Medicare Advantage - What's the Deal?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
Topic Author
chris319
Posts: 1659
Joined: Thu Jan 28, 2021 5:04 pm

Medicare Advantage - What's the Deal?

Post by chris319 »

It seems like I can't watch CNN or MSNBC for five minutes without seeing a commercial for a Medicare plan.

These commercials invariably tout a Medicare Advantage plan. They give a phone number to call and stress that the phone call is free and there is no obligation (as if they would charge money and obligate you). Frankly I'm getting tired of seeing Joe Namath multiple times per day.

My question is, why are Medicare Advantage plans advertised and marketed so heavily? Marketing costs money so there must be some benefit to the advertiser to justify the marketing cost. The money must come from somewhere. In addition to TV they advertise via direct mail.

Many of these TV spots are what are called "per inquiry", or P.I. spots. Every TV station and cable network is assigned a unique telephone number. Every time a viewer calls that number and asks about Acme Medicare, Acme Medicare is billed by the station or network for that inquiry. If they call and ask about the Super Non-Stick Frying Pan they saw on TV, that advertiser is billed by the station or network for the inquiry.

When advertising cars, motion pictures, fast-food places or personal-care products, the ads are generally not P.I. ads. The ad agency buys a certain amount of air time. The spots, usually 30 seconds in length, are scheduled at different times throughout the day.

Ironically, I can't even remember the name of the company Joe Namath hawks — not very effective advertising.
Financial decisions based on emotion often turn out to be bad decisions.
User avatar
Bogle7
Posts: 1984
Joined: Fri May 11, 2018 9:33 am
Location: In the Witness Protection Program

Profits are the deal

Post by Bogle7 »

All the insurance companies are paying for subscribers because Medicare is profitable.

I have a friend who has brokered Medigap policies for 15+ years. He makes a decent living.

Medicare is confusing.
My neighbors (ages 60 and 63, college educated, $3M+ in retirement funds) do not understand how it all works.

Personally, I love my Medicare Advantage plan with Kaiser. I pay only the standard premium (taken out of my Social Security benefit) and my co-pays are less than $100/year.
But, Kaiser is different than getting one from an insurance company.
I don't worry about the plan dropping doctors, hospitals, pharmacies, etc.
Last edited by Bogle7 on Thu Apr 15, 2021 5:43 pm, edited 3 times in total.
Old fart who does three index stock funds, baby.
Lexx
Posts: 376
Joined: Mon Dec 21, 2020 5:21 pm

Re: Medicare Advantage - What's the Deal?

Post by Lexx »

Medicare is a horrible morass of complicated and confusing policies and options. My mom got what she thought was the best (most expensive premiums) plan, but she still has copays. My family is with Kaiser and we've been happy with them, so in years when I qualify for Medicare, I will likely opt to continue with Kaiser. All the Kaiser facilities in our area are brand spanking new.
Big Dog
Posts: 4608
Joined: Mon Sep 07, 2015 4:12 pm

Re: Medicare Advantage - What's the Deal?

Post by Big Dog »

Joe Namath is advertising an insurance broker that specializes in Medicare.

But yes, Medicare is confusing and many people appreciate the help. The reasons that the ads run all year is that everyday thousands of Boomers are turning 65.
Wannaretireearly
Posts: 4880
Joined: Wed Mar 31, 2010 4:39 pm

Re: Medicare Advantage - What's the Deal?

Post by Wannaretireearly »

It's confusing as hell. Just got my mum fully setup.
I would talk to a local agent. Our experience going thru a local agent was good.

Edit: we went with medi gap insurance, not Medicare Advantage.
Last edited by Wannaretireearly on Thu Apr 15, 2021 5:03 pm, edited 1 time in total.
“At some point you are trading time you will never get back for money you will never spend.“ | “How do you want to spend the best remaining year of your life?“
123
Posts: 10415
Joined: Fri Oct 12, 2012 3:55 pm

Re: Medicare Advantage - What's the Deal?

Post by 123 »

My understanding is that Medicare Advantage plans get payment from Medicare for "taking care" of Medicare enrollees. That payment is monthly and can be based on the how the enrollee is stratified based on certain health care and medical issue criteria. If the insurance company (or HMO) manages the care of the person well (over a large number of enrollees) they will generate a profit between the amount that Medicare pays them (as well as any monthly payment to them by the enrollee) and the costs of the care they provide or arrange. The incentive for Medicare Advantage plans is to enroll as many people as possible to increase their revenue and potential profit. They have to take everyone who asks to enroll since there is no medical underwriting for Medicare Advantage programs.

The Medicare Advantage premiums, service co-pays, deductibles, and out-of-pocket maximums are all mechanisms to help control demand for health care services. People are incentivized to find the plan that works for them at their lowest total cost.
Last edited by 123 on Thu Apr 15, 2021 4:18 pm, edited 1 time in total.
The closest helping hand is at the end of your own arm.
Colorado Guy
Posts: 442
Joined: Sun Nov 05, 2017 12:57 pm

Re: Medicare Advantage - What's the Deal?

Post by Colorado Guy »

Bogle7 wrote: Thu Apr 15, 2021 3:22 pm All the insurance companies are paying for subscribers because Medicare is profitable.
Up front I will state that I don't know for sure what Medicare pays these insurance companies. With that said, I was told once (by an insurance sales rep) Medicare pay insurance companies something in the $1000/mth range. If correct, and if Americans turn 65 at a rate of 10,000/day (a frequent statistic for boomers), that represents $300,000,000/month or $3.6 Billion/year (!) Medicare could be paying insurance companies. So, the chase is on to get your attention.

Honestly, it is hard for me to believe those numbers, never really thought about it until now. Even if a fraction of that amount per month, that represents some real incentive. If someone has better intel, please advise.

The sales rep gets commissions as well (at least the one I talked to). FYI, Kaiser will have its own set of agents, separate from the ones who represent other Medicare Advantage options.

EDIT: In my rough calculations above (which is a ballpark estimate to begin with), I only considered the new revenue coming in each month, but not the dollars coming in from the previous month's capture. That is, for February, I only estimated $300,000,000 (the new Feb input), but forgot to add in the continuing funds for the new accounts captured in January. Going all the way to December, one needs to add in all the continuing Medicare payments for the accounts captured in previous months.

A quick calculation adding in all of these accounts comes to $23.4 billion annually to be potentially captured by Medicare Advantage companies. :shock: I believe it even less than before!
Last edited by Colorado Guy on Thu Apr 15, 2021 6:57 pm, edited 1 time in total.
philpill
Posts: 58
Joined: Sat Nov 21, 2015 6:46 am

Re: Medicare Advantage - What's the Deal?

Post by philpill »

the correct appellation is MEDICARE DISADVANTAGE. i know nothing about kaiser but here in NJ the disadvantage discourages you from seeing a specialist. they act as a gate keeper and do not utilize elite doctors, but rather those who can not develop a full practice. caveat emptor. not for me!
hicabob
Posts: 3796
Joined: Fri May 27, 2011 5:35 pm
Location: cruz

Re: Profits are the deal

Post by hicabob »

Bogle7 wrote: Thu Apr 15, 2021 3:22 pm
I have a friend who has brokered Medigap policies for 15+ years. He makes a decent living.

Medicare is confusing.
My 60 and 63 neighbors (college educated, $3M+ in retirement funds) do not understand how it all works.

Personally, I love my Medicare Advantage plan with Kaiser. I pay only the standard premium (taken out of my Social Security benefit) and my co-pays are less than $100/year.
But, Kaiser is different than getting one from an insurance company.
I don't worry about the plan dropping doctors, hospitals, pharmacies, etc.
It is confusing - I started researching it in earnest since I will eligible in a couple months. I was surprised how much insurance companies have their fingers into it. Naïve me thought it was more of a government run program. Kaiser is looking good to me so far, or A+B+ a hi deductible G.
Last edited by hicabob on Thu Apr 15, 2021 4:52 pm, edited 1 time in total.
bob60014
Posts: 3768
Joined: Mon Jul 31, 2017 8:59 pm
Location: The Land Beyond ORD

Re: Medicare Advantage - What's the Deal?

Post by bob60014 »

The same reason why we see a neverending stream of commercials for prescription drugs. There is a huge amount of $$$$ (read profit) in it!
Topic Author
chris319
Posts: 1659
Joined: Thu Jan 28, 2021 5:04 pm

Re: Medicare Advantage - What's the Deal?

Post by chris319 »

So the government subsidizes Medicare Advantage plans to the exclusion of Medigap plans. This creates a profit motive to push Medicare Advantage; is that about it?

This has "Washington lobbyists" written all over it.

Agreed. Medicare is a complicated mess.
Financial decisions based on emotion often turn out to be bad decisions.
hicabob
Posts: 3796
Joined: Fri May 27, 2011 5:35 pm
Location: cruz

Re: Medicare Advantage - What's the Deal?

Post by hicabob »

chris319 wrote: Thu Apr 15, 2021 5:44 pm So the government subsidizes Medicare Advantage plans to the exclusion of Medigap plans. This creates a profit motive to push Medicare Advantage; is that about it?

This has "Washington lobbyists" written all over it.

Agreed. Medicare is a complicated mess.
I assumed the govt gives the HMO with an advantage plan premiums for A + B for a customer? I'm curious as to how much the premium comes to? It makes retirement planning seem simple!
N.Y.Cab
Posts: 412
Joined: Wed Feb 07, 2018 7:46 pm

Re: Medicare Advantage - What's the Deal?

Post by N.Y.Cab »

I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
User avatar
Stinky
Posts: 14152
Joined: Mon Jun 12, 2017 11:38 am
Location: Sweet Home Alabama

Re: Medicare Advantage - What's the Deal?

Post by Stinky »

N.Y.Cab wrote: Thu Apr 15, 2021 7:53 pm I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
Or -

You sign up for Part A and Part B. Then you sign up for an Advantage plan, that gives you the supplemental coverage and drug plan for no cost. And the Advantage plan throws in gym membership plus dental plus vision benefits for free.

Some Advantage plans have restrictive doctor panels. Mine has a great panel.

YMMV
Retired life insurance company financial executive who sincerely believes that ”It’s a GREAT day to be alive!”
User avatar
aburntoutcase
Posts: 337
Joined: Tue Mar 13, 2018 12:06 pm

Re: Medicare Advantage - What's the Deal?

Post by aburntoutcase »

First of all to understand why Medicare Advantage plans exist you need to understand that Traditional Medicare is not great coverage. That is why Medigap/Medsupp plans were created and those premiums are expensive. Medicare Advantage plans have certain cost control features that Traditional Medicare lacks. Uncle Sam is prohibited from negotiating drug prices for example, but private MA plans can do that. MA plans also require prior authorization for certain expensive services such as hospital and skilled nursing facility stays. Originally they had more appeal to low and moderate income seniors who could get them at lower premiums than traditional medicare + medigap/medsupp. These days nearly 40% of Medicare beneficiaries are on MA plans so maybe that self-selection has changed. MA plans will often also bundle things like vision and dental care.

CMS (Fed agency that runs Medicare and Medicaid) pays MA plans a fixed risk adjusted per enrollee payment does not reimburse them for each procedure or service. So MA plans have an incentive to deliver more cost effective care and reduce risks of hospital admissions and readmissions. I know most people will think that they don't like that but unlike Europe we don't control provider prices off a government set schedule (well for traditional Medicare and Medicaid we do when it comes to things other than drugs but there is no utilization control) so someone needs to be thinking about cost control. Before controlling for population risk differences in aggregate CMS pays MA plans 104% of traditional medicare FFS per enrollee spending.

See Chapter 12 in the annual (March 2021) MedPAC Report to Congress on Medicare Payment Policy. MedPAC is an independent non-partisan Congressional Agency that advises the US Congress on matters relating to Medicare.

http://www.medpac.gov/-documents-/reports
Topic Author
chris319
Posts: 1659
Joined: Thu Jan 28, 2021 5:04 pm

Re: Medicare Advantage - What's the Deal?

Post by chris319 »

The Medicare for Dummies book helps explain things a little, but it doesn't make Medicare any less of a complicated mess. Even better is a booklet I received from ssa called "Medicare & You". The problem is, they didn't send me this booklet until AFTER I had signed up for Medicare (duh!). You need the information before you sign up, not after.

You want to sign up for Medicare when you turn 65, even if you are still working and covered by your employer's health insurance. This was my mistake. I thought I didn't need to sign up while I was still working. Luckily I signed up just in the nick of time and will not be penalized.

I have decided to get a Medicare supplement rather than an Advantage plan, in large part because I'm leery of the insurance companies which so aggressively market their Advantage plans. For one thing, you can pick any doctor. I have my eye on a Humana Plan G which happens to include Rx, dental and vision as I understand it. I will be signing up for that next month.

Next year I will have to guide my brother through this maze.
Financial decisions based on emotion often turn out to be bad decisions.
User avatar
aburntoutcase
Posts: 337
Joined: Tue Mar 13, 2018 12:06 pm

Re: Medicare Advantage - What's the Deal?

Post by aburntoutcase »

Humana is the company most levered to MA insurance and in the past decade its stock is up 470% while the S&P is up +200%. Clearing serving the MA senior population is a lucrative business. Now some of the stock price growth is simply being levered to a growing population of 65+ in the US. The question of how much public good the plans are creating relative to the good for their shareholders is a question beyond my pay grade. In general I am in favor of the German healthcare system where nearly all the care is delivered by private sector entities and private insurers manage the administrative tasks of insurance and payments but the federal government negotiates prices with *all* providers on a regional basis and makes the same reimbursement rates available to *all* insurers. It is called All Payer Rate setting. To me it represents the best tradeoff between not strangling innovation and creating rationing of care while having control over healthcare cost inflation.
Topic Author
chris319
Posts: 1659
Joined: Thu Jan 28, 2021 5:04 pm

Re: Medicare Advantage - What's the Deal?

Post by chris319 »

Disregarding their stock price and shareholders, is Humana worthwhile from the point of view of the insured?
Financial decisions based on emotion often turn out to be bad decisions.
PowderDay9
Posts: 1001
Joined: Fri Oct 12, 2018 12:29 pm

Re: Medicare Advantage - What's the Deal?

Post by PowderDay9 »

chris319 wrote: Thu Apr 15, 2021 8:58 pm Disregarding their stock price and shareholders, is Humana worthwhile from the point of view of the insured?
If you're buying a Medigap plan, I'd trust a big company like Humana or United over a small company. Tons of companies are selling Medigap and the behind the scenes strategy is to offer high commissions to get sales. If claims experience is worse than expected, close the plan to new members at some point. Often this is when large rate increases are happening.
Broken Man 1999
Posts: 8626
Joined: Wed Apr 08, 2015 11:31 am
Location: West coast of Florida, near Champa Bay !

Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

chris319 wrote: Thu Apr 15, 2021 8:58 pm Disregarding their stock price and shareholders, is Humana worthwhile from the point of view of the insured?
DW and I have a Humana Medicare Advantage PPO plan offered by MegaCorp with zero premium. We do pay the Medicare Part B premium.

I have been using the plan for many years, and I have never had issues with Humana with any of my PCP's care plans. And, I think it fair to say I consume more medical services than the average bear.

In my location, near Tampa FL, the Humana network is very large, plenty of specialists, and I've never had any problems using my insurance.

OTOH, in smaller locations, rural settings, etc., I might be hesitant to use an HMO, or PPO, from any provider, as their network might be limited.

Although I have had a PPO, the same coverage is offered to MegaCorp's retirees via a Humana HMO. Why anyone would select an HMO over a PPO, given both have zero premiums, I have no idea. Exactly the same coverage, so far as I can see. One of those great mysteries of life.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
BarbBrooklyn
Posts: 1717
Joined: Fri Aug 24, 2018 9:33 am
Location: NYC

Re: Medicare Advantage - What's the Deal?

Post by BarbBrooklyn »

chris319 wrote: Thu Apr 15, 2021 8:45 pm
You want to sign up for Medicare when you turn 65, even if you are still working and covered by your employer's health insurance. This was my mistake. I thought I didn't need to sign up while I was still working. Luckily I signed up just in the nick of time and will not be penalized.


Next year I will have to guide my brother through this maze.
At least for me, it was my employer that alerted me to the fact that I needed to sign up for Medicare at 65, because my employee insurance became secondary when I turned 65 and became Medicare eligible.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
Gretchen
Posts: 135
Joined: Mon Mar 19, 2007 5:48 am
Location: Southern CA

Re: Medicare Advantage - What's the Deal?

Post by Gretchen »

Husband and I had Medicare Advantage plans that worked fine, till they didn't.

Medicare Advantage is primary, so you need your PCP's referral to get anything done. When DH was diagnosed with a complete intestinal blockage due to Stage 3 colon cancer while we were away from home, we came very close to having emergency surgery denied. He was admitted to the hospital from the ER, diagnosed on a Friday, and scheduled for surgery the following Tuesday. The surgeon said it made sense to check out of the hospital, get a hotel room, spend three days drinking what I called "Drano" to flush out his intestines, and check back into the hospital on Tuesday. MA tried to deny authorization for the surgery, stating that it obviously wasn't an emergency if he was able to check out to prep for it. The hospital's very determined authorization nurse kept at it, pointing out that it was one emergency and would have cost a lot more to keep him hospitalized, so they finally relented.

When he started chemo, MA authorized the chemo but not putting in the chemo port. That took some fighting, and delayed the start of chemo for a month.

After his cancer proceeded to Stage 4, everything went along pretty well at our local cancer center, City of Hope, until the MA plan suddenly broke off their relationship with City of Hope. MA kept denying authorization for treatment until we got a Nurse Case Manager involved, but it was too late. He died in hospice at home last May.

As of January, I switched to a Medicare Supplement plan. There's a premium every month, but I can go anywhere that takes Medicare, which is primary, and the MS plan picks up the residual. No authorization required! I broke my arm at the shoulder, and when my orthopedist pronounced me ready for physical therapy, I was able to start the very next morning with the PT practice of my choice.

I'll never go back to a Medicare Advantage plan. They covered everything that's cheap, like Silver Sneakers, but they failed us when we needed them most.
retire2022
Posts: 3286
Joined: Tue Oct 02, 2018 6:10 pm
Location: NYC

Re: Medicare Advantage - What's the Deal?

Post by retire2022 »

BarbBrooklyn wrote: Fri Apr 16, 2021 10:08 am
chris319 wrote: Thu Apr 15, 2021 8:45 pm
You want to sign up for Medicare when you turn 65, even if you are still working and covered by your employer's health insurance. This was my mistake. I thought I didn't need to sign up while I was still working. Luckily I signed up just in the nick of time and will not be penalized.


Next year I will have to guide my brother through this maze.
At least for me, it was my employer that alerted me to the fact that I needed to sign up for Medicare at 65, because my employee insurance became secondary when I turned 65 and became Medicare eligible.
Yes for me it will be the case as explained in here:

https://www.cs.ny.gov/employee-benefits ... p-2019.pdf
JediMisty
Posts: 917
Joined: Tue Aug 07, 2018 7:06 am
Location: Georgia

Re: Medicare Advantage - What's the Deal?

Post by JediMisty »

Gretchen wrote: Fri Apr 16, 2021 11:41 am Husband and I had Medicare Advantage plans that worked fine, till they didn't.

Medicare Advantage is primary, so you need your PCP's referral to get anything done. When DH was diagnosed with a complete intestinal blockage due to Stage 3 colon cancer while we were away from home, we came very close to having emergency surgery denied. He was admitted to the hospital from the ER, diagnosed on a Friday, and scheduled for surgery the following Tuesday. The surgeon said it made sense to check out of the hospital, get a hotel room, spend three days drinking what I called "Drano" to flush out his intestines, and check back into the hospital on Tuesday. MA tried to deny authorization for the surgery, stating that it obviously wasn't an emergency if he was able to check out to prep for it. The hospital's very determined authorization nurse kept at it, pointing out that it was one emergency and would have cost a lot more to keep him hospitalized, so they finally relented.

When he started chemo, MA authorized the chemo but not putting in the chemo port. That took some fighting, and delayed the start of chemo for a month.

After his cancer proceeded to Stage 4, everything went along pretty well at our local cancer center, City of Hope, until the MA plan suddenly broke off their relationship with City of Hope. MA kept denying authorization for treatment until we got a Nurse Case Manager involved, but it was too late. He died in hospice at home last May.

As of January, I switched to a Medicare Supplement plan. There's a premium every month, but I can go anywhere that takes Medicare, which is primary, and the MS plan picks up the residual. No authorization required! I broke my arm at the shoulder, and when my orthopedist pronounced me ready for physical therapy, I was able to start the very next morning with the PT practice of my choice.

I'll never go back to a Medicare Advantage plan. They covered everything that's cheap, like Silver Sneakers, but they failed us when we needed them most.
Thank you for your post. It is very helpful and undoubtedly painful to recall. I'm sorry for your loss...
User avatar
FIREchief
Posts: 6916
Joined: Fri Aug 19, 2016 6:40 pm

Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Gretchen wrote: Fri Apr 16, 2021 11:41 am Husband and I had Medicare Advantage plans that worked fine, till they didn't.

As of January, I switched to a Medicare Supplement plan. There's a premium every month, but I can go anywhere that takes Medicare, which is primary, and the MS plan picks up the residual. No authorization required! I broke my arm at the shoulder, and when my orthopedist pronounced me ready for physical therapy, I was able to start the very next morning with the PT practice of my choice.

I'll never go back to a Medicare Advantage plan. They covered everything that's cheap, like Silver Sneakers, but they failed us when we needed them most.
Sorry for you loss Gretchen. Thank you for sharing this very personal story. It may be of great benefit to others. In my case, I'm years away from Medicare but fully convinced that I'll be using a Plan G Medigap policy (possibly high deductible). Health issues can spring up at any time and any place and the only thing worse than a serious health problem is a serious health problem with insurance complications.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
goaties
Posts: 542
Joined: Fri Jan 29, 2010 3:15 pm

Re: Medicare Advantage - What's the Deal?

Post by goaties »

deleted
Last edited by goaties on Thu Dec 08, 2022 5:16 am, edited 1 time in total.
musicmom
Posts: 338
Joined: Sat Apr 11, 2015 4:48 pm

Re: Medicare Advantage - What's the Deal?

Post by musicmom »

I look up providers on www.medicare.gov
DetroitRick
Posts: 1488
Joined: Wed Mar 23, 2016 9:28 am
Location: SE Michigan

Re: Medicare Advantage - What's the Deal?

Post by DetroitRick »

Having just started Medicare in February, my antennae have been up with this sort of advertising for the past year or so. But I have to say, the quality of information is beyond ludicrous in many cases. In retrospect, I think it's completely safe to ignore all of this stuff.

People say Medicare is complicated. I don't know if I agree, at least in comparison to all the other health insurance decisions that most of us have been making for the past few decades. But it does take some time to understand the moving parts - who covers what, at what levels, etc. Given the poor quality of information out there, I think that time is well worth it. I've heard enough bad info from experts that I would NEVER trust without verification. A lot of information and advertising in this area is simply predatory. Advertising featuring celebrity has-beens - always safe to ignore.

The most complicated aspects of Medicare, at least to me, lied with two big issues:
- The quality and availability of Advantage networks in your future lifetime. Same as HMO's, this simply can change over time and will change if you move. It ends up being a very personal preference and a location-specific one.
- Future premiums - no expert in Advantage, Supplement or Prescription D can accurately predict this. Nobody. Look at filings in your state for the past 5 years or so. I did - good luck with future rate predictions for all types of policies. It goes along with the impossibility of predicting both the underlying costs, and with the loss ratios in any of the 3 types of insurance (those loss ratios amazed me). Moving in the future? Multiply that uncertainty by a huge additional factor. Mitigating all this is the fact that you can change Advantage or Prescription D programs yearly everywhere, so that isn't so tough. But supplement policies, except in the small minority of states allowing yearly guarantee issue supplements (without medical underwriting), are a somewhat "permanent" decision unless you decide to shift to Advantage, or can pass medical underwriting in your old age.

My recommendation - ignore the advertising, do your own research, use experts where you are still uncomfortable. Start early, at least a year before decision time (not choosing a policy of course, but understanding the alternatives). Figure out what risk levels you are comfortable with, and what general premium levels you can afford. Then, laugh at those commercials.
musicmom
Posts: 338
Joined: Sat Apr 11, 2015 4:48 pm

Re: Medicare Advantage - What's the Deal?

Post by musicmom »

Joe Nameth seems to come every afternoon before my 4pm Judge Judy respite.
bikechuck
Posts: 1473
Joined: Sun Aug 16, 2015 9:22 pm

Re: Medicare Advantage - What's the Deal?

Post by bikechuck »

Stinky wrote: Thu Apr 15, 2021 8:09 pm
N.Y.Cab wrote: Thu Apr 15, 2021 7:53 pm I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
Or -

You sign up for Part A and Part B. Then you sign up for an Advantage plan, that gives you the supplemental coverage and drug plan for no cost. And the Advantage plan throws in gym membership plus dental plus vision benefits for free.

Some Advantage plans have restrictive doctor panels. Mine has a great panel.

YMMV
Your definition of "free" differs from mine.
KeepItSimpleSomehow
Posts: 56
Joined: Fri Jan 18, 2019 1:41 am

Re: Medicare Advantage - What's the Deal?

Post by KeepItSimpleSomehow »

My SoCal Medicare friends and neighbors praise KAISER with a fervor that is like no other. But I chose MediGap HDF.

My observation of what they LOVE:
* No additional premium to pay
* Facility is a one stop shop; Dr & labs & pharmacy
* "They are always so nice"

What I've also observed from the same people:
* No gym memberships; glasses; hearing aids, dental; etc ... the usual perks of MA HMOs which are also available for sign-up
* Waiting longer than they want for routine Dr appt. So they fake a concern to move to the top of the list.
* Flu/bronchitis season (pre Covid) waiting area overrun with people; not just Medicare seniors; every one in the community with Kaiser as employer ins company. Then the patient advances to the waiting area for the actual Dr also jammed. (I know because I drove neighbors there for care) Patient is stressing whole time being herded along with all the sick people next to them. (pre Covid)
* Once diagnostic (vs routine prevention) & treatments begin, they discover the co-pays and share costs add up quickly.
* Once a specialist is "allowed", the wait begins ... and ... delays for treatment. Those delays often weren't benign. (cancer; knee/hip replacements; PT) At the least enduring the worry of when/what to enduring the physical pain of the issue.
* Once some diagnosis/condition, they do not travel ... because unless ER ... typical HMO no coverage out of the local network.

Cannot explain their excitement and loyalty ... but it is strange ... like a ... cult :?
Don't know of anyone on other MA providers showing such zeal for say .. oh my Humana .. ahhhh my AARP UnitedHealthcare ...
mbres60
Posts: 1303
Joined: Tue Jul 03, 2007 1:47 pm

Re: Medicare Advantage - What's the Deal?

Post by mbres60 »

Gretchen - I'm sorry for your loss :( I agree that MA works until it doesn't. Back around 2006 or so when my parents lived in Florida my mother broke her hip. They were on Humana MA. When being released from the hospital to rehab, the facility they sent her to was horrible. A couple of years later she broke her other hip. Again, hospital great but rehab choices (we were given 3) were not. I asked a nurse and of the three choices she said the one my mother had been in previously was the best of the awful. People in the hospital kept telling us that regular Medicare is much better when you have hospitalizations and then rehab. Ultimately, we moved my parents to another state and the nursing home we put my mother in noticed that she had a really bad bedsore that the previous place did not take very good care of.

When my dh and I turned 65 we were lucky not to have to make a choice because he is a retired Fed employee so we have access to many health plans. We could go onto advantage if we wanted but we DON'T want to!!
Wrench
Posts: 1055
Joined: Sun Apr 28, 2019 10:21 am

Re: Medicare Advantage - What's the Deal?

Post by Wrench »

N.Y.Cab wrote: Thu Apr 15, 2021 7:53 pm I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
I'm right in the middle of making this choice. Curious as to why you would choose high-deductible plan G instead of normal G? I am debating with myself on this point. Difference in price between the two is on the order of $100 per month. Although I am currently healthy, it seems like all it would take would be one or two issues to crop up in the future like joint replacements, cancer, hospitalization from pneumonia or other infections, heart issues,etc. where one would lose out with the high deductible plan. The likelihood of such an event certainly increases with age. What is your thinking (or other BHs) relative to why you would get high deductible? I can certainly cover the deductible in any given year. But as one ages, it seems more likely that covering every year will be more likely, in which case the high deductible plan makes less sense.
oxothuk
Posts: 891
Joined: Thu Nov 10, 2011 7:35 pm

Re: Medicare Advantage - What's the Deal?

Post by oxothuk »

KeepItSimpleSomehow wrote: Fri Apr 16, 2021 3:04 pm My SoCal Medicare friends and neighbors praise KAISER with a fervor that is like no other. But I chose MediGap HDF.

My observation of what they LOVE:
* No additional premium to pay
* Facility is a one stop shop; Dr & labs & pharmacy
* "They are always so nice"

What I've also observed from the same people:
* No gym memberships; glasses; hearing aids, dental; etc ... the usual perks of MA HMOs which are also available for sign-up
* Waiting longer than they want for routine Dr appt. So they fake a concern to move to the top of the list.
* Flu/bronchitis season (pre Covid) waiting area overrun with people; not just Medicare seniors; every one in the community with Kaiser as employer ins company. Then the patient advances to the waiting area for the actual Dr also jammed. (I know because I drove neighbors there for care) Patient is stressing whole time being herded along with all the sick people next to them. (pre Covid)
* Once diagnostic (vs routine prevention) & treatments begin, they discover the co-pays and share costs add up quickly.
* Once a specialist is "allowed", the wait begins ... and ... delays for treatment. Those delays often weren't benign. (cancer; knee/hip replacements; PT) At the least enduring the worry of when/what to enduring the physical pain of the issue.
* Once some diagnosis/condition, they do not travel ... because unless ER ... typical HMO no coverage out of the local network.

Cannot explain their excitement and loyalty ... but it is strange ... like a ... cult :?
Don't know of anyone on other MA providers showing such zeal for say .. oh my Humana .. ahhhh my AARP UnitedHealthcare ...
I’ve had Kaiser for over 40 years. I transitioned from an employer plan to a MA plan when I reached 65 and it was seamless.

My wife and I have had several serious conditions over the years, including cancer and a coronary blockage. In every case Kaiser was very prompt and proactive about treatment. I’m not put off by sharing the same waiting room with other patients - cancer and heart disease are not contagious.

Personally, I don’t understand the excitement many people have about “specialists”. Maybe that’s a cult.
User avatar
JoeRetire
Posts: 15381
Joined: Tue Jan 16, 2018 1:44 pm

Re: Medicare Advantage - What's the Deal?

Post by JoeRetire »

chris319 wrote: Thu Apr 15, 2021 3:12 pm My question is, why are Medicare Advantage plans advertised and marketed so heavily? Marketing costs money so there must be some benefit to the advertiser to justify the marketing cost. The money must come from somewhere.
Why does any company advertise?
Would any company spend money on marketing if they didn't think they could draw enough additional business to make it worthwhile?

Hint: some companies advertise, some do not.
This isn't just my wallet. It's an organizer, a memory and an old friend.
ModifiedDuration
Posts: 1408
Joined: Sat Dec 05, 2015 3:33 pm

Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

Wrench wrote: Fri Apr 16, 2021 3:25 pm
N.Y.Cab wrote: Thu Apr 15, 2021 7:53 pm I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
I'm right in the middle of making this choice. Curious as to why you would choose high-deductible plan G instead of normal G? I am debating with myself on this point. Difference in price between the two is on the order of $100 per month. Although I am currently healthy, it seems like all it would take would be one or two issues to crop up in the future like joint replacements, cancer, hospitalization from pneumonia or other infections, heart issues,etc. where one would lose out with the high deductible plan. The likelihood of such an event certainly increases with age. What is your thinking (or other BHs) relative to why you would get high deductible? I can certainly cover the deductible in any given year. But as one ages, it seems more likely that covering every year will be more likely, in which case the high deductible plan makes less sense.
The “high deductible” is a misnomer, because, under high deductible Plan G Medicare Parts A and B do pay their shares first and then you pay the $1,484 Medicare Part A deductible (for 2021) if you are admitted to a hospital and the 20% of Medicare-approved costs that Part B does not cover, up to a total “deductible” of $2,370 (for 2021).

If you are in good health, it can be a good value, as the monthly premiums are very low and, over time, your out-of-pocket expenses could be significantly lower than the additional cost of a regular Plan G.

In my case, the Plan G high-deductible premium is $37 a month vs. about $150 a month for the lowest cost regular Plan G, so basically any year that I am not admitted to the hospital I should come out way ahead.

When I expressed surprise at the low $37 a month premium, the insurance agent that I was working with said, “The premium is so low because so few people end up reaching the annual deductible.”

I prepared a spreadsheet with differing assumptions on how often I would be hospitalized over the years (and have to pay the $1,484 Part A deductible) and varying assumptions on how much the 20% Part B coinsurance would be each year. The numbers did really point toward the high deductible plan.

This is insurance in the true sense of the word, providing coverage if a large expense is incurred due to a major medical issue.
Last edited by ModifiedDuration on Fri Apr 16, 2021 3:57 pm, edited 1 time in total.
User avatar
FIREchief
Posts: 6916
Joined: Fri Aug 19, 2016 6:40 pm

Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

oxothuk wrote: Fri Apr 16, 2021 3:31 pm Personally, I don’t understand the excitement many people have about “specialists”. Maybe that’s a cult.
Until you need a really good one who isn't "in network." :shock:
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
Broken Man 1999
Posts: 8626
Joined: Wed Apr 08, 2015 11:31 am
Location: West coast of Florida, near Champa Bay !

Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

FIREchief wrote: Fri Apr 16, 2021 3:54 pm
oxothuk wrote: Fri Apr 16, 2021 3:31 pm Personally, I don’t understand the excitement many people have about “specialists”. Maybe that’s a cult.
Until you need a really good one who isn't "in network." :shock:
My DW's orthopedic surgeon is the Tampa Bay Lightening's surgeon. He blocks off time during the playoff runs as he might be traveling with them. He did both her knee replacements.

DW had a cancer scare a year of two ago, her surgeon was not just another surgeon at the Moffitt Cancer Center, much higher pay grade. He took rhe route of watching her mass for two years, surgery not recommended.

Given the penetration of Medicare Advantage plans in various locations, especially in metro areas, there is zero issues with obtaining well regarded specialists.

DW had an MRI last week for some back issues, she was in PT Wednesday. Her PT person is the one she used for both her knee replacements. The physical therapist also works on the staff of her orthopedic doctor.

The idea that the care given MA patients being inferior, or unavailable has never been an issue, in her experience, or mine.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
User avatar
FIREchief
Posts: 6916
Joined: Fri Aug 19, 2016 6:40 pm

Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Broken Man 1999 wrote: Fri Apr 16, 2021 4:16 pm
Given the penetration of Medicare Advantage plans in various locations, especially in metro areas, there is zero issues with obtaining well regarded specialists.

DW had an MRI last week for some back issues, she was in PT Wednesday. Her PT person is the one she used for both her knee replacements. The physical therapist also works on the staff of her orthopedic doctor.

The idea that the care given MA patients being inferior, or unavailable has never been an issue, in her experience, or mine.
I fully believe this to be your experience, but you can't extrapolate that to all readers. A lot of us in other areas of the country, with established relationships with specialists with specific credentials, have checked and found them to not be in network for HMO's under Medicare Advantage and/or ACA. Are you suggesting that nobody should worry about access to specialists under MA? :confused

You haven't even mentioned facilities. Some types of robotic surgeries or other special procedures are only performed at a single hospital in town. What if that hospital is not in network for your MA plan?
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
radiowave
Posts: 3352
Joined: Thu Apr 30, 2015 5:01 pm

Re: Medicare Advantage - What's the Deal?

Post by radiowave »

I'm currently on Kaiser through employer and really have been happy with them. Retiring end of May and have been comparing options.

If I do the Medicare Advantage with Kaiser, I'll pay the Part B at 148/mo and get gym, drugs, dental and glasses/hearing coverage. It would be a seamless transition with current providers.

If I go the Medigap way, I pay Part B as above, additional 120/mo for Plan G and 7/mo for drug plan. I will also have to find providers that accept new Medicare patients and if I need referrals, will have to wrestle with that as well, especially arranging appointments. I have a few weeks for before I make a decision but staying with Kaiser seems to be a no brainer.
Bogleheads Wiki: https://www.bogleheads.org/wiki/Main_Page
orlandoman
Posts: 675
Joined: Tue Oct 19, 2010 7:27 am

Re: Medicare Advantage - What's the Deal?

Post by orlandoman »

Let's clear up something about Medicare Advantage plans:
- most Medicare Advantage plans are MA HMO plans or MA PPO plans
- under the MA HMO plan you do need a Personal Care Physician who serves as a gatekepper for specialists
- under the MA HMO plan you must use their network unless it is for emergency care
- under the MA PPO plan there is no Personal Care Physician who serves as a gatekepper for specialists
- under the MA PPO plan there is a network of doctors & facilities
- under the MA PPO plan you can use either network doctors/facilities or any doctor/facility that accepts Medicare (like Medigap)
- under the MA PPO plan there are higher deductables/copays/out of pocket maximums if you use out of network doctors/facilities
When people complain about MA plans, they are usually complaining about the MA HMO, not the MA PPO plan. People who make Medicare plan choices often do not understand all their plan choices. The MA HMO plan is the cheapest and that is often why they select it, not understanding the details.
"Borrow money from pessimists -- they don't expect it back"
Wrench
Posts: 1055
Joined: Sun Apr 28, 2019 10:21 am

Re: Medicare Advantage - What's the Deal?

Post by Wrench »

ModifiedDuration wrote: Fri Apr 16, 2021 3:44 pm
Wrench wrote: Fri Apr 16, 2021 3:25 pm
N.Y.Cab wrote: Thu Apr 15, 2021 7:53 pm I’m a few years away from eligibility, still healthy and working but learn a few from reading book for Dummies and watching YouTube videos. First you sign up for part A (free) and B ($148.50 per month) at SSA.gov. Then visit Medicare.gov to pick a cheap part D (about $7 a month) as a placeholder and a good old Medigap high-deductible plan G (around $60 a month).
I'm right in the middle of making this choice. Curious as to why you would choose high-deductible plan G instead of normal G? I am debating with myself on this point. Difference in price between the two is on the order of $100 per month. Although I am currently healthy, it seems like all it would take would be one or two issues to crop up in the future like joint replacements, cancer, hospitalization from pneumonia or other infections, heart issues,etc. where one would lose out with the high deductible plan. The likelihood of such an event certainly increases with age. What is your thinking (or other BHs) relative to why you would get high deductible? I can certainly cover the deductible in any given year. But as one ages, it seems more likely that covering every year will be more likely, in which case the high deductible plan makes less sense.
The “high deductible” is a misnomer, because, under high deductible Plan G Medicare Parts A and B do pay their shares first and then you pay the $1,484 Medicare Part A deductible (for 2021) if you are admitted to a hospital and the 20% of Medicare-approved costs that Part B does not cover, up to a total “deductible” of $2,370 (for 2021).

If you are in good health, it can be a good value, as the monthly premiums are very low and, over time, your out-of-pocket expenses could be significantly lower than the additional cost of a regular Plan G.

In my case, the Plan G high-deductible premium is $37 a month vs. about $150 a month for the lowest cost regular Plan G, so basically any year that I am not admitted to the hospital I should come out way ahead.

When I expressed surprise at the low $37 a month premium, the insurance agent that I was working with said, “The premium is so low because so few people end up reaching the annual deductible.”

I prepared a spreadsheet with differing assumptions on how often I would be hospitalized over the years (and have to pay the $1,484 Part A deductible) and varying assumptions on how much the 20% Part B coinsurance would be each year. The numbers did really point toward the high deductible plan.

This is insurance in the true sense of the word, providing coverage if a large expense is incurred due to a major medical issue.
Thanks. I hate decisions like this that depend on predicting future unknowns! If the difference in cost is ~$100 per month then you save roughly $1200 per year in premiums with high deductible plan. So very roughly, if you have one bad year every two years you break even. If a bad year is less frequent you win, more frequent you lose with the high deductible. Assuming your are healthy when you begin with no known chronic conditions, you probably win in the beginning. But, as you age, you are more likely to lose than win. If you start at age 65 and go 10 years without ever coming close to the deductible, then have a severe illness and die, the high deductible is the better plan. But if you start at 65 and are diagnosed with a chronic or critical disease within the first few years and live for many years, the regular plan would be better. The regular plan seems like a better deal to me to protect against the more likely scenario that as you age, your medical expenses will probably be higher every year. But honestly, who knows? Like I said, I hate these types of decisions...

Wrench
Broken Man 1999
Posts: 8626
Joined: Wed Apr 08, 2015 11:31 am
Location: West coast of Florida, near Champa Bay !

Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

FIREchief wrote: Fri Apr 16, 2021 4:28 pm
Broken Man 1999 wrote: Fri Apr 16, 2021 4:16 pm
Given the penetration of Medicare Advantage plans in various locations, especially in metro areas, there is zero issues with obtaining well regarded specialists.

DW had an MRI last week for some back issues, she was in PT Wednesday. Her PT person is the one she used for both her knee replacements. The physical therapist also works on the staff of her orthopedic doctor.

The idea that the care given MA patients being inferior, or unavailable has never been an issue, in her experience, or mine.
I fully believe this to be your experience, but you can't extrapolate that to all readers. A lot of us in other areas of the country, with established relationships with specialists with specific credentials, have checked and found them to not be in network for HMO's under Medicare Advantage and/or ACA. Are you suggesting that nobody should worry about access to specialists under MA? :confused
What I am saying is in metro areas there should be no problem having access to good specialists at all. Networks might be problematic in non-metro-areas.

In Miami Dade county, IIRC the penetration of MA plans is 35% plus, I think that few specialists could ignore MA insurance clients.

As I have stated before, in smaller, rural areas, I wouldn't use a MA plan.

So far as HMO and PPO, the same network is available for both, at least for my Humana plan. FWIW, I have never had to go out of network, ever, though I could have if I wanted/needed to do so.

In the Tampa area I have used the same PCP, and specialists for better than 20 years. We used HMOs when they first were offered. Our daughters use the same PCP as their mother uses. Long term relationships with all our caregivers. When MIL came to live with us the last few years of her life, she used our doctors until she passed. Funny thing, my PCP is the doctor for some of my specialist's family members.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
User avatar
Bogle7
Posts: 1984
Joined: Fri May 11, 2018 9:33 am
Location: In the Witness Protection Program

Medicare Advantage works for me

Post by Bogle7 »

Gretchen wrote: Fri Apr 16, 2021 11:41 amHusband and I had Medicare Advantage plans that worked fine, till they didn't.
It depends on the Medicare Advantage provider.
I had/have Kaiser and my total out-of-pocket costs for my colon cancer were $2500 for everything— doctor visits, surgery, port installation/removal, chemotherapy. I have the cheapest plan available.
Never had to fight the system. It just worked.
And, my benefits have improved over the last few years.

For me:
* gym memberships; glasses; hearing aids, dental; etc
* no wait for routine doc appointment
* during 7 years of experience, very low co-pays
* no delays for treatment (colon cancer, perianal abscess surgeries (3))

The only time I have waited is for my first Shingrix vaccine shot. Kaiser had shortages for over 6 months.
Old fart who does three index stock funds, baby.
Broken Man 1999
Posts: 8626
Joined: Wed Apr 08, 2015 11:31 am
Location: West coast of Florida, near Champa Bay !

Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

orlandoman wrote: Fri Apr 16, 2021 4:37 pm Let's clear up something about Medicare Advantage plans:
- most Medicare Advantage plans are MA HMO plans or MA PPO plans
- under the MA HMO plan you do need a Personal Care Physician who serves as a gatekepper for specialists
- under the MA HMO plan you must use their network unless it is for emergency care
- under the MA PPO plan there is no Personal Care Physician who serves as a gatekepper for specialists
- under the MA PPO plan there is a network of doctors & facilities
- under the MA PPO plan you can use either network doctors/facilities or any doctor/facility that accepts Medicare (like Medigap)
- under the MA PPO plan there are higher deductables/copays/out of pocket maximums if you use out of network doctors/facilities
When people complain about MA plans, they are usually complaining about the MA HMO, not the MA PPO plan. People who make Medicare plan choices often do not understand all their plan choices. The MA HMO plan is the cheapest and that is often why they select it, not understanding the details.
My Humana plan has zero deductibles for medical and pharmacy.

Max out pocket is $3000 for individual or family. With our very low co-pays, we have never came close to OOP of $3000. Max OOP we have faced was DW's knee replacements, she was a bleeder, so had to spend a couple of days in the hospital, just to be safe. And neither time did we hit max OOP.

Just like anything, I'm sure other providers are different, just like some ACA plans and Medigap plans aren't always the best.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
Broken Man 1999
Posts: 8626
Joined: Wed Apr 08, 2015 11:31 am
Location: West coast of Florida, near Champa Bay !

Re: Medicare Advantage works for me

Post by Broken Man 1999 »

Bogle7 wrote: Fri Apr 16, 2021 5:02 pm
Gretchen wrote: Fri Apr 16, 2021 11:41 amHusband and I had Medicare Advantage plans that worked fine, till they didn't.
It depends on the Medicare Advantage provider.
I had/have Kaiser and my total out-of-pocket costs for my colon cancer were $2500 for everything— doctor visits, surgery, port installation/removal, chemotherapy. I have the cheapest plan available.
Never had to fight the system. It just worked.
And, my benefits have improved over the last few years.

For me:
* gym memberships; glasses; hearing aids, dental; etc
* no wait for routine doc appointment
* during 7 years of experience, very low co-pays
* no delays for treatment (colon cancer, perianal abscess surgeries (3))

The only time I have waited is for my first Shingrix vaccine shot. Kaiser had shortages for over 6 months.
The wait for the Shingrix wasn't just for MA plans, at least in my area. For a while, no one seemed to have stocks of the product.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
jmw
Posts: 328
Joined: Thu Jul 02, 2015 2:01 pm

Re: Medicare Advantage - What's the Deal?

Post by jmw »

With such a smart forum, there are a lot of folks willing to bend over and accept an inferior product called Medicare disadvantage. Basically the country’s only single payer option is turned down for something like Kaiser or some other limiting HMO. My home country has nationalized health insurance that is like Kaiser but many folks will leave the country to pay cash for better care. Buy new cars loaded with depreciation but buy HMO to save a penny?

Keep in mind your Kaiser doc will not ever mention any options that are unattainable inside Kaiser or outside of Kaiser’s own guidelines. Ignorance is bliss? That’s why Kaiser folks never have to appeal anything.
hicabob
Posts: 3796
Joined: Fri May 27, 2011 5:35 pm
Location: cruz

Re: Medicare Advantage - What's the Deal?

Post by hicabob »

jmw wrote: Fri Apr 16, 2021 6:22 pm With such a smart forum, there are a lot of folks willing to bend over and accept an inferior product called Medicare disadvantage. Basically the country’s only single payer option is turned down for something like Kaiser or some other limiting HMO.
One problem is that a layman picking a better than average doc is extremely difficult. "Bedside manner" (charm) doesn't equal competency. From what I hear from a relative in the biz Kaiser pays quite well and the docs work a normal work week.
User avatar
FIREchief
Posts: 6916
Joined: Fri Aug 19, 2016 6:40 pm

Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Broken Man 1999 wrote: Fri Apr 16, 2021 4:57 pm What I am saying is in metro areas there should be no problem having access to good specialists at all. Networks might be problematic in non-metro-areas.

In Miami Dade county, IIRC the penetration of MA plans is 35% plus, I think that few specialists could ignore MA insurance clients.
Again, you seem to be extrapolating your own situation/experience to everybody, and it is simply not correct. I live in a large urban area.
So far as HMO and PPO, the same network is available for both, at least for my Humana plan. FWIW, I have never had to go out of network, ever, though I could have if I wanted/needed to do so.
Again, you're extrapolating your own limited experience to everybody else. HMO and PPO are generally not the same "network." They are often quite different, and most/all MA plans in my area are HMOs.
In the Tampa area I have used the same PCP, and specialists for better than 20 years. We used HMOs when they first were offered. Our daughters use the same PCP as their mother uses. Long term relationships with all our caregivers. When MIL came to live with us the last few years of her life, she used our doctors until she passed. Funny thing, my PCP is the doctor for some of my specialist's family members.
PCP is largely irrelevant. I have a great PCP and if I were ever in a situation where she was not in network, I would just pay OOP. PCP is a nit in the grand scheme of potential medical care requirements.
Last edited by FIREchief on Sat Apr 17, 2021 3:58 pm, edited 1 time in total.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
ModifiedDuration
Posts: 1408
Joined: Sat Dec 05, 2015 3:33 pm

Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

Wrench wrote: Fri Apr 16, 2021 4:42 pm
Thanks. I hate decisions like this that depend on predicting future unknowns! If the difference in cost is ~$100 per month then you save roughly $1200 per year in premiums with high deductible plan. So very roughly, if you have one bad year every two years you break even. If a bad year is less frequent you win, more frequent you lose with the high deductible. Assuming your are healthy when you begin with no known chronic conditions, you probably win in the beginning. But, as you age, you are more likely to lose than win. If you start at age 65 and go 10 years without ever coming close to the deductible, then have a severe illness and die, the high deductible is the better plan. But if you start at 65 and are diagnosed with a chronic or critical disease within the first few years and live for many years, the regular plan would be better. The regular plan seems like a better deal to me to protect against the more likely scenario that as you age, your medical expenses will probably be higher every year. But honestly, who knows? Like I said, I hate these types of decisions...

Wrench
It’s great that you are a few years away from Medicare and have already made the choice that is best for you.

For others who are reading this and deciding between Plan G and Plan G high deductible, I urge you to delve into the numbers.

I was able to obtain the annual premium schedules for ages 65 and up for the Plan G-HD I eventually took and for the lowest cost Plan Gs in my zip code.

I scheduled those on a spreadsheet and the results were eye opening.

The Plan G that was the lowest cost over the long term was $1,500 a year more than the Plan G-HD at age 65. Since Medicare is primary and will pay first, you either have to be hospitalized (and incur the $1,484 Part A deductible) or have over $7,500 in Part B costs at the low Medicare reimbursement rate for the high deductible option to not work in any particular year around age 65.

But, as you got older the spread widened between the Plan G-HD and the lowest cost Plan G:

At age 75, it was a $1,900 a year difference
At age 80, it was a $2,200 a year difference
Age 81 and above, it was a $2,300 a year difference

Since the difference in maximum annual out-of-pocket cost between Plan G and Plan G-HD is $2,167 (the difference between the Part B $203 deductible in Plan G and the $2,370 deductible in Plan G-HD, since the $203 Part B deductible counts against the $2,370 Plan G-HD deductible), it was an easy decision in my situation to go with Plan G-HD.

At age 65, if I have a “normal” year and have $1,000 in Medicare Part B expenses, my out-of-pocket is just $160 above a Plan G (20% of the amount above the $203 annual Part B deductible) and I would save $1,340.

For 80 and above, even if I reached the Plan G-HD deductible each year, I still save money over Plan G.

As someone else’s numbers could be very different, the only way to make an informed decision is to run the numbers.

Of course, some people may just be uncomfortable with the idea of a high-deductible plan and/or they may prefer the simplicity of Plan G and may, therefore, decide those factors outweigh the financial aspects and to just go with Plan G.
Post Reply