Medicare:: Supplemental Plan or Advantage Plan (medical, hospital, doctor, Humana)
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I'm turning 65 in the next few months and I'm facing some big decisions on what plan do I select. Medigap supplemental or Advantage plans. It is soooo very confusing and it seems like countless plans with many levels of coverage.
My head is spinning trying to research what would be best for me. It seems like your get more with an advantage type plan.
Anyway, what are the good and bad points of these two types of medicare plans?
If you have any chronic conditions, or a family history of them, get the supplemental plan. The Advantage ones are for those who are relatively healthy.
From what I learned one may be better off with a Medigap policy if one lives rural and the choice of doctors, hospitals, etc is much more limited.
I got help from the New River Valley Agency on Aging and it was all free. There may be similar agency in your area so check around.
ps: I know it isn't fun but after some research and reading here on C-D I learned a great deal and most of it was very helpful so that when I went to the meeting with the person from the agency I had a pretty good idea of what would likely be my best choice and it was confirmed by the woman who helped me. She is employed by the agency and did not have any conflict of interest in pointing me in the right direction.
And be sure to ask your current doctors if they'll accept the Advantage plan. My sister changed from a Supplemental/Medigap plan to a nationally-advertised Advantage plan, only to learn that her doctor didnt accept it.
Start with this thread - and read the links to other threads on CD in that thread, in particular the thread on high-deductible F in Texas. I have a high-deductible Medigap F as do many people here.
Generally, Advantage plans are run like HMOs with restricted networks, and gatekeeper aspects relative to your treatment. You are completely divorced from CMS Medicare. The Advantage carrier is paid by the government anywhere between $700-$1300 mo. per enrollee (depending on area) and doles out the Medicare benefits. It is a for-profit model and often doesn't work well for certain people. Plus, certain Advantage carriers play games on payment and treatment approval. Know that the Advantage carrier stands in place of Medicare - and you deal with them - not Medicare - on your treatment. Not always a good thing.
Advantage plans are all right in certain areas, if you aren't traveling, can accept the fact you have no coverage at Mayo or MD Anderson, and similar facilities, because they won't accept Advantage, and are in good health.
If you are in CA, the Kaiser Advantage plans are very good primarily because Kaiser owns its hospitals and employs the doctors. Tufts on the East Coast is also pretty good, I believe. UHC and Humana are to be avoided, imo, although their Medigaps are fine - because they have absolutely no say in what they must pay. If Medicare covers the service, the Medigap must pay their 20%, no questions asked.
Further Advantage plans usually have a max out-of-pocket in the area of $5,000-$7,000, and various copays for services.
Conversely, purchase Medigap F or G, and you will never have a copay or see a medical bill unless it is for a service not approved by Medicare. Your medical expenses are pretty much limited to the premiums for the Medigap, Part D, and the Part D copays.
Generally, a better choice than Advantage is a Medigap G or F - or high-deductible Medigap F - which is the most cost effective way to cap worse-case scenarios on Medicare expenses. In addition, Medigaps provide complete flexibility on doctors, and no gatekeeper other than Medicare itself on payment. You can go to Mayo, MDAnderson or any other provider which accepts Medicare. No networks.
Last edited by Ariadne22; 10-21-2014 at 11:57 PM..
I'm going thru the same torture, as I'll be turning 65 on April 9, and I'm under pressure to choose among all the different carriers. I almost feel like just closing my eyes and throwing a dart, and be it as it may!
I also have to renew my HMO insurance at work this Fall, to carry me through until April 9. A bit confused about that angle, as I then drop my HMO insurance, at that time, or I'm held to keeping this HMO until the end of the year?
I'm also planning to move, retire to Tucson next year as well, which adds further complications!
From reading the above post, I gain no comfort in reading about the potential disadvantages of Advantage plans, as I'd like to have more options about picking my own Dr.'s, which is probably asking for too much. Picture perfect, I could go to Mexico to get medical care and be reimbursed for it. Fat chance that would happen!
With the HMO I have right now, I'm fearful that the plan I pick I'll have one provider for orthopedic work and I wasn't happy at all with the orthopedic clinic they assigned me to. What if I get stuck with that orthopedic clinic with my new plan?
If you have any chronic conditions, or a family history of them, get the supplemental plan. The Advantage ones are for those who are relatively healthy.
I live in Massachusetts. If I take an advantage plan and say go on vacation lets say to Las Vegas and I get sick or injured I won't be covered because I'm away from home?
I live in Massachusetts. If I take an advantage plan and say go on vacation lets say to Las Vegas and I get sick or injured I won't be covered because I'm away from home?
Advantage plans do provide payment for out-of-network emergency room services. Ongoing out-of-network care in the area would require you call the advantage carrier. Whether or not you get cooperation depends on the company.
When I first signed up for UHC Advantage (which I no longer have) - zero premium was very attractive b/c I don't doctor. ER services AND out-of-network payments (at 70%) were provided in the event you needed ongoing care elsewhere.
After two years, UHC Advantage in WI became an HMO and paid for no out-of-network services other than ER, although it did have what it called its Passport service for travelers. However, UHC did not have providers in every state, nor even in the vacation areas of WI, if you can believe that, if you needed continuing care.
Investigate Advantage carriers carefully. Talk to your doctors and other medical providers. Which pay promptly and without problem, which don't, which are problematic on preapprovals for ongoing care for chronic conditions. As I said, in certain areas, MA's are great. I wish we had a Kaiser, here. We don't. I was very unhappy with UHC the two times I used it. Delayed payment one year for the first in-network provider, and refused payment for the second until I made a whole lot of noise and got instant resolution - which I've recounted on CD a few times. But, why should anyone have to raise the roof to get the Medicare Advantage company to pay for a routine visit to an in-network doctor? I thought only private insurance companies played these games. Oh, wait, MA's are private insurance.
MA is a for-profit model and some (not all) carriers act accordingly. So, before you choose an MA, ask your current providers which they accept/recommend. Billing people for doctor whom UHC wouldn't pay said my problem was "the kind of insurance" I had. Hundreds of internet stories bear out my experience. I was not unique. For that reason (and doctor flexibility), I prefer to have Original Medicare - which pays the doctor directly - and a high-deductible F Medigap for worst-case 20% issues. Around here, Medicare pays doctors very quickly, per statements I get quarterly from CMS.
Provider restriction is the biggest issue with MA's, imo, second to the gatekeeper/preapproval issues on medical care. If you're really sick, they becoome equal, especially if you require specialty care not provided in-network.
Last edited by Ariadne22; 10-22-2014 at 02:12 PM..
If you have any chronic conditions, or a family history of them, get the supplemental plan. The Advantage ones are for those who are relatively healthy.
Quote:
Originally Posted by Escort Rider
Why do you say this? Please elaborate.
Because copays and deductibles can easily run to $5-$7k/year on chronic conditions, far in excess of any premium for a Medigap G or F - which, together with Medicare, would have paid everything.
See:
Quote:
Originally Posted by ocnjgirl
The vast majority of Medicare Advantage plans are state-specific, you can't even use them outside your state let alone the country. My Mom had Blue Cross of Pa plan, and when I brought her here to NJ (she was being D/C'd from rehab and couldn't return home alone) her plan paid for nothing here.
We had to pay out of pocket for her to get a physical for ALF placement, no reimbursement. From the minute she set foot in NJ, she basically was uninsured until I could get her disenrolled from Pa to NJ Blue Cross (they are run completely separately, you can't switch just from one to the other) and it took weeks to complete the change. She would have been covered for ER only in NJ under the Pa Blue Cross Plan.
As a rehab therapist who's worked in geriatric health care for 18 years, I would scrimp so I could get traditional Medicare and a supplemental. If you ever get sick or need rehab, your co-pays are going to be astronomical with any HMO Medicare plan, and your choices of places to go for rehab may be limited as well.
You will also have to get re-approved for rehab every few days to a week, while under traditional with a supplemental, you can get up to 100 days of rehab after a 3-day hospitalization (as long as you're still making progress and have goals you haven't met yet).
My Mom had about $7000 total co-pays for that illness, including ambulance, hospital and rehab (about 2-3 weeks). I switched her to traditional as soon as open enrollment came, and now if she had the same illness and went to the same rehab, she'd have zero in co-pays. She thought her plan was great, no premiums, what could be better??
Better is a plan that covers everything, and without begging (her plan wanted to cut her after the first week, even though she couldn't walk by herself yet but had been living alone independently prior to getting sick).
Last edited by Ariadne22; 10-22-2014 at 02:15 PM..
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
