Post
by camper » Wed Mar 06, 2024 3:34 am
I hope everyone here knows that almost all doctors and facilities in the U.S. accept traditional Medicare, as well as Medicare + a Medicare Supplement (sometimes called "Medigap") plan, whereas a substantially smaller subset accepts any given Medicare Advantage plan. In addition, Copays and Deductibles may be different with Medicare Advantage plans. Also, MOST Medicare Advantage plans are local to certain counties in one state. You can usually get out of area emergency room visits covered (minus a copay), but may not anything else - though that may vary with prescription drugs, which can be astonishingly expensive.
This is sometimes a very good deal. Most Medicare Advantage plans are cheaper than equivalent Medicare+Medicare supplement plans, and they may offer additional coverage, like dental, vision, and free membership in one or more gyms (called a fitness benefit). But in some regions, there may be no doctors or facilities in a particular specialty on your specific Advantage plan that are "in network", and/or accept that insurance.
Many (all?) Medicare Advantage plans only partially cover service from "out of network providers". E.g., I had an emergency room visit. My insurance from from United HealthCare (UHC) - but note that UHC has a huge number of different health insurance plans, and to some extent the selection is state and/or county specific. The hospital was covered (minus a $90 copay), but they called in an emergency care physician who was not. I also had a normal visit to another hospital. The facility fee and visit was covered, but not some of the lab tests and procedures were not.
And I had to have a surgery at one particular hospital which was not especially well rated by U.S. News and Report, nor was the specific department in which the surgery occurred, because none of the other facilities accepted that insurance. When you add the fact that non-emergency surgery currently has huge wait times (e.g., 1/2 year or more) at typical well rated hospitals, it can be quite expensive.
BTW, although not all doctors accept Medicaid, it is a great deal in many ways - they pay for everything they cover at all. And many people who are eligible for Medicaid don't realize it - e.g., if your adjusted gross income is low enough, and your are below 65, it doesn't matter what your assets are - e.g., you can have a significant retirement account. There are also Medicare+Medicaid Dual Advantage plans, which to some extent have the same advantages and disadvantages as Medicare vs Medicare Advantage.
I am still on a Medicare Advantage plan. I had to change from a Dual Medicare+Medicaid plan to a non-Dual plan when my state finally unwinded me from the COVID health emergency.
I'm not sure that was the best possible idea. If I ever want to switch to Medicare+Supplement, because there are (somewhat expensive) plans that cover more, I will have to undergo insurance "underwriting" by the chosen Supplement plan, which could lead to very expensive rates (because I have pre-existing conditions like sleep apnea), and long wait times on coverage for pre-existing conditions. (That fact varies by state. States that don't allow insurance companies to require underwriting have much more expensive Medicare Supplement plans.) It is possible I could overcome this requirement by moving out of the area covered by my current insurance plan.
I could switch Medicare Advantage plans during certain parts of the year without underwriting - but in my county, none of the Advantage plans I am eligible for are better than what I am on. If I moved to Baltimore County, there are much better plans, accepted by much better hospitals and perhaps better doctors, that I would be eligible to enroll in.
It all ends up being a very complicated business. You sort of have to guess what will be the best deal for you personally.