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

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ModifiedDuration
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Joined: Sat Dec 05, 2015 3:33 pm

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

Post by ModifiedDuration »

adamthesmythe wrote: Fri Jan 21, 2022 7:58 pm Several posters have said that it is helpful to have a broker for Medigap policies. But I didn't see WHY...can someone say?

Since brokers are paid by the insurance company- is there any incentive to push particular companies?
There are a few reputable brokers that have been mentioned by Bogleheads consistently, such as Medicare Nationwide and Boomer Benefits.

They represent a lot of insurance carriers and people have made numerous favorable comments about dealing with them.

It is hard to get pricing information on Medigap plans (some states do offer this) and it is very difficult to find out what the price increase history is for particular insurance companies for the different Medigap plans, but the brokers can provide this. The insurance brokers know who has a history of smaller price increases over time and who has a history of largest premium increases.

Some of the insurance companies are known for playing games - start an insurance pool, then as participants start to age and premiums are increased, close that pool to new participants, and then start a new pool under another subsidiaries name with lower premiums.

The problem is that the closed pool will continue to age and see large premium increases going forward and the participants who can’t pass medical underwriting are stuck.

A broker can steer you away from such companies.

As there are three different pricing methodologies for Medigap plans (attained age, issued age, and community pricing), it is very helpful to work with someone who understands the ins and outs of these different methodologies.

In addition, if you have any sort of issues with your Medigap provider going forward, your agent can assist you.

Also, when making your initial decision, and then going forward, the broker can answer all your questions.

I have received excellent service from the broker that I have used and would recommend using a broker. Otherwise, you are just re-inventing the wheel,
Retired1809
Posts: 509
Joined: Fri Feb 23, 2007 3:11 pm
Location: North Carolina, USA

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

Post by Retired1809 »

The answer of which plan is better depends at least partially on how good the plans are where you live.

Here, we have excellent MA PPO plans. DW and I met with our trusted insurance adviser and made the decision to choose a MA PPO plan from Aetna. Zero premium. Zero copays for four of the five prescriptions she takes and by using GoodRx, the fifth prescription is only $12 per quarter.

The annual maximum out of pocket amount is reasonable. We figure that the monthly premiums for Medigap policies over the course of a year are practically as much as the maximum out-of-pocket amount of her MA PPO plan.

She can see any provider who accepts Medicare. This year, she discovered that she had breast cancer and had two lumpetomies followed by radiation. Our total out of pocket cost for all this and the rest of the year was around $2,800 which is much less than she would have paid for a year of Medigap coverage. Plus she received a check for $1,200 from her MA PPO plan for reimbursement of amounts paid to her dentist.

Before this year, she has never incurred more than $500 out of pocket in any year.

My former employer now provides a similar MA PPO plan to retirees. Her plan is so attractive that I almost chose hers this for 2022 over the plan provided to me by my former employer. Neither of us has ever had any medical provider reject our respective MA PPO plans. And again, we can go to any doctor or hospital that accepts Medicare.

I cannot advise you what you should do. But here in North Carolina, we are happy with out decision to choose MA PPO plans.

Wishing you good health.
PowderDay9
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by PowderDay9 »

rterickson wrote: Fri Jan 21, 2022 6:42 pm
drjazz wrote: Thu Jan 20, 2022 4:06 pm I’m a physician and have been on Medicare for 5 years. There are many excellent points in the prior posts; I apologize for any redundancies; here is my take:
1. Read latest issue of Medicare for Dummies
2.Use a Medicare broker; in my experience Medicare.gov does not always list all available Medigap/Advantage options. It won’t cost any more than enrolling on medicare.gov and they generally give good advice.
3.Unless you absolutely cannot afford Medigap premiums, and you are in an area with at least one high quality teaching hospital with a large physician network that accepts your plan, Medigap is the much better option (I favor plan G or plan G high deductible).
4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait (remember when banks gave you a toaster for opening a savings account?)
5. With Medigap you will be able to have almost any procedure/treatment recommended by your physician without “prior authorization”. If you require a complex surgery procedure or treatment you and your physician will be able to go to a center of excellence, surgeon with a lot of experience with a complex or rarely performed procedure, etc; with Medicare Advantage almost everything complicated will be subject to their review and even if approved you will have to stay in their network which may not include the surgeon you want. (Example- you need a mitral valve repair, your Medicare Advantage network says “We have a surgeon who does those so that’s where you’re going. How many did he do last year? 5. I want to go to Dr. Slick who did 100 last year and has great outcomes. Sorry, he’s not in our network; as far as we are concerned they are equivalent.” Sometimes they will approve out of network referrals but be prepared for a fight and high copay.
6. Medicare Advantage includes prescriptions, which the marketers tout as an advantage. I don’t see it that way. The insurance company has complete control over the formulary and can refuse to cover medications that might be a bit more expensive, and can drop meds that you may already be on without notice; you will have no recourse. If you have a separate Part D policy you have the option to change plans without penalty during open enrollment period every October-December (I have changed part D plans for this reason 3 times in the past 5 years)
7. In my experience Kaiser does a fantastic job with primary care, probably better that what is generally available in most of the country, however depending on where you live they may not offer complex specialized services of the same quality as you might find at for example Mayo or Hopkins. So it’s a matter of personal preference; how important is it to you to cover your long tail health risk?
One minor quibble on this otherwise excellent post:

Unlike traditional Medicare (and regular health insurance) which handle care on a per-service basis, Medicare Advantage plans are paid a lump sum each year for all of your care. IMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
This is true of all insurance. No insurance carrier can exist for very long if they pay out more claims than they take in for premium.

The financial difference between employer based group insurance and Medicare Advantage is who is funding the insurance. Yes, MA is funded by the federal government but the claims are handled just like any other insurance. Also, health insurance, including MA, is funded on a monthly basis.

The point #4 above by the physician is heavily biased from a provider prospective. All MA carriers have to pay out 85% of the money they receive from the federal government as claims. They can't just make more money by limiting care. Their goal is to provide efficient care so they can lower the cost, keep the member's monthly premium low and gain more membership. Again, it's illegal to keep more than 15% of the premium for admin and profit. Anything more than this will be returned to the member.

On contrast, Medigap plans often only pay out 60-65% of premiums as claims. Many times there is a 20-25% annual commission for the first 5-7 years, sometimes longer.

The reason why insurance companies want MA over Medigap is because there's more premium paid from the federal government for MA and there's ability to make care more efficient.

My general advice is to consider Medigap first if you can afford it. I especially like the high deductible options because I think you'll be in a better risk pool that may help reduce your future unknown rate increases. Just realize that Medigap is expensive and a large portion may be going to commissions.

I also think the higher density cities often have great MA options and those should be considered if you have them. You can save money on monthly premiums and self fund copays and coinsurances. All MA plans have a maximum out of pocket so your financial risk is limited.
ncbill
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by ncbill »

gips wrote: Fri Jan 21, 2022 7:18 pm
cashmoney wrote: Fri Jan 21, 2022 4:54 pm
gips wrote: Fri Jan 21, 2022 3:51 pm
cashmoney wrote: Fri Jan 21, 2022 2:21 pm
valleyrock wrote: Fri Jan 21, 2022 10:33 am A friend of mine has a totally different take. He has neither Medigap nor a Supplemental plan. Here's his reasoning:

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

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


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

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

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

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

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

disclaimer licensed agent

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

>>Hope he knows more about medicine than insurance.
I suspect he knows more about medicine and medigap insurance than the great majority of people in the US.
Again, IMHO the major weakness of his approach is coverage for hospital stays longer than 60 days, which as news stories have reported have been necessary for many of those with COVID-19.

I haven't yet seen him address that on his website.
skp
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by skp »

ncbill wrote: Sat Jan 22, 2022 7:15 am
gips wrote: Fri Jan 21, 2022 7:18 pm
cashmoney wrote: Fri Jan 21, 2022 4:54 pm
gips wrote: Fri Jan 21, 2022 3:51 pm
cashmoney wrote: Fri Jan 21, 2022 2:21 pm

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

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

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

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

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

disclaimer licensed agent

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

>>Hope he knows more about medicine than insurance.
I suspect he knows more about medicine and medigap insurance than the great majority of people in the US.
Again, IMHO the major weakness of his approach is coverage for hospital stays longer than 60 days, which as news stories have reported have been necessary for many of those with COVID-19.

I haven't yet seen him address that on his website.
I read Belk and was considering his advice but changed my mind. I'd prefer a known max out of pocket and am willing to buy insurance for the peace of mind. If f I remember correctly, he did address long stays. His point is most hospitalizations are not long., which as a nurse, anecdotally, I agree was true- Pre-COVID. I agree, with covid, I've seen 6 week stays. This was written precovid. In addition, even precovid, I think he was discounting the many readmissions there are.
I live in a rural area that doesn't have a lot of MA choices, and I've seen MA plans deny rehab placements. So I'll go with a medigap plan probably high deductible G.
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iamblessed
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

Retired1809 wrote: Fri Jan 21, 2022 9:27 pm The answer of which plan is better depends at least partially on how good the plans are where you live.

Here, we have excellent MA PPO plans. DW and I met with our trusted insurance adviser and made the decision to choose a MA PPO plan from Aetna. Zero premium. Zero copays for four of the five prescriptions she takes and by using GoodRx, the fifth prescription is only $12 per quarter.

The annual maximum out of pocket amount is reasonable. We figure that the monthly premiums for Medigap policies over the course of a year are practically as much as the maximum out-of-pocket amount of her MA PPO plan.

She can see any provider who accepts Medicare. This year, she discovered that she had breast cancer and had two lumpetomies followed by radiation. Our total out of pocket cost for all this and the rest of the year was around $2,800 which is much less than she would have paid for a year of Medigap coverage. Plus she received a check for $1,200 from her MA PPO plan for reimbursement of amounts paid to her dentist.

Before this year, she has never incurred more than $500 out of pocket in any year.

My former employer now provides a similar MA PPO plan to retirees. Her plan is so attractive that I almost chose hers this for 2022 over the plan provided to me by my former employer. Neither of us has ever had any medical provider reject our respective MA PPO plans. And again, we can go to any doctor or hospital that accepts Medicare.

I cannot advise you what you should do. But here in North Carolina, we are happy with out decision to choose MA PPO plans.

Wishing you good health.
Is the plan called Aetna Medicare Premier Plus or Aetna Medicare Elite?
JackoC
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JackoC »

PowderDay9 wrote: Sat Jan 22, 2022 1:58 am
rterickson wrote: Fri Jan 21, 2022 6:42 pm
drjazz wrote: Thu Jan 20, 2022 4:06 pm I’m a physician and have been on Medicare for 5 years. There are many excellent points in the prior posts; I apologize for any redundancies; here is my take:
One minor quibble on this otherwise excellent post:

Unlike traditional Medicare (and regular health insurance) which handle care on a per-service basis, Medicare Advantage plans are paid a lump sum each year for all of your care. IMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
This is true of all insurance. No insurance carrier can exist for very long if they pay out more claims than they take in for premium.

The financial difference between employer based group insurance and Medicare Advantage is who is funding the insurance. Yes, MA is funded by the federal government but the claims are handled just like any other insurance. Also, health insurance, including MA, is funded on a monthly basis.

The point #4 above by the physician is heavily biased from a provider prospective. All MA carriers have to pay out 85% of the money they receive from the federal government as claims. They can't just make more money by limiting care. Their goal is to provide efficient care so they can lower the cost, keep the member's monthly premium low and gain more membership. Again, it's illegal to keep more than 15% of the premium for admin and profit. Anything more than this will be returned to the member.

On contrast, Medigap plans often only pay out 60-65% of premiums as claims. Many times there is a 20-25% annual commission for the first 5-7 years, sometimes longer.

The reason why insurance companies want MA over Medigap is because there's more premium paid from the federal government for MA and there's ability to make care more efficient.

My general advice is to consider Medigap first if you can afford it. I especially like the high deductible options because I think you'll be in a better risk pool that may help reduce your future unknown rate increases. Just realize that Medigap is expensive and a large portion may be going to commissions.

I also think the higher density cities often have great MA options and those should be considered if you have them. You can save money on monthly premiums and self fund copays and coinsurances. All MA plans have a maximum out of pocket so your financial risk is limited.
I generally agree with your points, starting at the bottom line that I'll sign up for Plan G (perhaps high deductible) in the next few months when I start Medicare. And it wasn't a particularly hard decision for me.

However I also agree that it doesn't get you very far from the outside looking in (which basically includes doctors) to determine what's the best value for you in the market as it exists (what we focus on here, not our personal opinions how public policy should change it) by trying to figure out what profit the provider makes. In general for consumer goods and services purchases that's the wrong approach. And I also agree what counts with insurance is what % of premiums they pay out. Whether that's X% subtracting lots of overhead and a little profit or same X subtracting streamlined overhead and a lot of profit is irrelevant. And once you have public money directly entering in as with MA, not just premiums and payouts (as with car insurance, say) it's just too opaque to make any meaningful judgement IMO. IOW I believe you just have to do the best you can to evaluate what MA plans actually offer you and try to quantify the downside (which is basically, for me, limited networks) in the context of how much the premium difference makes in your personal financial situation. 'They are trying to give you as little as possible', sure, but like you say there are complicated regulatory restrictions on that. You're not going to figure out what's best based on 'who is most greedy', especially considering it's largely the same companies offering both products.
lws
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by lws »

Please continue to learn about SS, Medicare, and Medicaid.
I chose Medicare Advantage.
I chose the same HMO I've had for over 30 years.
My former employer subsidizes the cost.
Wrench
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Wrench »

arcticpineapplecorp. wrote: Sun Jan 16, 2022 1:02 pm
nisiprius wrote: Sun Jan 16, 2022 12:58 pm Here are my personal reasons why I thought Medicare plus Medigap was a better choice for us.

1) We checked carefully and verified that every doctor we were actually seeing, every specialist we ever could remember seeing, and one or two famous specialists in other cities, all accepted Medicare assignment. Not all of them would have been within the "network" for the Medicare Advantage plans we checked. The limited network was the big issue for me. It's a very complicated situation because of the availability of more expensive plans that let you go out-of-network-with-a-copay etc. It's very hard to cost out the value of "the provider network" because it is hard to put numbers on the probability that you might need a procedure that would actually justify going to an out-of-network high-volume surgeon in a national center of excellence.

2) When we selected what we thought was the right Medigap plan and let the Medicare website tool cost out estimated total annual out-of-pocket expenses, it was clear that the premium savings for Medicare Advantage were not spectacular. It certainly wasn't zero premium. It wasn't like half the cost or anything like that. It was maybe a ten- or fifteen-percent savings, but it wasn't pure savings because of the tradeoff of access to a smaller network.

3) Despite trying hard, I was never able to get a clear or a consistent answer to a simple question. This simple question was whether a Medicare Advantage customer has the right to switch to traditional Medicare plus Medigap if they decide a few years down the road that they just didn't like the plan. The kind of situation I was envisioning was, say, customer service turning sour after you'd been in the plan a few years. The conversation would always begin with the representative rattling a rapidfire list of a bunch of limited special-case situations in which you did. The general answer seemed to be "no," but there were serious inconsistencies between the printed brochure, the insurer's website, and the rep was telling me verbally.
they can switch from advantage to medigap, but would need to go through underwriting and may not qualify or the premium could be higher than if they went on first and dealt with the normal COLAS of the premiums.

your #1 was a very strong determinant for my girlfriend to suggest to her father to do the medigap instead of advantage. She called around and didn't feel real confident in the amount of providers accepting advantage.

medigap just seemed less risky cost and coverage wise.
Pretty much nothing about the Medicare decision is easy. For example, although the statement that one "can switch from advantage to medigap, but would need to go through underwriting" is generally true, there are a number of situations where there are guarantee issue rights so that it is possible to switch without underwriting. Four states, CT, MA, ME and NY specifically have guarantee issue rights protections either annually or continuously:
https://www.kff.org/medicare/issue-brie ... ss-states/
There are other less common situations as well where switching would not require underwriting.
Also, there are Medicare Advantage plans that are PPOs, not HMOs. The ability to go out of network then is simpler and though costs out of network are higher than in network, how much higher depends on the plan details.
Like much in financial planning, the decision is very dependent on personal situations. A younger healthy, wealthy retiree may even choose neither medigap nor medicare advantage, choosing instead to go with only Part A, B and D medicare. At the other end of the spectrum, my recently widowed MIL had little choice but to go with Medicare Advantage because she lost her husband's retiree coverage upon his death, and initial enrollment at her age meant premiums for Medigap plans with acceptable coverage were $750-$900 per month, while a solid Medicare Advantage PPO plan was about one tenth of that.
It is a shame that this decision is so complex. But that's the way it is...

Wrench
chris319
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by chris319 »

4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait
This was my first red flag. After all, who knows more about Medicare than Joe Namath or George Foreman? Thanks for confirming. There is one insurance co. which does advertise its Medigap supplements — no celebrity spokesperson.

I got a copy of Medicare for Dummies and it didn't do much to unconfuse me. I found a much better free guide published by Medicare itself.

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

What I didn't know is that you NEED to sign up for Medicare at age 65 regardless of whether or not you are covered by employer-provided health insurance. I just managed to squeak in. My brother will be 65 in June and I have to prod him to get on Medicare.

Plan G and get yourself a good agent and you're good to go.
Financial decisions based on emotion often turn out to be bad decisions.
Carl53
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Carl53 »

Even the agent advice is just that advice. My former employer offers a third party company to provide advice as well as manage a $1400 heath reimbursement account. They told my spouse that the RA infusions would not be covered under Part G as far as the drug cost. Doctor's office confirms that they always are.
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JoeRetire
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

GaryA505 wrote: Fri Jan 21, 2022 2:06 pm I'm just curious, if I was to try to switch from Medicare Advantage to Medigap, how difficult would that be?
It depends:
- on your state/county
- on the month in which you wanted to make the change
- on other conditions (such as moving, the MA plan no longer servicing your area, etc.)
- on your health conditions in cases of underwriting being required

It ranges from not possible, to trivially easy.
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JoeRetire
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

rterickson wrote: Fri Jan 21, 2022 6:42 pmIMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
Which of course is exactly the same as all the Medigap plans.
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JoeRetire
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

Wrench wrote: Sat Jan 22, 2022 4:00 pm Pretty much nothing about the Medicare decision is easy. For example, although the statement that one "can switch from advantage to medigap, but would need to go through underwriting" is generally true, there are a number of situations where there are guarantee issue rights so that it is possible to switch without underwriting. Four states, CT, MA, ME and NY specifically have guarantee issue rights protections either annually or continuously:
https://www.kff.org/medicare/issue-brie ... ss-states/
There are other less common situations as well where switching would not require underwriting.
Also, there are Medicare Advantage plans that are PPOs, not HMOs. The ability to go out of network then is simpler and though costs out of network are higher than in network, how much higher depends on the plan details.
Like much in financial planning, the decision is very dependent on personal situations. A younger healthy, wealthy retiree may even choose neither medigap nor medicare advantage, choosing instead to go with only Part A, B and D medicare. At the other end of the spectrum, my recently widowed MIL had little choice but to go with Medicare Advantage because she lost her husband's retiree coverage upon his death, and initial enrollment at her age meant premiums for Medigap plans with acceptable coverage were $750-$900 per month, while a solid Medicare Advantage PPO plan was about one tenth of that.
It is a shame that this decision is so complex. But that's the way it is...
Yup. The details matter.

- We live in Maine and thus ​can switch from Medicare Advantage to Medigap, should the desire arise, without medical underwriting
- our MA plan is a PPO
- all our previous doctors and hospitals are in network
- the plan has a national network of doctors
- no referrals needed
- easily affordable annual maximum

The plan is basically the same we had while I was employed. Just cheaper.
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bradinsky
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bradinsky »

Wrench wrote: Sat Jan 22, 2022 4:00 pm
arcticpineapplecorp. wrote: Sun Jan 16, 2022 1:02 pm
nisiprius wrote: Sun Jan 16, 2022 12:58 pm Here are my personal reasons why I thought Medicare plus Medigap was a better choice for us.

1) We checked carefully and verified that every doctor we were actually seeing, every specialist we ever could remember seeing, and one or two famous specialists in other cities, all accepted Medicare assignment. Not all of them would have been within the "network" for the Medicare Advantage plans we checked. The limited network was the big issue for me. It's a very complicated situation because of the availability of more expensive plans that let you go out-of-network-with-a-copay etc. It's very hard to cost out the value of "the provider network" because it is hard to put numbers on the probability that you might need a procedure that would actually justify going to an out-of-network high-volume surgeon in a national center of excellence.

2) When we selected what we thought was the right Medigap plan and let the Medicare website tool cost out estimated total annual out-of-pocket expenses, it was clear that the premium savings for Medicare Advantage were not spectacular. It certainly wasn't zero premium. It wasn't like half the cost or anything like that. It was maybe a ten- or fifteen-percent savings, but it wasn't pure savings because of the tradeoff of access to a smaller network.

3) Despite trying hard, I was never able to get a clear or a consistent answer to a simple question. This simple question was whether a Medicare Advantage customer has the right to switch to traditional Medicare plus Medigap if they decide a few years down the road that they just didn't like the plan. The kind of situation I was envisioning was, say, customer service turning sour after you'd been in the plan a few years. The conversation would always begin with the representative rattling a rapidfire list of a bunch of limited special-case situations in which you did. The general answer seemed to be "no," but there were serious inconsistencies between the printed brochure, the insurer's website, and the rep was telling me verbally.
they can switch from advantage to medigap, but would need to go through underwriting and may not qualify or the premium could be higher than if they went on first and dealt with the normal COLAS of the premiums.

your #1 was a very strong determinant for my girlfriend to suggest to her father to do the medigap instead of advantage. She called around and didn't feel real confident in the amount of providers accepting advantage.

medigap just seemed less risky cost and coverage wise.
Pretty much nothing about the Medicare decision is easy. For example, although the statement that one "can switch from advantage to medigap, but would need to go through underwriting" is generally true, there are a number of situations where there are guarantee issue rights so that it is possible to switch without underwriting. Four states, CT, MA, ME and NY specifically have guarantee issue rights protections either annually or continuously:
https://www.kff.org/medicare/issue-brie ... ss-states/
There are other less common situations as well where switching would not require underwriting.
Also, there are Medicare Advantage plans that are PPOs, not HMOs. The ability to go out of network then is simpler and though costs out of network are higher than in network, how much higher depends on the plan details.
Like much in financial planning, the decision is very dependent on personal situations. A younger healthy, wealthy retiree may even choose neither medigap nor medicare advantage, choosing instead to go with only Part A, B and D medicare. At the other end of the spectrum, my recently widowed MIL had little choice but to go with Medicare Advantage because she lost her husband's retiree coverage upon his death, and initial enrollment at her age meant premiums for Medigap plans with acceptable coverage were $750-$900 per month, while a solid Medicare Advantage PPO plan was about one tenth of that.
It is a shame that this decision is so complex. But that's the way it is...

Wrench
Hi Wrench,
Out of curiosity, how old is your MIL & does she have a lot of medical issues? I’m pushing 70 with more than my share of problems & my medigap G plan premium is $148 per month.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Wrench »

bradinsky wrote: Sun Jan 23, 2022 8:43 am
Wrench wrote: Sat Jan 22, 2022 4:00 pm
arcticpineapplecorp. wrote: Sun Jan 16, 2022 1:02 pm
nisiprius wrote: Sun Jan 16, 2022 12:58 pm Here are my personal reasons why I thought Medicare plus Medigap was a better choice for us.

1) We checked carefully and verified that every doctor we were actually seeing, every specialist we ever could remember seeing, and one or two famous specialists in other cities, all accepted Medicare assignment. Not all of them would have been within the "network" for the Medicare Advantage plans we checked. The limited network was the big issue for me. It's a very complicated situation because of the availability of more expensive plans that let you go out-of-network-with-a-copay etc. It's very hard to cost out the value of "the provider network" because it is hard to put numbers on the probability that you might need a procedure that would actually justify going to an out-of-network high-volume surgeon in a national center of excellence.

2) When we selected what we thought was the right Medigap plan and let the Medicare website tool cost out estimated total annual out-of-pocket expenses, it was clear that the premium savings for Medicare Advantage were not spectacular. It certainly wasn't zero premium. It wasn't like half the cost or anything like that. It was maybe a ten- or fifteen-percent savings, but it wasn't pure savings because of the tradeoff of access to a smaller network.

3) Despite trying hard, I was never able to get a clear or a consistent answer to a simple question. This simple question was whether a Medicare Advantage customer has the right to switch to traditional Medicare plus Medigap if they decide a few years down the road that they just didn't like the plan. The kind of situation I was envisioning was, say, customer service turning sour after you'd been in the plan a few years. The conversation would always begin with the representative rattling a rapidfire list of a bunch of limited special-case situations in which you did. The general answer seemed to be "no," but there were serious inconsistencies between the printed brochure, the insurer's website, and the rep was telling me verbally.
they can switch from advantage to medigap, but would need to go through underwriting and may not qualify or the premium could be higher than if they went on first and dealt with the normal COLAS of the premiums.

your #1 was a very strong determinant for my girlfriend to suggest to her father to do the medigap instead of advantage. She called around and didn't feel real confident in the amount of providers accepting advantage.

medigap just seemed less risky cost and coverage wise.
Pretty much nothing about the Medicare decision is easy. For example, although the statement that one "can switch from advantage to medigap, but would need to go through underwriting" is generally true, there are a number of situations where there are guarantee issue rights so that it is possible to switch without underwriting. Four states, CT, MA, ME and NY specifically have guarantee issue rights protections either annually or continuously:
https://www.kff.org/medicare/issue-brie ... ss-states/
There are other less common situations as well where switching would not require underwriting.
Also, there are Medicare Advantage plans that are PPOs, not HMOs. The ability to go out of network then is simpler and though costs out of network are higher than in network, how much higher depends on the plan details.
Like much in financial planning, the decision is very dependent on personal situations. A younger healthy, wealthy retiree may even choose neither medigap nor medicare advantage, choosing instead to go with only Part A, B and D medicare. At the other end of the spectrum, my recently widowed MIL had little choice but to go with Medicare Advantage because she lost her husband's retiree coverage upon his death, and initial enrollment at her age meant premiums for Medigap plans with acceptable coverage were $750-$900 per month, while a solid Medicare Advantage PPO plan was about one tenth of that.
It is a shame that this decision is so complex. But that's the way it is...

Wrench
Hi Wrench,
Out of curiosity, how old is your MIL & does she have a lot of medical issues? I’m pushing 70 with more than my share of problems & my medigap G plan premium is $148 per month.
MIL is 89. No medical issues to speak of, but that is irrelevant since she could enroll in a special enrollment period because she was prior covered on an "employee" plan. DW and I pay less than you do but are a few years younger. Age seems to matter A LOT for Medigap plans, especially on initial enrollment. Some plans claim age is not a factor because they are "community" priced but every time I've quoted them, age always seems to matter. It matters more on some plans than others, but the older you are, the more you pay. My MIL is an extreme example because of her initial enrollment age.

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

Post by bradinsky »

Wrench wrote: Sun Jan 23, 2022 9:04 am
bradinsky wrote: Sun Jan 23, 2022 8:43 am
Wrench wrote: Sat Jan 22, 2022 4:00 pm
arcticpineapplecorp. wrote: Sun Jan 16, 2022 1:02 pm
nisiprius wrote: Sun Jan 16, 2022 12:58 pm Here are my personal reasons why I thought Medicare plus Medigap was a better choice for us.

1) We checked carefully and verified that every doctor we were actually seeing, every specialist we ever could remember seeing, and one or two famous specialists in other cities, all accepted Medicare assignment. Not all of them would have been within the "network" for the Medicare Advantage plans we checked. The limited network was the big issue for me. It's a very complicated situation because of the availability of more expensive plans that let you go out-of-network-with-a-copay etc. It's very hard to cost out the value of "the provider network" because it is hard to put numbers on the probability that you might need a procedure that would actually justify going to an out-of-network high-volume surgeon in a national center of excellence.

2) When we selected what we thought was the right Medigap plan and let the Medicare website tool cost out estimated total annual out-of-pocket expenses, it was clear that the premium savings for Medicare Advantage were not spectacular. It certainly wasn't zero premium. It wasn't like half the cost or anything like that. It was maybe a ten- or fifteen-percent savings, but it wasn't pure savings because of the tradeoff of access to a smaller network.

3) Despite trying hard, I was never able to get a clear or a consistent answer to a simple question. This simple question was whether a Medicare Advantage customer has the right to switch to traditional Medicare plus Medigap if they decide a few years down the road that they just didn't like the plan. The kind of situation I was envisioning was, say, customer service turning sour after you'd been in the plan a few years. The conversation would always begin with the representative rattling a rapidfire list of a bunch of limited special-case situations in which you did. The general answer seemed to be "no," but there were serious inconsistencies between the printed brochure, the insurer's website, and the rep was telling me verbally.
they can switch from advantage to medigap, but would need to go through underwriting and may not qualify or the premium could be higher than if they went on first and dealt with the normal COLAS of the premiums.

your #1 was a very strong determinant for my girlfriend to suggest to her father to do the medigap instead of advantage. She called around and didn't feel real confident in the amount of providers accepting advantage.

medigap just seemed less risky cost and coverage wise.
Pretty much nothing about the Medicare decision is easy. For example, although the statement that one "can switch from advantage to medigap, but would need to go through underwriting" is generally true, there are a number of situations where there are guarantee issue rights so that it is possible to switch without underwriting. Four states, CT, MA, ME and NY specifically have guarantee issue rights protections either annually or continuously:
https://www.kff.org/medicare/issue-brie ... ss-states/
There are other less common situations as well where switching would not require underwriting.
Also, there are Medicare Advantage plans that are PPOs, not HMOs. The ability to go out of network then is simpler and though costs out of network are higher than in network, how much higher depends on the plan details.
Like much in financial planning, the decision is very dependent on personal situations. A younger healthy, wealthy retiree may even choose neither medigap nor medicare advantage, choosing instead to go with only Part A, B and D medicare. At the other end of the spectrum, my recently widowed MIL had little choice but to go with Medicare Advantage because she lost her husband's retiree coverage upon his death, and initial enrollment at her age meant premiums for Medigap plans with acceptable coverage were $750-$900 per month, while a solid Medicare Advantage PPO plan was about one tenth of that.
It is a shame that this decision is so complex. But that's the way it is...

Wrench
Hi Wrench,
Out of curiosity, how old is your MIL & does she have a lot of medical issues? I’m pushing 70 with more than my share of problems & my medigap G plan premium is $148 per month.
MIL is 89. No medical issues to speak of, but that is irrelevant since she could enroll in a special enrollment period because she was prior covered on an "employee" plan. DW and I pay less than you do but are a few years younger. Age seems to matter A LOT for Medigap plans, especially on initial enrollment. Some plans claim age is not a factor because they are "community" priced but every time I've quoted them, age always seems to matter. It matters more on some plans than others, but the older you are, the more you pay. My MIL is an extreme example because of her initial enrollment age.

Wrench
Thanks! That’s crazy expensive even at that age. My brother in Arizona is 72 & he pays twice what I pay monthly. The reason given is that along with his age, the larger population of Medicare eligible people in that area pushes the rates up. You would think that there would be more consistency across the country.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by iamblessed »

Can you go from Medicare Advantage back to Part A, B and D medicare without underwriting?
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by mkc »

iamblessed wrote: Sun Jan 23, 2022 11:22 am Can you go from Medicare Advantage back to Part A, B and D medicare without underwriting?
See post by JoeRetire above.

Generally no, unless it's within a short timeframe or you live in a guaranteed-issue state.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Tdubs »

JoeRetire wrote: Sun Jan 23, 2022 7:25 am
rterickson wrote: Fri Jan 21, 2022 6:42 pmIMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
Which of course is exactly the same as all the Medigap plans.
Though isn't it true that a Medigap plan can't be a gatekeeper? If it is covered by Medicare, they cover it, right?
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JackoC »

Tdubs wrote: Sun Jan 23, 2022 11:32 am
JoeRetire wrote: Sun Jan 23, 2022 7:25 am
rterickson wrote: Fri Jan 21, 2022 6:42 pmIMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
Which of course is exactly the same as all the Medigap plans.
Though isn't it true that a Medigap plan can't be a gatekeeper? If it is covered by Medicare, they cover it, right?
True and that's IMO the basic advantage of Medigap from where I stand (really does depend where you live besides personal circumstances). But the previous exchange was about 'the plans would not exist if not profitable', and *that* does not distinguish MA and Medigap. Moreover, the accurate (IME of cable programs/channels with an older audience) observation that MA is advertised more doesn't mean anything either in choosing one. Of course you can't take any commercial at face value, but the fact that a provider pays for commercials doesn't track with a poorer value to you if there's a large amount of public money subsidizing the product as is the case with MA not Medigap, but also regulations MA plans face Medigap ones don't (like minimum payout ratio 85% as was detailed in a post above). Even if MA plans are more profitable for insurers, it doesn't mean they're worse for end users. There's no valid simple shortcut like "I won't choose whichever one has the most TV commercials".
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

Carl53 wrote: Sun Jan 23, 2022 7:15 am Even the agent advice is just that advice. My former employer offers a third party company to provide advice as well as manage a $1400 heath reimbursement account. They told my spouse that the RA infusions would not be covered under Part G as far as the drug cost. Doctor's office confirms that they always are.


That is the downside of having to use the agents at the health exchanges such as AON or Willis Towers Watson that corporation hire to manage retiree health benefits.They are usually less experienced.An experienced agent would know that RA infusions are usually covered under part B but can sometimes be covered part D depending on the drug and how it administered.Another downside of using employer health exchanges such as AON is that some Medigap carriers in some zip codes will not pay commission to agents/health exchanges when enrolling a person using a Guarantee Issue code such as "losing employer group health coverage" ( because claims experience is higher with these cases)therefore the exchange will only offer medigap with the carriers that do pay a commission for all Guarantee Issue cases.This means they may not offer you the lowest cost plan.

Always shop price outside of the health exchange to make sure you are always getting the lowest premium.They discourage this but some times you can still get the monthly subsidy even if you bypass their agency to purchase health insurance.Sometimes they stipulate you have to at least buy one policy from the exchange such as the part D or dental plan to remain eligible for the subsidy .

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

Post by cashmoney »

JackoC wrote: Sun Jan 23, 2022 11:59 am
Tdubs wrote: Sun Jan 23, 2022 11:32 am
JoeRetire wrote: Sun Jan 23, 2022 7:25 am
rterickson wrote: Fri Jan 21, 2022 6:42 pmIMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
Which of course is exactly the same as all the Medigap plans.
Though isn't it true that a Medigap plan can't be a gatekeeper? If it is covered by Medicare, they cover it, right?
True and that's IMO the basic advantage of Medigap from where I stand (really does depend where you live besides personal circumstances). But the previous exchange was about 'the plans would not exist if not profitable', and *that* does not distinguish MA and Medigap. Moreover, the accurate (IME of cable programs/channels with an older audience) observation that MA is advertised more doesn't mean anything either in choosing one. Of course you can't take any commercial at face value, but the fact that a provider pays for commercials doesn't track with a poorer value to you if there's a large amount of public money subsidizing the product as is the case with MA not Medigap, but also regulations MA plans face Medigap ones don't (like minimum payout ratio 85% as was detailed in a post above). Even if MA plans are more profitable for insurers, it doesn't mean they're worse for end users. There's no valid simple shortcut like "I won't choose whichever one has the most TV commercials".


Most of the advertising you see for MA ( ie medicare helpline,medicare hotline)is paid for by marketing companies either directly affiliated with an insurance agency or FMO- "field marketing organization " such as Ehealth, medicare.com etc or a marketing company that is generating leads to sell to agents.I don't have any data to back this but I would estimate that about only 30% of the advertising on TV in the annual enrollment period is directly from the carriers.IMO the reason for this is because insurance agent are not allowed to cold call to sell MA or PDP plans like they can for medicare supplement and the enrollment in a MA plan lends it self better for telephonic call center enrollment compared to medicare supplement.Also commissions can be higher for MA vs medigap

Yes MA is more profitable for insurance companies than medigap because they get all the reimbursement from medicare trust fund of about 1000.00 per month on average but more importantly because they can manage the care for better outcome for both the members and their bottomline.In some cases this can be seen as drawback but there is definitely some positive benefits of this too such as targeting management of chronic conditions such as diabetes.The MA plans encourage establishing relationship with a pcp and will reward members when they complete preventives services and call members who do not - things that original medicare does not do.

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

Post by tj »

mkc wrote: Sun Jan 23, 2022 11:24 am
iamblessed wrote: Sun Jan 23, 2022 11:22 am Can you go from Medicare Advantage back to Part A, B and D medicare without underwriting?
See post by JoeRetire above.

Generally no, unless it's within a short timeframe or you live in a guaranteed-issue state.
I don't think that's correct. You have to go through underwriting for Medigap, so if you don't pass Medigap underwriting, you'd be responsible for the Medicare co-insurance that Medigap typically pays for - but you don't have to go through underwriting to revert to Medicare itself.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

Tdubs wrote: Sun Jan 23, 2022 11:32 am
JoeRetire wrote: Sun Jan 23, 2022 7:25 am
rterickson wrote: Fri Jan 21, 2022 6:42 pmIMO, this creates a very strong incentive to make sure that they pay out less than they take in. These private plans wouldn't exist if there weren't a way to make a profit.
Which of course is exactly the same as all the Medigap plans.
Though isn't it true that a Medigap plan can't be a gatekeeper? If it is covered by Medicare, they cover it, right?
They exist to make a profit, which was the complaint about the private (MA) plans.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

cashmoney wrote: Sun Jan 23, 2022 1:02 pm Yes MA is more profitable for insurance companies than medigap because they get all the reimbursement from medicare trust fund of about 1000.00 per month on average but more importantly because they can manage the care for better outcome for both the members and their bottomline.
I also suspect that they have a generally healthier membership base (on average) than the most expensive Medigap plans do. So, even with an 85% payout level, then can still make money.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

JoeRetire wrote: Sun Jan 23, 2022 1:31 pm
cashmoney wrote: Sun Jan 23, 2022 1:02 pm Yes MA is more profitable for insurance companies than medigap because they get all the reimbursement from medicare trust fund of about 1000.00 per month on average but more importantly because they can manage the care for better outcome for both the members and their bottomline.
I also suspect that they have a generally healthier membership base (on average) than the most expensive Medigap plans do. So, even with an 85% payout level, then can still make money.

Yes the healthier and younger gravitate to MA but what is interesting is that MA plans also get additional funding for members who are diagnosed with chronic conditions such as diabetes.This is one of the reasons they are so gun ho about sending nurses to members home for the "house call visits" - they can identify those with chronic conditions sooner.IMO this is win-win situation.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by JoeRetire »

cashmoney wrote: Sun Jan 23, 2022 1:43 pm
JoeRetire wrote: Sun Jan 23, 2022 1:31 pm
cashmoney wrote: Sun Jan 23, 2022 1:02 pm Yes MA is more profitable for insurance companies than medigap because they get all the reimbursement from medicare trust fund of about 1000.00 per month on average but more importantly because they can manage the care for better outcome for both the members and their bottomline.
I also suspect that they have a generally healthier membership base (on average) than the most expensive Medigap plans do. So, even with an 85% payout level, then can still make money.

Yes the healthier and younger gravitate to MA but what is interesting is that MA plans also get additional funding for members who are diagnosed with chronic conditions such as diabetes.This is one of the reasons they are so gun ho about sending nurses to members home for the "house call visits" - they can identify those with chronic conditions sooner.IMO this is win-win situation.
Ah, good point! I forgot about that.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Carl53 »

cashmoney wrote: Sun Jan 23, 2022 12:09 pm
Carl53 wrote: Sun Jan 23, 2022 7:15 am Even the agent advice is just that advice. My former employer offers a third party company to provide advice as well as manage a $1400 heath reimbursement account. They told my spouse that the RA infusions would not be covered under Part G as far as the drug cost. Doctor's office confirms that they always are.


That is the downside of having to use the agents at the health exchanges such as AON or Willis Towers Watson that corporation hire to manage retiree health benefits.They are usually less experienced.An experienced agent would know that RA infusions are usually covered under part B but can sometimes be covered part D depending on the drug and how it administered.Another downside of using employer health exchanges such as AON is that some Medigap carriers in some zip codes will not pay commission to agents/health exchanges when enrolling a person using a Guarantee Issue code such as "losing employer group health coverage" ( because claims experience is higher with these cases)therefore the exchange will only offer medigap with the carriers that do pay a commission for all Guarantee Issue cases.This means they may not offer you the lowest cost plan.

Always shop price outside of the health exchange to make sure you are always getting the lowest premium.They discourage this but some times you can still get the monthly subsidy even if you bypass their agency to purchase health insurance.Sometimes they stipulate you have to at least buy one policy from the exchange such as the part D or dental plan to remain eligible for the subsidy .

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The health exchange agent made a statement similar to this.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bertilak »

I went with Medigap instead of Advantage to maximize my freedom in choosing a provider. This is more expensive than an Advantage plan. Which is "better" for you depends on what you want and what you value. I placed much value on freedom to choose. But it is a matter of degree. You don't have complete freedom of choice even with Medigap.

So, "better" depends on intangibles.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bertilak »

cashmoney wrote: Sun Jan 23, 2022 12:09 pm
Carl53 wrote: Sun Jan 23, 2022 7:15 am Even the agent advice is just that advice. My former employer offers a third party company to provide advice as well as manage a $1400 heath reimbursement account. They told my spouse that the RA infusions would not be covered under Part G as far as the drug cost. Doctor's office confirms that they always are.


That is the downside of having to use the agents at the health exchanges such as AON or Willis Towers Watson that corporation hire to manage retiree health benefits.They are usually less experienced.An experienced agent would know that RA infusions are usually covered under part B but can sometimes be covered part D depending on the drug and how it administered.Another downside of using employer health exchanges such as AON is that some Medigap carriers in some zip codes will not pay commission to agents/health exchanges when enrolling a person using a Guarantee Issue code such as "losing employer group health coverage" ( because claims experience is higher with these cases)therefore the exchange will only offer medigap with the carriers that do pay a commission for all Guarantee Issue cases.This means they may not offer you the lowest cost plan.

Always shop price outside of the health exchange to make sure you are always getting the lowest premium.They discourage this but some times you can still get the monthly subsidy even if you bypass their agency to purchase health insurance.Sometimes they stipulate you have to at least buy one policy from the exchange such as the part D or dental plan to remain eligible for the subsidy .

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Thanks. I have learned something! I get my Medigap from Towers Watson (now called VIA). This is subsidized by the company I retired from. What is the best way to see if I can get a better deal? Should I call my State Health Insurance Assistance Program (SHIP)? They seem to be focused on financial assistance, which I am not looking for.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

bertilak wrote: Sun Jan 23, 2022 2:28 pm
cashmoney wrote: Sun Jan 23, 2022 12:09 pm
Carl53 wrote: Sun Jan 23, 2022 7:15 am Even the agent advice is just that advice. My former employer offers a third party company to provide advice as well as manage a $1400 heath reimbursement account. They told my spouse that the RA infusions would not be covered under Part G as far as the drug cost. Doctor's office confirms that they always are.


That is the downside of having to use the agents at the health exchanges such as AON or Willis Towers Watson that corporation hire to manage retiree health benefits.They are usually less experienced.An experienced agent would know that RA infusions are usually covered under part B but can sometimes be covered part D depending on the drug and how it administered.Another downside of using employer health exchanges such as AON is that some Medigap carriers in some zip codes will not pay commission to agents/health exchanges when enrolling a person using a Guarantee Issue code such as "losing employer group health coverage" ( because claims experience is higher with these cases)therefore the exchange will only offer medigap with the carriers that do pay a commission for all Guarantee Issue cases.This means they may not offer you the lowest cost plan.

Always shop price outside of the health exchange to make sure you are always getting the lowest premium.They discourage this but some times you can still get the monthly subsidy even if you bypass their agency to purchase health insurance.Sometimes they stipulate you have to at least buy one policy from the exchange such as the part D or dental plan to remain eligible for the subsidy .

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Thanks. I have learned something! I get my Medigap from Towers Watson (now called VIA). This is subsidized by the company I retired from. What is the best way to see if I can get a better deal? Should I call my State Health Insurance Assistance Program (SHIP)? They seem to be focused on financial assistance, which I am not looking for.


Yes SHIP can give you a list of all carriers offered in your area and see if any of those are omitted from VIA list- especially the big players like UHC,Humana,MOO etc
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by mkc »

tj wrote: Sun Jan 23, 2022 1:19 pm
mkc wrote: Sun Jan 23, 2022 11:24 am
iamblessed wrote: Sun Jan 23, 2022 11:22 am Can you go from Medicare Advantage back to Part A, B and D medicare without underwriting?
See post by JoeRetire above.

Generally no, unless it's within a short timeframe or you live in a guaranteed-issue state.
I don't think that's correct. You have to go through underwriting for Medigap, so if you don't pass Medigap underwriting, you'd be responsible for the Medicare co-insurance that Medigap typically pays for - but you don't have to go through underwriting to revert to Medicare itself.
:oops: I was thinking iamblessed was asking about switching from MA to MediGap, not just the parts A, B and purchasing a supplemental D pharmacy coverage.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bertilak »

cashmoney wrote: Sun Jan 23, 2022 3:01 pm Yes SHIP can give you a list of all carriers offered in your area and see if any of those are omitted from VIA list- especially the big players like UHC,Humana,MOO etc
Thanks.

I currently use Humana. What I don't know is if I will get a better rate by going to them directly instead of going through VIA (Towers Watson), and if so, would the loss (I presume) of my company subsidy be compensated by that better (if any) rate?
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by oldcomputerguy »

iamblessed wrote: Sun Jan 16, 2022 10:07 am I am new to this I wanted to hear from others.
As in so many other things, there isn't really a "one size fits all" answer. Which one is "better" depends on your personal needs and situation.

A couple of examples:

I started Medicare last year. I looked both at Medicare Advantage and at traditional Medicare with a supplement. My research seemed to indicate that Medicare Advantage suffered from more instances of people having trouble getting claims paid. Also, none of the Medicare Advantage plans offered in my area were accepted at my preferred hospital. Finally, the Medicare Advantage plans in my area required that I go to one of a limited list of providers for my initial healthcare needs, which did not mesh well with the travelling I'm doing these days. So while it was more expensive, I settled on traditional Medicare and a supplement (for the record, I subscribed to the AARP plan G) and a separate Part D medication provider. My total cost each month for all this is $170.10 for the Part B premium, $125.33 for the supplement, and $12.90 for the Part D, for a total of $308.33 per month, but after having paid my Part B deductible, I've not paid another medical bill since I signed up, which coverage makes it a lot easier for me to budget for insurance and medical needs.

On the other end of the spectrum, my mom (who is now 85 years old) and her husband (77) just moved this past enrollment period from a combination Medicare/Medigap plan to a Medicare Advantage plan. They don't have the objections I had to such (their preferred providers are on the list and they don't travel), and the plan is saving them a bit of pocket change each month in premiums versus what they had been paying previously.

I'm afraid there's no quick and easy solution. Both plans have their places and accomplish different goals. You really should do the reading and the research regarding both options, then if you still need to ask a professional about the two choices at least you'll have the background to make sense of their answer.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Tdubs »

oldcomputerguy wrote: Sun Jan 23, 2022 4:48 pm
My research seemed to indicate that Medicare Advantage suffered from more instances of people having trouble getting claims paid.
If you have citations to share, I'd appreciate it.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by oldcomputerguy »

^ Sorry, all that was done last year, and I don't think I kept it. Let me see what I can find.

ETA: I wasn't able to put my finger on my stuff from last year, but I did do a quick Google search and found some things you may want to check into.

Disadvantages of Medicare Advantage Plans
In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’
Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.”6
The Pros and Cons of Medicare Advantage
It’s easy to see the appeal of Advantage. Original Medicare doesn’t cover all your medical expenses, while Advantage plans have cost-sharing requirements but then cap your out-of-pocket costs. Plus, you have low premiums and the simplicity of all-in-one coverage.

But there can be hidden risks to Advantage plans, especially for those with major health issues.

“Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need,” says Tricia Neuman, senior vice president at Kaiser.
You might also check this out: Why Medicare Advantage Plans are Bad: 7 Top Complaints
There is only one success - to be able to spend your life in your own way. (Christopher Morley)
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cashmoney »

bertilak wrote: Sun Jan 23, 2022 4:31 pm
cashmoney wrote: Sun Jan 23, 2022 3:01 pm Yes SHIP can give you a list of all carriers offered in your area and see if any of those are omitted from VIA list- especially the big players like UHC,Humana,MOO etc
Thanks.

I currently use Humana. What I don't know is if I will get a better rate by going to them directly instead of going through VIA (Towers Watson), and if so, would the loss (I presume) of my company subsidy be compensated by that better (if any) rate?

Rates are going to be the same for the same plan with same carrier no matter who you purchase it from- it is more an issue of which plans you will be shown by the health exchange.I didn't mention previously but also verify that the part D plan they are recommending is indeed the most cost effective for your medication list on medicare.gov.The health exchanges will be contracted to sell many part D plans but not all of them so they may be times when the plan they are recommending is not most cost effective over all.

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

Post by bertilak »

cashmoney wrote: Sun Jan 23, 2022 5:12 pm Rates are going to be the same for the same plan with same carrier no matter who you purchase it from- it is more an issue of which plans you will be shown by the health exchange.I didn't mention previously but also verify that the part D plan they are recommending is indeed the most cost effective for your medication list on medicare.gov.The health exchanges will be contracted to sell many part D plans but not all of them so they may be times when the plan they are recommending is not most cost effective over all.

disclaimer licensed agent.
Thanks.

I am actually quite happy with Humana. I have not recently verified the Part D plan, but I did a few years ago (2018). My current theory is they are probably still among the best and it is not worth the hassle to make any changes, even if there is some trivial difference.

I used to have BC/BS for Part B. I signed up for Plan N thinking I might save a little. That did not work out as I got Nickeled and Dimed right out of any savings, plus making all those N+D payments was a pain. BC/BS would not let me switch to Plan G (to avoid N+D charges) without underwriting. I learned that if I switched to Humana (no underwriting required) then Humana would let me switch to Plan G, also without underwriting. Humana earned my business with that!

EDIT: fixed mistaken switch between Plan N and Plan G. The above should be correct now
Last edited by bertilak on Sun Jan 23, 2022 6:59 pm, edited 1 time in total.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by tj »

bertilak wrote: Sun Jan 23, 2022 5:41 pm
cashmoney wrote: Sun Jan 23, 2022 5:12 pm Rates are going to be the same for the same plan with same carrier no matter who you purchase it from- it is more an issue of which plans you will be shown by the health exchange.I didn't mention previously but also verify that the part D plan they are recommending is indeed the most cost effective for your medication list on medicare.gov.The health exchanges will be contracted to sell many part D plans but not all of them so they may be times when the plan they are recommending is not most cost effective over all.

disclaimer licensed agent.
Thanks.

I am actually quite happy with Humana. I have not recently verified the Part D plan, but I did a few years ago (2018). My current theory is they are probably still among the best and it is not worth the hassle to make any changes, even if there is some trivial difference.

I used to have BC/BS for Part B. I signed up for Plan G thinking I might save a little. That did not work out as I got Nickeled and Dimed right out of any savings, plus making all those N+D payments was a pain. BC/BS would not let me switch to Plan N (to avoid N+D charges) without underwriting. I learned that if I switched to Humana (no underwriting required) then Humana would let me switch to Plan N, also without underwriting. Humana earned my business with that!
This doesn't make sense. Plan N would have been the one that nickels and dimes you, whereas Plan G would cover everything except the deductible.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bertilak »

tj wrote: Sun Jan 23, 2022 6:43 pm
bertilak wrote: Sun Jan 23, 2022 5:41 pm
cashmoney wrote: Sun Jan 23, 2022 5:12 pm Rates are going to be the same for the same plan with same carrier no matter who you purchase it from- it is more an issue of which plans you will be shown by the health exchange.I didn't mention previously but also verify that the part D plan they are recommending is indeed the most cost effective for your medication list on medicare.gov.The health exchanges will be contracted to sell many part D plans but not all of them so they may be times when the plan they are recommending is not most cost effective over all.

disclaimer licensed agent.
Thanks.

I am actually quite happy with Humana. I have not recently verified the Part D plan, but I did a few years ago (2018). My current theory is they are probably still among the best and it is not worth the hassle to make any changes, even if there is some trivial difference.

I used to have BC/BS for Part B. I signed up for Plan G thinking I might save a little. That did not work out as I got Nickeled and Dimed right out of any savings, plus making all those N+D payments was a pain. BC/BS would not let me switch to Plan N (to avoid N+D charges) without underwriting. I learned that if I switched to Humana (no underwriting required) then Humana would let me switch to Plan N, also without underwriting. Humana earned my business with that!
This doesn't make sense. Plan N would have been the one that nickels and dimes you, whereas Plan G would cover everything except the deductible.
OOPS! sorry. I got those reversed. Fixed in the referenced post.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Tdubs »

oldcomputerguy wrote: Sun Jan 23, 2022 5:05 pm ^ Sorry, all that was done last year, and I don't think I kept it. Let me see what I can find.

ETA: I wasn't able to put my finger on my stuff from last year, but I did do a quick Google search and found some things you may want to check into.

Disadvantages of Medicare Advantage Plans
In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’
Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.”6
The Pros and Cons of Medicare Advantage
It’s easy to see the appeal of Advantage. Original Medicare doesn’t cover all your medical expenses, while Advantage plans have cost-sharing requirements but then cap your out-of-pocket costs. Plus, you have low premiums and the simplicity of all-in-one coverage.

But there can be hidden risks to Advantage plans, especially for those with major health issues.

“Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need,” says Tricia Neuman, senior vice president at Kaiser.
You might also check this out: Why Medicare Advantage Plans are Bad: 7 Top Complaints
Thanks!
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by toriaacres »

It really depends on your needs and lifestyle. Medigap is a supplement plan that works with Original Medicare and fills in the gaps in your coverage.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Looking4Answers »

I had close relative denied admission to nursing home for rehab. They had Medicare Advantage. Were under the special one year provision and switched to original Medicare in order to have their stay paid for.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Dregob »

iamblessed wrote: Sun Jan 16, 2022 10:29 am
arcticpineapplecorp. wrote: Sun Jan 16, 2022 10:18 am if you can afford the monthly premium of medigap, that should cap your medical expenses (especially if you choose a plan G).

if you can't afford the monthly premium of medigap, you may not have much choice but the cheaper advantage plan. you still might have to deal with any costs incurred that aren't covered. In my state people on advantage are left with some bills (not all is paid, especially if hospitalizations are needed especially more than 1 or 2 a year).

so your state matters and your health matters and your financial picture matters.

i would go with medigap (part g) and my mom does, because I like to contain costs and insurance is to cover what you don't want to or can't afford to pay out of pocket. With advantage (in my state anyway) you're gambling a bit with additional costs not covered fully. it's a pay more now or pay more later.

some in other states (i think NY) love advantage (there was a poster a couple months ago that said he didn't experience what I'm describing), which is why it might vary by state. So understand what you might be on the hook for later if you choose advantage. Many I speak to in my state were surprised at what they had to pay for.

you'll also need part D if want prescription coverage which advantage and medigap don't cover.

Call your SHIP dept in your area and they'll go over the comparisons between the two plans (medigap and advantage) go over costs, etc and then you can make a more informed decision. Do a search here: https://www.google.com/search?q=SHIP+me ... nt=gws-wiz
Good information. What do you and your mother pay each month? If one of you went to the hospital would all the bill be covered? On some of the advantage plans I looked at the max. out of pocket was around $3.5k - 4k each year.
Exactly. My max out of pocket is $3900 on my MA plan. I am not giving advice on what plan is best for you but a part g plan plus drug coverage will be about $325/month so when I was looking it seemed like the calculations were done and "you can pay me now or pay me later."
Bottom line: MA plans have a yearly cap.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by Artsdoctor »

chris319 wrote: Sat Jan 22, 2022 9:57 pm
4. There is a reason that Medicare Advantage plans are heavily marketed via TV, email, direct mail - it is profitable for the insurance companies. The model is that they are being paid by Medicare to limit care and keep costs down; the less care they approve the more they make. All of the “extras” they offer are roach motel bait
This was my first red flag. After all, who knows more about Medicare than Joe Namath or George Foreman? Thanks for confirming. There is one insurance co. which does advertise its Medigap supplements — no celebrity spokesperson.

I got a copy of Medicare for Dummies and it didn't do much to unconfuse me. I found a much better free guide published by Medicare itself.

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

What I didn't know is that you NEED to sign up for Medicare at age 65 regardless of whether or not you are covered by employer-provided health insurance. I just managed to squeak in. My brother will be 65 in June and I have to prod him to get on Medicare.

Plan G and get yourself a good agent and you're good to go.
The booklet you reference appears to be straightforward--but can still be confusing if you don't know the ins and outs of signing up for Medicare. You don't NEED to sign up for Medicare if you're working for an employer who offers "creditable coverage" (meaning, at least equal to Medicare in benefits) and you have more than 20 employees. Most people will apply for Part A because it's free and keep their employer coverage. However, you're not required to do this (say, if you want to contribute to an HSA).
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by bertilak »

Artsdoctor wrote: Sat Jan 14, 2023 2:28 pm You don't NEED to sign up for Medicare if you're working for an employer who offers "creditable coverage" (meaning, at least equal to Medicare in benefits) and you have more than 20 employees. Most people will apply for Part A because it's free and keep their employer coverage. However, you're not required to do this (say, if you want to contribute to an HSA).
When I retired, one confusion I ran into was Part B. I investigated the possibilities and the first thing I figured out was signing up for Part A was a no-brainer, so I did so. After further investigation, I decided to sign up for Part B. When I tried to do so I was told I had already declined Part B! Now I would have to jump through some hoops to sign up for a declined Part B. I told the rep I hadn't declined anything but had simply deferred my decision. Perhaps I had "declined" to sign up at that time. She eventually allowed me to sign up, but I still don't know if it was me or her that was playing the idiot.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by cheese_breath »

Not giving advice, but a cheap advantage plan would have saved me money when I was younger and healthy. But now in my 80s and needing more medical attention, the tables have turned.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by 557880yvi »

Medigap Plan and here is why. Me and SO are incredibly healthy, in top physical condition, doing all the things we retired early to do. Could have selected a Medicare Advantage Plan (which means you leave Medicare for an insurance company) and saved a few dollars. But in most cases, you can't go back to Medicare/Medigap plans without underwriting. Have always lived by the mantra that you get what you pay for. Have also experienced the horrors of delays or disapproved pre-authorizations and suboptimal choices of providers, hospitals and services when you must use only in-network providers. So last year when we had to make a choice, we chose Medicare/Medigap plans for a few hundred dollars more a month.

In December, I had a devastating, freak injury that resulted in dislocating and shattering all the bones in my ankle (for those in the medical profession, a trimalleolar fracture and it was as bad as they get). Because I had chosen Medicare/Medigap, I was able to find the best ankle surgeon at the best hospital-no in or out of network issues, never had to wait a minute for any insurance company to pre-approve any of the multitude of x-rays, MRI's and many other tests needed to determine IF my ankle could be repaired. Had surgery - plates and lots of screws to hold all the bones together. Will need as much as a year of PT, many doctor's visits (have already had 4 cast changes) and many other medical services during what could be as long as a 2-year recovery.

When I log into my Medicare & Medigap accounts - every service from the ambulance, emergency room, tests, imaging, doctors' visits and surgery (which incredibly, was done outpatient!) have been covered, the 20% that Medicare does not pay covered in full by my Medigap plan. So my cost (except for some small copays for prescriptions under part D) has been $0. And when PT starts there are no limits on the number of sessions and all costs will be covered in full. If I had chosen a MA plan, the most important issue is that the best surgeon and the best hospital may not have been in-network. And regardless of choice, my out-of-pocket costs with copays, coinsurances and deductibles would have wiped out years of savings on the MA plan.

So please consider, if you can afford the few extra dollars a month, choosing traditional Medicare/Medigap. It might be the best investment you ever make.
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Re: Which do you think is better and why Medicare Advantage or Medigap?

Post by brian91480 »

iamblessed wrote: Sun Jan 16, 2022 10:07 am I am new to this I wanted to hear from others.
There are Medicare brokers you can work with. Free for you. Experts in Medicare.

They get paid commissions by the coverage provider... regardless of which plan you choose. So your best interest is kept in mind. Coverage is the same cost to you compared to if you bypass the professional expertise.

--- Brian
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