Medicare Advantage - What's the Deal?

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Lexx
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Re: Medicare Advantage - What's the Deal?

Post by Lexx »

This whole thing is so confusing. I'm still 5 years away from Medicare but I do want to budget for it. Right now I have a Platinum ACA plan with Kaiser, which while very expensive, has worked out very well for me. I've not had an issue getting treatment.

However with Medicare it seems Kaiser only offers Medicare Advantage. Are folks with Kaiser Medicare Advantage happy with it? What's the "best" Medicare coverage to sign up for irrespective of costs?
ModifiedDuration
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Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

Lexx wrote: Fri Apr 16, 2021 8:02 pm This whole thing is so confusing. I'm still 5 years away from Medicare but I do want to budget for it. Right now I have a Platinum ACA plan with Kaiser, which while very expensive, has worked out very well for me. I've not had an issue getting treatment.

However with Medicare it seems Kaiser only offers Medicare Advantage. Are folks with Kaiser Medicare Advantage happy with it? What's the "best" Medicare coverage to sign up for irrespective of costs?
As far as your last question goes, what’s “best” is in the eye of the beholder.

The most comprehensive coverage that would be available to you would be Traditional Medicare (Parts A and B) and a Medicare Supplement Plan G.

Your only out-of-pocket cost for Medicare covered services would then be a $203 annual deductible (which goes up several dollars a year) and you would be able to see any physician who accepts Medicare (almost all physicians) and is currently accepting new Medicare patients.

In addition, you would have to select a Part D prescription plan.
oxothuk
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Re: Medicare Advantage - What's the Deal?

Post by oxothuk »

jmw wrote: Fri Apr 16, 2021 6:22 pm Keep in mind your Kaiser doc will not ever mention any options that are unattainable inside Kaiser or outside of Kaiser’s own guidelines.
What would be the purpose of discussing options that aren’t really options?

Leaving aside the very rich who can self fund medical care, the rest of us have to work within some kind of plan. Every plan has guidelines which draw a line between what they will/won’t cover. Nothing unique about Kaiser in that regard.
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El Greco
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Re: Medicare Advantage - What's the Deal?

Post by El Greco »

Here's my take on Medicare Advantage: These plans, by far, are the most heavily promoted by insurance companies as opposed to A,B, D and Medigap.

This tells me that Medicare Advantage takes better care of the insurance company and not-so-great care of me.

In fact, whenever an insurer or a bank or a car dealer pushes one product over another I usually gravitate to the one they are NOT pushing. It's a good rule of thumb that has served me well over the years. YMMV
curious_georgey
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Re: Medicare Advantage - What's the Deal?

Post by curious_georgey »

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.
Surprised to hear this. I was under the impression if you were still working and employer had more than 2o employees you didn't need to enroll at 65 as employer coverage remained primary. Would you please elaborate?
Wrench
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Re: Medicare Advantage - What's the Deal?

Post by Wrench »

ModifiedDuration wrote: Fri Apr 16, 2021 7:24 pm
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.
I appreciate your insights and approach - thank you for sharing it. I agree with you - everyone should carefully analyze it for their own situation, costs, health prospects and financial situation. I would also suggest it never hurts to start early as you have, but also be willing to modify your thoughts/approach because a lot can change in a few years in this decision (example - plan F went away for those turning 65 after 2020). Who knows, maybe the deductible limits will double or halve, or the normal plan will go away completely. Changes are inevitable, but the nature of them is unknown.

I'm actually months away from Medicare, not years. So this decision is upon me right now. The other factor in this decision is whether the supplemental plan pricing is rated on attained age, issue age or community pricing. Price increases in the first will be larger than the second and are somewhat unknown in the third, but will likely go up. Then you throw in the size and reputation of the insurance company, the reported quality of their service and the decision quickly becomes mind-boglingly difficult, at least for me. And one more complication for me - I own a business and the business will pay the premiums as deductible expenses (at least for a few years) so they are effectively paid pre-tax. I'm normally very analytical so your spreadsheet approach is one I would usually be totally into. But in this case, there are factors that are not truly quantifiable, including emotional ones for my spouse and me. I think I may go with my gut (and my older brother's recommendation), which is the normal plan G (or maybe even Plan F, which is available to me as well). Or, maybe not... ARRGGG!!!!

Wrench
Wrench
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Re: Medicare Advantage - What's the Deal?

Post by Wrench »

curious_georgey wrote: Sat Apr 17, 2021 8:12 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.
Surprised to hear this. I was under the impression if you were still working and employer had more than 2o employees you didn't need to enroll at 65 as employer coverage remained primary. Would you please elaborate?
You should sign up for Medicare Part A though I don't know whether you absolutely have to if you are covered by a qualified employer sponsored health plan. Since Part A is free, there is no downside to doing so. Whether you should sign up for Medicare Part B (or A for that matter) depends on what your employer tells you. Check with them. When I turned 65, my (large) employer notified me and told me exactly what my options were. I'm not sure that notification was required by social security but I suspect it was.
ModifiedDuration
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Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

Wrench wrote: Sat Apr 17, 2021 8:19 am I think I may go with my gut (and my older brother's recommendation), which is the normal plan G (or maybe even Plan F, which is available to me as well). Or, maybe not... ARRGGG!!!!

Wrench
Due to all the factors that are important to you in making this decision, you might find a good Medicare supplement insurance agent to be helpful.

Good luck!
ikowik
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Re: Medicare Advantage - What's the Deal?

Post by ikowik »

curious_georgey wrote: Sat Apr 17, 2021 8:12 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.
Surprised to hear this. I was under the impression if you were still working and employer had more than 2o employees you didn't need to enroll at 65 as employer coverage remained primary. Would you please elaborate?
You are correct, but check with your employer to make sure as plans have different requirements. I work for a large organization with hundreds of employees. While working I and wife are on employer- subsidized health insurance coverage. When I turned 65, enrolling in Medicare was optional for me. I enrolled in Part A as there is no extra cost to it, but delaying part B until retirement. No penalty for late enrollment in Part B since I have proof of creditable coverage. My wife HAS to enroll in Part A and B when she turns 65, irrespective of my employment status, to avoid penalty for late enrollment. Medicare becomes primary coverage for her at 65, employer plan is secondary.
Broken Man 1999
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Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

FIREchief wrote: Fri Apr 16, 2021 6:57 pm
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. I won't share medical details, but I have had a condition requiring surgery and extensive follow up. If I were covered by a MA plan, my surgeon would not be available to me. He has specific skills possessed by exactly two surgeons in my city, and neither are in the HMO type networks.
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.
What you are doing is stating YOUR experiences. What I am doing is stating MY experiences. If that is considered extrapolating, then I believe we are both doing it. Is your experience superior to mine?

We are blindly touching the elephant in different places, and coming away with what we believe is the correct description.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
N.Y.Cab
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Re: Medicare Advantage - What's the Deal?

Post by N.Y.Cab »

The downside for getting part A while working is you no longer can contribute to HSA. You can sign up later without penalty in special enrollment if coming from group health plan of 20 or more employees.
ModifiedDuration
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Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

ikowik wrote: Sat Apr 17, 2021 8:38 am
curious_georgey wrote: Sat Apr 17, 2021 8:12 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.
Surprised to hear this. I was under the impression if you were still working and employer had more than 2o employees you didn't need to enroll at 65 as employer coverage remained primary. Would you please elaborate?
You are correct, but check with your employer to make sure as plans have different requirements. I work for a large organization with hundreds of employees. While working I and wife are on employer- subsidized health insurance coverage. When I turned 65, enrolling in Medicare was optional for me. I enrolled in Part A as there is no extra cost to it, but delaying part B until retirement. No penalty for late enrollment in Part B since I have proof of creditable coverage. My wife HAS to enroll in Part A and B when she turns 65, irrespective of my employment status, to avoid penalty for late enrollment.. Medicare becomes primary coverage for her at 65, employer plan is secondary.
Your spouse should not have to enroll in Medicare Parts A and B at age 65 to avoid the late enrollment penalty if she is covered by the same plan that you have at your large company.

See below: “I have coverage through my spouse who is currently working”:

https://www.medicare.gov/sign-up-change ... -parts-a-b

Am I missing something in this case?
ikowik
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Re: Medicare Advantage - What's the Deal?

Post by ikowik »

ModifiedDuration wrote: Sat Apr 17, 2021 8:54 am
ikowik wrote: Sat Apr 17, 2021 8:38 am
curious_georgey wrote: Sat Apr 17, 2021 8:12 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.
Surprised to hear this. I was under the impression if you were still working and employer had more than 2o employees you didn't need to enroll at 65 as employer coverage remained primary. Would you please elaborate?
You are correct, but check with your employer to make sure as plans have different requirements. I work for a large organization with hundreds of employees. While working I and wife are on employer- subsidized health insurance coverage. When I turned 65, enrolling in Medicare was optional for me. I enrolled in Part A as there is no extra cost to it, but delaying part B until retirement. No penalty for late enrollment in Part B since I have proof of creditable coverage. My wife HAS to enroll in Part A and B when she turns 65, irrespective of my employment status, to avoid penalty for late enrollment.. Medicare becomes primary coverage for her at 65, employer plan is secondary.
Your spouse should not have to enroll in Medicare Parts A and B at age 65 to avoid the late enrollment penalty if she is covered by the same plan that you have at your large company.

See below: “I have coverage through my spouse who is currently working”:

https://www.medicare.gov/sign-up-change ... -parts-a-b

Am I missing something in this case?
This is why I said check with the specific employer plan. While generally true, my employer's plan (a state employee plan) requires the dependent (spouse) enroll at time of first eligibility in Parts A and B (Medicare is primary payer then), but the employee (myself) can wait until employment stops-a bit weird, I agree, especially as the plan re-reimburses us for Part B premiums. Other plans may have different ways of dealing with this.
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David Jay
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Re: Medicare Advantage - What's the Deal?

Post by David Jay »

We are both up for Medicare this winter (birthdays are one month apart).

I have seriously looked at the “A + B only” based on this Doctor’s arguments: https://truecostofhealthcare.org/medica ... insurance/

In the end, I chickened out and now we are focusing these choices:
1. High Deducible “G” + Placeholder “D”
2. Priority Health MA PPO, the network is affiliated with Spectrum Hospitals so it covers about 90% of doctors in West Michigan

I figure that if I am unhappy with MA I can go to A + B + D without underwriting, again based on Dr. Belk’s analysis (link above).
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
tj
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Re: Medicare Advantage - What's the Deal?

Post by tj »

John Greaney posted an article late last year:

https://retireearlyhomepage.com/medicare2020.html
In Summary -- what I'm doing

I'm going with traditional fee-for-service Medicare, a high-deductible Plan G Medigap plan with a premium of about $600/yr and the cheapest Part D drug plan offered, that's a premium of about $160/yr at current pricing. And of course, I'll be paying the Medicare Part B premium of about $150/month ($1,800/yr) for a total health premium of about $2,560/yr.
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Re: Medicare Advantage - What's the Deal?

Post by hicabob »

David Jay wrote: Sat Apr 17, 2021 9:51 am
I have seriously looked at the “A + B only” based on this Doctor’s arguments: https://truecostofhealthcare.org/medica ... insurance/
Very interesting article! Thanks for linking it.
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chris319
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Re: Medicare Advantage - What's the Deal?

Post by chris319 »

Forget about Humana. I misinterpreted the information on their web site. Now it's between Blue Shield and Cigna.

I see that it really does come down to price shopping.
Last edited by chris319 on Sat Apr 17, 2021 10:46 am, edited 1 time in total.
Financial decisions based on emotion often turn out to be bad decisions.
ncbill
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Re: Medicare Advantage - What's the Deal?

Post by ncbill »

Better check how that MA plan interfaces with Hospice.

One horror story I read online had a patient in a facility already on Hospice & under a MA plan break their hip, so the facility called an ambulance and had them transported to the hospital for surgery.

But the MA plan claimed doing the above without prior authorization ended Hospice coverage & automatically dis-enrolled them from the MA plan itself, so the patient was now only covered by Part A & B, no supplement, leaving the patient responsible for all co-pays & drug costs.

So a few years ago when I signed up a relative already in their 70s for Part B, who hadn't done so before due to financial constraints, I made sure to pick a traditional Medigap plan (Plan G) plus a drug plan.

Which was fortunate when they were diagnosed with a terminal illness later that year & only had to pay the annual deductible for the care they received before they died.
muddlehead
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Re: Medicare Advantage - What's the Deal?

Post by muddlehead »

Forgive me. Haven't read the comments. Here's our (wife and I) story. Both 65. Have Medicare Advantage through Kaiser. Northern California. Medicare costs $158 per month for each of us - or something close to that. Med Adv costs $24 per month for each of us. Med Adv covers what Medicare doesn't - or so they say.
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CommodoreBogle
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Re: Medicare Advantage - What's the Deal?

Post by CommodoreBogle »

Lexx wrote: Fri Apr 16, 2021 8:02 pm This whole thing is so confusing...

However with Medicare it seems Kaiser only offers Medicare Advantage. Are folks with Kaiser Medicare Advantage happy with it? ...
Yes, IMHO if you are happy with Kaiser today you will be very happy with their Advantage plans (costs tend to go down a little).
This assumes that you, like us, will likely stay in a Kaiser covered area. Probably not much good if you move to Florida, or Texas, unless you plan on driving to Georgia to see a doc for routine stuff. (NOTE: Emergencies are handled anywhere)
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Re: Medicare Advantage - What's the Deal?

Post by Dottie57 »

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
I thought Medigap was the supplement plan and. Advantage takes over the responsibilities of Medicare with Feds paying the Advantage providers.
SevenBridgesRoad
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Re: Medicare Advantage - What's the Deal?

Post by SevenBridgesRoad »

David Jay wrote: Sat Apr 17, 2021 9:51 am
I have seriously looked at the “A + B only” based on this Doctor’s arguments: https://truecostofhealthcare.org/medica ... insurance/

In the end, I chickened out and now we are focusing these choices:
1. High Deducible “G” + Placeholder “D”
2. Priority Health MA PPO, the network is affiliated with Spectrum Hospitals so it covers about 90% of doctors in West Michigan
Would you walk us through your thinking on why you chickened out? Much appreciated.
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Stinky
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Re: Medicare Advantage - What's the Deal?

Post by Stinky »

Dottie57 wrote: Sat Apr 17, 2021 11:21 am
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
I thought Medigap was the supplement plan and. Advantage takes over the responsibilities of Medicare with Feds paying the Advantage providers.
My Advantage plan, which costs me nothing, provides for “supplemental” coverage that fills in the holes in Medicare, somewhat similar to a medigap plan. It also provides a drug plan plus other benefits.

I pay nothing for Medicare coverage and Advantage except Plan B premium, plus IRMAA surcharge.
Retired life insurance company financial executive who sincerely believes that ”It’s a GREAT day to be alive!”
Shallowpockets
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Re: Medicare Advantage - What's the Deal?

Post by Shallowpockets »

Medicare, not advantage. Can pick your own docs. Go to specialists.
Get out the phone book. Start thumbing through, where to start. Dr X, is he good? Does he take new Medicare patients? Dr G maybe. Someone at the supermarket told me about him. He is so nice. I have a headache, I want to see a specialist about it. Good thing because it might be brain cancer, no time to see primary Dr X I found online.
Labs, OK, got to drive over there. Give repeat info to them. Wait around. Maybe I need an MRI, Dr X referred me to the place he has a monetary interest in. They might do two this time.
Am so glad I have the freedom to pick and choose among this endless list of providers right there. Look, I am scrolling down to see all of them.
Jeez, I can’t even decide which salad dressing to buy there are so many choices.
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FIREchief
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Broken Man 1999 wrote: Sat Apr 17, 2021 8:49 am
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.
What you are doing is stating YOUR experiences. What I am doing is stating MY experiences. If that is considered extrapolating, then I believe we are both doing it. Is your experience superior to mine?
Not really. You made the statement above that "in metro areas there should be no problem having access to good specialists at all" as a generalization. You didn't limit it to your area, but suggested to readers that this is true in general. I believe that it is important to point out the error in this for somebody in the process of making this very important decision. Silver sneakers and pre-paid dental isn't going to mean much when a person is laying in the HMO hospital recovering from surgery by a below average surgeon because that's all their MA plan will cover.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
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David Jay
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Re: Medicare Advantage - What's the Deal?

Post by David Jay »

SevenBridgesRoad wrote: Sat Apr 17, 2021 11:25 am
David Jay wrote: Sat Apr 17, 2021 9:51 am I have seriously looked at the “A + B only” based on this Doctor’s arguments: https://truecostofhealthcare.org/medica ... insurance/

In the end, I chickened out and now we are focusing these choices:
1. High Deducible “G” + Placeholder “D”
2. Priority Health MA PPO, the network is affiliated with Spectrum Hospitals so it covers about 90% of doctors in West Michigan
Would you walk us through your thinking on why you chickened out? Much appreciated.
Tail risk.

I think Dr. Belk is right but we have a moderate portfolio and I fear a large bill. Single digit thousands per year I can handle (i.e. High Deductible G), hundreds of thousands would put us in the poor house. One of the books I read said that if everything went wrong (months-long hospital stays, most expensive drugs possible, etc. for a couple of decades) that one could spend $900,000 over a lifetime on Medicare. I know it's just a theoretical number but it is still concerning.

1. With high-deductible G I know the maximum per year and have nationwide acceptance.

2. With MA PPO I have zero monthly cost, so healthy out-of-pocket is the same as A + B but there will be no Part D penalty if I want to go to an A+B+D in the future due to a need for costly drugs.

I am leaning towards (2) mentally treating it as a "super A+B" plan, I can always return to A + B at open enrollment and I can purchase a more robust Part D penalty-free.
Last edited by David Jay on Sat Apr 17, 2021 1:52 pm, edited 1 time in total.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
SevenBridgesRoad
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Re: Medicare Advantage - What's the Deal?

Post by SevenBridgesRoad »

David Jay wrote: Sat Apr 17, 2021 1:30 pm
SevenBridgesRoad wrote: Sat Apr 17, 2021 11:25 am
David Jay wrote: Sat Apr 17, 2021 9:51 am I have seriously looked at the “A + B only” based on this Doctor’s arguments: https://truecostofhealthcare.org/medica ... insurance/

In the end, I chickened out and now we are focusing these choices:
1. High Deducible “G” + Placeholder “D”
2. Priority Health MA PPO, the network is affiliated with Spectrum Hospitals so it covers about 90% of doctors in West Michigan
Would you walk us through your thinking on why you chickened out? Much appreciated.
Tail risk.

I think Dr. Belk is right but we have a moderate portfolio and I fear a large bill. Single digit thousands per year I can handle (i.e. High Deductible G), hundreds of thousands would put us in the poor house. One of the books I read said that if everything went wrong (months-long hospital stays, most expensive drugs possible, etc. for a couple of decades) that one could spend $900,000 over a lifetime on Medicare. I know it's just a theoretical number but it is still concerning.

1. With high-deductible G I know the maximum per year and have nationwide acceptance.

2. With MA PPO I have zero monthly cost, so healthy out-of-pocket is the same as A + B but there will be no Part D penalty if I want to go to an A+B+D in the future due to a need for costly drugs.

I am leaning towards (2) mentally treating it as a "super A+B" plan, I can always return to A + B at open enrollment and I can purchase penalty-free Part D.
Makes sense. Thanks.
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Re: Medicare Advantage - What's the Deal?

Post by mkc »

David Jay wrote: Sat Apr 17, 2021 1:30 pm
1. With high-deductible G I know the maximum per year and have nationwide acceptance.

2. With MA PPO I have zero monthly cost, so healthy out-of-pocket is the same as A + B but there will be no Part D penalty if I want to go to an A+B+D in the future due to a need for costly drugs.

I am leaning towards (2) mentally treating it as a "super A+B" plan, I can always return to A + B at open enrollment and I can purchase a more robust Part D penalty-free.
I believe (depending on your state), you can apply at open enrollment if you want to switch from MA to medigap, but you'll have to go through underwriting for the medigap policy. That is, of course, if you want medigap coverage and not just A + B.
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Re: Medicare Advantage - What's the Deal?

Post by David Jay »

mkc wrote: Sat Apr 17, 2021 2:02 pm
David Jay wrote: Sat Apr 17, 2021 1:30 pm
1. With high-deductible G I know the maximum per year and have nationwide acceptance.

2. With MA PPO I have zero monthly cost, so healthy out-of-pocket is the same as A + B but there will be no Part D penalty if I want to go to an A+B+D in the future due to a need for costly drugs.

I am leaning towards (2) mentally treating it as a "super A+B" plan, I can always return to A + B at open enrollment and I can purchase a more robust Part D penalty-free.
I believe (depending on your state), you can apply at open enrollment if you want to switch from MA to medigap, but you'll have to go through underwriting for the medigap policy. That is, of course, if you want medigap coverage and not just A + B.
No medigap. A+B+D would be the plan if the drug co-pay became excessive and it was expected to be an ongoing (years or decades long) condition.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

David Jay wrote: Sat Apr 17, 2021 1:30 pm One of the books I read said that if everything went wrong (months-long hospital stays, most expensive drugs possible, etc. for a couple of decades) that one could spend $900,000 over a lifetime on Medicare. I know it's just a theoretical number but it is still concerning.
I would be more concerned with needing ten or more years in a SNF, which would likely exceed that $900K.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
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Re: Medicare Advantage - What's the Deal?

Post by David Jay »

FIREchief wrote: Sat Apr 17, 2021 2:17 pm
David Jay wrote: Sat Apr 17, 2021 1:30 pm One of the books I read said that if everything went wrong (months-long hospital stays, most expensive drugs possible, etc. for a couple of decades) that one could spend $900,000 over a lifetime on Medicare. I know it's just a theoretical number but it is still concerning.
I would be more concerned with needing ten or more years in a SNF, which would likely exceed that $900K.
Acknowledged, but this is a thread on Medicare.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
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Kaiser, before and after

Post by Bogle7 »

Lexx wrote: Fri Apr 16, 2021 8:02 pm Right now I have a Platinum ACA plan with Kaiser, which while very expensive, has worked out very well for me...
However with Medicare it seems Kaiser only offers Medicare Advantage. Are folks with Kaiser Medicare Advantage happy with it?
1. Here is the link to Kaiser Colorado's Medicare Advantage 3 options and their respective monthly cost.
https://medicare.kaiserpermanente.org/w ... er-boulder
The most expensive plan costs you $193/mo.

2. Here is the link to Kaiser Colorado Obamacare plans.
https://individual-family.kaiserpermane ... an/compare
The monthly costs range from $500-$900.

3. I have the cheapest Kaiser Medicare Advantage plan.
My wife has a Kaiser Bronze Obamacare plan.
We are both very happy with Kaiser and we see no difference in service.

P.S. We are members of the cult.
Last edited by Bogle7 on Sat Apr 17, 2021 5:06 pm, edited 1 time in total.
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Re: Medicare Advantage - What's the Deal?

Post by Dottie57 »

Stinky wrote: Sat Apr 17, 2021 11:31 am
Dottie57 wrote: Sat Apr 17, 2021 11:21 am
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
I thought Medigap was the supplement plan and. Advantage takes over the responsibilities of Medicare with Feds paying the Advantage providers.
My Advantage plan, which costs me nothing, provides for “supplemental” coverage that fills in the holes in Medicare, somewhat similar to a medigap plan. It also provides a drug plan plus other benefits.

I pay nothing for Medicare coverage and Advantage except Plan B premium, plus IRMAA surcharge.
QQ - If you travel (domestic and foreign) what is your coverage? If it’s for “emergency” services, do you know what is considered an emergency and what is not?
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Re: Medicare Advantage - What's the Deal?

Post by Broken Man 1999 »

FIREchief wrote: Sat Apr 17, 2021 1:14 pm
Broken Man 1999 wrote: Sat Apr 17, 2021 8:49 am
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.
What you are doing is stating YOUR experiences. What I am doing is stating MY experiences. If that is considered extrapolating, then I believe we are both doing it. Is your experience superior to mine?
Not really. You made the statement above that "in metro areas there should be no problem having access to good specialists at all" as a generalization. You didn't limit it to your area, but suggested to readers that this is true in general. I believe that it is important to point out the error in this for somebody in the process of making this very important decision. Silver sneakers and pre-paid dental isn't going to mean much when a person is laying in the HMO hospital recovering from surgery by a below average surgeon because that's all their MA plan will cover.
Would you feel better if I stated this: In metro areas there should be no problem having access to good specialists at all, unless you have an issue in a metro area that only two doctors can possibly address?

Broken Man 1999
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Broken Man 1999 wrote: Sat Apr 17, 2021 3:42 pm
FIREchief wrote: Sat Apr 17, 2021 1:14 pm
Broken Man 1999 wrote: Sat Apr 17, 2021 8:49 am
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.
What you are doing is stating YOUR experiences. What I am doing is stating MY experiences. If that is considered extrapolating, then I believe we are both doing it. Is your experience superior to mine?
Not really. You made the statement above that "in metro areas there should be no problem having access to good specialists at all" as a generalization. You didn't limit it to your area, but suggested to readers that this is true in general. I believe that it is important to point out the error in this for somebody in the process of making this very important decision. Silver sneakers and pre-paid dental isn't going to mean much when a person is laying in the HMO hospital recovering from surgery by a below average surgeon because that's all their MA plan will cover.
Would you feel better if I stated this: In metro areas there should be no problem having access to good specialists at all, unless you have an issue in a metro area that only two doctors can possibly address?

Broken Man 1999
I'm pretty sure you know what I meant at this point..... Do you really think that folks in metro areas should just assume that they will have access to top specialists if/when they might need them and to sign up for MA for access to a gym that they will never use and pre-paid dental cleanings? I thought we should be providing the whole story to folks. I'm pretty sure that there are doctors in any MA area that can address most/all "issues" at some level of skill and training. If that's all you want, good for you! :beer

ETA: I had shared at a very high level a personal experience. The readers can take that at face value or not. If I were to provide more details (I won't) it would drive my point home with crystal clarity for many on the forum. Of course, others would just laugh it off (as you may be doing here). I don't wish for you or anyone to learn about this the "hard way."
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
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Re: Medicare Advantage - What's the Deal?

Post by JackoC »

DetroitRick wrote: Fri Apr 16, 2021 2:29 pm 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.
The main reason my preliminary research leads to me to believe I'll sign up for regular Medicare+Medigap plan next year is what you but only a few other responses mentioned: in almost all states (CT, MA, ME, NY are exceptions, look up the details if you live there) you may have to go through medical underwriting if you first sign up for MA but later decide to revert to Medigap, whereas there's no health underwriting for either MA or Medigap if you begin with and stay with them. The MA plan will be cheaper to possibly 'free' or even negative cost including the add on benefits, but you might find that the cost control methods they use have a negative impact on your healthcare. Which would seem very difficult to predict. You can easily find horror stories of people for whom MA was a poor choice, although people with bad experience generally make more noise. One other related factor is if a MA plan has a geographically restricted network, the potential problem going through underwriting back into regular Medicare or another co's MA plan in another region could be a practical restriction on your ability to move.

I also agree not to pay much attention to the commercials. Like with most things, a commercial is genuinely useful to inform you of the existence and general nature of a product/service you wouldn't otherwise be aware of, but not to make a purchase decision. I believe the advice of most experts is that if you can easily afford the premiums for regular Medicare and a robust Medigap plan like 'G', just do that. If the savings from MA would be important to your standard of living, then wade into the specifics of MA and see if the tradeoff works for you.
Last edited by JackoC on Sat Apr 17, 2021 4:47 pm, edited 1 time in total.
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Re: Medicare Advantage - What's the Deal?

Post by DetroitRick »

There is a simple solution for people, like me, that even after a lot of thought and research don't have a particularly strong opinion on traditional Medicare vs. Medicare Advantage. Just start with Medicare + a supplement + Prescription D - if you aren't sure. These initial costs, with a bit of shopping, will be relatively insignificant for a few years. Move to an Advantage program later if you want, during annual enrollment. This avoids, in most states, getting hit with medical underwriting if you transition TO a supplement. There is no "hit" from transitioning to an Advantage program.

I know plenty of people in Advantage plans, and plenty holding supplement plans, who happy with their choices. I know some who hate the supplement rate increases over time. And, I know people that have transitioned in both directions. But you can always later transition to Advantage, and many do, on equal footing with the early adopters. At least in the current system.

You can use this time to assess things like your own health prospects, where you will be living, what medical inflation in general looks like, your preferences for broad/narrow drug formularies, network strength, and your tolerance for copays and coinsurance. Maybe even talk to providers, patients, billers, in your area and get specific input for your situation.

My own decision was to kick this can down the road (Medicare + Supplement G at $122/mo + RX at $23/mo, cheaper than what I'm used to anyway) - we will likely move in the next few years, and local health systems and their networks are undergoing rapid consolidations and acquisitions anyway. I'll know more at 68 about my own decision with Advantage than I will at 65.

BTW, I could have almost flipped a coin on Supplement G vs. High Deductible G vs. N - all were excellent coverage and minimal cost for a while. My choice between the 3 would have varied depending on which insurer I went with (as the spreads differed significantly company to company). Plus, my G will get cheaper virtually everywhere we are considering moving anyway.
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

JackoC wrote: Sat Apr 17, 2021 4:43 pm I believe the advice of most experts is that if you can easily afford the premiums for regular Medicare and a robust Medigap plan like 'G', just do that. If the savings from MA would be important to your standard of living, then wade into the specifics of MA and see if the tradeoff works for you.
This summarizes what I have learned very well. :beer
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

DetroitRick wrote: Sat Apr 17, 2021 4:47 pm BTW, I could have almost flipped a coin on Supplement G vs. High Deductible G vs. N
This is exactly where I am at. I'm leaning towards HD G simply because I don't mind the high deductible, especially since prior to meeting the deductible Plan B will still cover 80% of most/all services. If DW or I experience a significant deterioration in health prior to age 65, we might swing towards the regular G.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

David Jay wrote: Sat Apr 17, 2021 2:40 pm
FIREchief wrote: Sat Apr 17, 2021 2:17 pm I would be more concerned with needing ten or more years in a SNF, which would likely exceed that $900K.
Acknowledged, but this is a thread on Medicare.
touché :oops:
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ModifiedDuration
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Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

FIREchief wrote: Sat Apr 17, 2021 5:09 pm
DetroitRick wrote: Sat Apr 17, 2021 4:47 pm BTW, I could have almost flipped a coin on Supplement G vs. High Deductible G vs. N
This is exactly where I am at. I'm leaning towards HD G simply because I don't mind the high deductible, especially since prior to meeting the deductible Plan B will still cover 80% of most/all services. If DW or I experience a significant deterioration in health prior to age 65, we might swing towards the regular G.
And the high deductible plan is more attractive for those who are starting on Medicare with high HSA balances, as Medigap premiums cannot be charged to a HSA account tax-free, but any additional out-of-pocket expenses incurred due to having the HD plan can be charged to the HSA account tax-free.
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

ModifiedDuration wrote: Sat Apr 17, 2021 5:41 pm
FIREchief wrote: Sat Apr 17, 2021 5:09 pm
DetroitRick wrote: Sat Apr 17, 2021 4:47 pm BTW, I could have almost flipped a coin on Supplement G vs. High Deductible G vs. N
This is exactly where I am at. I'm leaning towards HD G simply because I don't mind the high deductible, especially since prior to meeting the deductible Plan B will still cover 80% of most/all services. If DW or I experience a significant deterioration in health prior to age 65, we might swing towards the regular G.
And the high deductible plan is more attractive for those who are starting on Medicare with high HSA balances, as Medigap premiums cannot be charged to a HSA account tax-free, but any additional out-of-pocket expenses incurred due to having the HD plan can be charged to the HSA account tax-free.
That's a great point. We have a moderate balance in our HSA's, but one that will likely be consumed by the first ten years or so of Part B premiums. They're invested 100% in US TMI and we've deferred withdrawing three or four years of qualified expenses. If the market keeps going up like it has, maybe it will turn into 15 years of Part B premiums. 8-)

If God forbid DW or I wind up in a SNF at some point, than incremental balances in our HSAs will be no better than our tIRA balances (assuming continued deductibility of medical expenses over the 7.5% AGI threshold), as withdrawals from either would experience that triple-tax-advantaged allure of HSAs.
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Re: Medicare Advantage - What's the Deal?

Post by Dead Man Walking »

Medicare Advantage - What’s the deal? The deal is that Medicare plans are part of the Affordable Care Act. Buried in the voluminous text of the act are provisions that deal with Medicare plans. Ever wonder why the Affordable Care Act hasn’t been repealed? If it were repealed, the provisions regarding Medicare, including Medicare Advantage plans, would be repealed. Medicare is the third rail when it comes to political action.

DMW
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Re: Medicare Advantage - What's the Deal?

Post by FIREchief »

Dead Man Walking wrote: Sat Apr 17, 2021 7:22 pm Medicare Advantage - What’s the deal? The deal is that Medicare plans are part of the Affordable Care Act. Buried in the voluminous text of the act are provisions that deal with Medicare plans. Ever wonder why the Affordable Care Act hasn’t been repealed? If it were repealed, the provisions regarding Medicare, including Medicare Advantage plans, would be repealed. Medicare is the third rail when it comes to political action.

DMW
Haven't Medicare Advantage plans been around at least a decade longer than the ACA? :confused
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Re: Medicare Advantage - What's the Deal?

Post by Dead Man Walking »

FIREchief wrote: Sat Apr 17, 2021 7:43 pm
Dead Man Walking wrote: Sat Apr 17, 2021 7:22 pm Medicare Advantage - What’s the deal? The deal is that Medicare plans are part of the Affordable Care Act. Buried in the voluminous text of the act are provisions that deal with Medicare plans. Ever wonder why the Affordable Care Act hasn’t been repealed? If it were repealed, the provisions regarding Medicare, including Medicare Advantage plans, would be repealed. Medicare is the third rail when it comes to political action.

DMW
Haven't Medicare Advantage plans been around at least a decade longer than the ACA? :confused
Yes, but a lobbyist told me that the ACA made them more attractive to both insurers and consumers. From what I’ve read in this thread, his assessment of the advantages for consumers may be misplaced. I know that his group represents some large insurers.

DMW
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Re: Medicare Advantage - What's the Deal?

Post by Turbo29 »

Shallowpockets wrote: Sat Apr 17, 2021 12:25 pm Medicare, not advantage. Can pick your own docs. Go to specialists.
Get out the phone book. Start thumbing through, where to start. Dr X, is he good? Does he take new Medicare patients? Dr G maybe. Someone at the supermarket told me about him. He is so nice. I have a headache, I want to see a specialist about it. Good thing because it might be brain cancer, no time to see primary Dr X I found online.
Labs, OK, got to drive over there. Give repeat info to them. Wait around. Maybe I need an MRI, Dr X referred me to the place he has a monetary interest in. They might do two this time.
Am so glad I have the freedom to pick and choose among this endless list of providers right there. Look, I am scrolling down to see all of them.
Jeez, I can’t even decide which salad dressing to buy there are so many choices.
I have a Medicare advantage PPO plan and I can pick any specialist that takes Medicare just as you can.
It is by the goodness of God that in our country we have those three unspeakably precious things: freedom of speech, freedom of conscience, and the prudence never to practice either of them. --M. Twain
ModifiedDuration
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Re: Medicare Advantage - What's the Deal?

Post by ModifiedDuration »

Dead Man Walking wrote: Sat Apr 17, 2021 7:59 pm
FIREchief wrote: Sat Apr 17, 2021 7:43 pm
Dead Man Walking wrote: Sat Apr 17, 2021 7:22 pm Medicare Advantage - What’s the deal? The deal is that Medicare plans are part of the Affordable Care Act. Buried in the voluminous text of the act are provisions that deal with Medicare plans. Ever wonder why the Affordable Care Act hasn’t been repealed? If it were repealed, the provisions regarding Medicare, including Medicare Advantage plans, would be repealed. Medicare is the third rail when it comes to political action.

DMW
Haven't Medicare Advantage plans been around at least a decade longer than the ACA? :confused
Yes, but a lobbyist told me that the ACA made them more attractive to both insurers and consumers. From what I’ve read in this thread, his assessment of the advantages for consumers may be misplaced. I know that his group represents some large insurers.

DMW
That would be incorrect. The Affordable Care Act negatively impacted Medicare Advantage Plans, as it reduced government payments to the insurers:

“The Patient Protection and Affordable Care Act (ACA) relied on reductions in Medicare Advantage (MA) payment rates to finance a significant portion of the subsidies associated with coverage expansion.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419768/
Last edited by ModifiedDuration on Sat Apr 17, 2021 9:41 pm, edited 1 time in total.
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Re: Medicare Advantage - What's the Deal?

Post by Rudy Tooty »

I like my medicare advantage plan. No premiums. Low or zero co-pays for most services. Emergency care paid if I travel out of state or country. Annual eye exams free and frame/lens allowance every 2 years. Big selection of doctors in network. They even throw in $100 worth of OTC products every quarter. Drug formulary covers most prescription meds. Generics $0. If you want brand products it will cost more. The downside is if you need one of the latest and greatest drugs for some serious illness - I think the co-insurance is 30%. I have the VA as a backup - so I get most of my meds through them. If you want to choose your own specialist without going through a primary care doc and without worrying whether he or she is in a network (as long as they accept medicare insurance) - better to go with supplemental. But it might cost an extra couple hundred bucks (or more) premium each month on top of the standard SS deduction, plus you'll need Part D coverage for meds, which is an added premium. If money is no concern go with supplemental. But I strongly suggest those signing up for medicare to speak with a certified insurance agent who specializes in medicare plans before making any decision. Find a good one who knows all the angles.
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Re: Medicare Advantage - What's the Deal?

Post by ram »

My thoughts:

Medicare advantage plans may be less desirable for the typical high net worth individual on this forum as compared to the average American.

Medicare advantage plans would be less desirable for people who live in 2 or more locations during the course of the year.

There are a lot of people in US who are of the opinion that they have paid enough to Medicare during their working lives and can not afford/ do not wish to pay additional substantial amounts for their health care after the age of 65. For them the Medicare advantage plans may be a reasonable option.

For Medicare advantage plans the insurance risk is taken by the insurance company. It makes perfect business sense to have a higher number of premium payers to successfully cover the risk. This is likely at least part of the reason for the advertisements.

For traditional Medicare the insurance risk is taken by the federal government. One may take the position that the government is the "seller" of traditional Medicare. And it has elected not to advertise. (at least advertise widely).
Ram
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Re: Medicare Advantage - What's the Deal?

Post by mmoneytalks »

chris319 wrote: Thu Apr 15, 2021 8:45 pm 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.

The “Medicare & You” handbook is available to anyone even if you aren’t yet enrolled in Medicare. The problem is you first need to know the handbook exists. (I accidentally came across it.)

https://www.medicare.gov/Pubs/pdf/10050 ... nd-You.pdf

https://www.medicare.gov/forms-help-res ... nt-formats
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