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With open enrollment just around the corner, I am thinking of changing to an Advantage Plan. However, have not had occasion to use either Medicare or my current supplement and drug plan. Any information those of you with the Advantage Plan or experiences, good or bad would be invaluable to my decision making process. Thank you very much.
Essentially, Advantage Plans are run as HMOs (not always), and include drug plans (not always), with a cap on out-of-pocket (mine is $4,450), but lower or no premium vs. a high Medicare Supplement premium.
You are required to use their doctors or pay a higher copay or coinsurance. In urban areas, the networks can be so extensive the HMO feature is not a problem. You're in Chicago. I would think the list of network providers would be very broad. I am in an Advantage in Milwaukee. All the best docs and hospitals participate, so it's no problem here.
If you travel a lot, you may prefer to keep a Medicare Supplement. Advantage plans can present problems if you are out of network and run into health issues while vacationing or traveling.
More doctors and hospitals accept Medicare/Medicare Supplement patients than accept Advantage patients, especially in certain areas.
You might consider a high-deductible Medicare Supplement if it is offered in your state. In WI, high-deductible F is about $600/year (BCBS), with a $2,040 deductible. If you never doctor, you're probably ahead with a high deductible plan instead of the very high Supplement premium. Of course, you'd still need to purchase Part D if you feel coverage for medication is necessary.
I recently experienced an annoying billing problem with an in-network Advantage provider which was only resolved when I reported them to the BBB and United Healthcare. Then problem was solved in 48 hours. I am convinced the problem was with the provider, not UHC. I suspect this type of thing may be more prevalent than with Medicare providers. Although people on this board have said they also have problems with Medicare not paying for certain things it should.
Last edited by Ariadne22; 10-01-2012 at 03:54 PM..
I have had both types. The advantage plan is fine if you don't have to have any surgeries or visit the doctor often. Most require you to pay anything that they determine is not covered and getting them to change their decision is often impossible. A good example is how something is coded. I had cataract surgery and the hospital listed the anesthesia instead of the doctor. They said that person was not in their network.
Day Surgery $300.00 each time.. Hospital stay $275.00 per day for the first 5 days. Be sure to check on these type of costs. Also.. I had a corneal transplant.. my co pay would be $800.00
I got a medigap plan and payed a little more per month but I have had to pay nothing out of pocket for 2 surgeries and multiple doctor visits.
Excellent summary by Ariadne in post #2 above. As stated, Medicare Advantage Plans can differ quite a bit depending on the area of the country, and even from plan to plan within the same area. But the variations within an area will be less because those plans are completing against one another for customers, and one must live within the area as defined in order to enroll in a given plan. So the OP will still have to look into what's available to him/her. If the plan is a large HMO where all the doctors are employees of that HMO, such as my Kaiser plan in Los Angeles and Orange Counties, then there are no billing issues because there are no billings. I have enjoyed that aspect of it - the total absence of paperwork, approvals, etc. Of course I need a referral from the primary doc to see a specialist, but there has never been the least hesitation in that regard. The whole Medicare business is complex, and I can never blame anyone for being confused.
I got a medigap plan and payed a little more per month
That must have been one expensive Advantage plan if the Medigap was only "a little more."
My Advantage plan has no premium. Copays $20/$40/$50. Most basic stuff is covered. I had cataract surgery while I was employed so never had to do that under Advantage. Have visited maybe three doctors in two years, paying only $40 copays.
Most Medigap premiums are about 2K/year, plus drug coverage - so figure $2500/yr. I have heard in some southern states Medigap can be had for about $80/mo. That's pretty unbelievable. Perhaps there are co-insurance features which reduce the premium.
I would go with a high-deductible F. That way the coverage is there when you really need it, and you're not bleeding the huge Medigap premiums year after year after year.
Here is a good illustration of some of the differences.
Quote:
Originally Posted by Keeper
I have had both types. The advantage plan is fine if you don't have to haveany surgeries or visit the doctor often. Most require you to pay anything that they determine is not covered and getting them to change their decision is often impossible. A good example is how something is coded. I had cataract surgery and the hospital listed the anesthesia instead of the doctor. They said that person was not in their network.
Day Surgery $300.00 each time.. Hospital stay $275.00 per day for the first 5 days. Be sure to check on these type of costs. Also.. I had a corneal transplant.. my co pay would be $800.00
I have not the slightest doubt about the accuracy of your description of your experiences, and that just goes to illustrate the vast differences among plans which fall under the name "Medicare Advantage Plans".
My plan is excellent especially if you have surgeries or visit the doctor often. My copay to see a doctor is $5, and that includes specialists. Out patient surgery is $75, which I think has gone up to $125. No fee for surgery if you are hospitalized. Hospital stay is $125 per day for the first 10 days, and that is going up to $175 for 2013.
A little over two years ago, in August of 2010, I had hernia surgery for a total out-of-pocket cost of $75, including the pain meds and the pre-and post-surgery visits (removal of the staples during the latter). Back then the out-patient surgery fee was only $50, and since they didn't keep me overnight there was no hospitalization fee. Even with the increases since that time, and the increases coming up, if I have the same surgery in 2013 it would be about $150, which is not bad at all.
I certainly do thank you both for your invaluable information here. My brothers live in Hesperia California and have Kaiser, so I completely understand how you could be very happy with your Advantage Plan. I live in Galena, Illinois in Jo Daviess County. They have a few Advantage Plans, but my friends have experienced just what Ariadne has experienced. In McHenry County, there were no Advantage plans offered. I think I will take your advice and stay with the Hi Ded Plan F that I have. It costs $55.00 per month and the AARP Medicare Rx Drug Plan is $35.00 a month. Sure, I would like not to pay $90 a month, but as you say, the copays and surgeries down the road could be detrimental as well. Again, thanks so much for taking the time to respond.
The cost increases of medigap plans is something you need to look at. I signed on to a medigap plan N and initially my cost was $85 a month. The following year the cost went to $110. Seven months later there was another increase of $45. At the end of the second year there would have been another increase. I cancelled the policy.
After a lot of research it is my opinions that if you are in reasonably good health and do not take a lot of meds you are better off with a MA plan. On the other hand if you have a lot of OV's, meds and/or serious conditions you are better off with a medigap plan. The other factor is if you are entitled to VA care and meds. If so, you are generally better off with a MA.
One thing I learned the hard way is not to trust and independent insurance agent. If you are working with one I strongly urge you to check up on the information you were given and make sure you have a plan that is best suited to you.
Simply here is my take:
Medigap plans generally cost more and you have to have separate prescription coverage if you want it. These plans are straight forward and you know what you have.
Medicare Advantage plans can be risky based upon what part of the country you live in or if you travel as they rely on "the network". In many places of the country with an Advantage plan you could be in for a nasty surprise on a hospital stay as one of the many areas you go through could very well be out of the network and you will be stuck with the bill. If you travel, most likely you will be out of their network which could end up costing you big time.
Simply here is my take:
Medigap plans generally cost more and you have to have separate prescription coverage if you want it. These plans are straight forward and you know what you have.
Medicare Advantage plans can be risky based upon what part of the country you live in or if you travel as they rely on "the network". In many places of the country with an Advantage plan you could be in for a nasty surprise on a hospital stay as one of the many areas you go through could very well be out of the network and you will be stuck with the bill. If you travel, most likely you will be out of their network which could end up costing you big time.
Excellent point and everyone should look into it. My Med. Advantage Plan covers me nation-wide. I am not stuck with the bill - they are. If that weren't the case I would never have signed up for that plan.
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Here is a good illustration of some of the differences.
