Original Medicare vs. Medicare Advantage

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enad
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Re: Original Medicare vs. Medicare Advantage

Post by enad »

Leesbro63 wrote: Thu Oct 06, 2022 7:58 am Someone above mentioned Plan N. A friend of mine, who is turning 65 soon, just signed up for Plan N. What are the benefits of Plan G over Plan N for the extra cost?
Per the link I supplied:

Plan N is comparable to plan G but you also have a $50 co-pay for Emergency Room, $20 co-pay for doctors (after the deductible, not in addition to it) and the potential 15% excess. More popular than HDG but still requested less than 10% of the time. If someone was considering an Advantage plan, the author would consider this plan first for all of its freedom of provider choice and lower out of pocket – plus zero out of pocket hospital coverage.
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

enad wrote: Thu Oct 06, 2022 8:02 am
Leesbro63 wrote: Thu Oct 06, 2022 7:58 am Someone above mentioned Plan N. A friend of mine, who is turning 65 soon, just signed up for Plan N. What are the benefits of Plan G over Plan N for the extra cost?
Per the link I supplied:

Plan N is comparable to plan G but you also have a $50 co-pay for Emergency Room, $20 co-pay for doctors (after the deductible, not in addition to it) and the potential 15% excess. More popular than HDG but still requested less than 10% of the time. If someone was considering an Advantage plan, the author would consider this plan first for all of its freedom of provider choice and lower out of pocket – plus zero out of pocket hospital coverage.
Plan N has been increasing in popularity.

In the first 6 months of 2022, 38% of newly eligible Medicare participants who chose a Medigap plan picked Plan N:

https://medicaresupp.org/medicare-data-2022/#Turning-65

It appears the agent prepared their write-up in 2021 and was either discussing the total Medigap population (not people who were currently enrolling in Medigap plans) or had outdated or incorrect information.

The agent also apparently does not understand Plan G-HD:

“High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.”

This is just plain wrong. With a Plan G-HD, after you pay the $233 Part B deductible, Medicare would pick-up 80% of the Medicare-approved reimbursement rate. You would just be responsible for the other 20%, until you have paid $2,490 (in 2022) for the year.
McDougal
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Re: Original Medicare vs. Medicare Advantage

Post by McDougal »

Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
Chuckles960
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Re: Original Medicare vs. Medicare Advantage

Post by Chuckles960 »

McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

Chuckles960 wrote: Thu Oct 06, 2022 11:45 am
McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
It makes no difference if you sign-up for Part A, except if you still want to contribute to an HSA after age 65.

If you sign-up for Part A, you are no longer eligible to contribute to an HSA.
Leesbro63
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Re: Original Medicare vs. Medicare Advantage

Post by Leesbro63 »

Chuckles960 wrote: Thu Oct 06, 2022 11:45 am
McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
So if you sign up for Part A, does the employer (or, perhaps self-employed insurance) get a lower rate on the continuing (non-Medicare) insurance? Because the big risk (hospitalization costs) to the insurer has now been accepted by Uncle Sam.
Last edited by Leesbro63 on Thu Oct 06, 2022 12:23 pm, edited 1 time in total.
runninginvestor
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Re: Original Medicare vs. Medicare Advantage

Post by runninginvestor »

Fremdon Ferndock wrote: Tue Oct 04, 2022 10:28 am [...]

3) Medicare Advantage plans usually pay just 20 days in a LTC or rehab facility; after that the copays can be in the neighborhood of $200/day for 21- 100 days. Medicare also pays just 20 days and the copay is similar for 21-100 days; however, your Medigap plan will pick up the copay so it costs you nothing for up to 100 days. Friend recently broke her leg and had to stay in rehab for 3 months; Medicare + Medigap covered it. If she'd been on an Advantage plan she would have paid $200/day for the next 80 days, or $16K. So, you're much better off on Medicare if you need a long stay in rehab or a LTC factility; but you need a 3 night prior stay in a hospital to qualify; most Medicare Advantage plans don't require the 3 might stay.

[...]
One question on this, if the SNF was in network (or even out of network in a ppo) , the MOOP (max out of pocket) for MA plans in 2022 is $7,550 in network and ~$11k combined in/out network (can't remember the exact limit for combined off the top of my head). These will increase a little bit in 2023 though.

A lot of the plans, for the skilled nursing facility and inpatient stays, they will show $x for days n through m, then $0 for days >m. That cut off, m, is basically the maximum number of days you can pay that coinsurance until you hit the out of pocket for the plan.
tj
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Re: Original Medicare vs. Medicare Advantage

Post by tj »

Leesbro63 wrote: Thu Oct 06, 2022 12:01 pm
Chuckles960 wrote: Thu Oct 06, 2022 11:45 am
McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
So if you sign up for Part A, does the employer (or, perhaps self-employed insurance) get a lower rate on the continuing (non-Medicare) insurance? Because the big risk (hospitalization costs) to the insurer has now been accepted by Uncle Sam.
Part A is secondary to an employer plan, so the employer plan would pay whatever it normally does and Part A would pay any applicable remaining benefit after coordinating.
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

tj wrote: Thu Oct 06, 2022 12:27 pm
Leesbro63 wrote: Thu Oct 06, 2022 12:01 pm
Chuckles960 wrote: Thu Oct 06, 2022 11:45 am
McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
So if you sign up for Part A, does the employer (or, perhaps self-employed insurance) get a lower rate on the continuing (non-Medicare) insurance? Because the big risk (hospitalization costs) to the insurer has now been accepted by Uncle Sam.
Part A is secondary to an employer plan, so the employer plan would pay whatever it normally does and Part A would pay any applicable remaining benefit after coordinating.
Part A is secondary if the employer has 20 or more employees.

Part A is primary if the employer has less than 20 employees.

https://www.medicare.gov/basics/get-sta ... ng-past-65
Leesbro63
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Re: Original Medicare vs. Medicare Advantage

Post by Leesbro63 »

ModifiedDuration wrote: Thu Oct 06, 2022 12:38 pm
tj wrote: Thu Oct 06, 2022 12:27 pm
Leesbro63 wrote: Thu Oct 06, 2022 12:01 pm
Chuckles960 wrote: Thu Oct 06, 2022 11:45 am
McDougal wrote: Thu Oct 06, 2022 10:41 am Regarding underwriting, question about a person who opts not to apply for Medicare (all of it - A and B, D, medigap supplement, Medicare advantage) at age 65 because they are covered by a qualified plan at work. When their work plan ends and they do apply at a later age, is underwriting waived, does it automatically apply, does it depend on choice of MA or medigap? Does age matter? Case by case basis? Curious how this situation is handled.
The rules are clear...in short, it is no different from if you were 65.

Some people advise signing up for Part A at 65, since it is free. Probably makes no difference either way.
So if you sign up for Part A, does the employer (or, perhaps self-employed insurance) get a lower rate on the continuing (non-Medicare) insurance? Because the big risk (hospitalization costs) to the insurer has now been accepted by Uncle Sam.
Part A is secondary to an employer plan, so the employer plan would pay whatever it normally does and Part A would pay any applicable remaining benefit after coordinating.
Part A is secondary if the employer has 20 or more employees.

Part A is primary if the employer has less than 20 employees.

https://www.medicare.gov/basics/get-sta ... ng-past-65
So does the small employer get a discount because this employee has the risk of hospital cost covered by Medicare?
montanagirl
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Re: Original Medicare vs. Medicare Advantage

Post by montanagirl »

protagonist wrote: Tue Oct 04, 2022 11:11 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
In your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)
There's no way of knowing. My friend broke her hip and was discharged from hospital to nursing home for rehab. They ended up keeping her the whole 100 days, but her fedgov Mail Handlers policy did not cover the 20% daily cost.

I even called MH to confirm and they said "we don't cover nursing homes!" and hung up on me, as if I'd asked about long term care.

As soon as she was able she had to go take a large distribution from her investments to pay the nursing home.
tallguy3891
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Re: Original Medicare vs. Medicare Advantage

Post by tallguy3891 »

montanagirl wrote: Thu Oct 06, 2022 5:02 pm
protagonist wrote: Tue Oct 04, 2022 11:11 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
In your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)
There's no way of knowing. My friend broke her hip and was discharged from hospital to nursing home for rehab. They ended up keeping her the whole 100 days, but her fedgov Mail Handlers policy did not cover the 20% daily cost.

I even called MH to confirm and they said "we don't cover nursing homes!" and hung up on me, as if I'd asked about long term care.

As soon as she was able she had to go take a large distribution from her investments to pay the nursing home.
The regular plans I saw listed for MHBP in FEHB have limits of 28 days or 40 days for skilled nursing facility, BUT if one has another plan or Medicare which is primary, then zero days.

However, if the person is enrolled in the newer MHBP Medicare Advantage Retiree Plan (under Standard Option), then I believe the brochure states the skilled nursing facility days could have been 100 days per Medicare benefit period. This is a "Part C" plan option specific to FEHB enrollees.
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jabberwockOG
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Re: Original Medicare vs. Medicare Advantage

Post by jabberwockOG »

michaeljc70 wrote: Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Two types of premiums that I know of are available Medigap plans - one has premium costed based on attained age, the other has premium costed as community rated. The community rated cost premium may start out a little higher but it does not increase based on your individual age. My monthly cost for a community rated AARP branded UHC Plan G is $117 per month for myself, wife is $107. I'd suggest avoiding supplement plans with attained age premiums if possible, my 90 year old mother has an attained age costed Plan F supplement and her premiums are relatively high at this point.
Last edited by jabberwockOG on Thu Oct 06, 2022 10:17 pm, edited 1 time in total.
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

jabberwockOG wrote: Thu Oct 06, 2022 6:13 pm
michaeljc70 wrote: Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Two types of premiums that I know of are available Medigap plans - one has premium costed based on attained age, the other has premium costed as community rated. The community rated cost premium may start out a little higher but it does not increase based on your individual age. My monthly cost for a community rated AARP branded UHC Plan G is $117 per month for myself, wife is $107. I'd suggest avoiding supplement plans with attained age premiums if possible, my 90 year old mother has an attained age costed Plan F supplement and her premiums are quite relatively at this point.
The third type of premium pricing for Medigap policies is issue-age, where the premium is determined based upon your age when the policy was issued. Going forward, the premium only increases with inflation.

https://www.medicare.gov/supplements-ot ... p-policies
bradinsky
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Re: Original Medicare vs. Medicare Advantage

Post by bradinsky »

jabberwockOG wrote: Thu Oct 06, 2022 6:13 pm
michaeljc70 wrote: Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Two types of premiums that I know of are available Medigap plans - one has premium costed based on attained age, the other has premium costed as community rated. The community rated cost premium may start out a little higher but it does not increase based on your individual age. My monthly cost for a community rated AARP branded UHC Plan G is $117 per month for myself, wife is $107. I'd suggest avoiding supplement plans with attained age premiums if possible, my 90 year old mother has an attained age costed Plan F supplement and her premiums are quite relatively at this point.
Hi JabberwockOG,
Your premium looks great. Could I please ask your age? I’m 70 my G plan premium for 2023 is going to be a few pennies over $160.
Chuckles960
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Re: Original Medicare vs. Medicare Advantage

Post by Chuckles960 »

jabberwockOG wrote: Thu Oct 06, 2022 6:13 pmTwo types of premiums that I know of are available Medigap plans - one has premium costed based on attained age, the other has premium costed as community rated. The community rated cost premium may start out a little higher but it does not increase based on your individual age. My monthly cost for a community rated AARP branded UHC Plan G is $117 per month for myself, wife is $107. I'd suggest avoiding supplement plans with attained age premiums if possible, my 90 year old mother has an attained age costed Plan F supplement and her premiums are quite relatively at this point.
I am sure this has been discussed ad nauseum before, but the UHC plans are NOT entirely community-based, because they give "discounts" based on age until age 81 so they are in part attained-age. This allows them to offer apparently low prices to most people, since they enrol well before age 81; but they will go up quickly.
skp
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Re: Original Medicare vs. Medicare Advantage

Post by skp »

JoeRetire wrote: Sun Oct 02, 2022 5:14 pm
Chuckles960 wrote: Sun Oct 02, 2022 3:18 pmEverything depends on the particular MA plan, and what services you personally will need in future---which of course you do not know.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
The advantage of original medicare+F/G is not that it is the cheapest plan,it is that it is the no-worries plan.
If you are willing to pay enough, you will have fewer worries.
I agree with all of this except that the I'd like to point out that "no worries plan" depends on your risk tolerance. I consider myself to have extremely low tolerance for risk, yet I still retired this month at age 65 and healthy with an Aetna Advantage plan. Up till the last minute I was convinced that I was going with a G. But I decided that we have enough assets that the 6500 out of pocket limit doesn't scare me. I figure that the savings on preventive dental, vision, gym membership, CVS OTC drugs will mitigate any co pays I may have. We are relatively healthy. It covers all the doctors and all the hospitals in the area that I can think of. The only "worry" I can think of is that as a nurse I've seen issues with covering rehab. However, out of my grandparents, and in laws- 8- only one needed rehab. I feel that the low probability of needing it, plus savings over the years and that I have assets to pay for it also mitigates the risk. If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
runninginvestor
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Re: Original Medicare vs. Medicare Advantage

Post by runninginvestor »

montanagirl wrote: Thu Oct 06, 2022 5:02 pm
protagonist wrote: Tue Oct 04, 2022 11:11 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
In your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)
There's no way of knowing. My friend broke her hip and was discharged from hospital to nursing home for rehab. They ended up keeping her the whole 100 days, but her fedgov Mail Handlers policy did not cover the 20% daily cost.

I even called MH to confirm and they said "we don't cover nursing homes!" and hung up on me, as if I'd asked about long term care.

As soon as she was able she had to go take a large distribution from her investments to pay the nursing home.
I'll link to a post I made not too long ago;
https://bogleheads.org/forum/viewtopic. ... 8#p6867038

"
"...the average length of stay has hovered around 26 days for a while. There's an interesting phenomenon in that since the underlying data has spikes (if you take the distribution) around day 7/14/20-21 as well. It's not uncommon for 7 days and 14 days to be typical stays for less severe cases, as facilities may be prone to operate on weekly programs.

Similarly, there's a spike on day 20-21 bc that's when traditional Medicare cost sharing switches to the patient, so patients will tend to want to be discharged. The average LOS around 26 days is (my conjecture) likely around how much patients are willing to bear out of pocket with a mindset of 1 more week of care , excluding paying for an extra 2 days over the weekend.

https://www.kff.org/medicare/issue-brie ... ilization/
""


Edit:
Here's a link to a site with a downloadable pdf with a little data on the 7/14/21 days spikes;
https://us.milliman.com/en/insight/vari ... facilities
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

runninginvestor wrote: Thu Oct 06, 2022 7:07 pm
montanagirl wrote: Thu Oct 06, 2022 5:02 pm
protagonist wrote: Tue Oct 04, 2022 11:11 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
In your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)
There's no way of knowing. My friend broke her hip and was discharged from hospital to nursing home for rehab. They ended up keeping her the whole 100 days, but her fedgov Mail Handlers policy did not cover the 20% daily cost.

I even called MH to confirm and they said "we don't cover nursing homes!" and hung up on me, as if I'd asked about long term care.

As soon as she was able she had to go take a large distribution from her investments to pay the nursing home.
I'll link to a post I made not too long ago;
https://bogleheads.org/forum/viewtopic. ... 8#p6867038

"
"...the average length of stay has hovered around 26 days for a while. There's an interesting phenomenon in that since the underlying data has spikes (if you take the distribution) around day 7/14/20-21 as well. It's not uncommon for 7 days and 14 days to be typical stays for less severe cases, as facilities may be prone to operate on weekly programs.

Similarly, there's a spike on day 20-21 bc that's when traditional Medicare cost sharing switches to the patient, so patients will tend to want to be discharged. The average LOS around 26 days is (my conjecture) likely around how much patients are willing to bear out of pocket with a mindset of 1 more week of care , excluding paying for an extra 2 days over the weekend.

https://www.kff.org/medicare/issue-brie ... ilization/
""


Edit:
Here's a link to a site with a downloadable pdf with a little data on the 7/14/21 days spikes;
https://us.milliman.com/en/insight/vari ... facilities
Just to mention that all Medigap plans (except A and B) will cover the $194.50 a day co-pay from days 21-100.
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enad
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Re: Original Medicare vs. Medicare Advantage

Post by enad »

skp wrote: Thu Oct 06, 2022 7:02 pm If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
It you move will you be able to keep your advantage plan? and if you have to go back to original medicare, could a plan G or N cost you more than if you enrolled at 65?
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
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JoeRetire
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Re: Original Medicare vs. Medicare Advantage

Post by JoeRetire »

enad wrote: Thu Oct 06, 2022 7:17 pm
skp wrote: Thu Oct 06, 2022 7:02 pm If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
It you move will you be able to keep your advantage plan? and if you have to go back to original medicare, could a plan G or N cost you more than if you enrolled at 65?
"If you’re moving out of your plan’s network area, you’ll have two options. You can re-enroll in another Medicare Advantage plan, perhaps one with the same provider or you can switch back to Original Medicare. If you switch back to Original Medicare, you’ll have a special right to apply for certain Medicare Supplement plans and be automatically accepted without having to answer medical questions. "
https://www.gomedigap.com/medicare-opti ... -medicare/
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ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

enad wrote: Thu Oct 06, 2022 7:17 pm
skp wrote: Thu Oct 06, 2022 7:02 pm If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
It you move will you be able to keep your advantage plan? and if you have to go back to original medicare, could a plan G or N cost you more than if you enrolled at 65?
If you have Medicare Advantage you would probably have to switch plans.

If you are going back to Original Medicare, whether the Medigap plan would cost more than for someone who enrolled at age 65 would depend on the pricing method used by the Medigap insurer:

Community pricing - since everyone pays the same premium regardless of age, it wouldn’t matter.

Attained age - if you were say 70 now, it wouldn’t matter if you joined at age 65 or at age 70, all 70 year olds would pay the same premium.

Issue age - as premium price is determined based on the age you obtain the policy, in this case whether you obtained the policy at age 65 or at a later age would make a difference.

By the way, if you move and lose your Medicare Advantage plan and switch back to Original Medicare, you would have Guaranteed Issue Rights for Plan G (and G-HD) without underwriting, but not for Plan N.

You would also have Guaranteed Issue Rights without underwriting for Plan F (and F-HD), if you were eligible for Medicare prior to January 1, 2020.
Last edited by ModifiedDuration on Thu Oct 06, 2022 8:30 pm, edited 1 time in total.
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enad
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Re: Original Medicare vs. Medicare Advantage

Post by enad »

JoeRetire wrote: Thu Oct 06, 2022 7:41 pm
enad wrote: Thu Oct 06, 2022 7:17 pm
skp wrote: Thu Oct 06, 2022 7:02 pm If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
It you move will you be able to keep your advantage plan? and if you have to go back to original medicare, could a plan G or N cost you more than if you enrolled at 65?
"If you’re moving out of your plan’s network area, you’ll have two options. You can re-enroll in another Medicare Advantage plan, perhaps one with the same provider or you can switch back to Original Medicare. If you switch back to Original Medicare, you’ll have a special right to apply for certain Medicare Supplement plans and be automatically accepted without having to answer medical questions. "
https://www.gomedigap.com/medicare-opti ... -medicare/
ModifiedDuration wrote: Thu Oct 06, 2022 7:45 pm
enad wrote: Thu Oct 06, 2022 7:17 pm
skp wrote: Thu Oct 06, 2022 7:02 pm If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
It you move will you be able to keep your advantage plan? and if you have to go back to original medicare, could a plan G or N cost you more than if you enrolled at 65?
If you have Medicare Advantage you would probably have to switch plans.

If you are going back to Original Medicare, whether the Medigap plan would cost more than for someone who enrolled at age 65 would depend on the pricing method used by the Medigap insurer:

Community pricing - since everyone pays the same premium regardless of age, it wouldn’t matter.

Attained age - if you were say 70 now, it wouldn’t matter if you joined at age 65 or at age 70, all 70 year olds would pay the same premium.

Issue age - as premium price is determined based on the age you obtain the policy, in this case whether you obtained the policy at age 65 or at a later age would make a difference.

By the way, if you move and lose your Medicare Advantage plan and switch back to Original Medicare, you would have Guaranteed Issue Rights for Plan G (and G-HD) without underwriting, but not for Plan N.

You would also have Guaranteed Issue Rights without underwriting for Plan F (and F-HD), if you were eligible for Medicare prior to January 1, 2020.
Thank-you
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
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jabberwockOG
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Re: Original Medicare vs. Medicare Advantage

Post by jabberwockOG »

bradinsky wrote: Thu Oct 06, 2022 6:49 pm
jabberwockOG wrote: Thu Oct 06, 2022 6:13 pm
michaeljc70 wrote: Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Two types of premiums that I know of are available Medigap plans - one has premium costed based on attained age, the other has premium costed as community rated. The community rated cost premium may start out a little higher but it does not increase based on your individual age. My monthly cost for a community rated AARP branded UHC Plan G is $117 per month for myself, wife is $107. I'd suggest avoiding supplement plans with attained age premiums if possible, my 90 year old mother has an attained age costed Plan F supplement and her premiums are quite relatively at this point.
Hi JabberwockOG,
Your premium looks great. Could I please ask your age? I’m 70 my G plan premium for 2023 is going to be a few pennies over $160.
67
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dodecahedron
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Re: Original Medicare vs. Medicare Advantage

Post by dodecahedron »

ModifiedDuration wrote: Thu Oct 06, 2022 8:37 am The agent also apparently does not understand Plan G-HD:

“High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.”

This is just plain wrong. With a Plan G-HD, after you pay the $233 Part B deductible, Medicare would pick-up 80% of the Medicare-approved reimbursement rate. You would just be responsible for the other 20%, until you have paid $2,490 (in 2022) for the year.
I am generally a fan of high-deductible plans and I agree that the quoted agent misunderstands them and is wrong to be so dismissive.

However I think Modified Duration somewhat overstates the case for G-HD above.

Medicare has separate deductibles for Part A and Part B.

"If you are hospitalized - even for a day -" (the hypothetical stated by the agent) you will face a Part A deductible of $1,600 (in 2023) before Medicare starts paying its 80% share of your hospital bills. The fact that you might have already paid your Part B deductible doesn't preclude your also facing a Part A deductible before Medicare pays anything towards your hospitalization.
Dregob
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Re: Original Medicare vs. Medicare Advantage

Post by Dregob »

skp wrote: Thu Oct 06, 2022 7:02 pm
JoeRetire wrote: Sun Oct 02, 2022 5:14 pm
Chuckles960 wrote: Sun Oct 02, 2022 3:18 pmEverything depends on the particular MA plan, and what services you personally will need in future---which of course you do not know.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
The advantage of original medicare+F/G is not that it is the cheapest plan,it is that it is the no-worries plan.
If you are willing to pay enough, you will have fewer worries.
I agree with all of this except that the I'd like to point out that "no worries plan" depends on your risk tolerance. I consider myself to have extremely low tolerance for risk, yet I still retired this month at age 65 and healthy with an Aetna Advantage plan. Up till the last minute I was convinced that I was going with a G. But I decided that we have enough assets that the 6500 out of pocket limit doesn't scare me. I figure that the savings on preventive dental, vision, gym membership, CVS OTC drugs will mitigate any co pays I may have. We are relatively healthy. It covers all the doctors and all the hospitals in the area that I can think of. The only "worry" I can think of is that as a nurse I've seen issues with covering rehab. However, out of my grandparents, and in laws- 8- only one needed rehab. I feel that the low probability of needing it, plus savings over the years and that I have assets to pay for it also mitigates the risk. If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
My wife and I too just signed up for an Advantage plan. I'm not arguing the merits of Gap v Advantage but I have not seen one post against Advantage plans where the poster, him/herself actually had the problem. My Advantage plan is almost exactly the health plan I have had for 35 years. Same network, same rules. Should I have been living in fear all this time?
vested1
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Re: Original Medicare vs. Medicare Advantage

Post by vested1 »

Dregob wrote: Thu Oct 06, 2022 11:20 pm
skp wrote: Thu Oct 06, 2022 7:02 pm
JoeRetire wrote: Sun Oct 02, 2022 5:14 pm
Chuckles960 wrote: Sun Oct 02, 2022 3:18 pmEverything depends on the particular MA plan, and what services you personally will need in future---which of course you do not know.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.
The advantage of original medicare+F/G is not that it is the cheapest plan,it is that it is the no-worries plan.
If you are willing to pay enough, you will have fewer worries.
I agree with all of this except that the I'd like to point out that "no worries plan" depends on your risk tolerance. I consider myself to have extremely low tolerance for risk, yet I still retired this month at age 65 and healthy with an Aetna Advantage plan. Up till the last minute I was convinced that I was going with a G. But I decided that we have enough assets that the 6500 out of pocket limit doesn't scare me. I figure that the savings on preventive dental, vision, gym membership, CVS OTC drugs will mitigate any co pays I may have. We are relatively healthy. It covers all the doctors and all the hospitals in the area that I can think of. The only "worry" I can think of is that as a nurse I've seen issues with covering rehab. However, out of my grandparents, and in laws- 8- only one needed rehab. I feel that the low probability of needing it, plus savings over the years and that I have assets to pay for it also mitigates the risk. If you have money, why wouldn't you go with an advantage plan assuming that the plan has a good network?
My wife and I too just signed up for an Advantage plan. I'm not arguing the merits of Gap v Advantage but I have not seen one post against Advantage plans where the poster, him/herself actually had the problem. My Advantage plan is almost exactly the health plan I have had for 35 years. Same network, same rules. Should I have been living in fear all this time?
And how healthy were you 35 years ago as compared to today? What will your health be like in 10 years? Therein lies the rub. Much of this depends on one's attitude concerning insurance and methods in which to mitigate risk. I won't criticize you for your perception of risk or your method of dealing with it. Please do me a favor though by not calling my perception of risk to be "fear". I would prefer to think of it as "prudence", and am willing to pay more out of pocket now in order to lessen the effects of some possible future health crisis.
vested1
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Re: Original Medicare vs. Medicare Advantage

Post by vested1 »

I attended a short seminar this week that was given by a private consulting company concerning Medicare open enrollment. The presenter did a fairly good job at covering the differences in Original Medicare and MA. They favored neither MA nor Original Medicare with supplemental. I only went to ask a couple of specific questions, and not with the intent of using their services, which are duplicated by the intermediaries my wife and I must go through to qualify for our individual HRA's.

There are positive and negative aspects to each choice, but some aspects are troubling in both. It shouldn't be a surprise that the negative aspects for the Medicare recipient are a boon to insurance companies. The following is what I gleaned from the seminar as to the answers to my questions.

Part D in Original Medicare allows the provider (Humana, Wellcare, etc) to determine which drugs are in their formulary and which tier those drugs are in. That's why it's important to check your coverage and tier level every year. As a reminder, different tiers have different co-pays. My wife and I take a few of the same medications. My part D (Wellcare) premium is half the price of my wife's (Humana). My cost for those drugs we have in common is zero. We only chose Humana for her because it covered a tier 5 drug the best of all available choices. She hasn't taken that drug since May because her new doctor says she was misdiagnosed and that she doesn't need it, saving us 6k a year in co-pays for a drug she has been on for a decade. Her health has remained the same since then. We will be choosing a different Part D provider for my wife for 2023.

The medications we have in common are in lower tiers in Wellcare's formulary than the same ones in Humana's, meaning higher costs for the same drugs using Humana. In fact we pay full price for the 7 prescriptions she takes in tiers 1 through 3 for Humana because even though some have no deductible, they all have a co-pay that magically amounts to the amount that Medicare doesn't cover. This makes paying the premium merely a means to get qualified for the HRA, with zero benefit on those prescriptions. For some reason, Part D providers are allowed to determine which drugs they will cover and what the tier will be in. This is determined by their own internal profit/loss margin according to the presenter of the seminar. I imagine that the same is true with a MA plan, because those are administered by private insurance companies too.

This would seem to open up the opportunity for abuse, since there seems to be nothing to prevent an insurance company from declaring what is considered a tier 1 drug in a competitor's formulary (or not covered) as a tier 5 drug in their formulary, although if it were that extreme it may be seen as too blatant an abuse by the "ruling authority".

The other question I had was about the process of underwriting if you wanted to change from Advantage to original Medicare or from say, Plan N to Plan G. The presenter said that the applicant is asked to fill out a questionnaire with 30 questions, although I found less than that online after the seminar. The questions are pretty broad and I would encourage members to search them out before making a decision. For instance, you will be denied coverage if you take 3 or more medications to control blood pressure or anything to do with the heart. You will be denied coverage if you have been diagnosed in the last 3 years with COPD, which my wife was mistakenly diagnosed with in 2021 as well. The list goes on and on. There can also be a gap of coverage if you time the transition incorrectly, even if you are accepted in the new plan. Have you had any one of certain operations in the last 3 years or have you ever had a stent? Sorry, you are denied.

Maybe someday healthcare decision for seniors will be less complicated. I expect that to happen when the sun rises in the west.
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beyou
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Re: Original Medicare vs. Medicare Advantage

Post by beyou »

benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
This…..

I am not yet there, but when I am, the best thing about Medicare is getting away from having an insurance company make ANY decisions for me. I want to pick my own docs, and not have to argue about what I need or do not need. I have had too many trivial issues blow up into major ones because of an insurer not doing the right thing. Can’t wait to get away from managed care.
TheGreyingDuke
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Re: Original Medicare vs. Medicare Advantage

Post by TheGreyingDuke »

dodecahedron wrote: Sat Oct 01, 2022 7:57 pm

And--in my state (NY), if I should ever develop a major issue I am unconditionally allowed to switch back to Traditional Medicare plus Medigap pretty much any time I want to, with as little as a month's notice or less.
That seems to be the point, even someone who is satisfied with the Advantage plan they have, contemplates switching to a traditional plan in the event of a "major issues"; major issues are the reason we buy any insurance. I grant the the NY provisions for easy transition back to "Original" may alleviate the concern, but most people do not have that option.
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
tm3
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Re: Original Medicare vs. Medicare Advantage

Post by tm3 »

beyou wrote: Fri Oct 07, 2022 6:36 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
This…..

I am not yet there, but when I am, the best thing about Medicare is getting away from having an insurance company make ANY decisions for me. I want to pick my own docs, and not have to argue about what I need or do not need. I have had too many trivial issues blow up into major ones because of an insurer not doing the right thing. Can’t wait to get away from managed care.
Amen.

Slick sales pitches sell MA plans.
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TomatoTomahto
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Re: Original Medicare vs. Medicare Advantage

Post by TomatoTomahto »

tm3 wrote: Fri Oct 07, 2022 7:11 am
beyou wrote: Fri Oct 07, 2022 6:36 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
This…..

I am not yet there, but when I am, the best thing about Medicare is getting away from having an insurance company make ANY decisions for me. I want to pick my own docs, and not have to argue about what I need or do not need. I have had too many trivial issues blow up into major ones because of an insurer not doing the right thing. Can’t wait to get away from managed care.
Amen.

Slick sales pitches sell MA plans.
+1

I'm only beginning my "Medicare Journey" because I'm still covered under my wife's employer's insurance plan. It makes my head hurt to consider the alternatives, but the volume of mailings we receive makes me question why insurance companies, which have consistently not been my friend over the years, would suddenly be looking to be my best friend. The only sentence less likely to be true than "I'm from the government and I'm here to help you" is "I'm from an insurance company and I'm here to help you."

One of the great virtues of having saved prodigiously is that I can ignore some of the helpful suggestions to save money on premiums; I want whatever the Bentley version (forget Cadillac) of Medicare is. If I "waste" some annual premiums, that's okay, but the last thing I need with our medical care is an insurer deciding that they don't think our care is cost effective. I pay extra for concierge medical care; what that doctor says is what should happen.
I get the FI part but not the RE part of FIRE.
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beyou
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Re: Original Medicare vs. Medicare Advantage

Post by beyou »

To be fair, there are locations specific options for MA.
Relatives in SE Florida tell me they have a plan that has an extensive network, and even pays decently for out of network, so they are told. For people who can’t afford the difference (higher cost traditional medicate with or without gap), some are lucky to have better options than others.

But to me, even the best options still involve evil insurance companies making decisions about my health. Their inherent conflict of interest is one I would avoid if I can afford to avoid it. Specifically I mean Medicare Advantage, not gap/supplemental where the insurance co has no medical say in your coverage, and it is purely a financial transaction. gap/supplemental for Traditional is fine if you can afford it and want to cap out of pocket costs. But Advantage is for the advantage of insurers, not you.
tj
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Re: Original Medicare vs. Medicare Advantage

Post by tj »

dodecahedron wrote: Thu Oct 06, 2022 10:32 pm
ModifiedDuration wrote: Thu Oct 06, 2022 8:37 am The agent also apparently does not understand Plan G-HD:

“High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.”

This is just plain wrong. With a Plan G-HD, after you pay the $233 Part B deductible, Medicare would pick-up 80% of the Medicare-approved reimbursement rate. You would just be responsible for the other 20%, until you have paid $2,490 (in 2022) for the year.
I am generally a fan of high-deductible plans and I agree that the quoted agent misunderstands them and is wrong to be so dismissive.

However I think Modified Duration somewhat overstates the case for G-HD above.

Medicare has separate deductibles for Part A and Part B.

"If you are hospitalized - even for a day -" (the hypothetical stated by the agent) you will face a Part A deductible of $1,600 (in 2023) before Medicare starts paying its 80% share of your hospital bills. The fact that you might have already paid your Part B deductible doesn't preclude your also facing a Part A deductible before Medicare pays anything towards your hospitalization.
Hospital bills don't have 80% coinsurance. Only Part B.
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enad
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Re: Original Medicare vs. Medicare Advantage

Post by enad »

vested1 wrote: Fri Oct 07, 2022 6:20 am I attended a short seminar this week that was given by a private consulting company concerning Medicare open enrollment. The presenter did a fairly good job at covering the differences in Original Medicare and MA. They favored neither MA nor Original Medicare with supplemental. I only went to ask a couple of specific questions, and not with the intent of using their services, which are duplicated by the intermediaries my wife and I must go through to qualify for our individual HRA's.

There are positive and negative aspects to each choice, but some aspects are troubling in both. It shouldn't be a surprise that the negative aspects for the Medicare recipient are a boon to insurance companies. The following is what I gleaned from the seminar as to the answers to my questions.

Part D in Original Medicare allows the provider (Humana, Wellcare, etc) to determine which drugs are in their formulary and which tier those drugs are in. That's why it's important to check your coverage and tier level every year. As a reminder, different tiers have different co-pays. My wife and I take a few of the same medications. My part D (Wellcare) premium is half the price of my wife's (Humana). My cost for those drugs we have in common is zero. We only chose Humana for her because it covered a tier 5 drug the best of all available choices. She hasn't taken that drug since May because her new doctor says she was misdiagnosed and that she doesn't need it, saving us 6k a year in co-pays for a drug she has been on for a decade. Her health has remained the same since then. We will be choosing a different Part D provider for my wife for 2023.

The medications we have in common are in lower tiers in Wellcare's formulary than the same ones in Humana's, meaning higher costs for the same drugs using Humana. In fact we pay full price for the 7 prescriptions she takes in tiers 1 through 3 for Humana because even though some have no deductible, they all have a co-pay that magically amounts to the amount that Medicare doesn't cover. This makes paying the premium merely a means to get qualified for the HRA, with zero benefit on those prescriptions. For some reason, Part D providers are allowed to determine which drugs they will cover and what the tier will be in. This is determined by their own internal profit/loss margin according to the presenter of the seminar. I imagine that the same is true with a MA plan, because those are administered by private insurance companies too.

This would seem to open up the opportunity for abuse, since there seems to be nothing to prevent an insurance company from declaring what is considered a tier 1 drug in a competitor's formulary (or not covered) as a tier 5 drug in their formulary, although if it were that extreme it may be seen as too blatant an abuse by the "ruling authority".

The other question I had was about the process of underwriting if you wanted to change from Advantage to original Medicare or from say, Plan N to Plan G. The presenter said that the applicant is asked to fill out a questionnaire with 30 questions, although I found less than that online after the seminar. The questions are pretty broad and I would encourage members to search them out before making a decision. For instance, you will be denied coverage if you take 3 or more medications to control blood pressure or anything to do with the heart. You will be denied coverage if you have been diagnosed in the last 3 years with COPD, which my wife was mistakenly diagnosed with in 2021 as well. The list goes on and on. There can also be a gap of coverage if you time the transition incorrectly, even if you are accepted in the new plan. Have you had any one of certain operations in the last 3 years or have you ever had a stent? Sorry, you are denied.

Maybe someday healthcare decision for seniors will be less complicated. I expect that to happen when the sun rises in the west.
Thank-you so much for your very informative post. I scan this particular thread and look for tidbits to file and save and your comments were very helpful to me.
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
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dodecahedron
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Re: Original Medicare vs. Medicare Advantage

Post by dodecahedron »

tj wrote: Fri Oct 07, 2022 10:30 am
dodecahedron wrote: Thu Oct 06, 2022 10:32 pm
ModifiedDuration wrote: Thu Oct 06, 2022 8:37 am The agent also apparently does not understand Plan G-HD:

“High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.”

This is just plain wrong. With a Plan G-HD, after you pay the $233 Part B deductible, Medicare would pick-up 80% of the Medicare-approved reimbursement rate. You would just be responsible for the other 20%, until you have paid $2,490 (in 2022) for the year.
I am generally a fan of high-deductible plans and I agree that the quoted agent misunderstands them and is wrong to be so dismissive.

However I think Modified Duration somewhat overstates the case for G-HD above.

Medicare has separate deductibles for Part A and Part B.

"If you are hospitalized - even for a day -" (the hypothetical stated by the agent) you will face a Part A deductible of $1,600 (in 2023) before Medicare starts paying its 80% share of your hospital bills. The fact that you might have already paid your Part B deductible doesn't preclude your also facing a Part A deductible before Medicare pays anything towards your hospitalization.
Hospital bills don't have 80% coinsurance. Only Part B.
You are correct that bills from the hospital itself do not have 80% coinsurance, but pretty much all hospitalized inpatients are getting Part B services (from doctors, therapists, etc.) while hospitalized and those Part B services have 80% coinsurance. So, if you are hospitalized as an inpatient, you would typically face both the $1600 Part A deductible and the $233 Part B deductible within the first day and with the 20% coinsurance on all the Part B docs treating you while you are inpatient it likely won't take long to hit the $2490 Plan G deductible either.

I don't necessarily think this is a deal-killer on high-deductible plans, by the way. In fact, when I spent 18 months on a Medigap, I chose a plan F-HD. And I previously had a Bronze High-Deductible ACA plan (in which I managed to hit the $13K max OOP with an unexpected hospitalization of less than 24 hours due to a ruptured appendix in the first year I had the plan, but still stayed on the same high-deductible for the next four years until I hit 65.). It was worth it in retrospect.

But if you go with a high-deductible plan, or any plan with significant cost-sharing, it is good to know what the possible risks are. When I was in the ER awaiting results to confirm my need for emergency appendectomy eight years ago, I remember that it was a relief to think, I know I have a $13K max OOP this year, and I have already spent about $2K this year, so even the financial worst case is not a disaster. Nice not to have to worry about finances at a time when there are sufficient medical worries anyway.
InMyDreams
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Re: Original Medicare vs. Medicare Advantage

Post by InMyDreams »

dodecahedron wrote: Fri Oct 07, 2022 10:58 am
tj wrote: Fri Oct 07, 2022 10:30 am
dodecahedron wrote: Thu Oct 06, 2022 10:32 pm
ModifiedDuration wrote: Thu Oct 06, 2022 8:37 am The agent also apparently does not understand Plan G-HD:

“High Deductible Plan G (HDG) is similar but has a $2340 deductible; it is lower in price, since you are responsible for the first $2340 (subject to change) of allowable medical costs before Medicare or your plan pick up. I do not recommend. The first time you are hospitalized - even for a day - you will wish you had the regular Plan G or Plan N.”

This is just plain wrong. With a Plan G-HD, after you pay the $233 Part B deductible, Medicare would pick-up 80% of the Medicare-approved reimbursement rate. You would just be responsible for the other 20%, until you have paid $2,490 (in 2022) for the year.
I am generally a fan of high-deductible plans and I agree that the quoted agent misunderstands them and is wrong to be so dismissive.

However I think Modified Duration somewhat overstates the case for G-HD above.

Medicare has separate deductibles for Part A and Part B.

"If you are hospitalized - even for a day -" (the hypothetical stated by the agent) you will face a Part A deductible of $1,600 (in 2023) before Medicare starts paying its 80% share of your hospital bills. The fact that you might have already paid your Part B deductible doesn't preclude your also facing a Part A deductible before Medicare pays anything towards your hospitalization.
Hospital bills don't have 80% coinsurance. Only Part B.
You are correct that bills from the hospital itself do not have 80% coinsurance, but pretty much all hospitalized inpatients are getting Part B services (from doctors, therapists, etc.) while hospitalized and those Part B services have 80% coinsurance. So, if you are hospitalized as an inpatient, you would typically face both the $1600 Part A deductible and the $233 Part B deductible within the first day and with the 20% coinsurance on all the Part B docs treating you while you are inpatient it likely won't take long to hit the $2490 Plan G deductible either.

I don't necessarily think this is a deal-killer on high-deductible plans, by the way. In fact, when I spent 18 months on a Medigap, I chose a plan F-HD. And I previously had a Bronze High-Deductible ACA plan (in which I managed to hit the $13K max OOP with an unexpected hospitalization of less than 24 hours due to a ruptured appendix in the first year I had the plan, but still stayed on the same high-deductible for the next four years until I hit 65.). It was worth it in retrospect.

But if you go with a high-deductible plan, or any plan with significant cost-sharing, it is good to know what the possible risks are. ...
Other costs that add up quickly
* "Hospital" stays that are considered outpatient because they were 23 hour observations
* The quantity of high-cost care that is done in an outpatient setting - Chemo, radiation, surgery... and some of those are repeating charges.

Also consider that once you are receiving the high cost treatments - will they continue each year for most or all of your remaining years?
And, when you are at your sickest, that's when those bills are coming in and need management.
Chuckles960
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Joined: Thu May 13, 2021 12:09 pm

Re: Original Medicare vs. Medicare Advantage

Post by Chuckles960 »

zlandar
Posts: 594
Joined: Wed Apr 10, 2019 8:51 am

Re: Original Medicare vs. Medicare Advantage

Post by zlandar »

If you can afford the premiums skip MA. If you can't get MA.

https://clark.com/insurance/health-insu ... age-plans/
jebmke
Posts: 25271
Joined: Thu Apr 05, 2007 2:44 pm
Location: Delmarva Peninsula

Re: Original Medicare vs. Medicare Advantage

Post by jebmke »

vested1 wrote: Fri Oct 07, 2022 6:20 am Part D in Original Medicare allows the provider (Humana, Wellcare, etc) to determine which drugs are in their formulary and which tier those drugs are in. That's why it's important to check your coverage and tier level every year. As a reminder, different tiers have different co-pays. My wife and I take a few of the same medications. My part D (Wellcare) premium is half the price of my wife's (Humana). My cost for those drugs we have in common is zero. We only chose Humana for her because it covered a tier 5 drug the best of all available choices. She hasn't taken that drug since May because her new doctor says she was misdiagnosed and that she doesn't need it, saving us 6k a year in co-pays for a drug she has been on for a decade. Her health has remained the same since then. We will be choosing a different Part D provider for my wife for 2023.

The medications we have in common are in lower tiers in Wellcare's formulary than the same ones in Humana's, meaning higher costs for the same drugs using Humana. In fact we pay full price for the 7 prescriptions she takes in tiers 1 through 3 for Humana because even though some have no deductible, they all have a co-pay that magically amounts to the amount that Medicare doesn't cover. This makes paying the premium merely a means to get qualified for the HRA, with zero benefit on those prescriptions. For some reason, Part D providers are allowed to determine which drugs they will cover and what the tier will be in. This is determined by their own internal profit/loss margin according to the presenter of the seminar. I imagine that the same is true with a MA plan, because those are administered by private insurance companies too.

This would seem to open up the opportunity for abuse, since there seems to be nothing to prevent an insurance company from declaring what is considered a tier 1 drug in a competitor's formulary (or not covered) as a tier 5 drug in their formulary, although if it were that extreme it may be seen as too blatant an abuse by the "ruling authority".
Figuring out Part D is somewhat of a mystical experience. In my case (and this year, my wife's case too) we have concluded that Part D is really only needed for catastrophic coverage so we will be using the rock bottom plan available.

In my case, I rarely access it so it is a losing proposition. My wife has found that she can get her normal prescriptions less expensively with a discount coupon outside the insurance so she will dump her higher priced plan and go with a rock bottom plan as well.
Stay hydrated; don't sweat the small stuff
tm3
Posts: 771
Joined: Wed Dec 24, 2014 6:16 pm

Re: Original Medicare vs. Medicare Advantage

Post by tm3 »

TomatoTomahto wrote: Fri Oct 07, 2022 8:09 am
tm3 wrote: Fri Oct 07, 2022 7:11 am
beyou wrote: Fri Oct 07, 2022 6:36 am
benne77 wrote: Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
This…..

I am not yet there, but when I am, the best thing about Medicare is getting away from having an insurance company make ANY decisions for me. I want to pick my own docs, and not have to argue about what I need or do not need. I have had too many trivial issues blow up into major ones because of an insurer not doing the right thing. Can’t wait to get away from managed care.
Amen.

Slick sales pitches sell MA plans.
+1

I'm only beginning my "Medicare Journey" because I'm still covered under my wife's employer's insurance plan. It makes my head hurt to consider the alternatives, but the volume of mailings we receive makes me question why insurance companies, which have consistently not been my friend over the years, would suddenly be looking to be my best friend. The only sentence less likely to be true than "I'm from the government and I'm here to help you" is "I'm from an insurance company and I'm here to help you."

One of the great virtues of having saved prodigiously is that I can ignore some of the helpful suggestions to save money on premiums; I want whatever the Bentley version (forget Cadillac) of Medicare is. If I "waste" some annual premiums, that's okay, but the last thing I need with our medical care is an insurer deciding that they don't think our care is cost effective. I pay extra for concierge medical care; what that doctor says is what should happen.
Your situation and mindset is very similar to mine, although I have not enrolled in concierge care (yet). Just chiming in here to say it sounds like you are on the right track, make haste slowly, continue to think things through, and my prediction is that like it did for me the clouds will eventually part, the fog will lift, and out of what I think is an unnecessarily confusing (by design?) array of choices your best option(s) will become clear.
tunafish
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Re: Original Medicare vs. Medicare Advantage

Post by tunafish »

Possibly someone has posted this already. I don't have the moral fiber to read all the replies.

The NYTimes headline is:

"‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud."

https://www.nytimes.com/2022/10/08/upsh ... tions.html

Note that when MedicareAdvantage is ripped off by BigPrivateInsuranceCompanies, taxpayers foot the bill.
tj
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Joined: Wed Dec 23, 2009 11:10 pm

Re: Original Medicare vs. Medicare Advantage

Post by tj »

zlandar wrote: Sat Oct 08, 2022 8:26 am If you can afford the premiums skip MA. If you can't get MA.

https://clark.com/insurance/health-insu ... age-plans/

People who prefer a health care system like kaiser Permanente have no choice but to use advantage. KP does not offer medigap.
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CWRadio
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Location: SE Michigan Ionosphere

Re: Original Medicare vs. Medicare Advantage

Post by CWRadio »

Medigap policies can be priced or "rated" in 3 ways:

Community-rated (also called “no age-rated”)
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
https://www.medicare.gov/supplements-ot ... p-policies

Be careful picking your Medigap plan. The cheapest may not be the best in the long run. Be on guard for insurance companies that close their plans to new customers after a few years. Paul
Leesbro63
Posts: 10581
Joined: Mon Nov 08, 2010 3:36 pm

Re: Original Medicare vs. Medicare Advantage

Post by Leesbro63 »

CWRadio wrote: Sat Oct 08, 2022 11:34 am Medigap policies can be priced or "rated" in 3 ways:

Community-rated (also called “no age-rated”)
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
https://www.medicare.gov/supplements-ot ... p-policies

Be careful picking your Medigap plan. The cheapest may not be the best in the long run. Be on guard for insurance companies that close their plans to new customers after a few years. Paul
So for the long player, which is best?
Fremdon Ferndock
Posts: 1181
Joined: Fri Dec 24, 2021 11:26 am

Re: Original Medicare vs. Medicare Advantage

Post by Fremdon Ferndock »

zlandar wrote: Sat Oct 08, 2022 8:26 am If you can afford the premiums skip MA. If you can't get MA.

https://clark.com/insurance/health-insu ... age-plans/
Pay now (premiums) or pay later (deductibles, copays, more restricted treatment).
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
cashmoney
Posts: 717
Joined: Thu Jun 29, 2017 11:15 pm

Re: Original Medicare vs. Medicare Advantage

Post by cashmoney »

Leesbro63 wrote: Sat Oct 08, 2022 11:47 am
CWRadio wrote: Sat Oct 08, 2022 11:34 am Medigap policies can be priced or "rated" in 3 ways:

Community-rated (also called “no age-rated”)
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
https://www.medicare.gov/supplements-ot ... p-policies

Be careful picking your Medigap plan. The cheapest may not be the best in the long run. Be on guard for insurance companies that close their plans to new customers after a few years. Paul
So for the long player, which is best?

In general the insurance carriers with an old block of business with a large numbers of policyholders tend to have more rate stability but this really varies by state and at what rate age band you started at.In most parts of Fl. for example the long term lower cost plan has been UHC and second would be Florida Blue.In many states commissions paid to agents are less with the Blues and UHC then some of the smaller carriers so that can play in to the long term cost.When a carrier opens up a new book of business they may offer bonuses to agents and sometimes even ease underwriting to push that plan to try to build up the book faster.

disclaimer licensed agent.
Fremdon Ferndock
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Re: Original Medicare vs. Medicare Advantage

Post by Fremdon Ferndock »

Recently attended an event where an insurance agent presented on MA plans. His opinion on Aetna was negative; he suggested that things may have gone downhill after the acquisition by CVS to the tune of around $60B. Anything to this? Friend of mine on Aetna recently had a bad experience being kicked out of rehab after just 10 days, which was way short of what she needed.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
orlandoman
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Re: Original Medicare vs. Medicare Advantage

Post by orlandoman »

Just something to consider ... for those that don't want 3rd party insurance company involvement in treatment evaluation/decision making:
- how do you know you are getting the most appropriate care & that unnecessary tests, for example, are not being ordered because they are getting paid for?
- might there be an advantage to having a team review to make sure the most appropriate care is being given?
"Borrow money from pessimists -- they don't expect it back"
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bobcat2
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Re: Original Medicare vs. Medicare Advantage

Post by bobcat2 »

tunafish wrote: Sat Oct 08, 2022 10:36 am
NYTimes -

"‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud."

https://www.nytimes.com/2022/10/08/upsh ... tions.html

Note that when MedicareAdvantage is ripped off by BigPrivateInsuranceCompanies, taxpayers foot the bill.
:thumbsup :thumbsup

Yes , overbilling every year estimated to be between $12 billion and $25 billion. :evil: Hard to know how much, since Medicare doesn't have the resources to track the multitude of false data.

BobK
Last edited by bobcat2 on Sat Oct 08, 2022 2:48 pm, edited 1 time in total.
In finance risk is defined as uncertainty that is consequential (nontrivial). | The two main methods of dealing with financial risk are the matching of assets to goals & diversifying.
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