Medicare [selecting Original or Advantage?]
Medicare [selecting Original or Advantage?]
I am sure this question has been asked many times on this forum...I am looking for help in understanding which is best for me (Medicare Original or Advantage), etc. Is there an application that leads you through the decisions? Is it best to work with a Medicare expert?
Thanks.
Thanks.
- oldcomputerguy
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Re: Medicare [selecting Original or Advantage?]
I edited the title of your topic to provide a bit more clarity.
There is only one success - to be able to spend your life in your own way. (Christopher Morley)
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Re: Medicare [selecting Original or Advantage?]
I started off by reading several books on Medicare so I could make an informed decision, such as:
Medicare for Dummies and
Medicare Demystified
Medicare for Dummies and
Medicare Demystified
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Re: Medicare [selecting Original or Advantage?]
+1 on this. This topic is repeated all the time on these forums. No one can decide for you. It is not rocket science. You make your best choice. Did you know you can change Medicare providers every year if you wanted to? Even from Advantage to to Original. Yes, you can. You may have to put up with the underwriting requirements, but it is not prohibited to change.ModifiedDuration wrote: ↑Tue Oct 19, 2021 6:50 am I started off by reading several books on Medicare so I could make an informed decision, such as:
Medicare for Dummies and
Medicare Demystified
This is something you have to research. You are at square one and asking questions that can easily be found by yourself.
Due diligence. Then make a decision. No one way is perfect. Remember that.
Re: Medicare [selecting Original or Advantage?]
The best course of action is to meet with a SHIP counselor in your state and, ideally, in your county of residence. SHIP - State Health Insurance Assistance Programs - is an unbiased, volunteer advisory program to assist Medicare-eligible folks in making sound decisions. Go to https://www.shiphelp.org/ for more info and to locate a SHIP counselor.
Now is the time to take care of this: Medicare Open Enrollment runs from Oct. 15 to Dec. 7. Good luck!
Now is the time to take care of this: Medicare Open Enrollment runs from Oct. 15 to Dec. 7. Good luck!
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Re: Medicare [selecting Original or Advantage?]
If you plan to travel within/outside of the US or split your residence time between multiple states, check your coverage under potential Medicare/Medigap plans vs. Medicare/Advantage plans.
Re: Medicare [selecting Original or Advantage?]
Also check the networks of doctors and medical facilities for any MA plan that you consider.
Some folks (myself included) have broad networks in their MA plans. Others don’t have broad networks available to them, which pushes them toward traditional Medicare (plus supplement and drug plan).
Some folks (myself included) have broad networks in their MA plans. Others don’t have broad networks available to them, which pushes them toward traditional Medicare (plus supplement and drug plan).
Retired life insurance company financial executive who sincerely believes that ”It’s a GREAT day to be alive!”
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Re: Medicare [selecting Original or Advantage?]
I found this article fascinating. While its focus is discussing reversing the biases presented in favor of Med Advantage plans, it also highlights some of their pitfalls, so read it for that.
https://medicareadvocacy.org/medicare-y ... advantage/
IMO - it highlights the problems of comparing plans, both within MedAdvantage policies, but also between MedAdvantage policies and MediGaps. My impression is that MediGaps plans were defined in order to settle this issue within MediGap policies. I think it would be best if similar steps were taken with MedAdvantage.
https://medicareadvocacy.org/medicare-y ... advantage/
IMO - it highlights the problems of comparing plans, both within MedAdvantage policies, but also between MedAdvantage policies and MediGaps. My impression is that MediGaps plans were defined in order to settle this issue within MediGap policies. I think it would be best if similar steps were taken with MedAdvantage.
Re: Medicare [selecting Original or Advantage?]
I made this decision in August and went with a Medigap Plan G. Here’s why…
Pre-existing conditions can’t impact your Medigap premium during any guaranteed acceptance period. However, it can lock you into your initial choice if you develop a serious health issue so it’s really critical to choose wisely when you have guaranteed acceptance. So, I went with Plan G rather than a lesser Medigap plan or an MA plan. I can always “move down” from G or move to MA but may not be able to “move up” later. In addition, MA plans can restrict which doctors/hospitals you can use. On the other hand, Medigap plans will require a separate Part D drug plan. There is no straightforward and simple answer.
Yes, my choice costs more but I’m willing to pay for the flexibility now to choose my provider as well as the future flexibility to be able to switch. However, it’s a very personal choice and the incremental cost can vary a lot depending on how expensive your best Part D drug plan is.
It’s very complex but can impact your healthcare for the rest of your life so I suggest reading Medicare for Dummies carefully and doing your own analysis.
Pre-existing conditions can’t impact your Medigap premium during any guaranteed acceptance period. However, it can lock you into your initial choice if you develop a serious health issue so it’s really critical to choose wisely when you have guaranteed acceptance. So, I went with Plan G rather than a lesser Medigap plan or an MA plan. I can always “move down” from G or move to MA but may not be able to “move up” later. In addition, MA plans can restrict which doctors/hospitals you can use. On the other hand, Medigap plans will require a separate Part D drug plan. There is no straightforward and simple answer.
Yes, my choice costs more but I’m willing to pay for the flexibility now to choose my provider as well as the future flexibility to be able to switch. However, it’s a very personal choice and the incremental cost can vary a lot depending on how expensive your best Part D drug plan is.
It’s very complex but can impact your healthcare for the rest of your life so I suggest reading Medicare for Dummies carefully and doing your own analysis.
"The greatest enemy of a good plan is the dream of a perfect plan" - Carl Von Clausewitz
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Re: Medicare [selecting Original or Advantage?]
All this varies by state, but in NC, at least, you can't necessarily "move down" without medical underwriting. When I tried to switch from United Health Plan F to UH Plan G I "failed" underwriting and would have been charged a higher premium because of it. (I was just able to switch to Humana Plan G without underwriting because they had temporarily waived it.)
Thursday's child has far to go
Re: Medicare [selecting Original or Advantage?]
fwiw: USAA offers a Medigap policy that is significantly cheaper in my SoCal zip code (for F or G) than the competition. (UHC is one of the highest.) To my knowledge, USAA Medigap does not require a military connection. Might be worth a call for rates.
Re: Medicare [selecting Original or Advantage?]
Whenever I've checked a few different zip codes, State Farm is usually the cheapest in SoCal for a Medigap G.
One can check to see the reported rates for a given age at below link.
https://interactive.web.insurance.ca.go ... f?p=111:30
Re: Medicare [selecting Original or Advantage?]
Yes, that's a great website for CA info by zip. (State Farm is $104 higher for my age and zip code.)tj wrote: ↑Tue Oct 19, 2021 9:46 pmWhenever I've checked a few different zip codes, State Farm is usually the cheapest in SoCal for a Medigap G.
One can check to see the reported rates for a given age at below link.
https://interactive.web.insurance.ca.go ... f?p=111:30
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Re: Medicare [selecting Original or Advantage?]
Some folks inthe insurance business call Medicare Advantage "Medicare Disadvantage".
Be careful - there are usually many more medical providers that take Medicare "assignment" as compared to Medicare Advantage. Also, if you have any medical issues that will make you fail medical underwriting, then switching down the road to Advantage will not work - they just won't accept you.
Yes, traditional Medicare is usually more expensive. But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
Be careful - there are usually many more medical providers that take Medicare "assignment" as compared to Medicare Advantage. Also, if you have any medical issues that will make you fail medical underwriting, then switching down the road to Advantage will not work - they just won't accept you.
Yes, traditional Medicare is usually more expensive. But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
Retired and loving it!!!!
- oldcomputerguy
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Re: Medicare [selecting Original or Advantage?]
This is an important point to consider. I began Medicare last year, and in my research I found that my preferred hospital was not "in-network" for any of the Medicare Advantage plans offered in my area. That made it a bit easier to decide which route to take. Given that, and the fact that I do a fair bit of travelling, both domestically and internationally, I went with original Medicare with a Medigap plan. It's more expensive, but so far I've been quite satisfied.goshenBogle wrote: ↑Wed Oct 20, 2021 4:45 amBut in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
There is only one success - to be able to spend your life in your own way. (Christopher Morley)
Re: Medicare [selecting Original or Advantage?]
Not sure if it varies by state or by company but I agree you need to check out the details for your situation. I discussed with UHC, BCBS and Humana. As explained to me, a move up or a lateral requires underwriting. Plan G to Plan G HD was consider lateral. I’m not eligible for Plan F but maybe F to G is considered lateral as well since the only difference is the deductible.thursdaysd wrote: ↑Tue Oct 19, 2021 8:01 pm All this varies by state, but in NC, at least, you can't necessarily "move down" without medical underwriting. When I tried to switch from United Health Plan F to UH Plan G I "failed" underwriting and would have been charged a higher premium because of it. (I was just able to switch to Humana Plan G without underwriting because they had temporarily waived it.)
No matter the details, the key learning is that you may have to live with your initial choice for the rest of your life so choose carefully.
"The greatest enemy of a good plan is the dream of a perfect plan" - Carl Von Clausewitz
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Re: Medicare [selecting Original or Advantage?]
Did you mean switching down the road to Medigap will not work? I thought all MA plans had to accept any new subscribers during open enrollment.goshenBogle wrote: ↑Wed Oct 20, 2021 4:45 am Some folks inthe insurance business call Medicare Advantage "Medicare Disadvantage".
Be careful - there are usually many more medical providers that take Medicare "assignment" as compared to Medicare Advantage. Also, if you have any medical issues that will make you fail medical underwriting, then switching down the road to Advantage will not work - they just won't accept you.
Yes, traditional Medicare is usually more expensive. But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
The article I cited/linked in my previous posts talks about MA networks, and also about MA costs. If you have a chronic illness, or even a prolonged acute illness, you may meet your MA deductible Max Out of Pocket. If you get to your MA deductible Max Out of Pocket expense and add any of its premiums, the cost difference between an MA and a Medigap may not be much.
Last edited by InMyDreams on Wed Oct 20, 2021 10:46 am, edited 2 times in total.
Re: Medicare [selecting Original or Advantage?]
The span of Medicare Advantage networks is very location- and plan-specific.goshenBogle wrote: ↑Wed Oct 20, 2021 4:45 am But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
I've had the opposite experience. My MA plan is run by my local Blue Cross plan, which covers about 99% of the doctors and hospitals, etc. in my state. I haven't yet encountered any provider who is "out of network". I have very broad coverage, and since I rarely travel out of my area, I feel that I'm adequately covered.
It's important for anyone considering MA to check out their "panel" of doctors and hospitals.
Retired life insurance company financial executive who sincerely believes that ”It’s a GREAT day to be alive!”
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Re: Medicare [selecting Original or Advantage?]
My default position would be regular Medicare with a medigap policy ( high deductible) along with part D for prescription. At this point see if an advantage plan is clearly better considering your situation - network, cost, dental, eye etc. As others have suggested a good book on Medicare or some googling can really help. Best of luck.
Facts are stubborn things. Everything works until it doesn’t.
Re: Medicare [selecting Original or Advantage?]
I found a wealth of short videos on boomerbenefits.com to help understanding the nuts and bolts (and nuances) of original Medicare, Medicare Advantage, and Medical Supplement (aka Medigap) plans.
Re: Medicare [selecting Original or Advantage?]
This brings up another reasons I went with a Medigap plan. The MA plans in my current location aren’t too bad but, I’m not sure I’m going to live here another 30+ years. If I were to develop a health condition that precluded me from moving to Medigap later, this could also restrict the locations I might consider. Just another potential flexibility that I value enough to pay a somewhat higher cost now.Stinky wrote: ↑Wed Oct 20, 2021 10:30 amThe span of Medicare Advantage networks is very location- and plan-specific.goshenBogle wrote: ↑Wed Oct 20, 2021 4:45 am But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
I've had the opposite experience. My MA plan is run by my local Blue Cross plan, which covers about 99% of the doctors and hospitals, etc. in my state. I haven't yet encountered any provider who is "out of network". I have very broad coverage, and since I rarely travel out of my area, I feel that I'm adequately covered.
It's important for anyone considering MA to check out their "panel" of doctors and hospitals.
"The greatest enemy of a good plan is the dream of a perfect plan" - Carl Von Clausewitz
Re: Medicare [selecting Original or Advantage?]
If it wasn’t for cost most would chose straight Medicare
Plus supplements
Do not rely on the ability to go through underwriting with similar costs. Most people who want to switch back is bc they have a new medical problem and are not happy with their MA plan.
Plus supplements
Do not rely on the ability to go through underwriting with similar costs. Most people who want to switch back is bc they have a new medical problem and are not happy with their MA plan.
Re: Medicare [selecting Original or Advantage?]
For me, all the Part D plans in our state (MA) exclude my 3 most expensive drugs, coming to a couple $k a month. I don't like getting stuck in an HMO, but as all my current docs are available through it, and the my projected drugs come in at a 1/4th the cost of any Part D offerings, I'm kind of stuck with it.
Regards |
Bob
Re: Medicare [selecting Original or Advantage?]
If this is location specific, seems that if one moves, you can go from great to lousy coverage, and then wish you had gone with Medigap/original. I don’t plan to move but things change, I wouldn’t rule it out completely.Stinky wrote: ↑Wed Oct 20, 2021 10:30 amThe span of Medicare Advantage networks is very location- and plan-specific.goshenBogle wrote: ↑Wed Oct 20, 2021 4:45 am But in my case, living in a very small city, I like that every doc in town takes Medicare but many of them are not in the Advantage networks.
I've had the opposite experience. My MA plan is run by my local Blue Cross plan, which covers about 99% of the doctors and hospitals, etc. in my state. I haven't yet encountered any provider who is "out of network". I have very broad coverage, and since I rarely travel out of my area, I feel that I'm adequately covered.
It's important for anyone considering MA to check out their "panel" of doctors and hospitals.
Re: Medicare [selecting Original or Advantage?]
Lots of good ideas and personal experiences conveyed here, but everyone's situation is different and very much tied to his/her state and county of residence. Simply put, one can't rely on the experiences of others in choosing Medigap + Prescription Drug Plan versus a Medicare Advantage plan. So I reiterate:
Track down and meet with a SHIP counselor in your state and, ideally, in your county of residence. SHIP - State Health Insurance Assistance Programs - is an unbiased, volunteer advisory program to assist Medicare-eligible folks in making sound decisions. Go to https://www.shiphelp.org/ for more info and to locate a SHIP counselor.
Now is the time to take care of this: Medicare Open Enrollment runs from Oct. 15 to Dec. 7.
Track down and meet with a SHIP counselor in your state and, ideally, in your county of residence. SHIP - State Health Insurance Assistance Programs - is an unbiased, volunteer advisory program to assist Medicare-eligible folks in making sound decisions. Go to https://www.shiphelp.org/ for more info and to locate a SHIP counselor.
Now is the time to take care of this: Medicare Open Enrollment runs from Oct. 15 to Dec. 7.
Re: Medicare [selecting Original or Advantage?]
I believe your case is the exception rather than the rule. The original poster isn't as knowledgeable as you and clearly needs advice personalized for his situation and location.
Re: Medicare [selecting Original or Advantage?]
This isn't a hard decision and yet so many get tricked by the Advantage commercials running frequently right now and make the wrong decision. It's already apparent from the posts upstream that you are shooting yourself in the foot by saving a few bucks with an effectively irrevocable decision to go to Medicare disAdvantage and be trapped in HMOs for the rest of your life. Penny saved, pound foolish. Most who wish they can switch back to original Medicare cannot do so to due to medical underwriting. Original Medicare is the only form of universal healthcare in the US, and it's a very generous form vs what you find in other countries.
Medicare Advantage has a place for those who barely have enough income to survive such as those with Social Security and nothing else. Sadly that is the vast majority of retirees. I hope that is nobody here. If you can't afford to eat because you paid extra for Original Medicare plus Medigap, then you probably need to choose Advantage or find a way to make more money.
If you've hit your numbers, why are you even thinking about Advantage? Just spend the extra money and stop being so cheapskate on your healthcare going into the golden years. If you want to be cheap, buy a used junker instead of a new car. Or don't travel to Europe this year. But don't cheap out on healthcare.
Medicare Advantage has a place for those who barely have enough income to survive such as those with Social Security and nothing else. Sadly that is the vast majority of retirees. I hope that is nobody here. If you can't afford to eat because you paid extra for Original Medicare plus Medigap, then you probably need to choose Advantage or find a way to make more money.
If you've hit your numbers, why are you even thinking about Advantage? Just spend the extra money and stop being so cheapskate on your healthcare going into the golden years. If you want to be cheap, buy a used junker instead of a new car. Or don't travel to Europe this year. But don't cheap out on healthcare.
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Re: Medicare [selecting Original or Advantage?]
I'm surprised at the sentiment here against Medicare Advantage plans. The N.C. State Treasurer is defending the state's decision to move all Medicare-eligible state government retirees from the traditional State retiree insurance program that was a promised life-time benefit for the rest of the life for full-time state employees hired prior to around 2014. Are you saying that N.C. state government retirees were ripped off? The state legislature ostensibly did this due to budgetary pressures. See the Lake case.
Edit:
But I will add that state government retirees in N.C. are assigned to a premium-free PPO administered by Humana that is accepted by any provider that accepts original Medicare. The maximum annual out-of-pocket for health expenses is $4,000 combined in-network and out-of-network. Co-pays for primary care physicians are $20; $40 for specialists.
Edit:
But I will add that state government retirees in N.C. are assigned to a premium-free PPO administered by Humana that is accepted by any provider that accepts original Medicare. The maximum annual out-of-pocket for health expenses is $4,000 combined in-network and out-of-network. Co-pays for primary care physicians are $20; $40 for specialists.
Last edited by Retired1809 on Sat Oct 23, 2021 9:51 pm, edited 1 time in total.
- dodecahedron
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Re: Medicare [selecting Original or Advantage?]
I agree that the sweeping condemnation of Medicare Advantage plans is unwarranted.Retired1809 wrote: ↑Sat Oct 23, 2021 9:18 pm I'm surprised at the sentiment here against Medicare Advantage plans. The N.C. State Treasurer is defending the state's decision to move all Medicare-eligible state government retirees from the traditional State retiree insurance program that was a promised life-time benefit for the rest of the life for full-time state employees hired prior to around 2014. Are you saying that N.C. state government retirees were ripped off? The state legislature ostensibly did this due to budgetary pressures. See the Lake case.
I am fortunate to live in a state (NY) that allows switching back and forth between MA and traditional Medicare plus Medigap, without underwriting.
I was on a Medicare Advantage PPO plan for the first 18 months after turning 65. A PPO allows me to use out-of-network providers (for somewhat higher co-pays and coinsurance than in-network providers) as long as they take traditional Medicare whenever I prefer to do so. The PPO is and was very highly rated, five stars awarded by Medicare (based in part on customer satisfaction.) My MA provider also offers a 5-star MA HMO, but I preferred the flexibility of the PPO. With a PPO, I don't have a gatekeeping primary care physician. I can self-refer to specialists (in or out of network) as I see fit. (Of course, I can and do use a primary care physician for routine stuff, but I don't need a referral from her, e.g., to see a specialist if I think that is warranted.)
As the Pandemic began to emerge in the US in March 2020, I was concerned about possible bottlenecks in the approval process for emerging possible treatments for a novel disease, especially if hospitals were overcrowded, so after 18 months on the MA PPO I switched away from the MA PPO to traditional Medicare with a high-deductible Plan F supplement, effective April 1, 2020.
As things seem to have stabilized (and I am now triply vaccinated with a booster and my area has pretty high vaccination rates in general), I recently decided I felt comfortable returning to my MA PPO. Because it is a 5-star plan, there is a special provision that I don't have to wait for the annual enrollment period. I filed the application paperwork on 10/13 and have now been approved to go back on my MA PPO effective Nov 1, 2021.
The switching process, both from the MA PPO to the traditional with Medigap and then back to the MA PPO was quite painless and expeditious, thanks to a great local agent. (His commission comes from the insurance providers, so using him does not cost me any more than dealing with them directly.)
If something materializes in the future that makes me want to change back to Medicare plus Medigap, I feel confident that can be arranged expeditiously (within 30 days or less.)
But all of this would be very different if I lived in a different state with less flexibility, or if I did not have a national top-ranked MA PPO plan available in my region.
Re: Medicare [selecting Original or Advantage?]
My bolding for emphasis. I shudder at how many seniors end up going with the less than the best choice of health care plan due to shrewed insurance agent sellers.jmw wrote: ↑Sat Oct 23, 2021 11:35 am This isn't a hard decision and yet so many get tricked by the Advantage commercials running frequently right now and make the wrong decision. It's already apparent from the posts upstream that you are shooting yourself in the foot by saving a few bucks with an effectively irrevocable decision to go to Medicare disAdvantage and be trapped in HMOs for the rest of your life. Penny saved, pound foolish. Most who wish they can switch back to original Medicare cannot do so to due to medical underwriting. Original Medicare is the only form of universal healthcare in the US, and it's a very generous form vs what you find in other countries.
Medicare Advantage has a place for those who barely have enough income to survive such as those with Social Security and nothing else. Sadly that is the vast majority of retirees. I hope that is nobody here. If you can't afford to eat because you paid extra for Original Medicare plus Medigap, then you probably need to choose Advantage or find a way to make more money.
If you've hit your numbers, why are you even thinking about Advantage? Just spend the extra money and stop being so cheapskate on your healthcare going into the golden years. If you want to be cheap, buy a used junker instead of a new car. Or don't travel to Europe this year. But don't cheap out on healthcare.
I agree with your entire post...except...I was not aware that everyone cannot switch back to Original Medicare during the enrollment period without medical underwriting. Medigap Supplement...yes, that would require underwriting, but not Medicare A&B. If what you say is true, then I'm glad I found out.
- oldcomputerguy
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Re: Medicare [selecting Original or Advantage?]
I found this article on the Fidelity web site to be helpful when I was making my MA vs Medigap decision:
Are Medicare Advantage plans really an advantage?
Are Medicare Advantage plans really an advantage?
There is only one success - to be able to spend your life in your own way. (Christopher Morley)
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Re: Medicare [selecting Original or Advantage?]
M.Lee wrote: ↑Sun Oct 24, 2021 6:15 am
I agree with your entire post...except...I was not aware that everyone cannot switch back to Original Medicare during the enrollment period without medical underwriting. Medigap Supplement...yes, that would require underwriting, but not Medicare A&B. If what you say is true, then I'm glad I found out.
You do not need medical underwriting to switch to Traditional Medicare Parts A and B from Medicare Advantage during the Fall Medicare Annual Election (“Medicare Open Enrollment”) and Medicare Advantage Open Enrollment Periods, as well as if you have Trial Rights or fall under a special circumstance, such as moving.
Re: Medicare [selecting Original or Advantage?]
Thanks for this link. Not on Medicare yet, but I am concerned about the gatekeeper function of MA plans. From your link, I found this HHS report distressingly revealing about MA plans and denial of care decisions.InMyDreams wrote: ↑Tue Oct 19, 2021 12:23 pm I found this article fascinating. While its focus is discussing reversing the biases presented in favor of Med Advantage plans, it also highlights some of their pitfalls, so read it for that.
https://medicareadvocacy.org/medicare-y ... advantage/
IMO - it highlights the problems of comparing plans, both within MedAdvantage policies, but also between MedAdvantage policies and MediGaps. My impression is that MediGaps plans were defined in order to settle this issue within MediGap policies. I think it would be best if similar steps were taken with MedAdvantage.
https://oig.hhs.gov/oei/reports/oei-09-16-00410.asp
Re: Medicare [selecting Original or Advantage?]
Does anyone know if MA plan providers, governments, or a watchdog make available rates for denial of care decisions among various plans?
(Edited Post) HHS has a Star rating system for Part C and D plans.
https://www.cms.gov/Medicare/Prescripti ... rmanceData
(Edited Post) HHS has a Star rating system for Part C and D plans.
https://www.cms.gov/Medicare/Prescripti ... rmanceData
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Re: Medicare [selecting Original or Advantage?]
In each of the last two years with my former employer's Medicare Advantage group plan, I've paid zero in premiums, taken no prescription medication, only seen my doctor for the free annual wellness exam and only saw specialists doing the six month period last year when all copays for seeing specialists were waived. I walk two hours most days and watch what I eat and drink. Again, with my group PPO, I can see any provider that accepts original Medicare, anywhere in the US. I'm very happy with my MA plan. Again, I am puzzled by the tone of this thread which appears to have an anti-MA bias.
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Re: Medicare [selecting Original or Advantage?]
Here's how US News & World Report reported this NC health benefits change:Retired1809 wrote: ↑Sat Oct 23, 2021 9:18 pm I'm surprised at the sentiment here against Medicare Advantage plans. The N.C. State Treasurer is defending the state's decision to move all Medicare-eligible state government retirees from the traditional State retiree insurance program that was a promised life-time benefit for the rest of the life for full-time state employees hired prior to around 2014. Are you saying that N.C. state government retirees were ripped off? The state legislature ostensibly did this due to budgetary pressures. See the Lake case.
https://www.usnews.com/news/best-states ... h-coverageState Treasurer Dale Folwell, whose office oversees the North Carolina State Health Plan, has warned lawmakers for years about the fiscal threat of long-term retiree health expenses. But he neither sought the 2017 provision nor was consulted on it.
I would say, yes, the NC state government retirees were ripped off.
Full disclosure: I was briefly a NC state government employee many decades ago.
Re: Medicare [selecting Original or Advantage?]
You sound like the ideal candidate for an MA plan (i.e. you make almost no use of the plan and think that you won't for some time to come). Obviously it is great that you have a wide PPO network in your plan, but that's not the case in a lot of other plans. As a link posted by In My Dreams noted, it is MA plans that enjoy a bias from government publications and advertising. And hidden costs are a problem. As someone who makes little use of medical care, you may not see that aspect of your plan.Retired1809 wrote: ↑Sun Oct 24, 2021 8:12 am In each of the last two years with my former employer's Medicare Advantage group plan, I've paid zero in premiums, taken no prescription medication, only seen my doctor for the free annual wellness exam and only saw specialists doing the six month period last year when all copays for seeing specialists were waived. I walk two hours most days and watch what I eat and drink. Again, with my group PPO, I can see any provider that accepts original Medicare, anywhere in the US. I'm very happy with my MA plan. Again, I am puzzled by the tone of this thread which appears to have an anti-MA bias.
So, if this thread highlights the negatives of MA for the OP, then it provides a valuable corrective. As I approach Medicare age, I'm looking over my options and see MA plans that are very inexpensive and tempting. My family makes regular use of medical care. So, issues like preauthorizations and their denial of care policies matter a lot. There are some good MA plans out there, but others, I think, are just good at hiding their negatives until you get stuck with the bill.InMyDreams wrote: ↑Tue Oct 19, 2021 12:23 pm I found this article fascinating. While its focus is discussing reversing the biases presented in favor of Med Advantage plans, it also highlights some of their pitfalls, so read it for that.
https://medicareadvocacy.org/medicare-y ... advantage/
Re: Medicare [selecting Original or Advantage?]
The Medicare advantage plans that are available in your area are critical. Even if you have one that looks good now you have to be concerned about what they will be like 20 years from now. Kaiser is available in my area and I am pretty sure it will not change much but some of the other MA plans in my area did not look real stable.
I ended up going with a Kaiser MA plan but I don't think I would have selected any other MA company just because of concerns that they might not be stable.
In researching them one perceived issue is that some of the top doctors in a field may not be available with Kaiser. The flip side to this is that I have heard that Kaiser is very good at not having bad or low ranked doctors since they have a lot of incentive to not have them on staff. I am more concerned about avoiding a low quality doctor than I am with finding a top doctor so that seems like a reasonable tradeoff to me.
I have also heard anecdotal stories about people on traditional Medicare having long waits to get an appointment with a specialists so the idea that you can call up the top doctor's office in your city and get a timely appointment may be wishful thinking.
From what I have read when there is an opening for a doctor at Kaiser they generally have lots of doctors apply so they can be selective about who they hire so finding good doctors in most specialties is not a problem for them.
I ended up going with a Kaiser MA plan but I don't think I would have selected any other MA company just because of concerns that they might not be stable.
In researching them one perceived issue is that some of the top doctors in a field may not be available with Kaiser. The flip side to this is that I have heard that Kaiser is very good at not having bad or low ranked doctors since they have a lot of incentive to not have them on staff. I am more concerned about avoiding a low quality doctor than I am with finding a top doctor so that seems like a reasonable tradeoff to me.
I have also heard anecdotal stories about people on traditional Medicare having long waits to get an appointment with a specialists so the idea that you can call up the top doctor's office in your city and get a timely appointment may be wishful thinking.
From what I have read when there is an opening for a doctor at Kaiser they generally have lots of doctors apply so they can be selective about who they hire so finding good doctors in most specialties is not a problem for them.
Re: Medicare [selecting Original or Advantage?]
I have a question about Medigap Supplement underwriting. Perhaps I should start a new thread??
My question is does anyone know if these insurance companies are able to look at your health record? I mean, can they see what Medicare services billed?
If they can't, then how do they judge whether they should approve someone or not?
Last year, I tried to change Medigap policies and was denied. The letter said something about 'based on my past" or something. I wrote back asking for specifics and didn't get an answer.
My question is does anyone know if these insurance companies are able to look at your health record? I mean, can they see what Medicare services billed?
If they can't, then how do they judge whether they should approve someone or not?
Last year, I tried to change Medigap policies and was denied. The letter said something about 'based on my past" or something. I wrote back asking for specifics and didn't get an answer.
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Re: Medicare [selecting Original or Advantage?]
Yes, as part of the application you are giving them the right to get your medical records from the MIB (Medical Information Bureau). I did apply for a Supplement about 1 year ago & it did require underwriting. As part of the telephone interview, they asked me about pain a medication I was prescribed in 2014 after a medical procedure & it had no effect on the supplement approval.M.Lee wrote: ↑Sun Oct 24, 2021 10:52 am I have a question about Medigap Supplement underwriting. Perhaps I should start a new thread??
My question is does anyone know if these insurance companies are able to look at your health record? I mean, can they see what Medicare services billed?
If they can't, then how do they judge whether they should approve someone or not?
Last year, I tried to change Medigap policies and was denied. The letter said something about 'based on my past" or something. I wrote back asking for specifics and didn't get an answer.
You can get a free copy of your MIB record once a year at https://www.mib.com/request_your_record.html
"Borrow money from pessimists -- they don't expect it back"
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Re: Medicare [selecting Original or Advantage?]
What if you change state residency?
In MA (my state), I was told when I signed up for Advantage that I can switch seamlessly during open enrollment at any time without underwriting (this is very state-specific....I don't think most states allow that. MA Medicare is much different than other states).
I was thinking of possibly switching state residency to FL sometime in the future.
Three questions:
1..If I do, would I have to go through underwriting to get a FL Medigap plan?
2..Would it make sense to first switch to the MA equivalent before moving to FL (the choices are different in MA than in most other states)?
3. And if I am a "snowbird" (living half/half between MA and FL), but I qualify as a FL resident, could I keep my MA plan while declaring residency in FL? (eg: the best of both worlds....I anticipate the answer will be no but wishful thinking....)
Thanks.
In MA (my state), I was told when I signed up for Advantage that I can switch seamlessly during open enrollment at any time without underwriting (this is very state-specific....I don't think most states allow that. MA Medicare is much different than other states).
I was thinking of possibly switching state residency to FL sometime in the future.
Three questions:
1..If I do, would I have to go through underwriting to get a FL Medigap plan?
2..Would it make sense to first switch to the MA equivalent before moving to FL (the choices are different in MA than in most other states)?
3. And if I am a "snowbird" (living half/half between MA and FL), but I qualify as a FL resident, could I keep my MA plan while declaring residency in FL? (eg: the best of both worlds....I anticipate the answer will be no but wishful thinking....)
Thanks.