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Medicare Advantage vs Medigap
Self | 12-03-2020 | Captain Peter Blood

Posted on 12/03/2020 9:51:41 AM PST by Captain Peter Blood

I turned 65 in June and got on Medicare. I got the normal Medicare plans including Plan D, and optional Dental and Vision overage. Cost about $150 a total.

I opted not to go Medicare Advantage at that time until and I could research it and see if it was all that was claimed.

I recently talked to the Blue Cross rep here in Arkansas and after all my questions were answered and i knew my doctor was in the network I opted for a Advantage Plan, PPL plan for $49.00 a month and I am satisfied I made a good choice.

Now I take care of a 94 year old Aunt who is in good health. Recently though she was in the hospital with a UTI, slight case of pneumonia, and low potassium. She recovered well and is home.

Now she has a Medigap policy through Cigna for about $150 a month, Plan G, deductible of $195. It pays for everything that Medicare doesn't and is a good policy.

The advice I am asking is if switching her to a Advantage Plan would make sense or should I leave her where she is given her age and such?


TOPICS: Health/Medicine
KEYWORDS: advantageplan; health; insurance; medicare; medicareadvantage; medigapplan
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To: Swanks
#14: "Went with Mutual of Omaha supplemental over BCBS for about $20 less per mo. Not like that’s an unheard of firm."

These two heartily concur.


21 posted on 12/03/2020 10:13:35 AM PST by Governor Dinwiddie (Guide me, O thou great redeemer, pilgrim through this barren land.)
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To: Captain Peter Blood

Honestly, she’s 94. If she hasn’t had many problems with the coverage she has now, and the cost isn’t prohibitive, she’s better off sticking with what she has. If she switches at this age, she may never be able to get it back if the other doesn’t work out for her.


22 posted on 12/03/2020 10:18:16 AM PST by nuconvert ( Warning: Accused of being a radical militarist. Approach with caution.)
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To: Captain Peter Blood

Be advised that if you switch to advantage, you CAN’T go back to Medicare. I have regular Medicare and Cigna plan G...and I just went through a major issue. Appendicitis with complications. Was in hospital 8 days. My bill was over $85,000 and I came out owing less than $200 so far...which is awesome to me as part of that was deductible.

I’m not changing anything...


23 posted on 12/03/2020 10:20:43 AM PST by BamaBelle (The storm has arrived!)
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To: MayflowerMadam

I checked into all of very carefully before I made my own decision and was satisfied that it was a good deal for me. My doctors and hospitals were in their plan and I was happy.

For my Aunt though I may need to keep her where she is at her age, 94.


24 posted on 12/03/2020 10:24:45 AM PST by Captain Peter Blood (https://www.freerepublic.com/focus/bloggers/3804407/posts?q=1&;page=61)
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To: Captain Peter Blood

I have Medicare Part A and B, plus a supplemental plan. For $180/year, no deductible, it takes care of everything. Doc offices like it, because they get paid by medicare/insurance company, don’t have to bill me.


25 posted on 12/03/2020 10:25:00 AM PST by jimtorr
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To: BamaBelle

If I change my mind in the future I can’t go back to the original Medicare Plan? I need to check on that.


26 posted on 12/03/2020 10:27:23 AM PST by Captain Peter Blood (https://www.freerepublic.com/focus/bloggers/3804407/posts?q=1&;page=61)
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To: Captain Peter Blood

For that price I think it best to leave her where she is with the plan G. She can go to any doctor who takes Medicare (no network) and she does not need referrals, much easier paperwork, and after quitting they will not take her back unless she very clearly made it a “trial” and goes back quick.

I hate the “Part C” plans — they are a way to opt out of Medicare and into one of those failed HMOs essentially, the socialism of medicine, they make their money by declining enough services by trickery that they have lots left over.


27 posted on 12/03/2020 10:31:01 AM PST by Weirdad (Orthodox Americanism: It's what's good for the world! (Not communofascism!))
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To: Captain Peter Blood

At her age...leave it as it is.

.


28 posted on 12/03/2020 10:31:21 AM PST by Mears (...)
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To: Captain Peter Blood

I found some youtubes on choosing before I signed up a year ago and that’s what video said. I’ve talked to other folks who say the same...


29 posted on 12/03/2020 10:36:13 AM PST by BamaBelle (The storm has arrived!)
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To: Captain Peter Blood

Only one or two states allow you to go back to original Medicare, without underwriting, once you sign on to advantage plans. So in most cases, once you leave original Medicare...you are locked into advantage plans for life.


30 posted on 12/03/2020 10:47:32 AM PST by LongWayHome
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To: Swanks

Anthem Plan N here 4 yrs,Mutual of O 10 bucks less, underwriting I declared skin cancer they declined.
Later saw Mutual of O no Silver Sneakers. With out SS the Y is 25 a month.so

Sticking with Anthem not going Advntg till I am forced $$ to


31 posted on 12/03/2020 10:59:17 AM PST by CGASMIA68
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To: All

This is a HUGE and COMPLICATED thing. I have read all the comments above this one.

1) Advantage is presently about 38% of all 65+ health coverage. That number is growing. Medigap is NOT the remaining 62%. A large number of folks are on Medicaid, VA, TriCare, etc. Those other categories add up. Advantage will likely overtake Medigap within 10 yrs.

2) Don’t presume you can use Medigap when you “travel”. Yes, no question, if you travel somewhere and break your leg, you’re covered. But if you have a Medigap policy in Iowa with premiums based on Iowa costs and think you can spend 6 months winter in Florida and get covered there, you’re taking a risk. Asking for repeated treatment in the more expensive Florida locale will eventually get noticed and . . . risky.

3) If you travel and break a leg, Advantage will cover you for that. But if you try the 6 month winter thing with Advantage, the same issue will arise. You will need to change your coverage to a local Advantage carrier, and back again to Iowa. Same thing with Medigap, with varied premiums.

4) General rule of thumb, THERE IS NO GENERAL RULE OF THUMB. Advantage is not “the way to go”. Medigap is not “the way to go”. Medigap premiums will add up steeply. I saw some low numbers above which cannot be right. To evaluate premiums you have to look at plans with $0 deductible. Varying both numbers creates apples and oranges. Medigap premiums for $0 deductible will be $250+/month. $147/mo (next year) for Medicare. $25ish/mo for Part D drug coverage. Total is $5K/yr.

Typical Advantage is $0 premium, drugs included, $147/mo for Medicare. BUT, when you need treatment/care, there will be copays. Those copays add up. If you don’t get sick much, you’ll be way under the $5K/yr Medigap. If you do, you’ll go over $5K/yr, with an out of pocket max imposed on all Advantage plans of about $5500 for the year.

Last item: If you KNOW, for SURE, you’re going to be sick a lot, then Medigap is your correct choice. If you may not be sick much, with few doc visits, you’re taking no huge risk in Advantage.


32 posted on 12/03/2020 11:06:15 AM PST by Owen
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To: jimtorr

I see I made a major boo-boo. I said $180/year, I meant $180/month.


33 posted on 12/03/2020 11:07:15 AM PST by jimtorr
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To: Captain Peter Blood
Well, thanks to everyone... Me and mine have been thinking about this for the last few days..

We have "plan F", it's costing us a bundle, upwards of $800 a month tol.. I think I'll look into "plan G"..

34 posted on 12/03/2020 11:09:15 AM PST by unread (A REPUBLIC..! If you can keep it....)
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To: Captain Peter Blood

So you want to switch someone who is 94 to save $1200 per year? Are you making the payments or her?


35 posted on 12/03/2020 11:12:43 AM PST by FreedomNotSafety
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To: Captain Peter Blood

It is getting late. The deadline is Dec. 7.

Anything too good to be true still isn’t. Advantage is too good to be true. The incentive for Advantage is the same as an HMO, keep costs low, high co-pays and deny coverage or at least be niggardly in managing it. Make it a come-on with trinkets.

With Advantage; Medicare is handing over the annual premium to an insurance carrier and challenging them to provide coverage for less than they are getting from your Medicare premium. Good luck with that while still providing reputable coverage.

You can’t change each year without underwriting and as some have noted, you may be denied and so have to stick with the plan you started with. The annual open enrollment is a scam, it isn’t so, there is no “open” enrollment. It isn’t “open” if you have to go through underwriting and it isn’t “open” if you have a waiting period for pre-existing conditions if you are accepted after underwriting.

Consider this, the system was set up under obamacare. It is a scam and a trip through a filed littered with mines. You will have succeeded in navigating it if you are only slightly injured.


36 posted on 12/03/2020 11:18:54 AM PST by Sequoyah101 (I have a burning hatred of anyone who would vote for a demented, pedophile, crook and a commie whore)
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To: Owen

Clarifying my babble from above a few comments:

You use $0 deductible to evaluate premiums because you will never out-compute the insurance company’s computer. They know what the statistical norm is. If they raise deductible to lower monthly premium, they aren’t doing that so you come out ahead. You Will Never Come Out Ahead. That’s the nature of insurance.

So do all your Medigap analysis on plans with $0 deductible. Premium comparison then makes sense.

In the early days, Advantage’s big disadvantage was paperwork. All those copays each time you saw a doc. But computers have erased that.

You pay $320/night for an Advantage hospital stay copay. Typical Advantage plans say 1-5 nights $320/night and $0/night after 5 nights. Well, of course they know the average stay is 3 nights. They almost never have someone in for 20 days they are having to eat costs on. And if you go home and have to come back, the clock restarts.

Again, no rules of thumb. If you expect 20 hospital stays in a year, Medigap. If you expect 4 hospital stays the rest of your life, Advantage.


37 posted on 12/03/2020 11:20:27 AM PST by Owen
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To: Sequoyah101

Open enrollment refers to changing from one Advantage plan to another. Most areas have many, competing.


38 posted on 12/03/2020 11:21:51 AM PST by Owen
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To: Captain Peter Blood

Your hesitation is valid; best not to change anything at this point.


39 posted on 12/03/2020 11:27:06 AM PST by TurkeyLurkey
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To: Owen

Perhaps so. I would not touch Advantage at all if only because of the advertisements.

Without underwriting and acceptance we are stuck with the Medigap coverage we choose upon initial enrollment for the rest of my life. The caveat to that is failure of the company you initially pick. There is no fully “open” enrollment for Medigap.

I chose G with community based premiums that will go up with inflation but not for age. The only such plan offered in our state is via hated AARP and UnitedHealthCare. I considered Mutual of Omaha favorably but the only pricing available in our state is attained age based which provides a scale that gets pretty sporty pretty quickly plus inflation. People I have talked to are satisfied with United but people on this forum are variously disparaging of it though some seem to be mixing regular and Medigap coverages in comments about experience.

I have had BCBS for years as I paid through the nose for nothing but catastrophic coverage under barky care. I hate them and am willing and wanting to go somewhere else. They are administratively buffoons. Maybe something else is worse but I doubt it. Right now all of them are cluster flucks what with the entire nation trying to do all this crap in a two month period. What fool ever thought that was a good idea?


40 posted on 12/03/2020 11:35:52 AM PST by Sequoyah101 (I have a burning hatred of anyone who would vote for a demented, pedophile, crook and a commie whore)
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