory. After talking to my doctors and age 65+ friends I think the best option is one of the medigap plans. The MA plans have a better price but with limitations like requiring you to be in certain networks. All my smart friends seem to go with medigap plan F. That plan will change to plan G in 2020. I've read "Get What's Yours for Medicare" and would recommend that book for you to read.
You are probably getting tons of mailings from insurance companies. Take a look at the plans they are pushing. Most are MA plans and that alone tells me those plans may not be the best option. Good luck. Like you said, it's complicated.

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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Fri Oct 13, 2017 9:03 am

RustyShackleford wrote:
Thu Oct 12, 2017 6:23 pm
So I'm at the age where I have to make these decisions. Lord, it's complicated. I thought our health "care" delivery system was, as David Brooks said, "created by an evil genius", but I had no idea until now :-)
Anyhow, the first-order decision is whether to go with the Medicare Advantage (aka. Part C) or Medicare Supplemental (aka. medigap). I retired early and already have retiree health insurance through a former employer, but they require me to become Medicare primary at age 65. They are pushing hard for me to go with a Medicare Advantage plan (which they subsidize), through United Healthcare Group. But, they will also allow to keep my current plan (which is free, pretty lousy, a 70/30 BCBS plan), but with it becoming secondary to Medicare; in that event, I almost certainly want to go with some medigap, probably Plan F or G.
I am more concerned with getting the best coverage possible, and less concerned with cost. My secondary concern is probably simplicity. The Advantage is extremely simple, as UHC would handle everything, including prescriptions. It seems like the 70/30 + medigap would provide better coverage for less than $1000/year additional premium (which I'd probably save, certainly if out-of-pocket max kicked in), but it also seems like it could be ferociously complicated, since I'd be dealing with 4 insurance policies (Medicare, BCBS 70/30, Plan F or Plan G, and Part D prescription drug). So my main question, for those who've gone this route: how complicated is having this Frankenstein-like coverage going to be, versus Medicare Advantage ?
Thanks. And I'd welcome any other thoughts on this decision too.
1. Medicare Advantage (MA) plans vary greatly - both in the same markets and in different markets. I would not depend solely on the published documents, but want to speak with participants about both cost, quality and other factors.

2. There are also Medicare Cost (MC) plans in some areas that are similar to MA plans - but can offer more flexibility and options. We have a Kaiser MC plan.

3. If you go with the current BCBS being secondary to Medicare - I suspect you would not need or want a supplement (but check it out)

4. It may differ if a MA plan is subsidized (check details), but one potential disadvantage of an MA plan is that down the road if you return to Original medicare, you might not be able to purchase a supplement.

5. We are very, very happy with our Kaiser MC plan and we know several folks who are very happy with their Humana MA plan

6. In this area, one "challenge" with Original medicare is that a large percentage of Primary Care Physicians to not accept new Medicare patients - although most accept Medicare from existing patients making the transition.

7. While I think the issue is very overrated and has not been an issue for us, whatever choice(s) you make - there may be a need to change Physicians/providers - to some degree

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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Fri Oct 13, 2017 9:06 am

jcpct wrote:
Fri Oct 13, 2017 7:52 am
I'm in the same boat as you, just entering Medicare territory. After talking to my doctors and age 65+ friends I think the best option is one of the medigap plans. The MA plans have a better price but with limitations like requiring you to be in certain networks. All my smart friends seem to go with medigap plan F. That plan will change to plan G in 2020. I've read "Get What's Yours for Medicare" and would recommend that book for you to read.
You are probably getting tons of mailings from insurance companies. Take a look at the plans they are pushing. Most are MA plans and that alone tells me those plans may not be the best option. Good luck. Like you said, it's complicated.
I get tons of these as well. The conclusion you reach that highly promoted MA plans are "inferior" is something I disagree with highly. It seems that I get more advertisements for Supplemental plans.

It seems to me that (depending on the plan and details) with most MA (or MC) plans, you can find participating providers.

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Artsdoctor
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Re: Medicare Advantage vs. Supplemental

Post by Artsdoctor » Fri Oct 13, 2017 9:23 am

Rusty,

There are two fundamental questions that you have to start with. Only after you answer those questions can you proceed with comparing options.

1. Can I easily afford either the Medicare + Medigap or the Medicare Advantage plan?
2. How much emphasis do I want to place on choice?

Plans will vary tremendously from state to state, and if you're living in a major metropolitan area with excellent medical facilities, you will certainly have a reasonable number of choices. The concept would be that you will generally pay less for Medicare Advantage plans but you will have more restrictions on where you're going to get your coverage. Only you can decide where your priorities are.

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Re: Medicare Advantage vs. Supplemental

Post by kaneohe » Fri Oct 13, 2017 9:34 am

One option to consider: since this is all new to you and you're still learning, consider making your initial choice something that you can wiggle out of easily if you change your mind. My impression is that you can change from the supplement to an advantage plan later . Going the other way is more complex w/having to pass medical underwriting tests a good possibility. Also changing supplement plans can be an issue esp. going upstream to a more comprehensive plan.

The factors suggest getting a high level supplement plan may be a good choice initially....F or G.

I don't know about how that employer plan being secondary to a supplement plan works but I know that if it isn't a factor, Medicare/supplement/plan D is very simple. You can get Medicare/supplement to "talk" to each other so you don't have to do anything. Doctor sends bill to Medicare and Medicare tells supplement the charges and what they paid. You don't have to submit anything once you set this up. Same w/ Plan D. With the supplement you don't have to worry "much" about the network while you do if you have an HMO.

If,with more time and knowledge, you decide an Advantage plan would work for you, you can probably change more easily than the other way around.

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Re: Medicare Advantage vs. Supplemental

Post by blueblock » Fri Oct 13, 2017 5:50 pm

kaneohe wrote:
Fri Oct 13, 2017 9:34 am
You can get Medicare/supplement to "talk" to each other so you don't have to do anything. Doctor sends bill to Medicare and Medicare tells supplement the charges and what they paid. You don't have to submit anything once you set this up. With the supplement you don't have to worry "much" about the network while you do if you have an HMO.
Yes, this is how my Humana Supplement works. I've only had it since April, when I became eligible for Medicare, but the one time I used it, that's how it worked. I didn't have to do anything.

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Re: Medicare Advantage vs. Supplemental

Post by 2015 » Sat Oct 14, 2017 10:37 am

Watty wrote:
Thu Oct 12, 2017 9:56 pm
When I first started looking into this I found the "Medicare for Dummies" book to be very good despite it's title and I would highly recommend it. Be sure you are looking at the most recent edition if you get it.

I have not started Medicare yet but for my wife the initial decision was daunting but we went with a traditional plan and a Plan G supplement along with a part D drug plan. Once that was done the yearly mechanics are easy for us since the only thing we need to do is to look at the part d drug plan each year.
+1 for the Medicare for Dummies book. Very helpful.

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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 10:45 am

kaneohe wrote:
Fri Oct 13, 2017 9:34 am
One option to consider: since this is all new to you and you're still learning, consider making your initial choice something that you can wiggle out of easily if you change your mind. My impression is that you can change from the supplement to an advantage plan later . Going the other way is more complex w/having to pass medical underwriting tests a good possibility. Also changing supplement plans can be an issue esp. going upstream to a more comprehensive plan.
The factors suggest getting a high level supplement plan may be a good choice initially....F or G.
I don't know about how that employer plan being secondary to a supplement plan works but I know that if it isn't a factor, Medicare/supplement/plan D is very simple. You can get Medicare/supplement to "talk" to each other so you don't have to do anything. Doctor sends bill to Medicare and Medicare tells supplement the charges and what they paid. You don't have to submit anything once you set this up. Same w/ Plan D. With the supplement you don't have to worry "much" about the network while you do if you have an HMO.
If,with more time and knowledge, you decide an Advantage plan would work for you, you can probably change more easily than the other way around.
I believe that if you initially choose an Advantage plan, but do not like it - you can go back to Original medicare and get a supplement if it is done within the first year. I believe that many aspects (both positive and negative for you) may not be apparent until you have actual experience in the plan.

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Re: Medicare Advantage vs. Supplemental

Post by Johio » Sat Oct 14, 2017 11:53 am

MA plans are usually network based, while Medicare Supplement plans allow you to see any physician that accepts Medicare. For me the choice was pretty simple - I spend some time in Florida each year, so Medicare Supplement plan allows me to see a doctor in either my home state (OH) or Florida, as long as they accept Medicare. This applies to non-emergency situations. I do have a Part D plan since Medicare Supplement does not include drugs, and I had to buy a separate dental/vision plan.

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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 11:58 am

Johio wrote:
Sat Oct 14, 2017 11:53 am
MA plans are usually network based, while Medicare Supplement plans allow you to see any physician that accepts Medicare. For me the choice was pretty simple - I spend some time in Florida each year, so Medicare Supplement plan allows me to see a doctor in either my home state (OH) or Florida, as long as they accept Medicare. This applies to non-emergency situations. I do have a Part D plan since Medicare Supplement does not include drugs, and I had to buy a separate dental/vision plan.
Yes - spending significant time in multiple areas probably is less "convenient" in most MA plans.

Our Medicare Cost (MC) plan is much like a MA plan, but allows use of original medicare for any provider that accepts Original medicare. There is no supplement, though, so we would be on the hook for any charges not fully paid by Medicare.

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Re: Medicare Advantage vs. Supplemental

Post by celia » Sat Oct 14, 2017 12:27 pm

I think you need to start with YOUR health, your expected longevity and what illnesses the elders in your blood-line have struggled with.

You are guaranteed to get on any Medigap plan you choose when you turn 65 or when you (or your spouse, if coverage is through them) stop working and thus lose medical coverage. If you try to get on Medigap at other times you may find that you might not pass the medical underwriting questions the Medigap plan has. FYI, each Medigap plan has different questions, but it has been rumored that AARP UnitedHealthcare is the easiest to get on.

Although it might be hard to get on a Medigap plan later on, it is always easy to go on a Medicare Advantage plan. To me, they are all the same as long as your preferred medical group is included. But then, all the Medigap plans are the same as far as they have to pay the balance of the bills after Medicare determines if it is a covered benefit and what the "reasonable and customary" charge for your area is. (They don't use that term, but that is what it is, in effect.)

Now that you probably know you want a Medigap plan :D , you need to compare them to see which one. If you live in an area where you can change plans every year, just go with the cheapest. In some states, like California, you have the option to change plans in the month of your birthday. I don't know what other states allow, but from some past postings, some people seem stuck in the same Medigap plan and can't change (unless they go to Medicare Advantage).

Start with the website of your state's Department of Insurance to see which plans are available in your state or zip. There are a few Medicare plans (for example, F, N,...) that every Medigap must offer. So focus on the companies that offer the one you are interested in. Then I would look at the company's financial strength as determined by www.AMBest.com (you can sign up for a free account there). [We ended up going with a company in another state who doesn't market around here and have been very satisfied with them.]


For a drug plan, enter your prescriptions on Medicare's website to see which plan will offer you the least cost. You can change drug plans each year on the Medicare site and the meds will be the same whoever you select, so you can just select the one that will give you the least over-all cost (including premiums). If you should need to tangle with the donut hole, that is hell. Our experience is that the "contract prices" for brand name drugs that we get from the online tool change throughout the year as well as what phase of the drug plan we are in (deductible met or not, pre-hole, in-hole, post-hole). But so far, our yearly cost has ended up close to what it was estimated during the previous year running of the tool.

If you should need to see a specialist long term, the Medigap plans are advantageous. What if an outside specialist refers you to a more specialized specialist? Forget having a MA pay them, even if they paid for the original specialist. We were referred to one such doctor and he wouldn't even consider taking MA patients. (The "specialists" in our medical group were not very helpful.) We also learned that you need to find out if your current doctors accept Medicare ASSIGNMENT (meaning they or their medical group have contracted with Medicare), not just do they accept Medicare PAYMENTS (which everyone does). We had to change two doctors because of this, but it ended up better in the long run.

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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 12:39 pm

Although it might be hard to get on a Medigap plan later on, it is always easy to go on a Medicare Advantage plan. To me, they are all the same as long as your preferred medical group is included.
1. From speaking with folks on various MA plans, my conclusion is that they can differ greatly - even if you are happy with the network. For example, I would be quite sure a Kaiser type HMO MA plan differs in many ways (both good and not) from a plan using providers in their own offices. Some MA plans are PPOs, some are HMOs and some other.

2. I believe if you start (at 65) on a MA plan, then switch off in the 1st year, you can get on a Medigap plan.

3. I don't know all the details, but I think if you are on an MA plan and then do not have the availability of an MA plan, you can get a Medigap supplement.

I do agree that your probability/possibility of going to Original medicare and the ability (or not) of getting a MediGap plan is a consideration.

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Re: Medicare Advantage vs. Supplemental

Post by nisiprius » Sat Oct 14, 2017 12:43 pm

When I was looking around several years ago, I ended up with traditional Medicare + supplemental for these reasons. Everything depends on your area and your situation.

1) There was not a huge difference in total cost. Medicare Advantage had considerably lower premiums, but considerably higher out-of-pocket expenses. I used the cost estimates from the medicare.gov website. When I looked at the total cost, Medicare Advantage was lower, but it was like, you know, 10% or 15% lower, not like half the cost.

2) I spend some quality time looking up doctors on the Medicare provider directory and calling, and at least in our area I could not find any doctors I had ever used or thought I might use that didn't take Medicare assignment. The impression I got was the the "network" of providers accepting Medicare assignment was wider than any HMO network (as well as being national).

3) The biggie: I was unable after reasonable effort to get a straight consistent answer to this question: "If I sign up with your Medicare Advantage plan for a few years and I don't like it, do I have a right to switch to traditional Medicare and Medigap?" By the way, please don't respond to this post by giving what you think is the answer. It's complicated, it almost certainly varies by state, and the point is that the person I was talking to told me one thing; the printed plan literature told me another; and the insurance company's website told me a third. One piece of print material used the phrase "continuous open enrollment" and when I asked the rep to explain exactly what that meant, she said she couldn't because there was no such thing as "continuous open enrollment." Since I didn't see any compelling reason to go with Medicare Advantage, I decided I didn't want to risk the possibility of misunderstanding something--or something changing--and being locked in and unable to go back to traditional Medicare and Medigap.
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dm200
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 12:59 pm

nisiprius wrote:
Sat Oct 14, 2017 12:43 pm
When I was looking around several years ago, I ended up with traditional Medicare + supplemental for these reasons. Everything depends on your area and your situation.
1) There was not a huge difference in total cost. Medicare Advantage had considerably lower premiums, but considerably higher out-of-pocket expenses. I used the cost estimates from the medicare.gov website. When I looked at the total cost, Medicare Advantage was lower, but it was like, you know, 10% or 15% lower, not like half the cost.
2) I spend some quality time looking up doctors on the Medicare provider directory and calling, and at least in our area I could not find any doctors I had ever used or thought I might use that didn't take Medicare assignment. The impression I got was the the "network" of providers accepting Medicare assignment was wider than any HMO network (as well as being national).
3) The biggie: I was unable after reasonable effort to get a straight consistent answer to this question: "If I sign up with your Medicare Advantage plan for a few years and I don't like it, do I have a right to switch to traditional Medicare and Medigap?" By the way, please don't respond to this post by giving what you think is the answer. It's complicated, it almost certainly varies by state, and the point is that the person I was talking to told me one thing; the printed plan literature told me another; and the insurance company's website told me a third. One piece of print material used the phrase "continuous open enrollment" and when I asked the rep to explain exactly what that meant, she said she couldn't there was no such thing as "continuous open enrollment." When I showed her the print piece, she could only say "I've never seen that." Since I didn't see any compelling reason to go with Medicare Advantage, I decided I didn't want to risk being locked in and unable to go back to traditional Medicare and Medigap.
Yes - I agree that #3 is complicated AND difficult to know and understand.

Our Medicare plan is Medicare Cost (like MA). I believe it is less or much less expensive than Original Medicare and a supplement. [of course a lot depends on how sick you are or become]. In addition to the Medicare part B payment, we only pay $25 per month ($30 next year). Primary care visits are $20 and specialists are $45. About half of what I do with my Primary care physician is by email or phone (no charge) and there is a wonderful urgent care facility (can keep you up to 24 hours) that we use or would use for about 99% of what would otherwise be en ER visit. We judge the quality of care (physicians, facilities, other providers, etc.) to be very high as well. Referrals to specialists are easy and very fast. No need to find a specialist and wait for an appointment. Depending on the nature of the specialty, it is common that my PCP just consults him/her and gets back to me with no visit needed and no charge for the specialist.

The plan includes drug coverage as well. Optometry exams (including refractions) are included for a copay of $20. The only (to me) downside/risk is the annual out of pocket maximum (if I had significant problems, hospitalization, surgery, etc.) is $5,500 this year and $6,000 next year.

I can also say that I could not reach these totally positive conclusions just from reading the plan documents. Also, small things/issues add up. For about 10-15 years, away from this plan, several physicians offices were adjacent to a local hospital and it cost $4 (later $5) to park for their office visits. With our current plan, parking is free at all facilities. During that 10-15 years, neither was there any after hours care available - except for the ER.

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Re: Medicare Advantage vs. Supplemental

Post by RustyShackleford » Sat Oct 14, 2017 2:49 pm

Thanks very much, everyone, for your thoughtful responses. Here are my takeaways ...

1. I'm more likely to have more choice in providers with Medigap (vs. Medicare Advantage). Though I've called every doctor I've seen in the last years, including 4 specialists, and they all take the United Healthcare Medicare Advantage Plan (the only one I can get, at least that's subsidized by my retiree insurance). But who knows about if I travel out of my area ?

2. If in doubt, it makes more sense to start with Medigap, since I can always switch to Advantage during open enrollment. I can switch the other way as well, but subject to medical underwriting by the Medigap provider.

3. Get "Medicare for Dummies". (Just ordered from Amazon, but "not yet released"; hopefully it'll arrive in time for my decision, the end of November).

4. My premiums will be more if I go the Medigap route (the "enhanced" MA plan is $64/mo, whereas the Medigap F or G start at $100+/month and go up as you age), but out-of-pocket expenses will almost certainly be less.

5. My concerns about claims hassles if I go the Medigap route (with three levels of insurance: Medicare, 70/30, Medigap) are mostly unfounded, based on experiences related here.
Last edited by RustyShackleford on Sat Oct 14, 2017 2:58 pm, edited 3 times in total.

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Re: Medicare Advantage vs. Supplemental

Post by RustyShackleford » Sat Oct 14, 2017 2:54 pm

blmarsha123 wrote:
Thu Oct 12, 2017 9:23 pm
I could be wrong, but I think that what your company is saying is that either the UHC MA plan or the BCBS 70/30 plan would become secondary to Medicare.
Correct.
If the BCBS plan does not include drug coverage, then you would need a Part D plan. There would be no "fourth" policy or provider.
The BCBS plan does include drug coverage, but it's not that great, so probably would want Part D too.

The four I count are: Medicare (A&B), BCBS 70/30, Medigap Plan F or Plan G, drug Plan D.

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Re: Medicare Advantage vs. Supplemental

Post by GerryL » Sat Oct 14, 2017 3:23 pm

RustyShackleford wrote:
Sat Oct 14, 2017 2:49 pm
Thanks very much, everyone, for your thoughtful responses. Here are my takeaways ...

1. I'm more likely to have more choice in providers with Medigap (vs. Medicare Advantage). Though I've called every doctor I've seen in the last years, including 4 specialists, and they all take the United Healthcare Medicare Advantage Plan (the only one I can get, at least that's subsidized by my retiree insurance). But who knows about if I travel out of my area ?

2. If in doubt, it makes more sense to start with Medigap, since I can always switch to Advantage during open enrollment. I can switch the other way as well, but subject to medical underwriting by the Medigap provider.

3. Get "Medicare for Dummies". (Just ordered from Amazon, but "not yet released"; hopefully it'll arrive in time for my decision, the end of November).

4. My premiums will be more if I go the Medigap route (the "enhanced" MA plan is $64/mo, whereas the Medigap F or G start at $100+/month and go up as you age), but out-of-pocket expenses will almost certainly be less.

5. My concerns about claims hassles if I go the Medigap route (with three levels of insurance: Medicare, 70/30, Medigap) are mostly unfounded, based on experiences related here.
A few more notes:
I (like many) went through all these thought processes a few years ago. I opted for original Medicare with Medigap F high-deductible. I am not a heavy consumer of medical care and appreciate the low monthly premium. I have had no billing issues with the few doctors I have used.

Like you, I figured I could always switch to an MA plan if needed, but I don't really see myself doing that, at least not in the foreseeable future.

In addition to Medicare, Medigap and Part D drug plan, I also have to manage payments for separate vision and dental plans. I do this through auto premium payments and a spreadsheet to keep track of all medical expenses that may count toward a tax deduction. During the annual open enrollment, I only need to revisit the Part D Drug plan and make a decision about continuing dental coverage.

While you're waiting for your copy of Medicare for Dummies to arrive, see if you can check out an older edition from the library. Much of the basic explanations are not going to change, and you will have the newer info coming soon. (Also, I think the author maintains a website where you might find info about changes.) Good luck. Soon you will be helping your younger friends navigate the Medicare maze.

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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 3:29 pm

RustyShackleford wrote:
Sat Oct 14, 2017 2:49 pm
Thanks very much, everyone, for your thoughtful responses. Here are my takeaways ...
1. I'm more likely to have more choice in providers with Medigap (vs. Medicare Advantage). Though I've called every doctor I've seen in the last years, including 4 specialists, and they all take the United Healthcare Medicare Advantage Plan (the only one I can get, at least that's subsidized by my retiree insurance). But who knows about if I travel out of my area ?
2. If in doubt, it makes more sense to start with Medigap, since I can always switch to Advantage during open enrollment. I can switch the other way as well, but subject to medical underwriting by the Medigap provider.
3. Get "Medicare for Dummies". (Just ordered from Amazon, but "not yet released"; hopefully it'll arrive in time for my decision, the end of November).
4. My premiums will be more if I go the Medigap route (the "enhanced" MA plan is $64/mo, whereas the Medigap F or G start at $100+/month and go up as you age), but out-of-pocket expenses will almost certainly be less.
5. My concerns about claims hassles if I go the Medigap route (with three levels of insurance: Medicare, 70/30, Medigap) are mostly unfounded, based on experiences related here.
#1 - yes - travel might (check details) be an issue, but I suspect emergency/urgent care for short term travel is probably covered

#2 - I am quite sure you can go from an MA plan to Original/medigap after one year without a problem.

#4 - your "out of pocket" expenses for an MA plan will depend on services received. If you don't have significant problems/issues the out of pocket for the MA plan could be very low.

I strongly suspect that the MA plan INCLUDES drug coverage (most, but not all, do)

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Re: Medicare Advantage vs. Supplemental

Post by itstoomuch » Sat Oct 14, 2017 3:35 pm

Moda Medicare Advantage, 2018, Oregon @ $119/mn ($117 for 2017)includes D (20% copay?), $3400 deduct, $25 copay/visit, and free gym membership which we (I) use daily because of the machines, pool, sauna, hottub, steamroom, showers, and plenty of retirees and parttime mermaid help :annoyed .

it's easy.
YMedicareMV
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 3:40 pm

itstoomuch wrote:
Sat Oct 14, 2017 3:35 pm
Moda Medicare Advantage, 2018, Oregon @ $119/mn ($117 for 2017)includes D (20% copay?), $3400 deduct, $25 copay/visit, and free gym membership which we (I) use daily because of the machines, pool, sauna, hottub, steamroom, showers, and plenty of retirees and parttime mermaid help :annoyed .
it's easy.
YMedicareMV
Do you mean $3,400 deductible OR $3,400 maximum out of pocket? My guess (based on our plan and your premium of $119) is that you mean $3,400 maximum out of pocket.

Part time mermaid help ?? Can you elaborate??

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Re: Medicare Advantage vs. Supplemental

Post by itstoomuch » Sat Oct 14, 2017 4:03 pm

^$3400 deductible and $3400 max annual Out-of-packet.

mermaids=is the name my wife calls the Silver & Fit leader, counter help, and stretch therapist :wink:

This is the recommendation of another FA that I use. His wife (MD) is head of the local Kaiser office.
YMMV
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 4:17 pm

itstoomuch wrote:
Sat Oct 14, 2017 4:03 pm
^$3400 deductible and $3400 max annual Out-of-packet.

mermaids=is the name my wife calls the Silver & Fit leader, counter help, and stretch therapist :wink:

This is the recommendation of another FA that I use. His wife (MD) is head of the local Kaiser office.
YMMV
My Kaiser Medicare plan does not have annual deductible, $25 ($30 in 2018) per month and $5,500 ($6,000 in 2018) max out of pocket.

No gym/pool benefits, BUT I am not into pool/swimming and our county has a great rec/fitness centers deal for seniors ($90/year for DW and I)

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Re: Medicare Advantage vs. Supplemental

Post by itstoomuch » Sat Oct 14, 2017 4:24 pm

^ Kaiser Permanente; $127/mn; $2500 oop; $15/visit, includes D @0-15% copay, The FA's wife is head of local Kaiser. We wanted to use our primary of 25 years.

Kaiser P with higher OOP: $44/mn, $25/visit, $4900 oop. same drug benefit
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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 4:27 pm

itstoomuch wrote:
Sat Oct 14, 2017 4:24 pm
^ Kaiser Permanente; $127/mn; $2500 oop; $15/visit, includes D @0-15% copay, The FA's wife is head of local Kaiser. We wanted to use our primary of 25 years.
If/when the particular Physician is no longer an issue, then you can always switch down the road. In our case, changing all Physicians going to Kaiser was not a problem for either DW or me. I am very happy with my Kaiser Primary Care Physician, but I don't think DW would like her at all. DW does like her PCP. It is so easy to change your PCP in our plan - would take about 10 seconds online and no reason needed. I actually know several folks who really dislike my PCP and have switched away. There are now so many Primary Care Physicians available in our Kaiser plan - you can choose older or younger, male or female (although female greatly outnumber male), speakers of many different languages, natives of many different countries around the world, as well as some with DO degrees vs MD. In Primary Care for adults in this area, some are "Family Practice" and some are "Internal Medicine".
Last edited by dm200 on Sat Oct 14, 2017 4:37 pm, edited 1 time in total.

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Re: Medicare Advantage vs. Supplemental

Post by itstoomuch » Sat Oct 14, 2017 4:33 pm

Yes.
My primary decided that she didnt want to go around Mt Hood in the winter and dodge the fires in the summer. So she up and left for Hawaii, taking her horses with her. We will be moving to WA probably in 2018 so we will change to a new Medicare plan.
Rev90517; 4 Incm stream buckets: SS+pension; dfr'd GLWB VA & FI anntys, by time & $$ laddered; Discretionary; Rentals. LTCi. Own, not asset. Tax 25%. Early SS. FundRatio (FR) >1.1 67/70yo

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Re: Medicare Advantage vs. Supplemental

Post by celia » Sat Oct 14, 2017 5:05 pm

RustyShackleford wrote:
Sat Oct 14, 2017 2:54 pm
The four I count are: Medicare (A&B), BCBS 70/30, Medigap Plan F or Plan G, drug Plan D.
Rusty, I don't think you can have an employer secondary plan AND a Medigap plan and don't know why you would even want that since one of them would never make any payments, as far as I know. When Medicare gets done making their payment, they automatically send the rest of the bill to your designated secondary insurance. A BCBS 70/30 plan through an employer IS NOT a Medigap plan. We were in that situation when we turned 65 (Medicare + employer secondary plan, no longer working) but had a hard time getting on a Medigap plan later since we had to go though medical underwriting.

In addition, you probably want to look for coverage for the most severe expense which would likely be extended hospitalization. MA plans and Medigap plans both cover unlimited hospitalization, but does your employer plan?

If you "want" four plans, then get: Medicare (A&B), Medigap Plan F/G, Drug plan, and vision/dental plan (found on your own).

Also, be aware that Plan F is being discontinued for new enrollees in 2020. Those on the plan may stay on it, but it is often assumed that those in the plan will only getting older and sicker as time goes on and make the premiums increase more than when younger/healthier seniors were able to join. You can always downgrade from Plan F to one a plan that offers fewer benefits, but you can't upgrade to a plan with more benefits unless you go thru medical underwriting again.

dm200 wrote:
Sat Oct 14, 2017 3:29 pm
#2 - I am quite sure you can go from an MA plan to Original/medigap after one year without a problem.
According to this page: Entering and Leaving Medicare Advantage Plans, you can return to the original Medigap plan you had if you go back within a year. I don't know what the rule is if you never had a Medigap plan.

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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 5:30 pm

dm200 wrote:
Sat Oct 14, 2017 4:17 pm
itstoomuch wrote:
Sat Oct 14, 2017 4:03 pm
^$3400 deductible and $3400 max annual Out-of-packet.
mermaids=is the name my wife calls the Silver & Fit leader, counter help, and stretch therapist :wink:
This is the recommendation of another FA that I use. His wife (MD) is head of the local Kaiser office.
YMMV
My Kaiser Medicare plan does not have annual deductible, $25 ($30 in 2018) per month and $5,500 ($6,000 in 2018) max out of pocket.
No gym/pool benefits, BUT I am not into pool/swimming and our county has a great rec/fitness centers deal for seniors ($90/year for DW and I)
I can also get a "high option" for about $100 MORE per month with lower copays (such a $10 primary care) and lower out of pocket max (I think about $3,500).

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Re: Medicare Advantage vs. Supplemental

Post by solobuildingblogs » Sat Oct 14, 2017 6:07 pm

From the standpoint of someone who is years away from medicare eligibility but runs a solo doctor's office:

Medicare with supplement gives you more choice. While I realize every area is different, the medicare advantage plans here have narrow networks and I often have patients phoning my office complaining they can't find a doctor in network that's close to their house, or that has a appointment in a timely fashion. In some fields, the offices that accept these plans run an assembly line. They have to, because they're exchanging lower reimbursements per patient for being guaranteed a patient population.

Keep in mind that if you're hospitalized, sometimes not every doctor that consults on you is in network for MA. I'd venture to guess that most are with traditional medicare.

Anytime you introduce a middleman who wants to make a profit, it's gonna be at someone's expense and someone is gonna lose- in this case the doctor and patient. Essentially, the way these commercial MA plans make money is by narrowing the network, making it harder for patients to see doctors and get care.

I know exactly how I would advise someone over 65 that can afford a supplement/ medigap to proceed... what may look like a savings of a couple hundred bucks per year may turn into a disaster if you have a unusual condition that needs referral to a specialist that no one in the MA network can treat... of course you can always get your MA to authorize a out of network auth but that's a hassle...

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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sat Oct 14, 2017 7:10 pm

solobuildingblogs wrote:
Sat Oct 14, 2017 6:07 pm
From the standpoint of someone who is years away from medicare eligibility but runs a solo doctor's office:
Medicare with supplement gives you more choice. While I realize every area is different, the medicare advantage plans here have narrow networks and I often have patients phoning my office complaining they can't find a doctor in network that's close to their house, or that has a appointment in a timely fashion. In some fields, the offices that accept these plans run an assembly line. They have to, because they're exchanging lower reimbursements per patient for being guaranteed a patient population.
Keep in mind that if you're hospitalized, sometimes not every doctor that consults on you is in network for MA. I'd venture to guess that most are with traditional medicare.
Anytime you introduce a middleman who wants to make a profit, it's gonna be at someone's expense and someone is gonna lose- in this case the doctor and patient. Essentially, the way these commercial MA plans make money is by narrowing the network, making it harder for patients to see doctors and get care.
I know exactly how I would advise someone over 65 that can afford a supplement/ medigap to proceed... what may look like a savings of a couple hundred bucks per year may turn into a disaster if you have a unusual condition that needs referral to a specialist that no one in the MA network can treat... of course you can always get your MA to authorize a out of network auth but that's a hassle...
Very good points from experiences with MA plans. I do not question these points for certain plans and/or certain areas. However, there are huge differences with different MA (or the similar MC) plans. That is why, in my view, it is vital to speak with both happy and unhappy participants of MA or MC plans being considered. Some MA (or MC) plans (like ours) take a proactive approach in finding an appropriate specialist for your condition. A recent example of mine - I had voice hoarseness for a few weeks. I emailed my Primary Care Physician about it in the middle of a Wednesday afternoon. She replied that evening and I saw the reply early on Thursday morning - if I thought I had an infection, see her. If I thought I did not, she would refer me to an ENT specialist. I replied I had no known infection and about 9:30 am I received a call from the ENT office that I would be seen by an ENT before noon that day. I actually had to hustle to arrive for the appointment on time. I was truly amazed at how quickly this was done - and this is well beyond what I would even expect. My wife last year had a similar experience with symptoms of dizziness/vertigo and was evaluated, had multiple scans/tests, saw a neurologist and more scan/tests - all within about 60 hours - start to finish, including an overnight stay at the urgent care facility. She is fine - nothing serious detected and problems have not recurred.

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Re: Medicare Advantage vs. Supplemental

Post by Dandy » Sun Oct 15, 2017 8:51 am

I have Medicare and my company plan as secondary. I chose that vs having Medi gap since I wanted to preserve the ability to go to the best doctor available vs the best that takes Medicare. This focus was made clear when 20 years ago my wife had a life threatening illness and by chance I could have her treated by the head doctor of a major NYC hospital. What would I have done if I had to pay 100% out of pocket to get the best doctor vs seeing the best in my plan at little or no cost? I know I would have chosen the best doctor and that might have cost me plenty. I am fortunate to be able to afford the extra hassle and expense of not having Medigap. Just something to keep in mind since you are more focused on having the best insurance not the lowest cost.

I believe many Medicare Advantage plans require you to stay in a tight network of providers. But also may offer other coverages e.g. dental or other benefits even something like gym membership.

Just a comment. We have some of the best doctors, hospitals and drug firms in the world and one of the worst heath insurance systems in the world. I don't see any nation trying to copy our approach which should be a clue that we need something less confusing and costly than our current patch work of health insurance coverage plans and provider networks that seem to be constantly changing coverages of providers, RX , co pays, deductibles, coinsurance percentages, insurance companies, out of pocket maximums, etc. :oops: Relief does not seem to be on the way and it is very difficult for most people to make good decisions.

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Re: Medicare Advantage vs. Supplemental

Post by blmarsha123 » Sun Oct 15, 2017 5:38 pm

dm200 wrote:
Sat Oct 14, 2017 7:10 pm
solobuildingblogs wrote:
Sat Oct 14, 2017 6:07 pm
From the standpoint of someone who is years away from medicare eligibility but runs a solo doctor's office:
Medicare with supplement gives you more choice. While I realize every area is different, the medicare advantage plans here have narrow networks and I often have patients phoning my office complaining they can't find a doctor in network that's close to their house, or that has a appointment in a timely fashion. In some fields, the offices that accept these plans run an assembly line. They have to, because they're exchanging lower reimbursements per patient for being guaranteed a patient population.
Keep in mind that if you're hospitalized, sometimes not every doctor that consults on you is in network for MA. I'd venture to guess that most are with traditional medicare.
Anytime you introduce a middleman who wants to make a profit, it's gonna be at someone's expense and someone is gonna lose- in this case the doctor and patient. Essentially, the way these commercial MA plans make money is by narrowing the network, making it harder for patients to see doctors and get care.
I know exactly how I would advise someone over 65 that can afford a supplement/ medigap to proceed... what may look like a savings of a couple hundred bucks per year may turn into a disaster if you have a unusual condition that needs referral to a specialist that no one in the MA network can treat... of course you can always get your MA to authorize a out of network auth but that's a hassle...
Very good points from experiences with MA plans. I do not question these points for certain plans and/or certain areas. However, there are huge differences with different MA (or the similar MC) plans. That is why, in my view, it is vital to speak with both happy and unhappy participants of MA or MC plans being considered. Some MA (or MC) plans (like ours) take a proactive approach in finding an appropriate specialist for your condition. A recent example of mine - I had voice hoarseness for a few weeks. I emailed my Primary Care Physician about it in the middle of a Wednesday afternoon. She replied that evening and I saw the reply early on Thursday morning - if I thought I had an infection, see her. If I thought I did not, she would refer me to an ENT specialist. I replied I had no known infection and about 9:30 am I received a call from the ENT office that I would be seen by an ENT before noon that day. I actually had to hustle to arrive for the appointment on time. I was truly amazed at how quickly this was done - and this is well beyond what I would even expect. My wife last year had a similar experience with symptoms of dizziness/vertigo and was evaluated, had multiple scans/tests, saw a neurologist and more scan/tests - all within about 60 hours - start to finish, including an overnight stay at the urgent care facility. She is fine - nothing serious detected and problems have not recurred.
Not to turn this thread into a point/counterpoint on Kaiser, but here's another real life Kaiser example ... My wife has a torn meniscus in her left knee. Kaiser's approach was to do a year of physical therapy and cortisone shots and see where we are. Gave us studies, papers that supported not scoping the knee even though her right knee was scoped a couple of years prior (non-Kaiser) and gives her no problems or pain since. Well, 8 months in she comes home complaining of terrible pain in her leg, above the knee to the toes. Tender to the touch. Described the pain as a broken leg, a 9 on the 1-10 scale (and this is someone who has a very high tolerance for pain). Went to after-hours ER (I think Kaiser calls it RADAR or something). Were there over three hours. Never saw a physician. Got an ultrasound, which took all of 5 minutes and was worthless (wife knows what a good ultrasound tech should do), indicating nothing obvious. Ditto for the CAT scan. The NP or whatever she was says "Well, we are at a loss. We've ruled out a blood clot and we don't see anything else obvious. Since you already have an appt with the orthopedic dept in 10 days, maybe they can help." And she gets released with a set of crutches. No pain or anti inflammatory medication. No mention of MRI. No mention of having her examined by a physician. Nothing. (And later, we get billed for almost $600 OOP for this ER "care" and gem of a diagnosis.) Turns out (after ranting to her primary care physician and getting immediately scheduled for an MRI and follow up with orthopedic surgeon along with a script for medications), she suffered a stress fracture, hence the broken leg feeling. But the orthopedic dept does nothing, except to say to stay off the leg for 4 - 6 weeks and then come back for a follow up. Oh yeah, and gives her another study paper on why scoping the knee isn't recommended.

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Re: Medicare Advantage vs. Supplemental

Post by dm200 » Sun Oct 15, 2017 7:07 pm

Not to turn this thread into a point/counterpoint on Kaiser, but here's another real life Kaiser example ... My wife has a torn meniscus in her left knee. Kaiser's approach was to do a year of physical therapy and cortisone shots and see where we are. Gave us studies, papers that supported not scoping the knee even though her right knee was scoped a couple of years prior (non-Kaiser) and gives her no problems or pain since. Well, 8 months in she comes home complaining of terrible pain in her leg, above the knee to the toes. Tender to the touch. Described the pain as a broken leg, a 9 on the 1-10 scale (and this is someone who has a very high tolerance for pain). Went to after-hours ER (I think Kaiser calls it RADAR or something). Were there over three hours. Never saw a physician. Got an ultrasound, which took all of 5 minutes and was worthless (wife knows what a good ultrasound tech should do), indicating nothing obvious. Ditto for the CAT scan. The NP or whatever she was says "Well, we are at a loss. We've ruled out a blood clot and we don't see anything else obvious. Since you already have an appt with the orthopedic dept in 10 days, maybe they can help." And she gets released with a set of crutches. No pain or anti inflammatory medication. No mention of MRI. No mention of having her examined by a physician. Nothing. (And later, we get billed for almost $600 OOP for this ER "care" and gem of a diagnosis.) Turns out (after ranting to her primary care physician and getting immediately scheduled for an MRI and follow up with orthopedic surgeon along with a script for medications), she suffered a stress fracture, hence the broken leg feeling. But the orthopedic dept does nothing, except to say to stay off the leg for 4 - 6 weeks and then come back for a follow up. Oh yeah, and gives her another study paper on why scoping the knee isn't recommended.
I think I would be unhappy as well. Our (multiple) experiences were nothing like this at all. Cannot understand or explain :confused

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Re: Medicare Advantage vs. Supplemental

Post by beardsworth » Mon Oct 16, 2017 9:47 am

When this thread was still young, I was exchanging Private Messages with the OP through this site. For just that reason, privacy, I’m not going to divulge anyone's personal details here.

But it’s a fact, whether on this forum or elsewhere, that the quality of perspectives and recommendations can only be as good as the underlying information provided, and in that sense there are a number of misimpressions above, which the OP has not been systematically correcting.

•The Medicare Advantage plan in question is in fact a “preferred provider” scheme with a network of “participating” providers. However, its network implementation is relatively open. If a provider accepts Medicare and will file with the plan and abide by its payments, the plan will treat the provider as in–network even if the provider is not actually on the official list of participants.

•The plan’s literature explicitly states that coverage is national, and the network in question is essentially the entire (and enormous) nationwide population of United Healthcare participating providers.

•Care outside the OP’s immediate geographical area, or the OP's new geographical area if the OP were to relocate in retirement, is therefore essentially a non-issue.

•The insured does not need to seek a network provider in the event of a medical emergency. Furthermore, emergency coverage under the plan is explicitly provided anywhere in the world.

•The most substantial co-pay in the basic version of the plan, in accordance with Medicare practice, is $150 per day for the first 10 days of inpatient hospitalization. This expense would obviously not be incurred in any year in which a participant was not hospitalized.

•The plan has co–pays for doctor office visits (under the basic version of the plan, $20 for a primary care doctor and $40 for a specialist) and assorted other services. Under the base version of the plan, there is a maximum annual co-pay of $4000 per year for all hospitalizations, doctors, tests, therapies, and other non-drug expenses combined. However, the plan has no deductibles which must be met before expenses begin to “count” against the total annual co–pay. In any case, it would be relatively rare for anyone to have a hospitalization or surgery very year, or even in a majority of years, and so this maximum co-pay would not likely to be a factor in most years, and is substantially offset by the plan's very low monthly premium.

•The plan does have co-pays, by expense tier, for individual drugs on its very large approved formulary. However, unlike a privately purchased Medicare Part D supplement for drugs, the plan does not have any “doughnut hole” during which no drug benefits are paid.

•Furthermore, and also unlike a private Part D drug supplement, the plan caps the participant’s out-of-pocket expense share for all drugs combined, regardless of type or price tier, at $2,500 per year.

•The plan’s drug benefit gives a discount for 90-day refills of “maintenance” drugs, so that the insured's out-of-pocket cost for a 90-day supply is generally only twice, rather than three times, the cost of a 30-day supply.

•Participation in the plan also confers free use, nationwide, of any facility in the Silver Sneakers fitness club network.

•Almost all private Medigap supplements in the OP’s state are “age rated,” meaning that premiums will regularly increase as the policy holder ages. This plan, however, is, functionally if not officially, a “community-rated” plan, since the monthly premium for an 85-year-old participant is exactly the same as the monthly premium for a 65-year-old.

•The monthly premium for the base version of this employer-sponsored Medicare Advantage plan is zero. For the slightly more generous enhanced version, the monthly premium is $66. A person in reasonably good health, who did not reasonably expect to have a lot of hospital stays, surgeries, and outpatient procedures in most years, might therefore prefer this plan, with its lower premium structure, as good basic coverage compared to a private Medicare supplement whose premium would be higher than this plan’s premium at age 65 and would then continuously increase from there. (And we can, for example, already predict what is about to happen to people who bought the very generous private Medigap F, which in a few years will close to the admission of newer, and therefore younger and presumably less sickly, participants.) Even aside from the question of expected vs. unexpected hospital visits and surgeries, a person with substantial current or anticipated drug costs might be attracted by this plan’s $2,500 annual cap on total patient drug co-pays, especially in light of a zero premium for the base version of the plan. Regardless of current or expected drug regimens, the plan's absence of a no-benefits doughnut hole is attractive in its own right, and even more so when the premium structure is considered.

None of the above is intended to say which of these choices, Advantage vs. private supplements, is the “right” one for the OP. That decision which must be his. It does mean however, that a substantial number of replies above have been based on generic impressions of “what a Medicare Advantage plan is like” or “what it's like to deal with a provider network,” or what drugs costs may be, rather than the specific ways in which this particular Medicare Advantage plan operates.
Last edited by beardsworth on Mon Oct 16, 2017 10:40 am, edited 1 time in total.

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Re: Medicare Advantage vs. Supplemental

Post by plannerman » Mon Oct 16, 2017 10:08 am

Here in Western NC, the largest insurer in the state, BCBS NC, and the largest hospital system, Mission, have had a falling out--the hospital is no longer in network for BCBS.

As I understand it, this does not affect traditional Medicare/Medigap patients but does affect those with BCBS Medicare Advantage plans--both PPO and HMO.

Just a heads up for those who are considering Medicare Advantage Plans and are assuming current providers that are in network will remain so.

plannerman

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Re: Medicare Advantage vs. Supplemental

Post by RustyShackleford » Mon Oct 16, 2017 12:49 pm

beardsworth wrote:
Mon Oct 16, 2017 9:47 am
When this thread was still young, I was exchanging Private Messages with the OP through this site. For just that reason, privacy, I’m not going to divulge anyone's personal details here.

But it’s a fact, whether on this forum or elsewhere, that the quality of perspectives and recommendations can only be as good as the underlying information provided, and in that sense there are a number of misimpressions above, which the OP has not been systematically correcting.
Thanks for this, Beardsworth. You're entirely correct that most of the responses have been generic and not specific to my particular situation. In fact, by summarizing the details of the MA plan being offered, I think you have helped me decide in favor of that. I feel like I'm in an enviable situation now of needing to be concerned not so much with minimizing costs, as with avoiding black swans. You correctly point out that a future need for very expensive non-covered drugs could make the $2500 annual out-of-pocket max for the MA plan a deciding factor.

RustyShackleford
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Joined: Thu Sep 13, 2007 12:32 pm
Location: NC

Re: Medicare Advantage vs. Supplemental

Post by RustyShackleford » Mon Oct 16, 2017 12:54 pm

plannerman wrote:
Mon Oct 16, 2017 10:08 am
Here in Western NC, the largest insurer in the state, BCBS NC, and the largest hospital system, Mission, have had a falling out--the hospital is no longer in network for BCBS.

As I understand it, this does not affect traditional Medicare/Medigap patients but does affect those with BCBS Medicare Advantage plans--both PPO and HMO.

Just a heads up for those who are considering Medicare Advantage Plans and are assuming current providers that are in network will remain so.
Thanks for the heads-up, but the MA plan being offered to me is not with BCBS.

I guess it's always a risk, with any health insurance plan that has an in-network/out-of-network distinction, that a provider could leave the network.

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dm200
Posts: 13141
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Location: Washington DC area

Re: Medicare Advantage vs. Supplemental

Post by dm200 » Mon Oct 16, 2017 1:42 pm

plannerman wrote:
Mon Oct 16, 2017 10:08 am
Here in Western NC, the largest insurer in the state, BCBS NC, and the largest hospital system, Mission, have had a falling out--the hospital is no longer in network for BCBS.
As I understand it, this does not affect traditional Medicare/Medigap patients but does affect those with BCBS Medicare Advantage plans--both PPO and HMO.
Just a heads up for those who are considering Medicare Advantage Plans and are assuming current providers that are in network will remain so.
plannerman
Not unique to its Medicare plan, but in this area (Virginia suburbs of Washington DC), Kaiser (except for ER) dropped its affiliation with (I think) the largest hospital group (Inova) and now sends patients needing actual hospitalization to several other hospitals. No impact on us because the hospital Kaiser uses most in the area is the one nearest us and (in my opinion) is a fine hospital. At that hospital (as with others used by Kaiser) there are Kaiser physicians (hospitalists) on regular duty (all shifts, I think) there and some wings are desingated for Kaiser patients.

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