OT: Medicare Advantage Plans

To my knowledge Plan G doesn't do anything for Part D plan medication deductibles.
It's mainly just going to pay the big part A deductible if you get hospitalized and then the 20% left over after Medicare pays on the Part B stuff once the Part B deductible has been met. I don't think it touches any plan D medication stuff at all. I will go look to make sure though.

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

Back when I first started selling insurance it was before the government got involved and mandated the standardized plans. Each company had their own little quirks to be as an incentive to make their policy "better" than the other company.
Then the federal government got involved...and as usual...they didn't necessarily make things any easier or clearer for seniors to understand. But at least the plans are standardized in terms of what is or isn't covered and all people really have to do is compare premiums for whichever coverage they want.

The standardized plans ...what I call the alphabet plans...don't do anything for medications at all. That's why people have to purchase a Medication Part D plan (not to be confused with the alphabet medigap plan D supplement) separately.

Many years ago there were plans that offered some help with medication costs but not now that I can find. It wasn't a big help anyway and I am not surprised they aren't around now. People ended up paying up front in premium for sure for that extra coverage. Unless people took a lot of real expensive medicines...they didn't save any money. Remember all insurance companies are in it to make money...they are banking that your premiums paid in end but being less than what they pay out in your behalf. It's the good old American way. They hope enough people won't use the insurance benefit compared to those that do use it.

Any Medication plan D deductibles or copays...you are on your own for those expenses.

If you get a regular medigap policy...what I call one of the alphabet plans...medications are NOT covered...nor are any deductibles to any Medication Part D plans a covered expense under a medigap plan.

https://www.medicare.gov/drug-coverage- ... g-coverage

So under the medigap standardized plans...those alphabet plans... there is zero coverage for medications.
You have to purchase a medication plan D policy separately and any deductibles or co pays to that medication plan...they are on you.
Your Medigap plan won't pay any portion. 2 totally separate insurance policies.

What I used to tell people when it came to a supplement ....think of it as if Medicare will pay a penny on something..then the insurance will pay. If Medicare won't pay...the insurance won't pay either. There were some exceptions where a little extra coverage was built in for things like glasses or wellness checks or stuff like that but those weren't the plan G or Fs...they were higher alphabet plans with much higher premiums. In all honesty it was a wash because what the plan paid (they all had limits) for something medicare didn't cover a person was just pre paying for it with their higher premiums.

Medications aren't paid for by Medicare so not a covered expense....so the medigap plans won't pay anything either...that's why they tell you to get a separate medication/drug plan.

Good morning everyone,

I have to admit I’m very hesitant about making this post. I came here to learn about CPAP as I am a new user (less than 3 weeks) and I haven’t made a post yet. Thus my hesitation to post on this topic.

I’ve been reading through this thread and there is so much misinformation throughout this thread it’s scary. Let me start by saying I’m a licensed insurance agent and we specialize in helping people with their retirement needs (a huge part is Medicare). I am not licensed in the OP’s home state of TX. I am not trying to solicit anyone. I am only here to encourage you to reach out to an Insurance Broker (someone who can help with a multitude of companies so the client gets what is best for them and not what’s best for the insurance company).

Some notes on a small portion of the misinformation I’ve seen here:

- There are clearly bad agents out there just like any other industry but there are many good ones too that want to help you navigate through all the craziness of Medicare. I know many agents that are good people that truly want to do the right thing and educate people.

- Medicare Advantage plans do in fact vary greatly from one county to another even in the same state. Just like any other insurance types there are pluses and minuses. Some have a monthly premium and some don’t. Some offer Rx coverage and some don’t. There are many SEP’s (Special Election Periods) that allow someone to change their mind and change plans. None of them require you to stay in that plan forever. One example, if you try a Medicare Advantage plan and decide you don’t like it and you want to go back to Original Medicare you can without health questions (and get a Medicare Supplement) under certain circumstances.

- Medicare Supplements (some companies not all) do allow you to sign up 6 months prior. Someone commented that they were under 65 when they first went into Medicare and the Supplements were unaffordable then (they are much more expensive under 65) but when you turn 65 you are then eligible for the 65 rate (not the higher rate from before 65) with no health questions.

There were many other things listed in this thread that is just simply wrong. Again, I make this long post not to solicit business from anyone but to encourage you to reach out to a BROKER (not an agent that represents one company only) to get specifics for your situation. Medicare is not one size fits all.

If anyone decides that you would like to know if I know someone in your state that could educate you on your rights and options let me know. Just to throw it out there I would not be compensated in any way to give you a name. I only help people myself if they are in FL, but the company I work for is nationwide.

Let me put it this way...unless you are an attorney, do you do your own legal work? Unless you are an accountant, do you do your own taxes (not the basic stuff)? What about other professions that specialize in something?

Get an agent that is insured, trained, certified, fingerprinted, background checked and licensed to educate you on your options and have that person review your plan every year.

I’ll get off my soap box now but I couldn’t not say something when I read so much wrong information. If this post is deemed inappropriate because I am in the insurance business please feel free to delete it. Thanks!

GeNomeZ wrote: ↑

Wed Jul 15, 2020 8:40 am

- Medicare Supplements (some companies not all) do allow you to sign up 6 months prior. Someone commented that they were under 65 when they first went into Medicare and the Supplements were unaffordable then (they are much more expensive under 65) but when you turn 65 you are then eligible for the 65 rate (not the higher rate from before 65) with no health questions.

I went on Medicare prior to age 65.
Yesterday I just did the AARP rate quote plan G thing for my area....354 a month and the explanation that because of when I went on Medicare I was at the level 2 tier for rates.
Might be different in your state but it sure isn't in my state. That "when did you go on Medicare" question screws me every time. Even when I turned 65.
I was also a licensed insurance agent....and I do have a prior business partner and licensed agent currently in the business to help me out. I had my own agency with my good friend.
So yes....get a licensed agent who actually puts his clients needs ahead of his own pocketbook....if you can.
We both know that isn't always so easy.

To be clear folks....I got no dog in this fight. I don't sell insurance anymore...I am retired.

I don't care if someone gets a medigap plan or an advantage plan. All I care about is that the person understands the pros and cons of either in terms of what they are paying for and getting for their premium dollars.

Trust me....there are pros and cons to both. Neither is a perfect solution by any means. Understand what you are getting so there are no ugly surprises later.

When I did sell insurance....I shot myself in the pocketbook quite often because I would go to a household where people qualified for Medicaid and didn't even need (nor could they afford any sort of supplement)...I ALWAYS put the client needs ahead of my pocket book.
I couldn't sleep at night if I didn't adhere to that policy. Back when I sold insurance there really weren't many advantage plans for us to sell...now there are tons out there.
Even if I were still in the business I would thoroughly explain the options and the pros and cons and let the person decide what to do.

Advantage plans....yes...they are less expensive up front. The little incidentals they tout as being such a plus...fluff IMHO and in most cases not that big of a deal. The fine print max limits are what they don't tell you for that fluff.

It all boils down to your own health and how much risk you are willing to assume. Do you want to assume some risk and not have the for sure amount of premium going out of your bank account each month or do you want to pay your monthly premium and not worry about it. In my situation it's a no brainer...for others maybe not so much so. I understand that.
What I hate is for people to bash the advantage plans as total crap because they aren't total crap. They meet a lot of people's wants and needs just fine no matter what age they go on medicare. It all depends on what your wants and needs are and of course figuring it out takes a bit of education ...a bit of work. Either be willing to do the work or find an agent who will do it for you and put your interests above theirs.

HI Pugsy,

I certainly don't want to come across combative in any way, but United HealthCare (AARP) does have a weird Tier 2 thing in your state, but most of the other carriers there do not. I just called a friend of mine who does work in your state and he said UHC is known for it. He also confirmed that when you turned 65 you had the option of getting a Medicare Supplement at the current age 65 rate with no health questions asked. If you are outside of that window you would have to answer health questions but still could get a current age rate. As long as someone can health qualify (if they aren't 65 any longer) they would get a much better rate than when they were under 65.

With all of that said, I also agree with your comment about Medicare Advantage plans being great options too. Over the last several years they have become very benefit rich and are great options. Like I said before it's not one size fits all and it's important for people to talk to an agent that not only can help with many different Supplement companies but also does many Medicare Advantage plan companies. What I do must have been different than what you were doing when you were an agent because as a broker can help them with their Medicare even if it's a Supplement, an Advantage plan or if they qualify for Medicaid. An insurance broker can help regardless of the situation.

I know exactly how you felt when you said you couldn't help someone with Medicaid with a Supplement. It's just not a good fit and like you I walked away not helping the person for the first few years I was in the industry (I was not a broker then). I too don't have a dog in this fight as I am not offering to be someones agent. I'm just recommending that people get in touch with the right type pf agent that can help decipher that craziness that is Medicare.

Thanks again!

There may be good people in the insurance industry, but there is no way a guy off the street can locate these type people unless he personally knows them. I know a guy that used to do business with companies that tout being a Christian minded business. After being screwed over multiple times by these businesses, he finally quit going to these type of businesses. Oh well... time for Smokey and the Bandit movie!

Sheriff

Sheriff Buford wrote: ↑

Wed Jul 15, 2020 10:38 am

There may be good people in the insurance industry, but there is no way a guy off the street can locate these type people unless he personally knows them. I know a guy that used to do business with companies that tout being a Christian minded business. After being screwed over multiple times by these businesses, he finally quit going to these type of businesses. Oh well... time for Smokey and the Bandit movie!

Sheriff

Very true. Enjoy the movie!

GeNomeZ wrote: ↑

Wed Jul 15, 2020 9:59 am

I certainly don't want to come across combative in any way, but United HealthCare (AARP) does have a weird Tier 2 thing in your state, but most of the other carriers there do not.

I will admit I haven't checked other carriers and to be honest...there is no real desire. I am comfortable with what I have. It's not perfect but I know and understand my risks.
I am still ahead of the game in the long run even if I was to get a medigap plan at whatever rate is lower than the UHC AARP plan. Come this fall I might look closer.

How I look at it....it's a for sure pay now for insurance premium for the insurance to maybe pay later or I can assume some of the risk and maybe pay later. My biggest risk is a hospital stay where I get hit with a co pay for each day in the hospital up to the out of pocket max my advantage plan has. I am okay with that. I figure I have saved well over $50,000 over the past 15 years I have been on Medicare by being willing to accept some risk.

It's really no different than taking a high deductible on a person's car insurance or home owners in exchange for a lower premium. We can either pay it up front in premium with a lower deductible or maybe I pay it later in the form of a higher deductible. I like the "maybe pay later" thing myself. Others might not be comfortable with it...and that's okay too.

This isn't rocket science. A person can learn about what is or isn't covered and what their risks are if they want to learn.
If they don't want to learn then that is their choice as well. Get a Plan G and a Part D supplement for meds and don't worry about it..the big stuff will be taken care of and a person has the peace of mind knowing that all they have to pay are their monthly premiums and now that Part B deductible along with whatever Medicare simply doesn't cover. Looks like they are doing away with the Plan F for newbies which paid the Part B deductible but to be honest...I never promoted it much because it was a wash...you paid that deductible spread out over 12 months in more monthly premium.

But when an insurance agent (like in Sheriff's case here) says "stay away from the advantage plans because they are crap" without explaining the options or risks we assume with the advantage plans...we know he has a big commission check in his mind. We both know that. He didn't even bother to explain things. Just told him the advantage plans were all crap.

My worst case scenario out of pocket with my advantage plan 3,750 annual. So far this year...45 dollars for one specialist visit and 2 PCP visits at 5 bucks each. Now if I do end up with a little surgery on my hand...200 out of pocket for the surgery center but that's a maybe at this point. I have still made money on the deal. Now I do realize I could have stroke tomorrow and the situation could change but again....I understand the risks and I am okay with it. That max out of pocket if I ever have to meet it...I can make monthly payments on it. In over 10 years with an advantage plan my out of pocket has totaled a little less than 2,000 and that includes a fractured wrist requiring pins..and a couple of back surgery procedures. I am well ahead of the game.

I agree with you Pugsy. His agent can probably only sell Medicare Supplements and so he trash talks Medicare Advantage....that's just terrible. Medicare Advantage plans can be great plans especially if, like you, the person understands what they are getting and what they aren't. With the Maximum out of Pockets most of them have the risk is limited.

Really what it boils down to is two things (although there are many other things like Rx coverage etc that must be weighed in eventually):
- Does the person care about being required to use a network (with an HMO) or have the ability to pay more for out of network (with a PPO) and are they ok with some unknown (risk) costs but with a cap?
Or
-Is a Medicare Supplement affordable so they don't have a network and know exactly worst case what their costs would be for the year?

Like you said it isn't rocket science. Where it gets muddy is finding the correct plan and correct insurance company once the person has decided which route is for them.

My wife would totally make fun of me right now if she knew I was on here talking about insurance. I've been accused of being passionate about my job lol.

But when an insurance agent (like in Sheriff's case here) says "stay away from the advantage plans because they are crap" without explaining the options or risks we assume with the advantage plans...we know he has a big commission check in his mind. We both know that. He didn't even bother to explain things. Just told him the advantage plans were meet it...I can make monthly payments
[/quote]

I was getting very hesitant dealing with someone that was telling me that the Advantage plans were crap, but not telling me their pluses. I’m dropping him like a hot potato. I may look into AARP’s United Healthcare plans, Tho’ they are too liberal for me... this is their business (bitness). Thanks for y’all’s input.

Sheriff

Sheriff Buford wrote: ↑

Wed Jul 15, 2020 2:19 pm

But when an insurance agent (like in Sheriff's case here) says "stay away from the advantage plans because they are crap" without explaining the options or risks we assume with the advantage plans...we know he has a big commission check in his mind. We both know that. He didn't even bother to explain things. Just told him the advantage plans were meet it...I can make monthly payments

I was getting very hesitant dealing with someone that was telling me that the Advantage plans were crap, but not telling me their pluses. I’m dropping him like a hot potato. I may look into AARP’s United Healthcare plans, Tho’ they are too liberal for me... this is their business (bitness). Thanks for y’all’s input.

Sheriff
[/quote]

If my parents lived in TX I would also recommend that they look at United American. I’m 45 and often consider if it’s something I would recommend to my parents then it’s a good fit for a client of mine.

A friend of mine helps a lot of people in TX and he tells me they have great rates, stable rate history, have been doing business in the Medicare space since Medicare started and are an A rated company.

Good luck with your searching!

Sheriff Buford wrote: ↑

Wed Jul 15, 2020 10:38 am

There may be good people in the insurance industry, but there is no way a guy off the street can locate these type people unless he personally knows them. I know a guy that used to do business with companies that tout being a Christian minded business. After being screwed over multiple times by these businesses, he finally quit going to these type of businesses. Oh well... time for Smokey and the Bandit movie!

Sheriff

"with companies that tout being a Christian minded business"

That's always a red flag to me for most things.

Pugsy wrote: ↑

Wed Jul 15, 2020 7:06 am

To my knowledge Plan G doesn't do anything for Part D plan medication deductibles.
It's mainly just going to pay the big part A deductible if you get hospitalized and then the 20% left over after Medicare pays on the Part B stuff once the Part B deductible has been met. I don't think it touches any plan D medication stuff at all. I will go look to make sure though.

You're 100% correct.

Sheriff Buford wrote: ↑

Wed Jul 15, 2020 6:54 am

Pugsy wrote: ↑

Tue Jul 14, 2020 10:09 am

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

No. Part D is totally separate and Plan G doesn't cover it at all.