I’m interested in any thoughts on Medicare Advantage plans vs. straight Medicare Supplement plans. Currently in the sign up process.
I have humana Medicare advantage plan for 6 years. I am very happy with it.
Three things about the Medicare Supplemental Plans are:
(1) they are not paid for merely by your Medicare premium, you pay additionally (mine $2k plus a year), and \
(2) while they do not have some “free benefits” that some Medicare Advantage plans have (dental, eye care, ect>), they essentially pay certain levels (depending on the insurer, the health care item & the specific plan) above the Medicare 80% amount, and
(3) they usually have no “network” or PPO; and usuually your Medicare Supplemental Plan is good anywhere in the U.S. with any provider that also takes Medicare.
From what I can tell (and it’s complicated), Advantage plans are better if you’re on a tight budget and relatively healthy. But who knows what one’s health will be like a year from now?
So I went with straight Medicare, and bought a supplement.
Advantage plans are just insurance. If you are tired of the insurance racket go Medicare and a supplement…
I would not purchase an Advantage Plan. I would purchase a supplemental along with keeping Medicare.
The only way to know for sure which is best is to have a crystal ball. Affordability is a factor, as is current and foreseeable healthcare needs.
I just had both knees replaced and paid nothing.
About 9 months before that had a major shoulder repair - zero cost to me.
For us if we add up all the costs including the $255 deductible, drug plan, and a Cobra dental and vision we pay about $7000/year.
Having a fixed cost is comforting.
I’m interested in any thoughts on Medicare Advantage plans vs. straight Medicare Supplement plans. Currently in the sign up process.
Here is my simple take on Medicare Advantage vs Traditional Medicare with Supplemental plans and what I and my wife have done with our health insurance:
Medicare Part A: Basically Covers hospital care, skilled care, hospice and home care.
Medicare Part B: Pays for Doctors and ancillary care / outpatient care
Medicare Part D: Covers prescription costs to a certain extent
Medicare Part C: Medicare Advantage Plans - Insurers assume responsibility for providing reimbursement for Medicare expenses in exchange for a fixed payment from the government on a per member basis. For this payment the insurers assumes financial liability and risk. They “manage” the care and attempt to optimize health by offering services and programs that are preventative in nature. For instance they incentivize preventative care such as immunizations (flu shots, pneumonia shots, shingles vaccines, RSV shots), health club and exercise programs, social interactions etc. They profit if the members consume less dollars of health care than the government calculated and paid for the insurance companies to assume that risk.
Costs: Medicare Part A: No cost to the member
Medicare Part B: $174.70 (2024)
Medicare Part D: Variable depending on insurer and benefit. Avg. $48
There is a “IRMAA” (Income-related annual adjustment) for singles and couples that increases the above Part B and D premiums by up to a maximum of $594 for Part B and can add up to $81.00 to the baseline Part D plan.
Part C: Medicare Advantage: Many plans are at zero premiums but members must maintain Part B coverage so they still pay the Part B and any IRMAA as well as a Part D IRMAA if applicable based on income. They do not pay an extra premium (for most plans) for the Advantage plan.
Medicare Supplement Insurance: Medicare Part B pays 80% of “allowed charges” with Medicare determining the “allowed charge.” This leaves the patient responsible for the 20%, and if the provider does not accept assignment up to an additional amount as allowed by medicare. To cover this amount many purchase a supplement plan from insurance companies. Many different plans are available and provides different levels of coverage and are at variable prices. The most popular plan right now is called Plan G. Medicare dictates that there are basic coverages that each plan has to offer regardless of which Insurance company offers the product so one Plan G has to cover the basics as determined by Medicare but they can offer additional coverages above the minimum so there is variability in the coverages depending on which company you choose. The prices for these plans are set by the insurers and are generally competitive across the spectrum of offering companies. There is an annual Part B deductible that has to be met before medicare Part B kicks in ($240 in 2024).
Part A Medicare for hospital charges also has an annual deductible. For 2024 this amounts to $1632 for inpatient hospital costs. Should the hospital duration extent to days 61-90 there is a daily deductible of $408. If Skilled Nursing Care is needed beyond 20-100 days post hospital care the deductible for that is $204.00/day.
The Medicare Supplements may cover these deductible costs depending on which Supplement plan is purchased. Plan G for instance does cover the deductibles except the Plan B $240 deductible.
Plan C Medicare Advantage programs have variable benefits depending on the company and plans. They have HMO plans that are more “managed” and somewhat restrictive as to providers and pre-authorizations and PPO plans which allow members to seek care from a wider range of providers (although at a slightly higher co-pay amount) and less restrictive pre-authorization requirements.
Most Medicare Advantage programs have some coverage for things like eye care, exams, glasses, etc.; hearing aid coverage; dental coverages; health club memberships (silver-sneakers). Some provide a supplemental benefits to purchase over-the-counter health products (vitamins, toothpaste, mineral supplements, women’s health care products, and others); and incentivize by providing small payments to members who meet criteria for improving their health like exercising, getting immunizations, doing annual health assessments. Most Medicare Advantage plans offer better coverage for foreign travel emergent care needs (although travel insurance should still be highly considered)
There is a deductible (generally for the first few days of hospitalization for in-patient care and small co-pays for out-patient care {less for HMO than PPO plans}).
Given all the above, I think the bottom line depends on your individual needs and desires, but Medicare Advantage appears better suited for those wanting to save money over the costs of Medicare supplement plans, and those who live in an area where most providers are enrolled as providers (for HMO plans) or are accepting Medicare patients (PPO plans) and where the hospitals are participating (most are.)
Those who want some eyeglass care, hearing aid care, gym memberships etc benefit from Advantage plans.
Traditional medicare is likely preferred for those who anticipate considerable services with multiple hospitalizations as Medicare Advantage programs can have a high out-of-pocket limit especially if utilizing “out-of-network” providers.
My wife and I chose a Medicare Advantage Plan as Supplemental Medigap plans (G) and plan D plans) were costing us over $5000/yr. and do not anticipate multiple prolonged care needs and live in a region where most providers are either in-network or accept Medicare so we can use our PPO plan and pay a slight additional co-pay ($50 for specialist vs $35 in-network specialist). We also travel internationally every couple years and find emergent care coverage of the Advantage programs to be preferable.
Consult an independent health insurance consultant and do not rely on Joe Namath of JJ Walker to assist you in making the decision regarding you Medicare or Medicare Advantage plan.
I have a friend that is an agent.
She told me that she could make 6 times the commission by putting me into an advantage plan.
She then said that she would not do that to me.
Medicare part G is what I have.
Everything is covered.
Anywhere I go.
2500 deductible.
You do pay for it, but it’s worth every penny.
I will have to choose at some point, I’m way past age but still working.
Based on everything I have seen during my medical career, I favor conventional Medicare. There are too many ways for MA contractors to scam the system at the patient’s expense.