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Most Advantage plans are zero deductible, and many of the copays are fixed dollar amounts that aren't very much if you are talking routine care. But for major services, those copays can be significant, and annual max out of pockets can often be in the $5000-$8000 range, understanding it will take a year with major services to hit that amount. You're saving on premiums, but have a higher copay cost exposure than original Medicare paired with a Supplement. So for those who would have conditions that require costly recurring treatment, Advantage plans probably aren't going to be the most cost effective option.
As for limited networks, that's going to be location-specific. Generally, the larger urban areas will have a lot of contracted providers, but smaller towns and rural areas, not so much. Of course, less populated areas usually have few choices of providers, to begin with.
Check again, May be different for some plans.
Many Advantage plans have zero premiums. Others may have low premiums. In a "good" year maybe you only pay the premium. You were healthy & don't need many services.
Could be a guy thing if you haven't seen a doctor in many years. So they get you in for a checkup. Then they find something. They may have considerable deductible + a co-pay to see the doctor. Over time maybe once a decade you run into a "bad" year.
True, Medicare Advantage may cover the same procedure as Medicare. But it may not provide the same coverage. Maybe Medicare Advantage should have the same letter grades so that you buy more coverage for a level of premium. For many individuals need to save the money in an account to be used someday.
My husband and I switched from traditional Medicare (plus we paid out-of-pocket for a supplement plan plus a drug plan) to a Medicare Advantage Plan with Blue Cross Blue Shield over a year ago.
We're very happy with our Advantage plan.
It includes some dental and vision coverage, $90 quarterly for OTC medicines/vitamins and some health supplies like toothbrushes, floss, paste, band-aids, etc. from membership drugstores (Walgreens, CVS, Walmart) and covers, for zero cost, the generic drugs we take for high blood pressure. The drug plan we used to have still cost us $ for these drugs...
This works well for us and saves us quite a bit of $. We're generally healthy except for the HBP. The doctors we see are fine.
We live in North Carolina so not sure if all BCBS Advantage plans offer the same coverage in other states.
Hope this helps.
I have Highmark Community Blue PPO Distinct in Pennsylvania . We get 190 dollars of OTC every quarter. This is my first year with Medicare. I needed to have Prescription drugs so I had to get part D that was why I took it.
The OTC is so so. I am not impressed at all. They charge high prices for small items. You can get vitamins, toothpaste(very small tube),fiber powder, band-aids, incontinence pads, diapers ,things like that but it all is hiked up in price. Not the best quality either.
My husband had it with a different company last year and it was better.
We pay 27 dollars a month for our plan with Highmark. I have no complaints. the last 3 years I was paying for my insurance via Obama Care and it was expensive $621 a month after government supplement based on my income. I had Highmark so I had basically the same policy now in retirement.
My doctors office said Highmark is my insurance not Medicare even though medicare takes the money from my SS and the 27 dollars from my check every month.
I am going to have shoulder surgery in June so I will see how that works.
I know there is a lot of hate against Advantage plans (I haven't had issues) - just today, got someone SUPER helpful about my being billed for things that I shouldn't have been. They are opening an investigation.
I’ll add that Medicare with a supplement you can see any doctor or specialist without a referral. Had open heart surgery with aortic valve replacement and mitral valve repair. I was on warfin for 3 months and had 2 months of physical rehab. My total out of pocket was was 224.00 I have original Medicare with a part g supplement and a part d drug plan. I seen people in rehab and at the warfin dr. Paying 20-30 copays for every visit and no idea what their out of pocket was on there plan.
I’ll add that Medicare with a supplement you can see any doctor or specialist without a referral.
Generally, HMO insurance plans are the only ones that may require a referral to see a specialist. That applies to non-Medicare HMO plans as well as Medicare Advantage HMOs. PPO plans, be they Medicare Advantage or non-Medicare, do not require referrals; nor as you state, does original Medicare or Medicare + Supplement.
I have Medicare with a supplement plan, but many specialists STILL want referrals from my PCP. CYA, most likely.
I had an Advantage plan years ago. They only paid 70% of my medical supplies, and I paid 30%. I had to go to their main hospital on another island (took all day) to see specialists or have tests like CTs or colonoscopies, even though they were available in my town. Hospitalization cost a bundle; I reached my $5000 copay every year. I paid a percentage of drugs, too.
Regular Medicare pays 80% of the supplies, etc. and my current supplement plant pays the rest. I'm out of pocket for some drugs, but all hospital bills are covered, even out of state.
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.
Just don’t get sick with one. Have a stroke and you might get booted from rehab in 2-3 weeks, whether you’ve regained function or not, while on traditional Medicare with supplemental you can get up to 100 days inpatient rehab. Also huge co-pays. My mother owed $5000 after hospital and 3 weeks of rehab. I switched her to traditional as soon as open enrollment came.
Speaking as a therapist with almost 30 years experience in geriatrics. The cut times are getting shorter and shorter.
I’d rather be able to get rehab till I can walk and dress myself again, than get free groceries. It’s going to be tough for me as I will not have high income in retirement but I will do all I can to avoid them.
Just don’t get sick with one. Have a stroke and you might get booted from rehab in 2-3 weeks, whether you’ve regained function or not, while on traditional Medicare with supplemental you can get up to 100 days inpatient rehab. Also huge co-pays. My mother owed $5000 after hospital and 3 weeks of rehab. I switched her to traditional as soon as open enrollment came.
Speaking as a therapist with almost 30 years experience in geriatrics. The cut times are getting shorter and shorter.
I’d rather be able to get rehab till I can walk and dress myself again, than get free groceries. It’s going to be tough for me as I will not have high income in retirement but I will do all I can to avoid them.
CMS requires Advantage plans to cover the same services as original Medicare, so theoretically you could get up to 100 days in rehab with Advantage.
I get your point, though. You will be scrutinized more closely with Advantage, and you will likely be approved for less days and be exposed to paying more out-of-pocket than with original Medicare combined with a Supplement. But be advised that even with original Medicare + Supplement, only a small percentage of patients admitted to skilled nursing or rehab, end up getting the full 100 days.
My mom was in a rehab facility after a knee replacement several years back. She had original Medicare + Supplement, so her stay (~60 days, IIRC) was covered in full. But believe me, you don't want to be in one of those places one day longer than absolutely necessary. Let's just say it was the antithesis of Club Med.
CMS requires Advantage plans to cover the same services as original Medicare, so theoretically you could get up to 100 days in rehab with Advantage.
I get your point, though. You will be scrutinized more closely with Advantage, and you will likely be approved for less days and be exposed to paying more out-of-pocket than with original Medicare combined with a Supplement. But be advised that even with original Medicare + Supplement, only a small percentage of patients admitted to skilled nursing or rehab, end up getting the full 100 days.
My mom was in a rehab facility after a knee replacement several years back. She had original Medicare + Supplement, so her stay (~60 days, IIRC) was covered in full. But believe me, you don't want to be in one of those places one day longer than absolutely necessary. Let's just say it was the antithesis of Club Med.
But we get to decide, meaning the team, the therapists, social worker, family and nursing. We make the decision whether the person needs to stay there longer, or not under traditional Medicare. It is only advantage plans that have gatekeepers, and the cut times are getting shorter and shorter every year. We have quite a few people that we keep for the entire hundred days.
Under an advantage plan, you can appeal if you get cut before you’re ready, but if you lose that appeal, you have to pay privately for however many days you stayed in the facility and got therapy while you were awaiting their decision. It could be several thousand dollars, a lot of people can’t afford to even take the chance.
Your mom would never have gotten 60 days for a knee replacement under an Advantage plan.
There are 2 problems with Advantage plans. The main one is you do not get to choose your doctor.
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That's a lie.
My Advantage plan provides a long list of doctors and facilities and, guess what, doctors I have already used are on the plan. So, yeah, you do get to choose your doctor.
Quote:
Originally Posted by GWoodle
Then you rely on the insurance co for the care you can get.
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Doesn't everybody who has insurance rely on the insurance company for care?
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