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I go on Medicare in five months. I'm getting all the literature trying to sell me on various advantage and supplement plans.
The deal is this: My wife is one year younger than I am and when she hits Medicare age--a year after me--we will probably both back on the state supplement plan. BTW, the state cannot refuse me either even if my health declines between now and then.
Since I'm healthy, I thought I would have a little fun for a year. What advantage and supplement plans offer the most benefits? One plan I've seen offers us about $600 in free groceries. I've heard of others that offer gym memberships and such.
I go on Medicare in five months. I'm getting all the literature trying to sell me on various advantage and supplement plans.
The deal is this: My wife is one year younger than I am and when she hits Medicare age--a year after me--we will probably both back on the state supplement plan. BTW, the state cannot refuse me either even if my health declines between now and then.
Since I'm healthy, I thought I would have a little fun for a year. What advantage and supplement plans offer the most benefits? One plan I've seen offers us about $600 in free groceries. I've heard of others that offer gym memberships and such.
Beware of Advantage plans with gimmicks and quirks. You can be sure a plan that offers $600 in free groceries is a scam. It's bad enough to offer rebate on your Medicare premium. With enough income you may not qualify for these plans.
There are 2 problems with Advantage plans. The main one is you do not get to choose your doctor. Then you rely on the insurance co for the care you can get.
Beware of waiting too long to get on Medicare. There is a premium penalty for every month you delay when you could be on the program. This penalty would last forever. The penalty is on both Part B & Part D plans.
There is a 7 month window to apply for both Social Security & Medicare. You may want Social Security to pay your Part B premium.
The deal is this: Medicare only pays for 80% of your health care expense. Then you buy a supplement (Medigap) plan to cover most of the 20%. You choose what Medigap plan you want.
Which is the "best"? That's going to depend on a lot of factors most of which we don't know. Personal factors and local factors. Medigap and Advantage plans operate somewhat differently in different states. The cost of offering services differs by location too. Why don't you talk to the SHIP office in your residence state? They can help you compare what's even available to you. You'd still need to decide what this or that service is worth.
There are 2 problems with Advantage plans. The main one is you do not get to choose your doctor. Then you rely on the insurance co for the care you can get.
With an HMO Advantage plan, you must choose a PCP that participates in the network. With a PPO Advantage plan, you can choose to visit any provider who accepts Medicare and will accept your plan. PPO plans do not require referrals to see a specialist. In-network providers will in most cases result in lower copays.
With Advantage plans, many services are subject to prior authorization by the insurance company, mostly treatment plans, the more costly diagnostic services, prosthetic devices, durable medical equipment, non-emergency hospital admission/surgery, and rehab. Emergency and urgent care do not require pre-authorization; and routine office visits, screenings, tests, and diagnostics generally do not require pre-authorization.
I go on Medicare in five months. I'm getting all the literature trying to sell me on various advantage and supplement plans.
The deal is this: My wife is one year younger than I am and when she hits Medicare age--a year after me--we will probably both back on the state supplement plan. BTW, the state cannot refuse me either even if my health declines between now and then.
Since I'm healthy, I thought I would have a little fun for a year. What advantage and supplement plans offer the most benefits? One plan I've seen offers us about $600 in free groceries. I've heard of others that offer gym memberships and such.
Hey Mark, I am a Medicare broker.
You are not giving us enough information to really assess your needs.
What state are you in? County? (These plans vary not only by state, but also county)
Do you take any Rx? doctors?
The Medicare Advantage plans are great... For some people. But they are not appropriate for everyone.
Depending on your needs, a Medicare Supplement may be more appropriate for you.
Many of the benefits in an Advantage plan are gimmicks, do not choose a Medicare plan based on groceries, OTC and gym memberships. Take into consideration your needs, budget, and risk tolerance.
If you don't mind sharing some of the info I asked above, I can assist. If you not comfortable doing it publicly, feel free to PM me. I do not need any real personal info like name, address etc..
Hey Mark, I am a Medicare broker.
You are not giving us enough information to really assess your needs.
What state are you in? County? (These plans vary not only by state, but also county)
Do you take any Rx? doctors?
The Medicare Advantage plans are great... For some people. But they are not appropriate for everyone.
Depending on your needs, a Medicare Supplement may be more appropriate for you.
Many of the benefits in an Advantage plan are gimmicks, do not choose a Medicare plan based on groceries, OTC and gym memberships. Take into consideration your needs, budget, and risk tolerance.
If you don't mind sharing some of the info I asked above, I can assist. If you not comfortable doing it publicly, feel free to PM me. I do not need any real personal info like name, address etc..
Possibly you can answer a question that other Brokers I have spoken to can't?
With these Advantage plans that have $0 monthly premiums how can they make any money not charging a premium? Specifically how are they recouping their costs for not charging a premium?
Nothing in life worth having is free and businesses are in business to make money. Insurance companies do not make money paying out on claims.
Possibly you can answer a question that other Brokers I have spoken to can't?
With these Advantage plans that have $0 monthly premiums how can they make any money not charging a premium? Specifically how are they recouping their costs for not charging a premium?
Nothing in life worth having is free and businesses are in business to make money. Insurance companies do not make money paying out on claims.
The Medicare Advantage plans receive Tax Vouchers.
Your whole working life, you paid taxes into the Medicare Trust Fund (and all the money is still there right ;-)
in addition to that you have a Medicare Part B premium that comes out of your SS check, typically $174.70/mo (If you are not on SS then you pay it quarterly to the US Treasury).
All of this money gets funneled to the Medicare Advantage plan in the form of a "Tax Voucher", all in all they are receiving between $1,000 - $1,200/mo to manage your care in the form of an HMO or PPO.
A lot of supplement plans offer free gym membership.The way I read this is your getting insurance thru your wife's plan when she retires? I would go original medicare with a supplement. Are you sure you even need to sign up for part b or are you or can you be on your wifes insurance right now? If she has a qaulified health care plan that you can be on that would be my first choice.If you join an advantage plan what will your insurance carrier from your state plan say.So many questions ut's hard to make ant recommendations.
Possibly you can answer a question that other Brokers I have spoken to can't?
With these Advantage plans that have $0 monthly premiums how can they make any money not charging a premium? Specifically how are they recouping their costs for not charging a premium?
Nothing in life worth having is free and businesses are in business to make money. Insurance companies do not make money paying out on claims.
The second way they make money is by restricting care. They get a Tax Voucher from Medicare to be their income. With 40% of the population this amounts to millions of dollars.
You have to check with your doctor if & what kind of Medicare Advantage they accept. With regular Medicare they accept assignment. In regular Medicare any procedure needs to be medically necessary. Then you get to choose any doctor that accepts assignment. Most do. For current patients you may have no problem. For new patients you need to ask.
In Medicare Advantage the insurance company can deny services. For some it may be more than 50% of the claims. So if they don't have claims they get to keep all the premium money. You may have to appeal to have your claim covered. This can be a waste of time if the procedure is medically necessary.
A big way Medicare Advantage saves money is in the way they treat patients. For a hospital stay may be discharged early. The devil is in the details of what they allow for your illness.
In regular Medicare they follow the schedule for Part A & B. Medicare pays 80%. Your Medigap plan pays the 20%.
In Medicare Advantage it replaces Part A & B so you get what the insurance company decides what the schedule is.
The Medicare Advantage plans receive Tax Vouchers.
Your whole working life, you paid taxes into the Medicare Trust Fund (and all the money is still there right ;-)
in addition to that you have a Medicare Part B premium that comes out of your SS check, typically $174.70/mo (If you are not on SS then you pay it quarterly to the US Treasury).
All of this money gets funneled to the Medicare Advantage plan in the form of a "Tax Voucher", all in all they are receiving between $1,000 - $1,200/mo to manage your care in the form of an HMO or PPO.
AND ALSO
Quote:
Originally Posted by GWoodle
The second way they make money is by restricting care. They get a Tax Voucher from Medicare to be their income. With 40% of the population this amounts to millions of dollars.
You have to check with your doctor if & what kind of Medicare Advantage they accept. With regular Medicare they accept assignment. In regular Medicare any procedure needs to be medically necessary. Then you get to choose any doctor that accepts assignment. Most do. For current patients you may have no problem. For new patients you need to ask.
In Medicare Advantage the insurance company can deny services. For some it may be more than 50% of the claims. So if they don't have claims they get to keep all the premium money. You may have to appeal to have your claim covered. This can be a waste of time if the procedure is medically necessary.
A big way Medicare Advantage saves money is in the way they treat patients. For a hospital stay may be discharged early. The devil is in the details of what they allow for your illness.
In regular Medicare they follow the schedule for Part A & B. Medicare pays 80%. Your Medigap plan pays the 20%.
In Medicare Advantage it replaces Part A & B so you get what the insurance company decides what the schedule is.
OK Got it and thanks!
Now more questions since I am researching this now for the Wife.
So correct me if I am wrong. If you sign up for an Advantage plan they literally take full control of your medical leaving Medicare completely out of the picture for all coverage from A to D services? Other than the "Tax Voucher" they collect for managing your care do they have any back file of claims with Medicare?
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