Traditional Medicare vs Advantage Plans

11/22/2018 | tnoldman

[TNoldman]

Hi FRiends,

Happy Thanksgiving I hope you are having good weather and a relaxing time.

I have a Question on Medicare Plans. My Wife and I are thinking about Advantage Plans to replace Traditional Medicare. We are 81/83 now and active. We currently have Traditional Medicare with a Gap Policy.

The latest offerings from United Healthcare Advantage Plans seem to have taken care of out-of-network services with their Passport which create instantaneous in-network charges in most States that we visit. Emergency care is Covered in any State. Our current Doctors accept this Advantage Plan.

Our Saving would be about $5000./year (both of us) or a 50% reduction in our Total Healthcare Costs.

What do you think?

Anyone with the Industry experience and/or personal or Family member experience please let us hear from you.

Decision time on or before Dec. 7th!

[Thank You Rush]

“”The issue is that you are restricted to the network, and if you have specialists or ongoing health issues they may not be covered under the Advantage plans.””

Not true as there is a choice of HMO with restrictions on outside services or a PPO without restrictions as long as the chosen service provider is enrolled in Medicare...

I know it’s no fun checking out each and every detail but it’s necessary. I goofed picking a plan one year and chose an HMO after making sure all our doctors were enrolled in the plan and thinking (stupid of me) we wouldn’t need to add to the list; we already had all we could handle - urologist, PC doctor, pulmonologist but didn’t consider my husband’s oxygen provider who turned out NOT to be in network..Had to change but the change worked out ok...Can’t afford to miss a single step in this important issue.

[jimbug]

We have traditional Medicare and an AARP United Healthcare Plan F as a supplemental. We pay $336 a month for the supplemental. I have a lot of health problems. It only takes one major health event to bankrupt the average American. The reason that you see the Advantage plans advertised is this: the companies make a ton of money since there are so many exclusions and limitations compared to traditional Medicare and a really good supplemental.

[Robert A Cook PE]

Bookmark. Age 63, 60.

[Thank You Rush]

I have no idea where you people are getting your information from. We’ve had Medicare Advantage plans since we signed up for SS in 2001 and have never experienced what so many here are relating about experiences. We don’t have “gatekeeper” doctors and we have never had any problem getting in to see any doctor of our choice WHO IS enrolled with Medicare.

Your statement of the main purpose of Medicare Advantage plans is untrue - there are additional benefits to the MA plans that original Medicare doesn’t have. Services are not cheap and they are not limited. Every time we turn around, a doctor or specialist is recommending and scheduling a CT Scan or MRI or some other fancy test for us..No one makes any money on those.

If you don’t mind paying your money out in high premiums instead of getting value for your $$$, have at it. Anyone looking at their EOB at the end of the month can see that the companies offering MA or those providing services aren’t in it for the buck! They do receive $$ from Medicare for each enrolled member but they should maybe operate a business without compensation?

“”remember, the main purpose of advantage plans is to provide the cheapest and most limited options possible so the company can make a profit ... also, your care will be 100% restricted by a gatekeeper doc assigned to you, and you might not be able to get one you get along with””

[USS Alaska]

I have a Question on Medicare Plans. My Wife and I are thinking about Advantage Plans to replace Traditional Medicare

I'm 77 and wife is 74 and have had the UPMC Advantage Plan for about ten years and have found it to be terrific for us.

UPMC also has some of the finest hospitals and doctors in Western PA, and it fits with our medical needs.

We use the 'For Life' plan, so other than signing over our medicare monthly amounts to UPMC, and several minimum deductibles, we pay no other premiums.

Our health is relatively good, and our combined prescription drug costs are less than $500/year, which I consider to be almost free.

The Advantage plans are almost always better than medicare for the user, but do research and see if any other plans in your area is better than the one you are looking at.

In Western PA, I highly recommend seniors at least explore the UPMC Advantage plan, and compare it to other plans, and then make a rational, not an emotional decision.

[Thank You Rush]

“”If you get a mail copy of Medicare and You 2019, it may list plans available in your area.””

They are in the back of the book depending on the state you live in - came in handy...

[Vigilanteman]

My wife turns 65 in February. They are going to charge us up the yazoo if we sign up (or so we're told) because I am still working and plan to keep on doing so.

Why shouldn't I? I'm making decent money and (mostly) enjoy the work?

But we did go to one of those Medicare seminars (independent agents put them on from time to time to drum up business) and learned a couple of interesting things:

1. AARP basically teams with another plan (including United) and marks them up for using the AARP marketing muscle. You are better off going to United (or whomever) by yourself or with an independent agent who doesn't operate in the dishonest fashion of AARP.
   
2. The government pays whatever plan you are on about $800 per person per month to do the admin work. This is exactly why they offer perks like no deductible, no co-pay, no-premium and even gym memberships if you sign up with them.

[Thank You Rush]

“”My wife turns 65 in February. They are going to charge us up the yazoo if we sign up (or so we’re told) because I am still working and plan to keep on doing so.””

I have no idea why that would be true. If she applies for SS for February (she wants to apply at least 3 months before then), she will automatically be enrolled in Part A and her choice to take Part B at the same time which she should do as there is a penalty for doing it later... She can choose or not a Medicare Advantage plan if that’s her choice after she’s gets enrolled. Is there some penalty if you continue to work and she’s retired? I have never heard of such a thing and that would surprise me..

As for you continuing to work, I would recommend it. My husband and I both applied on our 65th birthdays in 2001 and continued working until age 70.. So I reveal how old I am - big deal. Some of the young whippersnappers here who enjoy cussing at me need to know that I am old enough to be their great grandmother and I AM NOT A MALE who would think nothing of it.

We were given credit on our SS earnings every year that we worked so our benefits continued to grow each year. There is a sticking point with that somewhere but I forget just what - maybe if someone takes SS at an earlier age and they keep on working, their continued earnings don’t count? I know it used to be 62 but I don’t know what they consider early now.

[Thank You Rush]

“”You are better off going to United (or whomever) by yourself or with an independent agent who doesn’t operate in the dishonest fashion of AARP.””

I’ve steered away from United because of AARP...Is it possible to deal with them separately? I’m shopping and I keep running into AARP....

[RightField]

Mr. RightField has had an advantage program since he got on Medicare 10 years ago. It has not worked well for him for several reasons. He is restricted to a network and that does not give him good coverage when we travel. We travel 4-6 months of each year in our motorhome. Also, while procedures may be listed as 'covered' under the MA, in reality there are no providers in the network, so it would end up much more expensive than even stand-alone Medicare because of the higher cost for non-network providers. We also had situations where a network provider tried to sub-contract to a non-network provider (think anesthesiologist) and the non-network provider billed us for services. For that one, we threatened legal action and the provider backed down quickly.

Another annoying feature of the MA plan was that the insurance company was always trying to insert themselves between Mr. RightField and his doctors. The company always wanted to visit him in our home, to provide "extra care" and provide a "list of concerns" to be shared with the doctor on his next office visit. We would also get calls from the insurance company pharmacist to "go over" his list of medications and "coordinate" with his primary physician. We would get offers to get $25 gift cards to various restaurants or stores if he would just acquiesce to a in-home visit to have a nurse practitioner give him an addition exam ... and evaluate the safety of our home.

The requests for home visits got the same answer: The only entrance to our home is with an invitation or a warrant, and you have neither.

This year, Mr. RightField's MA has cancelled their program in our area. It is called a "Service Area Reduction," and opens up what is called a Special Election Period whereby Mr. RightField can get a guaranteed-issue supplement plan. We're going to go with Plan F (same as what I have). Yes, it is more expensive, and he has to get a prescription plan as well.

But, for us, the freedom to choose any provider, anywhere in the country, far outweighs any so-called extra benefit touted by a Medicare advantage program. Freedom isn't free.

[steve86]

Not a single MA plan offered in my county so the choice is easy. But I do have to decide between high deductible and regular Medigap Plan.

[RightField]

As I understand it, even changing between Medigap programs triggers medical rating, so choosing the correct Medigap program is important at the beginning. In our county in FL, the premium difference between F and high-deductible F is not enough to justify the high-deduc plan.

Plus, Plan F will not be offered after 2019. Those in Plan F will be able to continue the plan for the rest of their lives, but because there will be no new enrollees after 2019, the population of that plan will be older and sicker as the years go by. That probably will result in higher premium increases for that plan. Plan G is identical to F, except that you have to pay the small deductible. In our county, the difference in premium between regular F and G is (amazingly!) the exact cost of the deductible. Advantage goes to G, therefore, because the plan will continue after 2019.

[Vigilanteman]

We are going in to Social Security on Monday just to find out our options because the info given us over the phone just doesn't pass the smell test.

I think age 70-1/2 is when you get socked if you keep on working. I'll see if I still enjoy it by then. She does not have enough work credits to claim social security in her own right, but I am not sure that applies to medicare. It is supposed to be a separate program not based on work credits, isn't it?

[hanamizu]

My wife and I are on Medicare/Supplemental Plan F plus we each have part D drug plans. I had enjoyed very good health, but I was diagnosed with prostate cancer 2 1/2 years ago and had a prostatectomy. Medicare/plan F paid for everything. After 2 years PSA results started climbing and I’m now undergoing radiation therapy. No bills for it, so far. I figure my Supplemental Plan F cost of $175/mo is a pretty good deal, all in all.

What no one has mentioned so far is that each state is different when it comes to plans. In Missouri I can change plans not just in Oct/Dec but also in the month that I first enrolled in a plan without having pre-existing conditions applied against me—unlike if I switch now.

My mom 99 had an Advantage plan in SoCal, but she seemed to be very limited to doctors/hospitals, etc. Cal is big on HMOs but they are unknown here in SE MO. So I guess I’m saying a lot depends on where you live.

[LongWayHome]

First: if you leave original Medicare for an Advantage Plan & you DON’T live in one of only 2 or 3 states that allow “Guaranteed Issue” you could be locked out of going back to original Medicare, forever. Because you will be subject to a medical review & if you are unhealthy you will not be allowed back in.

Second: Advantage Plans are private companies & they will not always approve everything Medicare would. It happens all the time. Go read the horror stories all over the internet. Advantage Plans are ok if you are healthy, but not worth it IMO long-term.

[hanamizu]

Depending on where you live, Social Security can be a big help. They can tell you right away about her Medicare status. I could be wrong about your getting socked for working after 70 1/2. I still work—a little—and every year my Social Security gets bumped up because of it—a very little. I do believe (and could be wrong, so ask them) that SS benefits don’t keep going up if you defer claiming them after a certain age. You do have to starte drawing down IRAs after 70 1/2.

When I went into SS, I was struck by how few geezers/geezerettes were in the waiting room. Seems like everyone else there was drawing disability. And don’t even think about using a cell phone inside the office. Good luck.

[catnipman]

“I have no idea where you people are getting your information from”

Kaiser Permanente ...

[Thank You Rush]

Well, shoot - that’s isn’t suspect, is it? “Gatekeeper doctors?” Was that their phrase? I understand them selling their own programs but anyone signing up for Kaiser has to use Kaiser doctors and Kaiser hospitals - the client doesn’t get a choice. I’ve never wanted to be tied down to one place, doctors chosen by the plan so I’ve never checked out their programs. Years ago in CA, they had a terrible reputation and then people’s opinions about them started to change and I guess whatever was bad about them was taken care of but I still didn’t want to be part of it...Since coming to GA, we’ve run into a few people who have Kaiser and never have a problem.

[Thank You Rush]

“”She does not have enough work credits to claim social security in her own right, but I am not sure that applies to medicare. It is supposed to be a separate program not based on work credits, isn’t it?”

That is something I’ve never had to look into. I helped a friend who wasn’t 65 looking into filing at 62 and continuing to work but not this. I don’t have any idea. Medicare is automatic when a person files for SS - Part A is automatic and Part B is choice. If a woman files on her husband’s SS, that’s hazy to me. I know my sister in law did it but I never understood it. I guess a wife can also file on her divorced husband’s SS and vice versa...

I remember how surprised I was a few years back to hear that someone on Medicaid also was eligible for Medicare. I think it was in the news about someone on both - that wasn’t the story but I wondered at the time HOW on earth does that happen? I looked it up and I think it was AFTER 2 years on Medicaid, a person goes on Medicare also.

Anything and everything you ever wanted to know is online but understanding it is something else. I think the people who make the rules should be paraded in front of the country so we could all see where this stuff comes from.

[Thank You Rush]

Can you let me know what you learn when you go to SS on Monday? I’m curious... It never hurts to have more knowledge - even if we’re in danger of forgetting it!