Which do you think is better and why Medicare Advantage or Medigap?

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bradinsky
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bradinsky »

In Ohio, if you have any medical issues, I believe you are better off with the Medigap insurance. We have the G plan & the max we have ever paid beyond monthly premiums is the yearly deductible, which this year is about $230.
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iamblessed
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

JoeRetire wrote: Sun Jan 16, 2022 6:40 pm
iamblessed wrote: Sun Jan 16, 2022 6:39 pm So if I move out of the St. Louis area I could get Medigap then? Could I move somewhere else in Missouri or would I have to go out of state?
You need to move out of your insurance plan's "service area". Basically, to any place not covered by your plan.
Sounds like maybe even a county away might work. You might not have to move that far?
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JoeRetire
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

iamblessed wrote: Mon Jan 17, 2022 8:16 am
JoeRetire wrote: Sun Jan 16, 2022 6:40 pm
iamblessed wrote: Sun Jan 16, 2022 6:39 pm So if I move out of the St. Louis area I could get Medigap then? Could I move somewhere else in Missouri or would I have to go out of state?
You need to move out of your insurance plan's "service area". Basically, to any place not covered by your plan.
Sounds like maybe even a county away might work. You might not have to move that far?
Possibly. Depends on the plan.
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Tdubs
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Tdubs »

ncbill wrote: Mon Jan 17, 2022 7:53 am
Tdubs wrote: Sun Jan 16, 2022 2:31 pm
JoeRetire wrote: Sun Jan 16, 2022 2:10 pm
Tdubs wrote: Sun Jan 16, 2022 1:50 pm Anyone have a view on access to care? Aside from the reduced HMO networks of an MA, are they more restrictive "gatekeepers" than Medicare + Medigap when it comes to access to care and approving procedures and tests?
I have a PPO Medicare Advantage Plan.

I haven't seen any "gatekeeper" issues. I haven't had any problems at all getting access to care or access to providers.

I have a PCP and an oncology specialist. I visited a podiatrist a few times. Annually, I have an eye exam. Soon, I'll be visiting a dermatologist.
My wife has a PCP. She had surgery on her foot. Annually, she has an eye exam. She also has had some physical therapy, visited a chiropractor, and had some therapeutic massage.

We've never had a problem with any of that.

It may depend on your insurer, your plan, and your locale - I don't really know, we may just be lucky. I hear a lot of anecdotes about problems with Medicare Advantage plans - I suspect many of the issues are outliers or outdated information.
That is the issue, I have read anecdotes about MA plans taking the latitude they are given in implementing a Medicare standard of care and running with it. True? I don't know.
HMO MA plans (still the majority) will have gatekeepers...PPO not.

There's always a significant financial incentive to deny care.

As other posters note, it depends where you live as to how well regulated HMO MA plans are by your state.

And if you need care that your HMO MA plan has denied despite appeals, your only practical recourse to get back on a traditional Medigap plan that would pay for it is to literally pick up and move to another state...but will you be well enough to do so?

With that in mind, I'd always pick a traditional Medigap plan...I even did so as a caregiver for a relative so financially constrained in retirement that they didn't sign up for Part B coverage until their mid-70s when their back pain became too severe to ignore.

Had to wait until July 1 for both to take effect (Part B & Plan G plus a drug plan) but only paid the deductible & premiums for that year & the next when they died from what turned out to be terminal cancer, though most healthcare expenses post-diagnosis were covered by (Part A) Hospice.
Forgive my ignorance, but why wouldn't a MA PPO have at least some financial incentive to deny care?
Looking4Answers
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Looking4Answers »

Early in 2020, I knew two people (both in their 60s with health problems) that were denied coverage for a nursing home stay under their Medicare Advantage plans. It was crazy because both really needed the care and had no other options.

One was able to switch back to original Medicare because there is a provision under your first year that you can switch back, an option that you do not have after the first year. Medicare paid for the first 90 days. This was a short term nursing home stay (though a little more than the 90 days). The second person is still in the nursing home under Medicaid.
montanagirl
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by montanagirl »

I used Medicare Advantage my first year because I knew I could opt for medigap second year without underwriting. I had been laid off at 65 and could not get spousal until 66 and certainly didn't want to claim my own yet.

Worked great. Paid only 30/mo in a year I was getting unemployment and living on severance and savings. Then switched to medigap.
ncbill
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ncbill »

Tdubs wrote: Mon Jan 17, 2022 9:42 am
ncbill wrote: Mon Jan 17, 2022 7:53 am
Tdubs wrote: Sun Jan 16, 2022 2:31 pm
JoeRetire wrote: Sun Jan 16, 2022 2:10 pm
Tdubs wrote: Sun Jan 16, 2022 1:50 pm Anyone have a view on access to care? Aside from the reduced HMO networks of an MA, are they more restrictive "gatekeepers" than Medicare + Medigap when it comes to access to care and approving procedures and tests?
I have a PPO Medicare Advantage Plan.

I haven't seen any "gatekeeper" issues. I haven't had any problems at all getting access to care or access to providers.

I have a PCP and an oncology specialist. I visited a podiatrist a few times. Annually, I have an eye exam. Soon, I'll be visiting a dermatologist.
My wife has a PCP. She had surgery on her foot. Annually, she has an eye exam. She also has had some physical therapy, visited a chiropractor, and had some therapeutic massage.

We've never had a problem with any of that.

It may depend on your insurer, your plan, and your locale - I don't really know, we may just be lucky. I hear a lot of anecdotes about problems with Medicare Advantage plans - I suspect many of the issues are outliers or outdated information.
That is the issue, I have read anecdotes about MA plans taking the latitude they are given in implementing a Medicare standard of care and running with it. True? I don't know.
HMO MA plans (still the majority) will have gatekeepers...PPO not.

There's always a significant financial incentive to deny care.

As other posters note, it depends where you live as to how well regulated HMO MA plans are by your state.

And if you need care that your HMO MA plan has denied despite appeals, your only practical recourse to get back on a traditional Medigap plan that would pay for it is to literally pick up and move to another state...but will you be well enough to do so?

With that in mind, I'd always pick a traditional Medigap plan...I even did so as a caregiver for a relative so financially constrained in retirement that they didn't sign up for Part B coverage until their mid-70s when their back pain became too severe to ignore.

Had to wait until July 1 for both to take effect (Part B & Plan G plus a drug plan) but only paid the deductible & premiums for that year & the next when they died from what turned out to be terminal cancer, though most healthcare expenses post-diagnosis were covered by (Part A) Hospice.
Forgive my ignorance, but why wouldn't a MA PPO have at least some financial incentive to deny care?
The incentive, but not the ability.
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iamblessed
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

If you are stuck on Medicare Advantage it sounds like there is more freedom in the PPO?
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dodecahedron
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by dodecahedron »

ncbill wrote: Mon Jan 17, 2022 10:26 am
Tdubs wrote: Mon Jan 17, 2022 9:42 am Forgive my ignorance, but why wouldn't a MA PPO have at least some financial incentive to deny care?
The incentive, but not the ability.
This is not actually true. PPOs do have some ability to deny coverage for procedures they consider questionable.

I have a MA PPO, which I like a lot and which has an excellent national reputation. As a PPO, it gives me a lot of flexibility (e.g., I don't need to designate a primary care provider "gatekeeper" and obtain a referral to see a specialist of my choice, whether in or out of network, as long as the specialist accepts Medicare.)

However, my PPO also states that "Certain services require prior authorization in order to be covered."

So if I see a provider who recommends an expensive and potentially questionable procedure, s/he may need to file an application for prior authorization for the procedure to be covered by my PPO, even though traditional Medicare would not require such an authorization.

This provision does not bother me unduly, because generally I trust the reputation of my particular MA organization and because physicians I know as personal friends have told me that from their perspective as professionals, the organization is generally excellent to deal with. Also because, if push ever came to shove, my state of residence (NY) guarantees me an exit option to switch to traditional Medicare/Medigap on less than a month's notice.
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dodecahedron
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by dodecahedron »

iamblessed wrote: Mon Jan 17, 2022 10:57 am If you are stuck on Medicare Advantage it sounds like there is more freedom in the PPO?
Yes, definitely! Not quite as unlimited as traditional Medicare (see my previous post), so you do want to "kick some tires" to investigate their reputation for red tape denials in situations requiring prior authorization and general promptness of payments to providers.
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Voltaire2.0
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Voltaire2.0 »

Lots of good thoughts here. These are my crib notes. Apologies if this repeats other information.

Advantage Medigap
- If you had or think you will have major medical issues that require different specialists, facilities or leading-edge technology
- If medical services in your area (city, county or zip code) are limited or deficient
- If Medicare Advantage offerings in your zip code are limited or deficient
- If you travel and want to reduce the hassles/expense of out-of-network coverage
- If you want the option to switch to Medicare Advantage in the future (doing the reverse is impossible, or very difficult)

Medigap plans and premiums are virtually identical so other than availability in your area, the big differentiator is customer service. This is difficult to assess in advance.

Advantage Medicare Advantage

- If you want a lower monthly premium (usually)
- If you want prescription Rx, dental and vision options available through a single plan/carrier
- If you appreciate the plethora of plans available, in some zip codes
- If you live in an area that has many healthcare providers who participate in your plan(s)

It appears that understanding which providers participate in a given Medicare Advantage plan requires homework and can change each year. With Medigap the only question that need be asked is "Do you take Medicare?" or "Is this procedure Medicare approved?"

Good luck with your reseaarch.
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celia
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by celia »

Here's my overview of how Medicare works:
viewtopic.php?f=11&t=251181&p=3965770#p3965770

Note that the dollar amounts there are outdated.
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dodecahedron
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by dodecahedron »

Voltaire2.0 wrote: Mon Jan 17, 2022 12:29 pm Lots of good thoughts here. These are my crib notes. Apologies if this repeats other information.

Advantage Medigap
- If you had or think you will have major medical issues that require different specialists, facilities or leading-edge technology
- If medical services in your area (city, county or zip code) are limited or deficient
- If Medicare Advantage offerings in your zip code are limited or deficient
- If you travel and want to reduce the hassles/expense of out-of-network coverage
- If you want the option to switch to Medicare Advantage in the future (doing the reverse is impossible, or very difficult in most, but not all, states)

Medigap plans and premiums are virtually identical so other than availability in your area, the big differentiator is customer service. This is difficult to assess in advance.

Advantage Medicare Advantage

- If you want a lower monthly premium (usually)
- If you want prescription Rx, dental, hearing aids, free Silver Sneakers gym memberships and vision options available through a single plan/carrier
- If you appreciate the plethora of plans available, in some zip codes
- If you live in an area that has many healthcare providers who participate in your plan(s)

It appears that understanding which providers participate in a given Medicare Advantage plan requires homework and can change each year (even more frequently than each year! Providers can drop out of MA plans on very short notice, e.g., in the middle of the year, far away from annual enrollment times.). With Medigap the only question that need be asked is "Do you take Medicare?" or "Is this procedure Medicare approved?"

Good luck with your reseaarch.
Good summary (with my additions in red above.)

For research, I suggest checking with your state insurance department, which maintains statistics on complaints filed against insurance carriers.

Also, check with health care providers you know personally about which carriers are unreasonably difficult to deal with. If you have older physician friends who themselves are Medicare age, ask what plans they use for their own personal coverage.

Learn more about Medicare's star rating system for Advantage plans.
ncbill
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ncbill »

dodecahedron wrote: Mon Jan 17, 2022 11:19 am
ncbill wrote: Mon Jan 17, 2022 10:26 am
Tdubs wrote: Mon Jan 17, 2022 9:42 am Forgive my ignorance, but why wouldn't a MA PPO have at least some financial incentive to deny care?
The incentive, but not the ability.
This is not actually true. PPOs do have some ability to deny coverage for procedures they consider questionable.

I have a MA PPO, which I like a lot and which has an excellent national reputation. As a PPO, it gives me a lot of flexibility (e.g., I don't need to designate a primary care provider "gatekeeper" and obtain a referral to see a specialist of my choice, whether in or out of network, as long as the specialist accepts Medicare.)

However, my PPO also states that "Certain services require prior authorization in order to be covered."

So if I see a provider who recommends an expensive and potentially questionable procedure, s/he may need to file an application for prior authorization for the procedure to be covered by my PPO, even though traditional Medicare would not require such an authorization.

This provision does not bother me unduly, because generally I trust the reputation of my particular MA organization and because physicians I know as personal friends have told me that from their perspective as professionals, the organization is generally excellent to deal with. Also because, if push ever came to shove, my state of residence (NY) guarantees me an exit option to switch to traditional Medicare/Medigap on less than a month's notice.
Yep, like I said earlier, MA plans work fine if you're sure once denied by the HMO (or more rarely, the PPO) you will still be physically able to move to a state with guaranteed issue Medigap...preferably one that lets you switch on less than a month's notice.
Last edited by ncbill on Tue Jan 18, 2022 5:32 pm, edited 1 time in total.
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iamblessed
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

JoeRetire wrote: Sun Jan 16, 2022 6:40 pm
iamblessed wrote: Sun Jan 16, 2022 6:39 pm So if I move out of the St. Louis area I could get Medigap then? Could I move somewhere else in Missouri or would I have to go out of state?
You need to move out of your insurance plan's "service area". Basically, to any place not covered by your plan.
Let's say I had Humana would I need to move to an area that did not have Humana?
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JoeRetire
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

iamblessed wrote: Tue Jan 18, 2022 9:57 am
JoeRetire wrote: Sun Jan 16, 2022 6:40 pm
iamblessed wrote: Sun Jan 16, 2022 6:39 pm So if I move out of the St. Louis area I could get Medigap then? Could I move somewhere else in Missouri or would I have to go out of state?
You need to move out of your insurance plan's "service area". Basically, to any place not covered by your plan.
Let's say I had Humana would I need to move to an area that did not have Humana?
You need to move to an area that your particular Humana plan does not cover.
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chris319
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by chris319 »

Bogle7 wrote: Sun Jan 16, 2022 10:21 am Only the USA makes medical insurance so complicated.
You need to read a lot about each. Many hours, not a few minutes.
Medicare is a morass of complexity.

As far as I'm concerned there are two things to know about Medicare:

1. Plan G

2. Get a good agent.

That's what I did and now I must push my brother into these as he turns 65 in June.

A Medicare agent is compensated by the insurance companies, not by the insured, so it costs you no more than dealing directly with an insurance company. All the supplement plans are standardized by the govt so they all have the same coverage; after that you're just price shopping. I found Humana to be pretty expensive. I'm on Anthem Blue Cross in so. California. I also have Part D (prescriptions) and dental coverage.

My Medicare agent came highly recommended by retired co-workers and is one of the best retirement decisions I ever made. I have since referred two clients to him.
Financial decisions based on emotion often turn out to be bad decisions.
cadreamer2015
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cadreamer2015 »

Medigap plans and premiums are virtually identical so other than availability in your area, the big differentiator is customer service. This is difficult to assess in advance.
I've never had to contact customer service for my Medigap provider. They get the claim/EOB from Medicare and pay their balance. I'm not sure why I'd need to contact customer service.
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iamblessed
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

JoeRetire wrote: Tue Jan 18, 2022 10:00 am
iamblessed wrote: Tue Jan 18, 2022 9:57 am
JoeRetire wrote: Sun Jan 16, 2022 6:40 pm
iamblessed wrote: Sun Jan 16, 2022 6:39 pm So if I move out of the St. Louis area I could get Medigap then? Could I move somewhere else in Missouri or would I have to go out of state?
You need to move out of your insurance plan's "service area". Basically, to any place not covered by your plan.
Let's say I had Humana would I need to move to an area that did not have Humana?
You need to move to an area that your particular Humana plan does not cover.
Thanks for helping me understand all of this better.
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Kagord
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Kagord »

cadreamer2015 wrote: Tue Jan 18, 2022 12:01 pm
Medigap plans and premiums are virtually identical so other than availability in your area, the big differentiator is customer service. This is difficult to assess in advance.
I've never had to contact customer service for my Medigap provider. They get the claim/EOB from Medicare and pay their balance. I'm not sure why I'd need to contact customer service.
I'd 2nd this, Medigap Plan G + deductible covered waiver, never had one bill that wasn't fully paid, no problems with TCU 90 days fully covered..etc, at least with the providers I've used. But maybe others have had different experiences.
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dm200
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by dm200 »

iamblessed wrote: Sun Jan 16, 2022 10:07 am I am new to this I wanted to hear from others.
My opinion and experience:

1. Not just one comparison, but rather the details of all the varieties of what is available

2. Is keeping current providers important? Then that might tilt towards medigap

3. Medicare advantage might be less paperwork.

4. My wife and I have Kaiser Medicare advantage and love it. Keeping existing providers was not important to us.

5. Try to speak with others in your locality who have advantage plans

6. I believe you can try an advantage plan for up to a year and still go back to Medicare with medigap
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dm200
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by dm200 »

Tdubs wrote: Sun Jan 16, 2022 1:50 pm Anyone have a view on access to care? Aside from the reduced HMO networks of an MA, are they more restrictive "gatekeepers" than Medicare + Medigap when it comes to access to care and approving procedures and tests?
My wife and I have Kaiser MA. We have always been able to access any specialty we need in a timely manner.

Yes - most specialists require a referral from our primary care physician. However after that one initial referral, we don’t need any further referrals to keep seeing that appropriate specialist. For example, I have the medical need to regularly see an endocrinologist. I needed only one initial referral eleven year’s ago from my PCP - when I first went on Medicare.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by jmw »

dm200 wrote: Tue Jan 18, 2022 6:48 pm
iamblessed wrote: Sun Jan 16, 2022 10:07 am I am new to this I wanted to hear from others.
My opinion and experience:

1. Not just one comparison, but rather the details of all the varieties of what is available

2. Is keeping current providers important? Then that might tilt towards medigap

3. Medicare advantage might be less paperwork.

4. My wife and I have Kaiser Medicare advantage and love it. Keeping existing providers was not important to us.

5. Try to speak with others in your locality who have advantage plans

6. I believe you can try an advantage plan for up to a year and still go back to Medicare with medigap
2. Here is another problem with MA. If you end up having to go to assisted living with medical help someday, the part D vendor in the AL home will usually require you to pick from a shortlist of Part D standalone drug plans. They don't do Kaiser pharmacy. Kaiser doesn't have drive-thru pharmacies. That might matter when you get real old and don't want to stand a long time in the Kaiser pharmacy line. The AL has a limited number of docs that do house calls, and I've never seen a Kaiser doc (or any other HMO doc) there.

3. You'll definitely get a lot more paperwork with Medigap vs Kaiser Senior Advantage, but you can throw them away because they're just EOBs that almost always cover literally everything. The Part D ones you might want to look more carefully. If they don't cover something, the provider has to eat it unless the patient signed a form that something might be denied by Medicare.

4. If you want to go to some fancy cancer center or Cleveland Clinic, Mayo, or whatever. Your choices may be severely restricted or denied with almost all MA plans. With Medigap, you have freedom of choice.

5. Talk to others in your locality who have Medigap plans and especially those like me who switched our elderly from MA to Medigap.

6. Without the use of loopholes, MA is a one-way trip after the first year because you can't get Medigap when you need it due to medical underwriting.

My opinion is if you've won the game, you don't pick MA period to save in premiums due to the freedom to choose any provider that takes Medicare and zero copays no matter what. If MA copays influence you to skip care, that can be a fatal mistake in older folks.

[OT comment removed by admin LadyGeek]
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by book lover »

There is an excellent book you may want to read by Danielle Roberts of Boomer Benefits. She also has an excellent YouTube channel by the same name. Here's a link to her book:https://www.amazon.com/Costly-Medicare- ... 209&sr=8-3
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by LadyGeek »

This thread is now in the Personal Finance (Not Investing) forum (insurance comparison).
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by drjazz »

I’m a physician and have been on Medicare for 5 years. There are many excellent points in the prior posts; I apologize for any redundancies; here is my take:
1. Read latest issue of Medicare for Dummies
2.Use a Medicare broker; in my experience Medicare.gov does not always list all available Medigap/Advantage options. It won’t cost any more than enrolling on medicare.gov and they generally give good advice.
3.Unless you absolutely cannot afford Medigap premiums, and you are in an area with at least one high quality teaching hospital with a large physician network that accepts your plan, Medigap is the much better option (I favor plan G or plan G high deductible).
4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait (remember when banks gave you a toaster for opening a savings account?)
5. With Medigap you will be able to have almost any procedure/treatment recommended by your physician without “prior authorization”. If you require a complex surgery procedure or treatment you and your physician will be able to go to a center of excellence, surgeon with a lot of experience with a complex or rarely performed procedure, etc; with Medicare Advantage almost everything complicated will be subject to their review and even if approved you will have to stay in their network which may not include the surgeon you want. (Example- you need a mitral valve repair, your Medicare Advantage network says “We have a surgeon who does those so that’s where you’re going. How many did he do last year? 5. I want to go to Dr. Slick who did 100 last year and has great outcomes. Sorry, he’s not in our network; as far as we are concerned they are equivalent.” Sometimes they will approve out of network referrals but be prepared for a fight and high copay.
6. Medicare Advantage includes prescriptions, which the marketers tout as an advantage. I don’t see it that way. The insurance company has complete control over the formulary and can refuse to cover medications that might be a bit more expensive, and can drop meds that you may already be on without notice; you will have no recourse. If you have a separate Part D policy you have the option to change plans without penalty during open enrollment period every October-December (I have changed part D plans for this reason 3 times in the past 5 years)
7. In my experience Kaiser does a fantastic job with primary care, probably better that what is generally available in most of the country, however depending on where you live they may not offer complex specialized services of the same quality as you might find at for example Mayo or Hopkins. So it’s a matter of personal preference; how important is it to you to cover your long tail health risk?
Limoncello402
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Limoncello402 »

I did extensive "homework" in reading about Medigap vs. Advantage programs. Lots of study until I understood the situation fully. For me, it was Medigap hands down. My state does not have "G" (outlier state!) but I bought into the equivalent. This plan is of course more expensive but brings priceless peace of mind.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by GaryA505 »

Broken Man 1999 wrote: Sun Jan 16, 2022 1:28 pm
twh wrote: Sun Jan 16, 2022 12:32 pm
jabberwockOG wrote: Sun Jan 16, 2022 12:19 pm Most Advantage plans limit patient seeing doctors to a local or in State network, except for emergency care if it is travel related use.

If you come down with a serious illness, and want to to see a non local out of state specialist for second opinion, or travel to an out of state medical center that is well regarded for specialized or advanced treatment - with the typical Advantage plan you are free to go but you will pay for 100% of the medical bills.

In contrast to that - If you have traditional Medicare and a non local Medigap supplemental policy, you can choose to go to any doctor/specialist and any facility (assuming they accept medicare as most do) for treatment in the US and your costs will be covered by the policies.


Medicare Advantage plans are usually significantly less expensive then traditional Medicare plus a supplemental policy. As always there is no such thing as a free lunch.

If you live in a very large city with an abundance of excellent medical providers an Advantage plan may not be a bad thing but for anyone else, assuming you have the budget to pay extra, traditional medicare plus supplement would be my recommendation.
This used to be very true, but less so now. The AARP UHC Medicare C plans are not geographically limited. I was helping a friend recently and put in zip codes for a number of not-close-together cities and doctors on the plan everywhere I tried.
Even better than a MA plan is a MA PPO plan. No problem going to outside of the network providers. Still, even though I have consumed more medical services than the average bear, I haven't ever needed to go outside the Humana MA network. My 2021 OOP was $192.05. Fortunately, I was able to use some of the money saved by using a MA PPO to pay the outrageous sum! After all, those of us using MA plans really can't afford anything else! :D

Broken Man 1999
That's what I have, Medicare Advantage PPO.
Get most of it right and don't make any big mistakes. All else being equal, simpler is better. Simple is as simple does.
Jablean
Posts: 872
Joined: Sat Jun 02, 2018 2:38 pm

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Jablean »

jabberwockOG wrote: Sun Jan 16, 2022 4:37 pm
twh wrote: Sun Jan 16, 2022 12:32 pm
jabberwockOG wrote: Sun Jan 16, 2022 12:19 pm Most Advantage plans limit patient seeing doctors to a local or in State network, except for emergency care if it is travel related use.

If you come down with a serious illness, and want to to see a non local out of state specialist for second opinion, or travel to an out of state medical center that is well regarded for specialized or advanced treatment - with the typical Advantage plan you are free to go but you will pay for 100% of the medical bills.

In contrast to that - If you have traditional Medicare and a non local Medigap supplemental policy, you can choose to go to any doctor/specialist and any facility (assuming they accept medicare as most do) for treatment in the US and your costs will be covered by the policies.


Medicare Advantage plans are usually significantly less expensive then traditional Medicare plus a supplemental policy. As always there is no such thing as a free lunch.

If you live in a very large city with an abundance of excellent medical providers an Advantage plan may not be a bad thing but for anyone else, assuming you have the budget to pay extra, traditional medicare plus supplement would be my recommendation.
This used to be very true, but less so now. The AARP UHC Medicare C plans are not geographically limited. I was helping a friend recently and put in zip codes for a number of not-close-together cities and doctors on the plan everywhere I tried.

The reality is that in some states it is still very true. The difference between Advantage plans and traditional Medicare plus supplement plan is becoming more stark and restrictive on the Advantage side as they are faced with shrinking margins and rising healthcare costs.

If you can afford it and if you don't want to be nickle and dimed to death in case you actually get seriously ill my suggestion, for folks living in most places in the US, is to avoid Advantage plans. Despite what the insurance sales person wants you to believe, there is no such thing as a free lunch.
We've been very happy with AARP United Healthcare Advantage plan except for one glaring instance. It supposedly is a "travel" plan - in that you can call up and say I'm traveling here will you turn on protection for me and it's like you were insured in the new place. What they don't say is that not all areas of the country are covered. Even if you can get coverage there if it's your original starting point you may not get coverage there when traveling. Case in point is Las Vegas. If you are on UH's Advantage you can have an emergency like a stroke in Las Vegas and get covered but when they kick you out of the hospital into rehab - that's where the issue comes up. Rehab centers won't let you in unless you pay the $10,000 out of pocket out-of-service deductible first. UH agents were easy to get ahold of and thought they could turn on traveling easily but it didn't work because that county had been taken out. UH sometimes publishes the new counties that are added to the not covered list but the full list must only be online - I haven't looked again as my dad can't travel anymore. The hospital and rehab were all "why didn't you stay on regular medicare"? Now on the stay close to home side the Advantage insurance did pay for 3 months of rehab - after flying home - a knee replacement and spinal fusion with no questions asked and we've had no problem getting any local doctor we wanted.

So, since I do hope to travel, I'm paying close attention to the discussion and looking at the MedGap process instead of Advantage. We are throwing all of our HSA money into the older spouse's account so that the extra MedGap charges can be paid from that until the younger spouse is also on Medicare.
gips
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by gips »

we are snowbirds and travel a lot, place high value on choosing our own providers so trad medicare made more sense. we use plan g hi deductible, here was the analysis of plan g vs plan plan g hi deductible:

Plan G min = $3,687 ($268 monthly premium+203 deductible)
Plan G Hi min = $1,073 ($70 monthly premium + $203 deductible + $30 for annual drs. visit)
Plan G Hi max = $3,280 ($70 monthly premium + $2370 max deductible + $203 deductible)

so plan g hi deductible provides an opportunity to save $400-$1600 per year! not really sure why it’s not everyone’s choice in ny if signing up for trad medicare. i checked these numbers with our (excellent) ship office and they were correct in 2021.
Carl53
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Carl53 »

gips wrote: Fri Jan 21, 2022 4:06 am we are snowbirds and travel a lot, place high value on choosing our own providers so trad medicare made more sense. we use plan g hi deductible, here was the analysis of plan g vs plan plan g hi deductible:

Plan G min = $3,687 ($268 monthly premium+203 deductible) $3419?
Plan G Hi min = $1,073 ($70 monthly premium + $203 deductible + $30 for annual drs. visit) $1073
Plan G Hi max = $3,280 ($70 monthly premium + $2370 max deductible + $203 deductible) $3413?

so plan g hi deductible provides an opportunity to save $400-$1600 per year! not really sure why it’s not everyone’s choice in ny if signing up for trad medicare. i checked these numbers with our (excellent) ship office and they were correct in 2021.
ModifiedDuration
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ModifiedDuration »

Jablean wrote: Fri Jan 21, 2022 3:43 am We are throwing all of our HSA money into the older spouse's account so that the extra MedGap charges can be paid from that until the younger spouse is also on Medicare.
When you say “extra Medigap charges” I hope you are not referring to Medigap premiums, as Medigap premiums cannot be paid from an HSA account.
gips
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by gips »

Carl53 wrote: Fri Jan 21, 2022 5:04 am
gips wrote: Fri Jan 21, 2022 4:06 am we are snowbirds and travel a lot, place high value on choosing our own providers so trad medicare made more sense. we use plan g hi deductible, here was the analysis of plan g vs plan plan g hi deductible:

Plan G min = $3,687 ($268 monthly premium+203 deductible) $3419?
Plan G Hi min = $1,073 ($70 monthly premium + $203 deductible + $30 for annual drs. visit) $1073
Plan G Hi max = $3,280 ($70 monthly premium + $2370 max deductible + $203 deductible) $3413?

so plan g hi deductible provides an opportunity to save $400-$1600 per year! not really sure why it’s not everyone’s choice in ny if signing up for trad medicare. i checked these numbers with our (excellent) ship office and they were correct in 2021.
yes, thanks, the ship office corrected my numbers but I never updated my spreadsheet. Still, plan g hi presents a terrific opportunity to save $. I will add that I was working with a respected medicare broker at the time I did this analysis, they never raised the option since they don't sell g hi. So it's important everyone do their own homework.
Last edited by gips on Fri Jan 21, 2022 1:04 pm, edited 1 time in total.
valleyrock
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by valleyrock »

A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.

His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
ModifiedDuration
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ModifiedDuration »

valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.

His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
My wife is a physician and one of her specialities is geriatrics, so she is very familiar with illness that impact seniors, the courses of treatment, and the cost of these treatments.

She would very strongly recommend that people on Traditional Medicare get a both a Medicare Supplement and a Part D plan.

Her primary reason for Medigap is for situations like chemotherapy that are given on an outpatient basis, which would be a Part B expense and can easily run over $100,000 (yes, at the Medicare-approved rates) and if you don’t have a Medicare Supplement you would be liable for 20% of that (which could be $20,0000, $30,000, or more).

She would say to at least get a Plan G-high deductible for the $40 -$70 a month it costs to provide catastrophic coverage for a situation like this.

In addition, someone could get prescriptions for cancer treatment that would be a Part D expense and could also be very expensive (and GoodRx is not going to save you much on these expensive cancer treatments).

She would say at least get an inexpensive Part D policy for the prescription catastrophe insurance.

(By the way, Medigap and Medicare Supplement are the same thing).
buystoys
Posts: 29
Joined: Tue May 11, 2021 8:08 am

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by buystoys »

As already stated, which is better is difficult to assess on a broad term. It all depends on the county you live in, what is available, what the provider network looks like, and how much you can afford.

DH and I are on Medicare due to disability. We have no access to Medigap plans due to that and are both on Advantage plans. That's worked well for us as all our providers are in our network. We have regular doctor appointments, so it's nice to have no cost for them other than our deductible. We pay nothing for the Advantage plan.

Keep in mind that changes can be made to both types of plans during the year. Last year, both stopped covering sedation during nerve blocks. That means that something that was a simple procedure is now very painful. Whatever changes Medicare makes flows through to all the additional coverage.
Carl53
Posts: 2693
Joined: Sun Mar 07, 2010 7:26 pm

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Carl53 »

valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.

His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
I've been very healthy. But a two day stint in the hospital with a Covid induced pulmonary embolism a year ago would have wiped out a retired lifetime of Medigap avoidance savings I might have had by following your friends practice.
Dennisl
Posts: 343
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Dennisl »

Medicare Advantage sucks. I have to fight claims for patients all the time for procedures and studies denied by medicare advantage, that is covered by medicare, and should've been covered by medicare advantage. We're talking about well documented things that will significantly reduce your risk of complications for cancer treatment. Have had to sick the lawyers on them in the past. It's a reality. You will get sick and hospitalized. If you can afford it, medicare plus a supplemental is the way to go.
ncbill
Posts: 2053
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Location: Western NC

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ncbill »

valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.

His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
A long hospital stay, like what we've seen for COVID patients, IMHO is the Achilles heel of this approach since Part A pays for only 60 days.

Adding Plan G drastically increases the number of covered inpatient hospital days covered:

"Medicare Supplemental Plan G Provides The Following Benefits
Part A Hospital Coinsurance
Days 61-90 of a hospital stay in each Medicare benefit period
Days 91-150 of a hospital stay. Medicare will only pay for these 60 days once during your lifetime
Additional Part A Hospital Benefits
An extra 365 days of inpatient hospital care after you use your Original Medicare hospital benefits"

https://www.planmedigap.com/medigap-pla ... al-plan-g/
Jablean
Posts: 872
Joined: Sat Jun 02, 2018 2:38 pm

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Jablean »

ModifiedDuration wrote: Fri Jan 21, 2022 5:27 am
Jablean wrote: Fri Jan 21, 2022 3:43 am We are throwing all of our HSA money into the older spouse's account so that the extra MedGap charges can be paid from that until the younger spouse is also on Medicare.
When you say “extra Medigap charges” I hope you are not referring to Medigap premiums, as Medigap premiums cannot be paid from an HSA account.
Well shoot. There's something to do with Medicare that folks have said can only be paid by the spouse who is on Medicare HSA's. Is it just the regular Medicare premium? We're starting next year so I'm trying to get our ducks lined up.
ModifiedDuration
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ModifiedDuration »

Jablean wrote: Fri Jan 21, 2022 1:17 pm
ModifiedDuration wrote: Fri Jan 21, 2022 5:27 am
Jablean wrote: Fri Jan 21, 2022 3:43 am We are throwing all of our HSA money into the older spouse's account so that the extra MedGap charges can be paid from that until the younger spouse is also on Medicare.
When you say “extra Medigap charges” I hope you are not referring to Medigap premiums, as Medigap premiums cannot be paid from an HSA account.
Well shoot. There's something to do with Medicare that folks have said can only be paid by the spouse who is on Medicare HSA's. Is it just the regular Medicare premium? We're starting next year so I'm trying to get our ducks lined up.
Not sure what you are asking, but Medicare Part B and Part D premiums can be paid from your HSA (including IRMAA), as well as related deductibles, co-pays, and co-insurance, and also dental, vision, hearing, long term care premiums (within IRS limits), and long term care itself.

Just not Medicare Supplement premiums.
cashmoney
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

drjazz wrote: Thu Jan 20, 2022 4:06 pm I’m a physician and have been on Medicare for 5 years. There are many excellent points in the prior posts; I apologize for any redundancies; here is my take:
1. Read latest issue of Medicare for Dummies
2.Use a Medicare broker; in my experience Medicare.gov does not always list all available Medigap/Advantage options. It won’t cost any more than enrolling on medicare.gov and they generally give good advice.
3.Unless you absolutely cannot afford Medigap premiums, and you are in an area with at least one high quality teaching hospital with a large physician network that accepts your plan, Medigap is the much better option (I favor plan G or plan G high deductible).
4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait (remember when banks gave you a toaster for opening a savings account?)
5. With Medigap you will be able to have almost any procedure/treatment recommended by your physician without “prior authorization”. If you require a complex surgery procedure or treatment you and your physician will be able to go to a center of excellence, surgeon with a lot of experience with a complex or rarely performed procedure, etc; with Medicare Advantage almost everything complicated will be subject to their review and even if approved you will have to stay in their network which may not include the surgeon you want. (Example- you need a mitral valve repair, your Medicare Advantage network says “We have a surgeon who does those so that’s where you’re going. How many did he do last year? 5. I want to go to Dr. Slick who did 100 last year and has great outcomes. Sorry, he’s not in our network; as far as we are concerned they are equivalent.” Sometimes they will approve out of network referrals but be prepared for a fight and high copay.
6. Medicare Advantage includes prescriptions, which the marketers tout as an advantage. I don’t see it that way. The insurance company has complete control over the formulary and can refuse to cover medications that might be a bit more expensive, and can drop meds that you may already be on without notice; you will have no recourse. If you have a separate Part D policy you have the option to change plans without penalty during open enrollment period every October-December (I have changed part D plans for this reason 3 times in the past 5 years)
7. In my experience Kaiser does a fantastic job with primary care, probably better that what is generally available in most of the country, however depending on where you live they may not offer complex specialized services of the same quality as you might find at for example Mayo or Hopkins. So it’s a matter of personal preference; how important is it to you to cover your long tail health risk?

I agree with much of what you say here however the part D plans built in to MA plans to begin with are usually superior to most stand alone plans in both cost and formulary.This is one of the main carrots used to entice enrollment.In Fl for example to get the equivalent drug benefit of what is included in the 0 premium UHC/AARP MA plans you would have to get the UHC/AARP preferred rx part D plan for 101.20 monthly.As far as the extra benefits offered being trash that is not always the case.Some of the MA plans have really stepped up the game with the dental benefits and now offer comprehensive PPO dental benefits that would cost about 50.00 a month to buy as a separate dental plan- and without the waiting period for comprehensive services.Eyeglasses and refractions at 0 cost,gym memberships,free OTC products and some plans now have ligit hearing aid benefits too.Not everybody can use these extra benefits but for those who do it can add up.

disclaimer licensed agent.
GaryA505
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by GaryA505 »

I'm just curious, if I was to try to switch from Medicare Advantage to Medigap, how difficult would that be?
Get most of it right and don't make any big mistakes. All else being equal, simpler is better. Simple is as simple does.
cashmoney
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.


His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
Don't take insurance advice from this guy.If he ever has to pay 20% for infusions,chemo,dialysis etc.. it won't be all rainbows and unicorns anymore.Also for expensive elective services he may be denied if he can't prove he can pay the balance.There is no discount for drugs because you are eligible for medicare however low cost generics can sometimes be had cheaper for anybody with discount plans such as goodrx vs medicare part D but goodrx is not going to help when you need tier 5 drugs that can cost thousands.Unlike a medicare supplement Part D is a subsidized program to the tune if about 120 per month per person.Why someone eligible wouldn't at least take the lowest premium plan ( less than 10.00 in many states)to be covered for catostphrocic rx cost and avoid future penalty is beyond me.

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ModifiedDuration
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ModifiedDuration »

GaryA505 wrote: Fri Jan 21, 2022 2:06 pm I'm just curious, if I was to try to switch from Medicare Advantage to Medigap, how difficult would that be?
In most states, if you have had Medicare Advantage for over a year, you would have to pass medical underwriting to get a Medigap plan.

Some states have more lenient rules.
gips
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by gips »

cashmoney wrote: Fri Jan 21, 2022 2:21 pm
valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.


His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
Don't take insurance advice from this guy.If he ever has to pay 20% for infusions,chemo,dialysis etc.. it won't be all rainbows and unicorns anymore.Also for expensive elective services he may be denied if he can't prove he can pay the balance.There is no discount for drugs because you are eligible for medicare however low cost generics can sometimes be had cheaper for anybody with discount plans such as goodrx vs medicare part D but goodrx is not going to help when you need tier 5 drugs that can cost thousands.Unlike a medicare supplement Part D is a subsidized program to the tune if about 120 per month per person.Why someone eligible wouldn't at least take the lowest premium plan ( less than 10.00 in many states)to be covered for catostphrocic rx cost and avoid future penalty is beyond me.

disclaimer licensed agent
here's a video by dr david belk, md, who supports the idea of eschewing medigap insurance. I watched this video, did some research and decided to purchase medigap (plan g, hi-deductible, about $70/month) and, as you suggest, the lowest cost part D plan but imo, he makes a cogent argument:

https://www.youtube.com/watch?v=qTpErd_G2zI&t=0s

ps I think I started a thread on this idea and it got deleted or closed or something, hopefully not crossing any moderation boundaries...
cashmoney
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

gips wrote: Fri Jan 21, 2022 3:51 pm
cashmoney wrote: Fri Jan 21, 2022 2:21 pm
valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.


His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
Don't take insurance advice from this guy.If he ever has to pay 20% for infusions,chemo,dialysis etc.. it won't be all rainbows and unicorns anymore.Also for expensive elective services he may be denied if he can't prove he can pay the balance.There is no discount for drugs because you are eligible for medicare however low cost generics can sometimes be had cheaper for anybody with discount plans such as goodrx vs medicare part D but goodrx is not going to help when you need tier 5 drugs that can cost thousands.Unlike a medicare supplement Part D is a subsidized program to the tune if about 120 per month per person.Why someone eligible wouldn't at least take the lowest premium plan ( less than 10.00 in many states)to be covered for catostphrocic rx cost and avoid future penalty is beyond me.

disclaimer licensed agent
here's a video by dr david belk, md, who supports the idea of eschewing medigap insurance. I watched this video, did some research and decided to purchase medigap (plan g, hi-deductible, about $70/month) and, as you suggest, the lowest cost part D plan but imo, he makes a cogent argument:

https://www.youtube.com/watch?v=qTpErd_G2zI&t=0s

ps I think I started a thread on this idea and it got deleted or closed or something, hopefully not crossing any moderation boundaries...

Unless I missed something this doctor is saying the only thing you owe for hospital stay is the part A deductible which is wrong. In addition to the part A deductible you pay 20% part B physician charges .Hope he knows more about medicine than insurance.BTW hi deductible plan G is probably what I will take when I turn 65

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rterickson
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by rterickson »

drjazz wrote: Thu Jan 20, 2022 4:06 pm I’m a physician and have been on Medicare for 5 years. There are many excellent points in the prior posts; I apologize for any redundancies; here is my take:
1. Read latest issue of Medicare for Dummies
2.Use a Medicare broker; in my experience Medicare.gov does not always list all available Medigap/Advantage options. It won’t cost any more than enrolling on medicare.gov and they generally give good advice.
3.Unless you absolutely cannot afford Medigap premiums, and you are in an area with at least one high quality teaching hospital with a large physician network that accepts your plan, Medigap is the much better option (I favor plan G or plan G high deductible).
4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait (remember when banks gave you a toaster for opening a savings account?)
5. With Medigap you will be able to have almost any procedure/treatment recommended by your physician without “prior authorization”. If you require a complex surgery procedure or treatment you and your physician will be able to go to a center of excellence, surgeon with a lot of experience with a complex or rarely performed procedure, etc; with Medicare Advantage almost everything complicated will be subject to their review and even if approved you will have to stay in their network which may not include the surgeon you want. (Example- you need a mitral valve repair, your Medicare Advantage network says “We have a surgeon who does those so that’s where you’re going. How many did he do last year? 5. I want to go to Dr. Slick who did 100 last year and has great outcomes. Sorry, he’s not in our network; as far as we are concerned they are equivalent.” Sometimes they will approve out of network referrals but be prepared for a fight and high copay.
6. Medicare Advantage includes prescriptions, which the marketers tout as an advantage. I don’t see it that way. The insurance company has complete control over the formulary and can refuse to cover medications that might be a bit more expensive, and can drop meds that you may already be on without notice; you will have no recourse. If you have a separate Part D policy you have the option to change plans without penalty during open enrollment period every October-December (I have changed part D plans for this reason 3 times in the past 5 years)
7. In my experience Kaiser does a fantastic job with primary care, probably better that what is generally available in most of the country, however depending on where you live they may not offer complex specialized services of the same quality as you might find at for example Mayo or Hopkins. So it’s a matter of personal preference; how important is it to you to cover your long tail health risk?
One minor quibble on this otherwise excellent post:

Unlike traditional Medicare (and regular health insurance) which handle care on a per-service basis, Medicare Advantage plans are paid a lump sum each year for all of your care. IMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
gips
Posts: 1760
Joined: Mon May 13, 2013 5:42 pm

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by gips »

cashmoney wrote: Fri Jan 21, 2022 4:54 pm
gips wrote: Fri Jan 21, 2022 3:51 pm
cashmoney wrote: Fri Jan 21, 2022 2:21 pm
valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

For Part B, Medicare pays 80%, so he is responsible for the other 20%. But all the medical services are billed at the Medicare cost, not the overly inflated costs that uninsured people are billed. So, he's paying 20% of a much lower, pre-established cost. Same for prescription drugs, he says.

So, in the end, instead of paying out thousands per year (depends on the plan, the state, etc.) for a Medigap policy, he figures he pays only a few hundred dollars a year. Now, he's never had a seriously long hospital stay or anything. He does have a serious chronic condition, but it's not involved hospital stays. But his point remains and it bears investigating the Medicare costs for various procedures, which are standardized, and think about what 20% of that would be.


His other point is that physicians love Medicare because they are paid right away (compared to the insurance company bureaucracy) and they know exactly what they will be paid.
Don't take insurance advice from this guy.If he ever has to pay 20% for infusions,chemo,dialysis etc.. it won't be all rainbows and unicorns anymore.Also for expensive elective services he may be denied if he can't prove he can pay the balance.There is no discount for drugs because you are eligible for medicare however low cost generics can sometimes be had cheaper for anybody with discount plans such as goodrx vs medicare part D but goodrx is not going to help when you need tier 5 drugs that can cost thousands.Unlike a medicare supplement Part D is a subsidized program to the tune if about 120 per month per person.Why someone eligible wouldn't at least take the lowest premium plan ( less than 10.00 in many states)to be covered for catostphrocic rx cost and avoid future penalty is beyond me.

disclaimer licensed agent
here's a video by dr david belk, md, who supports the idea of eschewing medigap insurance. I watched this video, did some research and decided to purchase medigap (plan g, hi-deductible, about $70/month) and, as you suggest, the lowest cost part D plan but imo, he makes a cogent argument:

https://www.youtube.com/watch?v=qTpErd_G2zI&t=0s

ps I think I started a thread on this idea and it got deleted or closed or something, hopefully not crossing any moderation boundaries...

Unless I missed something this doctor is saying the only thing you owe for hospital stay is the part A deductible which is wrong. In addition to the part A deductible you pay 20% part B physician charges .Hope he knows more about medicine than insurance.BTW hi deductible plan G is probably what I will take when I turn 65

disclaimer licensed agent
here is one of his videos on medigap. His point is you'll owe 20% of the medicare negotiated rate for doctors which is often about 10-15% of the rack rate:
https://www.youtube.com/watch?v=DqW-wFnxhp0&t=22s

>>Hope he knows more about medicine than insurance.
I suspect he knows more about medicine and medigap insurance than the great majority of people in the US.
adamthesmythe
Posts: 5774
Joined: Mon Sep 22, 2014 4:47 pm

Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by adamthesmythe »

Several posters have said that it is helpful to have a broker for Medigap policies. But I didn't see WHY...can someone say?

Since brokers are paid by the insurance company- is there any incentive to push particular companies?
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