OT: Medicare Advantage Plans

[bwexler]

Ok... I guess I'm becoming an ole' geezer! I have started researching the Medicare debacle. I see advertisements saying their Advantage plan is better than anybody else's. I trust you folks immensely. Tell me what plan you use and the plusses and minuses of your plan. Thanks for everything!

I also remember seeing here years back that when you go on Medicare, they require yo to do another sleep test. Is that true?

Sheriff

I have been on a variety of Advantage plans for 10 years now.
I research a dozen or so each year that the Medicare.gov site suggests might be best for me. I attend their info meetings ask lots of very specific questions and collect documented information.
Then I create a spreadsheet with my best guess of what I may encounter in the new year, doctor visits, meds, CPAP a new machine. I fill in the cost for each competing company and total the costs. I look at weather my doctors are in network. After looking at my total annual costs for each company it is usually obvious who to choose. IT IS COMMON FOR THE BEST COMPANY THIS YEAR TO BE TERRIBLE NEXT YEAR. It might be considered buying market share with people like LSAT who just settle in and never look at the competition. No one seems to stay on top of my list for more than 2 years.

[zorki1c]

I have had the AARP United Health Care Plan for 10 years. Obviously we have been happy with it or we wold have switched. The Plan has Co Pays for most items. Plans vary by state.....We currently pay $10 for primary care visits..$35 for Specialists....There is a dental benefit and an eye care benefit. DME supplies costs 20% of the negotiated rate...Most RX are free for Generic Drugs... Using the Advantage Plan eliminates the need for a Medicare Supplement and a Drug Plan. The advantage Plan uses our Part B benefit plus costs us $27 mo each.

Same here. No complaints. When we switched from a Blue Cross plan to AARP I had to get a new sleep study. Other that we've had no problems and we have been on advantage plans for a decade. Never have run into any of the problems cited by some posters and both my wife and I have had some major medical procedures. One of the advantages is all the billing is handled by the plans. we don't have to deal with separate prescription plans. If you have some really expensive drugs there might be better plans but most of our prescriptions have little or no co-pay.

[atab]

I switched to Medicare on 01/01/2020 and did extensive research before doing that. You can always switch plans every year during the open enrollment period; so the risk is limited to an year. You can get any plan and always go back to original medicare. There is one caveat: if you are getting a supplemental plan (aka medigap), you will have to undergo underwriting if you do not choose the supplemental plan the first time. But there is no underwriting in reverse direction: you can come back to regular medicare from supplemental plan during open enrollment with no hassle.
I ended up choosing a medicare advantage plan offered by AARP. I pay only for medicare part B; no part D charges. They also credit me $120/year by allowing me to buy non-prescription medication from Walmart free of charge. If you are going for an advantage plan, note that the providers are limited (HMO) to what the plan offers. So you have to check all your doctors. I checked all my doctors and about 10 other prominent doctors in the area and all of them were in my plan. One good thing about advantage plans is there is an out of pocket maximum (OPM). The OPM can vary with the plan but can't be higher than $6700 (in year 2020). It is high, but I feel more comfortable than in regular medicare, where there is no OPM.
In Feb, I had to go to emergency on an unexpected medical emergency, had one procedure and a surgery. Was in hospital for 7 days. I had to pay $1800 out of the total hospital+Doctor bill of $72,000. I would have paid more if I had regular medicare.
I ordered CPAP equipment after switching to medicare. I used Lincare before and called Lincare again. They said, since my insurance has changed, they need a new prescription. Had a virtual visit with sleep doctor (no cost to me), everything resolved. (I had to pay 20% for CPAP stuff under my advantage plan.)

atab

[Sheriff Buford]

In Feb, I had to go to emergency on an unexpected medical emergency, had one procedure and a surgery. Was in hospital for 7 days. I had to pay $1800 out of the total hospital+Doctor bill of $72,000. I would have paid more if I had regular medicare.
I
atab
[/quote]

If I had the Medicare G plan, wouldn't there have been no copay for the hospital, in your example, after I satisfied the yearly $198 Medicare B copay? Or, was you referring to the regular medicare and medicare B with no supplement?


Sheriff

[Pugsy]

https://www.medicare.gov/supplements-ot ... p-policies

When you are actually admitted to the hospital there is a deductible you have to pay. The Plan G will pay it in full for you each and every time you might incur that expense...and remember it is NOT an annual deductible...it's a per hospital admission unless someone is readmitted for the SAME problem within a relatively short period of time.

So you pay the monthly premiums and the insurance pays the deductible for you. The insurance pays the portion that is your responsibility.

Hospital admissions are all covered under part A the only part of a hospital admission that is your part...that deductible. Right now a little over 1400 per admission.

And Medicare ALWAYS reduces the allowed amounts on all those high hospital bills...Hospitals have to write off the difference.
This us true with the Advantage plans as well. Unless you get an EOMB from someone you won't ever know how much is actually written off. The reduction is massive. It's not a little reduction. Hospitals make money due to volume of Medicare patients and not so much each individual.

[no_more_headaches]

Medicare + supplemental Plan G + Part D here. I am willing to pay the extra few bucks to not have to worry about copays and major deductibles.

But mostly I want to be able to choose at a moments notice which doctor and facility I want to go to. For example my wife just had a squamous cell removed from her scalp. It was the size of a quarter. The dermatologist doctor said he wasn't comfortable closing it. Our son-in-law who is an ENT surgeon interned with somebody who is now a plastic surgeon. He was able to get her in for a consultation the same day and did the surgery 4 days later. It looks pretty good and it does not look like she will have a bald spot. All this in the middle of a pandemic.

Had we been on an HMO forget it take what they give you.

BTW underwriting also applies even if you stay on medicare and the supplemental and you choose a crap supplemental plan initially with large deductibles and copays. If you decide that life is going to be more doctors you can't just switch up to a plan G from now on without underwriting.

Just start with a plan G and enjoy life because we are all getting older and our health is going to go downhill eventually. period!

[Pugsy]

Hey Sheriff, how much does a plan G cost where you live?
I tried to figure it out but apparently it also varies by area and company selling it.

OMG I just did a pretend thing on the AARP Texas rate and an area 1 zip code (which is the cheapest) based on my own situation.
Plan G would cost me 354 a month....it's because I got Medicare prior to age 65.
If I had got it after/when I turned 65....115 a month.
And I would have had to do another Part D for meds...so even more cost.

Now you guys know why I do the advantage plan.

[no_more_headaches]

AARP Plan G Northern Callifornia - $115 for age 66. Yes I signed up at 65. My drug plan is like $15 a month and my regular meds are no generic copay.

[Sam_01]

For me, the bottom line is stick with Medicare, not an Advantage Plan. Why? Medicare coverage is straight forward. If it’s a Medicare covered expense, Medicare will pay 80% of the cost. If it’s covered, it’s covered. The Doctor does not have to go to any insurance co. for prior approval or try to convince the insurance company that the procedure is medically necessary for your good health.

If a Doctor has agreed to accept Medicare payments they cannot bill you for uncovered procedures unless you, the patient, have signed a statement saying you understand that it may not be covered and that you are willing to accept responsibility for the charge.

Advantage plans sound great. They provide free coverage for stuff Medicare doesn’t cover. As a young insurance trainee I received some very wise advice from one of my instructors. He said “there is no such thing as a free lunch”. You can also add, you get what you pay for.

Advantage plans sell themselves as managed care which sounds great. The reality is they get to decide what is best for you, not your doctor, not you. Their criteria of what’s best is based on what is it going to cost the company. With Medicare, if it’s a Medicare covered expense, it’s covered.

I chose to purchase a Medicare supplement plan and Prescription plan from AARP. Under the supplemental plan, if the charge is covered by Medicare, the plan will pay the 20% that you are responsible for. The Part B coverage is not cheap but wishing that you are not going to get “too sick” may not work out for you. A single procedure that does not even require an over-nite hospital stay can run into the thousands. I don’t have ruby slippers and I can’t just click my heels and wish that I will stay healthy. I had a procedure a year ago which required a 6 day hospital stay. Cost was $60K+ and was covered 100% by Medicare and AARP.

Medicare covers 80% of my CPAP costs (machine and supplies). New machine every 5 years. Supplemental insurance picks up the remaining 20%. I do have to have a visit with my sleep doctor annually, but this is covered by my insurance.

[shragae]

- where does Medicare cover the cpap costs?

I'm on Medicare with a Plan G gap policy. The gap has to pay the 20% if Medicare pays for something (in part B). I just got CPAP in February and Medicare paid for the sleep test and all my CPAP gear including new masks & stuff every 90 days...

[shragae]

Medicare + supplemental Plan G + Part D here. I am willing to pay the extra few bucks to not have to worry about copays and major deductibles...

Just start with a plan G and enjoy life because we are all getting older and our health is going to go downhill eventually. period!

100% agree. And hospitals will often admit you as an "observation" patient which falls under part B unless you are in the hospital for a few days. If the doctor hasn’t written an order for you to be admitted to the hospital, the services you receive will be categorized as observation That can quickly add up to thousands! Medicare beneficiaries who are enrolled in Part A, but not Part B, will be responsible for their entire hospital bill if they are classified as Observation Status. If you have Part B it pays 80% but you are stuck with the remaining 20%...

If your doctor is putting you in the hospital do your best to ensure it isn't as "observation."

[shragae]

Hey Sheriff, how much does a plan G cost where you live?
I tried to figure it out but apparently it also varies by area and company selling it.

OMG I just did a pretend thing on the AARP Texas rate and an area 1 zip code (which is the cheapest) based on my own situation.
Plan G would cost me 354 a month....it's because I got Medicare prior to age 65.
If I had got it after/when I turned 65....115 a month.
And I would have had to do another Part D for meds...so even more cost.

Now you guys know why I do the advantage plan.

I think it really depends on whether you have a healthy family history or not. My Plan G is around $120 a month and then my prescription (Part D) plan is around $80 a month on top of that -- and it sucks. I often use GoodRX to cut down the costs...

So why would I pay $200 a month on top of the $135 to Medicare? Family history. Once I pay that $148 deductible annually I have no out of pocket expenses and I have pulmonologists, cardiologists, endocrinologists... you get the idea! So far no big hospital stays, but I'm only 1 year into Medicare. As others have pointed out if went with an Advantage plan and wanted to return to Medicare I'd have to undergo underwriting and if anyone would even insure me it would cost a hell of a lot more than I'm paying now!

On top of all that I have a young adult son who I'm still paying Obamacare for -- isn't life grand?

[Pugsy]

On top of all that I have a young adult son who I'm still paying Obamacare for -- isn't life grand?

Yeah...it's grand. We get to choose which way we get screwed.

I would be able to get a standard supplement if I wanted to go that route and for some people the peace of mind knowing they pay X amounts of dollars every month and they know that's all they ever have to spend is worth it to them. I don't have any health issues that would prohibit me from getting a supplement if there were underwriting requirements (which where I live the only health question is "are you in end stage kidney failure" but other states might have other questions).

My big problem is that I went on Medicare prior to turning 65 due to a disability....so for me to get a Plan G...it would cost me 354 a month...that's over 4200 a year. Since I am basically healthy otherwise and my advantage plan has a 3750 annual max out of pocket limit...I am still ahead of the game even if I end up with something really big happening cost wise. Now if I had got medicare at age 65 or later (I am 68 now) then we could be having a different discussion.
I am looking at a hand surgery...my out of pocket cost will be 200 plus 45 for the specialist office visit...that's it. Still a lot less than one month premium of a Plan G for me.

Now if I were just now getting Medicare or had went on it at age 65 then I would look more closely and decide how much risk I wanted to take.
Supplement plans...it's a for sure pay now for the insurance to maybe pay the out of pocket portion later.
Advantage plans...it's a maybe pay more later risk.
Some people are okay with that risk and some aren't. In my case I simply can't afford 354 a month for a supplement. That's actually more than 1/3 what I draw each month from social security. If I end up having something big happen cost wise...I can always make payments on it later. I would rather take the risk and maybe pay later since I know that my total max out of pocket will still be less than what the supplement costs. For sure pay now or maybe pay later....I choose maybe later.

In 10 years I have had maybe a total of around 2,000 out of pocket for various things...broken wrist requiring surgery and some joint injections and RFA done on nerves in my back.
If I had gone the supplement route...that's a for sure 42,480 (using the 354 premium per month number) I would have paid in premium out of pocket over the years. I am still well ahead of the game.

Even if I had gone on Medicare at age 65...and had a plan G at 115 a month...that's 1380 a year times 10 years...13,800 over 10 years so still ahead of the game.

It all depends on how much risk a person can accept and is willing to accept. For me it's a no brainer obviously.
This is where the education comes in and of course we have factor in our own health history.

[shragae]

Yup, Pugsie, you nailed it.

[Sheriff Buford]

Hey Sheriff, how much does a plan G cost where you live?

I'm not sure. I got on Medicare.gov and inserted my prescriptions. It gave me some info, but I was in a hurry, so I couldn't decipher the info.

Question: If I purchase Plan D for prescriptions.... does Plan G pay the deductibles for the prescriptions?

Thank You for ya'lls input!

Sheriff