Medicare Advantage Plans vs Original Medicare Plus a Supplement

[Flopper]

I'm trying to help my neighbor decide on a Medicare plan as she just became eligible for Medicare. Any thoughts about these types of plans would be appreciated but please no political dissuasions.

 

[Hang on Sloopy]

I'm trying to help my neighbor decide on a Medicare plan as she just became eligible for Medicare. Any thoughts about these types of plans would be appreciated but please no political dissuasions.

Step 1. Does she take any medications? Have her add up a yrly cost from the pharmacist if she does. We must determine first if Part D is cost effective or not

 

[Flopper]

Step 1. Does she take any medications? Have her add up a yrly cost from the pharmacist if she does. We must determine first if Part D is cost effective or not

She takes at least a dozens meds but before she can consider whether she needs a part d plan she has to decide whether to go with a Medicare Advantage plan which includes drugs. I had an Advantage and had some very bad experiences but maybe my experiences are not typical.

 

[Hang on Sloopy]

She takes at least a dozens meds but before she can consider whether she needs a part d plan she has to decide whether to go with a Medicare Advantage plan which includes drugs. I had an Advantage and had some very bad experiences but maybe my experiences are not typical.

OMG! She needs a supplement plan no matter what. She probably has 8 doctor appointments per month

HUMANA dollar for dollar, pound for pound, is a very good product overall and highly reputable if available. Humana has a lot of perks

What issues did you have

 

[Flopper]

OMG! She needs a supplement plan no matter what. She probably has 8 doctor appointments per month

HUMANA dollar for dollar, pound for pound, is a very good product overall and highly reputable if available. Humana has a lot of perks

What issues did you have

When you say Humana, are you saying they have a supplement or an Advantage plans? IMHO, the original Medicare plus a supplement and a drug plan is the way to go for those that have significant medical problems. The cost of a supplement and a drug plan will run in the range of $150 to $300 plus your part B cost which is well above the cost of Advantage Plans.

There is lots of sales hype about Advantage plans with perks such as free gym membership, dental benefits, vision benefits, discounts at retail establishments. Costs can run anywhere for $0 a month to a hundred or so. The fact that the deductibles, copays, drug formularies, networks, rules for getting services, and out of network policies vary widely from policy to policy makes comparison very hard.

A second option is a Medicare Supplement. You may not see these plans advertised much at all and there are usually no perks. All Medicare supplements have open enrollment for the first 6 months after you start Medicare. This is the best time to buy as you have the best selection of companies and the best prices. After open enrollment, you may be able to join but that depends on your state and whether the company offers open enrollments at a later date. It is very easy to compare Medicare Supplement Plans. No matter which company you select, your benefits will be same. I have plan F which cost $235/mo. It pays essentially everything that Medicare does not pay. I have not paid a single cent in medical cost in last 5 years excluding drugs. I get no medical bills. There is no network, so I can go to any doctor or hospital in country that accepts Medicare which is about 97%. There are no referrals. If have significant drug costs, then a part D drug plan might be a probably be good buy.

What I have found is that people that have few medical problems are better off with an Advantage plan. However people that use medical service often or just like being able to go any doctor anywhere in the country would find the supplement plans the best choice. However there is a major problem, if you do not sign up for a supplement in the first 6 months, your choices may be very limited in future.

 

[Flopper]

OMG! She needs a supplement plan no matter what. She probably has 8 doctor appointments per month

HUMANA dollar for dollar, pound for pound, is a very good product overall and highly reputable if available. Humana has a lot of perks

What issues did you have

The major issue I had with a Medicare Advantage plan was the hospital and clinic my wife and I went to announced in the middle of open enrollment, our Advantage plan was dropping them. So we had to find new doctors in a clinic across town that was covered by our insurance. It was a long drive and we did not like most of doctors nor the long waits for service. Two years later the insurance company dropped their Advantage plan in our area. So we had to find another Advantage plan. However rather do that I talked to a local health insurance consultant where I learn that AARP was having an open enrollment of their Medicare Supplements. The wife and I both applied and were accepted. That was about 6 years go. Since then we have not had to change doctors, pay a single medical copay or deductible, never had to get a referral to see a specialist, need had any medical procedure denied, and best of all when we traveled we could go to any doctor or hospital in the US that accepts Medicare which is 97% of them. It cost more than the advantage plans but has been well worth it to us.

 

[Rigby5]

I have very narrow knowledge on this, but we are very happy with the Presbyterian MediCare PPC, which is a Medicare Advantage plan.

Presbyterian MediCare PPO | Presbyterian Health Plan, Inc.

Learn about Presbyterian MediCare PPO plans - benefits, eligibility, enrollment and much more!

www.phs.org

{...

Presbyterian MediCare PPO​

Presbyterian Medicare Advantage plans combine safe ways to get care from home with many $0 and low-cost options, so you can get the care you need. Presbyterian offers you the value that comes with our integrated system of physicians, hospitals and health plan – all working together to keep you healthy.
With our PPO plans, you receive more benefits than Original Medicare and several valuable services for $0 copay.

Presbyterian MediCare PPO Benefits​

$0 in-network copay for these valuable benefits and more!​

• Dental cleanings, X-rays, and exams
• Routine eye exam
• Hearing exam (hearing aids also available with a copay)
• Telehealth visits with in-network providers
• Lab services and diagnostic tests
• Foot care
• Diabetic test strips and lancets
• Annual physical exam

...}

My wife has had both hips done, etc., and it has been great.
I don't need any medical care so was skipping it, but for free I got dental and optical, so finally went for it.

 

[Flopper]

The major issue I had with a Medicare Advantage plan was the hospital and clinic my wife and I went to announced in the middle of open enrollment, our Advantage plan was dropping them. So we had to find new doctors in a clinic across town that was covered by our insurance. It was a long drive and we did not like most of doctors nor the long waits for service. Two years later the insurance company dropped their Advantage plan in our area. So we had to find another Advantage plan. However rather do that I talked to a local health insurance consultant where I learn that AARP was having an open enrollment of their Medicare Supplements. The wife and I both applied and were accepted. That was about 6 years go. Since then we have not had to change doctors, pay a single medical copay or deductible, never had to get a referral to see a specialist, need had any medical procedure denied, and best of all when we traveled we could go to any doctor or hospital in the US that accepts Medicare which is 97% of them. It cost more than the advantage plans but has been well worth it to us.

My experience was pretty bad but that mean everyone's is.

I have very narrow knowledge on this, but we are very happy with the Presbyterian MediCare PPC, which is a Medicare Advantage plan.

Presbyterian MediCare PPO | Presbyterian Health Plan, Inc.

Learn about Presbyterian MediCare PPO plans - benefits, eligibility, enrollment and much more!

www.phs.org

{...

Presbyterian MediCare PPO​

Presbyterian Medicare Advantage plans combine safe ways to get care from home with many $0 and low-cost options, so you can get the care you need. Presbyterian offers you the value that comes with our integrated system of physicians, hospitals and health plan – all working together to keep you healthy.
With our PPO plans, you receive more benefits than Original Medicare and several valuable services for $0 copay.

Presbyterian MediCare PPO Benefits​

$0 in-network copay for these valuable benefits and more!​

• Dental cleanings, X-rays, and exams
• Routine eye exam
• Hearing exam (hearing aids also available with a copay)
• Telehealth visits with in-network providers
• Lab services and diagnostic tests
• Foot care
• Diabetic test strips and lancets
• Annual physical exam

...}

My wife has had both hips done, etc., and it has been great.
I don't need any medical care so was skipping it, but for free I got dental and optical, so finally went for it.

I'm glad your plan is is working for you. As long as the network and policies of the plan meet your needs there is no reason to change but you should be aware of a few facts about Advantage plans. The Advantage plans were created to cut the cost of providing Medicare coverage. The way they work is when you join a plan you sign over your Medicare payments to them and they manage your benefits. They must cover everything that Medicare covers plus they general offer perks such as basic dental, eye exams, and a fitness programs. Where they make their money is negotiating contracts with lower cost healthcare providers to form a network which Medicare can not do and managing access to services such as thorough a primary care provider requiring referrals to see specialists, and limiting choice of medical providers to a network. Specialist, diagnostics, and treatments in great demand and thus come at a high fee are limited in the network so patients typically have longer waits than other providers. Also unlike Medicare the providers in the network come and go as the insurance company renegotiates their contracts every 3 to 5 years. If the hospital and clinic across town agrees to lower rates than your hospital and clinic then you will be faced with either changing your plan or changing doctors and other healthcare providers.

The PPO option sounds great because it gives you the right to go to any doctor or hospital and the plan pays say 70% or 80%. What patients don't ask is 70% of what. Most assume it to be the bill. In some cases it is but with many plans the payment is based on what the plan pay an in network provider which can be half of what you would be billed by an out of network provider.

The bottom line is Advantage plans can be good or terrible but in all cases they come with restrictions. If you can live with those restrictions then they can save you some money. For various reasons, Advantage plans are not my cup of tea. I prefer original Medicare plus a supplement and at times a part d drug plan. This gives me coverage anywhere in the country and all I need is an appointment and 100% of the bills are paid by Medicare and the Supplement.