Original Medicare vs. Medicare Advantage
Re: Original Medicare vs. Medicare Advantage
Well said--The advantage of original medicare plus supplement plan F/G is not that it is the cheapest plan, it is the no-worries plan.
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Re: Original Medicare vs. Medicare Advantage
That is a false assumption. Not all are run by for-profit insurance companies. There are non-profit insurance foundations that were started by major health care/hospital systems and exist for the purpose of facilitating the finances of care delivery, not to try to make a profit. In fact, of the three choices I am considering, original Medicare plus Medigap is the only one that would involve a for-profit insurance company (for the Medigap policy and drug plan).Chuckles960 wrote: ↑Sun Oct 02, 2022 3:18 pm It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit.
Those are probably not the good MA plans in your area.Chuckles960 wrote: Plus, as already noted, you will be paying for those obnoxious commercials.
If the decision were only about cost, my decision would be easy-- original Medicare. But I've seen first hand with a relative some of the issues with care delivery under original Medicare.
Re: Original Medicare vs. Medicare Advantage
If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
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Re: Original Medicare vs. Medicare Advantage
Only a Medigap Plan F would cover all deductibles and co-pays and that plan is no longer available to newly-eligible Medicare participants.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
The closest policy would be Plan G, where you would be responsible for the $233 Part B deductible.
The two other Medigap plans that are the most popular with newly-eligible Medicare participants are Plan N and Plan G-HD, both of which have lower premiums as well as lower benefits.
Re: Original Medicare vs. Medicare Advantage
You are correct.ModifiedDuration wrote: ↑Sun Oct 02, 2022 4:55 pmOnly a Medigap Plan F would cover all deductibles and co-pays and that plan is no longer available to newly-eligible Medicare participants.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
The closest policy would be Plan G, where you would be responsible for the $233 Part B deductible.
The two other Medigap plans that are the most popular with newly-eligible Medicare participants are Plan N and Plan G-HD, both of which have lower premiums as well as lower benefits.
Re: Original Medicare vs. Medicare Advantage
I'm sure that may be the case with your MA plan but I'm not finding that to be the case with mine. I belong to a very large group that has healthcare included in the retirement package. For years we received free Medicare with a choice of free secondary insurance plus drug coverage. Even paid IRMAA if required. Horizon was our secondary choice. No complaints. A few years back a MA plan was added as an additional choice. I have found this to be the clear winner. Both my wife and I have been to many different doctors with many different issues and never once had to think about if we were covered or not. Also this is a very large group of retirees with various medical issues and if there were issues we would hear about it.orlandoman wrote: ↑Sun Oct 02, 2022 2:17 pmThe , "Accepted everywhere Medicare is ..." is misleading. What that means is that the MA plan will pay as in-network if the physician will accept it. Physicians can take Medicare patients but only take a few or no MA plans. A dermatologist group I visit, takes Medicare but only a few MA plans in fact they stopped taking new patients for the PPO MA plan I belonged to at the time.mpnret wrote: ↑Sun Oct 02, 2022 1:29 pmMine is also a PPO. Accepted everywhere Medicare is and it's the best plan I have ever been on. Also free being it's part of a retirement package.
Based on some of the posts here I'm assuming all MA plans are not equal. Sounds like it may be tied to where you live.
Re: Original Medicare vs. Medicare Advantage
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.Chuckles960 wrote: ↑Sun Oct 02, 2022 3:18 pmEverything depends on the particular MA plan, and what services you personally will need in future---which of course you do not know.
Correct. Exactly the same as with Medigap plans. Exactly the same as with employer-sponsored plans.It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit.
If you are willing to pay enough, you will have fewer worries.The advantage of original medicare+F/G is not that it is the cheapest plan,it is that it is the no-worries plan.
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Re: Original Medicare vs. Medicare Advantage
For me currently, the advantages of Medicare traditional make it worth the extra cost.
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Re: Original Medicare vs. Medicare Advantage
100% agree.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
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Re: Original Medicare vs. Medicare Advantage
Regarding HMO vs PPO, the MA PPO plans I have seen offered here have high co-pays and or coinsurance for out of network. So they are basically HMOs, plus the option of going out of network that you will do your best not to ever use.
Even in network there are co-pays. But certainly these MA plans are the cheapest option if you will never need anything. Plus some of them include dental insurance (they never mention that the yearly limit is only maybe $500) and other minor freebies.
Even in network there are co-pays. But certainly these MA plans are the cheapest option if you will never need anything. Plus some of them include dental insurance (they never mention that the yearly limit is only maybe $500) and other minor freebies.
Re: Original Medicare vs. Medicare Advantage
They are not like HMOs. HMO's require referrals to see specialists. With a PPO, a preferred provider option, you cna see whoever you want. PPO does not mean everybody is in network.Chuckles960 wrote: ↑Sun Oct 02, 2022 7:46 pm Regarding HMO vs PPO, the MA PPO plans I have seen offered here have high co-pays and or coinsurance for out of network. So they are basically HMOs, plus the option of going out of network that you will do your best not to ever use.
Even in network there are co-pays. But certainly these MA plans are the cheapest option if you will never need anything. Plus some of them include dental insurance (they never mention that the yearly limit is only maybe $500) and other minor freebies.
Re: Original Medicare vs. Medicare Advantage
In my current year for my MA, which is an HMO, a referral or pre authorization is not required to see a specialist, even I am surprised at that. Last year it was required I believe. According to the 2023 notice of changes I just received it say MAY BE required.tj wrote: ↑Sun Oct 02, 2022 8:07 pmThey are not like HMOs. HMO's require referrals to see specialists. With a PPO, a preferred provider option, you cna see whoever you want. PPO does not mean everybody is in network.Chuckles960 wrote: ↑Sun Oct 02, 2022 7:46 pm Regarding HMO vs PPO, the MA PPO plans I have seen offered here have high co-pays and or coinsurance for out of network. So they are basically HMOs, plus the option of going out of network that you will do your best not to ever use.
Even in network there are co-pays. But certainly these MA plans are the cheapest option if you will never need anything. Plus some of them include dental insurance (they never mention that the yearly limit is only maybe $500) and other minor freebies.
I know they relaxed some of the rules during Covid so maybe they are just reverting back to how it was beforehand.
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Re: Original Medicare vs. Medicare Advantage
I understand that they get a monthly payment from Medicare for each person in their plan, whether they received services in that month or not. So, the MA plans have a fixed budget to work with and known statistics of how many people receive each service each year.prd1982 wrote: ↑Sat Oct 01, 2022 10:45 am I haven’t switched to Medicare Advantage because I cannot understand the financial side of it. Based on the advertising, insurance companies want you to pick MA vs. a supplement. The MA plans swear they are paid the same amount by the federal government as traditional Medicare. Yet MA plans promise more benefits at a significantly lower cost. I cannot find any explanation as to how they do it. Do they deny service? Do they make it difficult to get service? Do they reimburse medical facilities at a lower rate?
But you must get the service within your group or get a referral to go outside of it. In our case, our primary medical group sees both MA and Medicare/Medigap patients. Some specialists who are outside the medical group will see both groups of patients. But when a specialist refers you to a more specialized specialist at a “teaching hospital” near us, the hospital will only see the Medicare/Medigap patients since their insurance pays promptly. These patents can also self-refer if they are savvy enough to find the best doctors for their needs.
According to the Medicare site, 36 million people (56%) of people on Medicare are on Original Medicare and 28 million people (43%) are on Medicare Advantage. Of the 28 million, 11 million of those are on Medicaid (17% of the total Medicare population), as they don’t have much choice. Many of the others on MA probably are lower income too or unable to afford the costs associated with Original Medicare.
https://www.cms.gov/newsroom/news-alert ... ogram-chip
So, those that can afford either plan tend to choose Original Medicare.
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Re: Original Medicare vs. Medicare Advantage
MGBMartin wrote: ↑Sun Oct 02, 2022 8:22 pmIn my current year for my MA, which is an HMO, a referral or pre authorization is not required to see a specialist, even I am surprised at that. Last year it was required I believe. According to the 2023 notice of changes I just received it say MAY BE required.tj wrote: ↑Sun Oct 02, 2022 8:07 pmThey are not like HMOs. HMO's require referrals to see specialists. With a PPO, a preferred provider option, you cna see whoever you want. PPO does not mean everybody is in network.Chuckles960 wrote: ↑Sun Oct 02, 2022 7:46 pm Regarding HMO vs PPO, the MA PPO plans I have seen offered here have high co-pays and or coinsurance for out of network. So they are basically HMOs, plus the option of going out of network that you will do your best not to ever use.
Even in network there are co-pays. But certainly these MA plans are the cheapest option if you will never need anything. Plus some of them include dental insurance (they never mention that the yearly limit is only maybe $500) and other minor freebies.
I know they relaxed some of the rules during Covid so maybe they are just reverting back to how it was beforehand.
Many more of the UHC HMO plans for 2023 are " open access" meaning you do not need a referral to see specialist.
MA plans can be the less expensive if you live in a state with high medicare supplement rates and good MA options such as Fl.In 2023 in Fl many MA plans have out of pocket maximum less than 3000.00 .This can be less then the minimum out of pocket in premiums you pay for a medicare supplement and part D and part B 233.00 deductible and most likely will be much less since it is unusual to ever reach the MOOP on MA plan
The dental benefits by law have to be "mentioned " in writing in the Summary of Benefits of plan and many of the big carrier' plans UHC,Aetna, Humana etc will have 1500-2500 of dental benefits with minimal restrictions for 2023.Also unless you DIY enroll online the agent that enrolls you in a plan is required to review the Summary of Benefits with you including the dollar amount of dental benefit included.
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Re: Original Medicare vs. Medicare Advantage
All of them mention the yearly limit of all benefits.Chuckles960 wrote: ↑Sun Oct 02, 2022 7:46 pmPlus some of them include dental insurance (they never mention that the yearly limit is only maybe $500)
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Re: Original Medicare vs. Medicare Advantage
I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
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Re: Original Medicare vs. Medicare Advantage
Again, this depends on your state! In NY, age-dependent Medigap premiums are illegal. A 65-year-old New Yorker with a Plan G pays the same monthly premium as 105-year-old New Yorker with a Plan G! And switching among different Medigap carriers and plans at any age is permitted without underwriting in NY.michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Last edited by dodecahedron on Mon Oct 03, 2022 10:03 am, edited 1 time in total.
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Re: Original Medicare vs. Medicare Advantage
So, is the state government subsidizing older people or are the younger people subsidizing the older people?dodecahedron wrote: ↑Mon Oct 03, 2022 10:00 amAgain, this depends on your state! In NY, age-dependent Medigap premiums are illegal. A 65-year-old New Yorker with a Plan G pays the same monthly premium as 105-year-old New Yorker with a Plan G!michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
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Re: Original Medicare vs. Medicare Advantage
Younger, healthier folks on Medigap who don’t use much medical care cross-subsidize folks who use a lot in NY. That is one reason it can make sense for New Yorkers who expect to use little health care to start out on an MA plan and only switch to Medigap if and when a potentially expensive diagnosis occurs or seems likely.michaeljc70 wrote: ↑Mon Oct 03, 2022 10:03 amSo, is the state government subsidizing older people or are the younger people subsidizing the older people?dodecahedron wrote: ↑Mon Oct 03, 2022 10:00 amAgain, this depends on your state! In NY, age-dependent Medigap premiums are illegal. A 65-year-old New Yorker with a Plan G pays the same monthly premium as 105-year-old New Yorker with a Plan G!michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
And note that good MA plans often cover and promote preventive care far more than Trad Medicare with Medigap does. My hope is to take advantage of my MA plans lifestyle intervention coverage and avoid down the road expensive interventions like bypass surgery.
Last edited by dodecahedron on Mon Oct 03, 2022 10:16 am, edited 1 time in total.
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Re: Original Medicare vs. Medicare Advantage
I've watched a number of this guy's videos
https://www.youtube.com/watch?v=hrkbOjBtBsw&t=686s
My understanding is that Advantage is essentially an HMO. Where a medicare supplement is goon anywhere with anyone, Advantage is most like an HMO. My may have to deal with the hassle of ONLY going to an in network provider and if you don't, you pay the bill and they may pay nothing. Go out of the area where the Advantage plan is local and you might find no in network providers at all. So if you go to visit relatives or on vacation and need medical care, be prepared to pay 100% of it.
All of the annoying TV ads yelling at you that you can get more services and get money back by guys like Joe Namath are yelling at you to go over to them and paying big money for ads because they want to take your money and provide as little as possible to you. I don't buy it.
https://www.youtube.com/watch?v=hrkbOjBtBsw&t=686s
My understanding is that Advantage is essentially an HMO. Where a medicare supplement is goon anywhere with anyone, Advantage is most like an HMO. My may have to deal with the hassle of ONLY going to an in network provider and if you don't, you pay the bill and they may pay nothing. Go out of the area where the Advantage plan is local and you might find no in network providers at all. So if you go to visit relatives or on vacation and need medical care, be prepared to pay 100% of it.
All of the annoying TV ads yelling at you that you can get more services and get money back by guys like Joe Namath are yelling at you to go over to them and paying big money for ads because they want to take your money and provide as little as possible to you. I don't buy it.
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Re: Original Medicare vs. Medicare Advantage
Responded to PM but having trouble sending it to you and not sure you are receiving it.Northern Flicker wrote: ↑Mon Oct 03, 2022 12:10 amThere are some hideous ones but also some good ones. PM sent.
Re: Original Medicare vs. Medicare Advantage
Read the posts…Jack FFR1846 wrote: ↑Mon Oct 03, 2022 10:15 am I've watched a number of this guy's videos
https://www.youtube.com/watch?v=hrkbOjBtBsw&t=686s
My understanding is that Advantage is essentially an HMO. Where a medicare supplement is goon anywhere with anyone, Advantage is most like an HMO. My may have to deal with the hassle of ONLY going to an in network provider and if you don't, you pay the bill and they may pay nothing. Go out of the area where the Advantage plan is local and you might find no in network providers at all. So if you go to visit relatives or on vacation and need medical care, be prepared to pay 100% of it.
All of the annoying TV ads yelling at you that you can get more services and get money back by guys like Joe Namath are yelling at you to go over to them and paying big money for ads because they want to take your money and provide as little as possible to you. I don't buy it.
Not all MA plans are HMO’s
Not all MA companies advertise on TV or are for profit. Many where I live are but mine is a non profit healthcare organization of 15 hospitals, 85 facilities and 4500 doctors with not a supposed celebrity in sight.
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Re: Original Medicare vs. Medicare Advantage
Which company do you use?MGBMartin wrote: ↑Mon Oct 03, 2022 10:42 amRead the posts…Jack FFR1846 wrote: ↑Mon Oct 03, 2022 10:15 am I've watched a number of this guy's videos
https://www.youtube.com/watch?v=hrkbOjBtBsw&t=686s
My understanding is that Advantage is essentially an HMO. Where a medicare supplement is goon anywhere with anyone, Advantage is most like an HMO. My may have to deal with the hassle of ONLY going to an in network provider and if you don't, you pay the bill and they may pay nothing. Go out of the area where the Advantage plan is local and you might find no in network providers at all. So if you go to visit relatives or on vacation and need medical care, be prepared to pay 100% of it.
All of the annoying TV ads yelling at you that you can get more services and get money back by guys like Joe Namath are yelling at you to go over to them and paying big money for ads because they want to take your money and provide as little as possible to you. I don't buy it.
Not all MA plans are HMO’s
Not all MA companies advertise on TV or are for profit. Many where I live are but mine is a non profit healthcare organization of 15 hospitals, 85 facilities and 4500 doctors with not a supposed celebrity in sight.
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Re: Original Medicare vs. Medicare Advantage
OP, I found this to be an interesting report. It illustrates some of the cost and choice differences between MedAdvantage and Medigap plans
https://medicareadvocacy.org/wp-content ... ctsEmailID}}
I chose MediGap because I feel it leaves open the greatest possible choices of seeking care. I think (not sure) that there are (old?) studies showing that people who are relatively healthy are satisfied with their MA plans (low cost!). Those who are starting to seek more medical care, and are running into the constraints of their MA plan, are less satisfied.
https://medicareadvocacy.org/wp-content ... ctsEmailID}}
I chose MediGap because I feel it leaves open the greatest possible choices of seeking care. I think (not sure) that there are (old?) studies showing that people who are relatively healthy are satisfied with their MA plans (low cost!). Those who are starting to seek more medical care, and are running into the constraints of their MA plan, are less satisfied.
Re: Original Medicare vs. Medicare Advantage
BayCare.tj wrote: ↑Mon Oct 03, 2022 10:44 amWhich company do you use?MGBMartin wrote: ↑Mon Oct 03, 2022 10:42 amRead the posts…Jack FFR1846 wrote: ↑Mon Oct 03, 2022 10:15 am I've watched a number of this guy's videos
https://www.youtube.com/watch?v=hrkbOjBtBsw&t=686s
My understanding is that Advantage is essentially an HMO. Where a medicare supplement is goon anywhere with anyone, Advantage is most like an HMO. My may have to deal with the hassle of ONLY going to an in network provider and if you don't, you pay the bill and they may pay nothing. Go out of the area where the Advantage plan is local and you might find no in network providers at all. So if you go to visit relatives or on vacation and need medical care, be prepared to pay 100% of it.
All of the annoying TV ads yelling at you that you can get more services and get money back by guys like Joe Namath are yelling at you to go over to them and paying big money for ads because they want to take your money and provide as little as possible to you. I don't buy it.
Not all MA plans are HMO’s
Not all MA companies advertise on TV or are for profit. Many where I live are but mine is a non profit healthcare organization of 15 hospitals, 85 facilities and 4500 doctors with not a supposed celebrity in sight.
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Re: Original Medicare vs. Medicare Advantage
I choose a MA plan as it almost resembles to a T the BCBS HMO plan I had at work, it is a bit more expensive though. The providers that I have been going to for over a decade were not part of standard Medicare, but are in the MA plan. The only real "problem" for me - already pointed out - is that the MA plan doesn't travel well.
My MA plan is actually supplied by the hospital near us - Providence. So - it seems to me - that the folks who provide the service also decide if you can have access to the service: prior authorization (hospital care) or a Doctors referral (to see a specialist). I got to believe there is a source of tension between those two sides, but so far so good other then my asthma med is not on their formulary. Dependable breathing is so over rated.
So for me, it came down to the Providers and also that I can continue to walk the couple of blocks to see them.
-jim
My MA plan is actually supplied by the hospital near us - Providence. So - it seems to me - that the folks who provide the service also decide if you can have access to the service: prior authorization (hospital care) or a Doctors referral (to see a specialist). I got to believe there is a source of tension between those two sides, but so far so good other then my asthma med is not on their formulary. Dependable breathing is so over rated.
So for me, it came down to the Providers and also that I can continue to walk the couple of blocks to see them.
-jim
now what?
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Re: Original Medicare vs. Medicare Advantage
You are correct in your points. Confusion comes from the alphabet soup of available Medigap plans: A, B, D, G, High deductible G, K, L, M, N AND Plans C, F and High deductible F (if you were Medicare eligible before 2020). The Medigap Plans have various coinsurance, deductibles and out-of-pockets. The best time to choose a plan is when turning 65 as there will be no underwriting. If a plan is chosen later, underwriting may take place depending on the state.tallguy3891 wrote: ↑Sat Oct 01, 2022 1:09 pm Again, I think it is very important to define terms here due to the multitudes constantly reaching age 65 who might be following this.
"Original Medicare" is Parts A and B. Part D is prescription coverage with many choices available.
I don't know of anyone who recommends having parts A and B only, due to the amounts it covers by itself.
Medicare Advantage plans (Part C plans) are plans which, when one goes that route, the private company then "takes over" so to speak the gov't A and B and runs the insurance plan. One still pays Part B premiums (and Part A if required). There are numerous plans in this category with different drug coverage, copays, coinsurance, varying premiums to pay, and sometimes Medicare premium reimbursements, and catastrophic coverage limits.
Medigap plans are offered by private companies and supplement "Original Medicare" parts A and B. One has to pay the Parts A and B premiums and also pay the premium for the Medigap plan chosen. Most people I think also choose a Part D Medicare prescription plan separately to go along with this to cover their Rx. These plans' rules vary by state as far as getting in or changing options.
There is good info on these items at the Medicare.gov site. This is my understanding of these options. If anyone has info to add or clarify, please do so since this is a recurring hot topic.
As you stated everyone should have Original Medicare Parts A & B. But, these alone will not cover 100%. Thus, the donut hole.
To supplement A & B, one chooses a Medigap plan AND a Part D Drug Plan (many choices available depending on what meds are being taken at the time of enrolling and the Part D plan can be changed yearly)
OR
choose a Medicare Advantage (Part C) plan to coexist with the original Parts A & B. The confusion with Medicare Advantage Plans is once again the myriad of available companies.
Medicare.gov shows the Part D and MA plans available in the client's zip code.
Death is certain but the route is murky. Healthcare is an individual choice based on genetics, individual health conditions etc.
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Re: Original Medicare vs. Medicare Advantage
To be clear, the donut hole is for part D. Part B has no donut hole. If you don't have a supplement (for original Medicare), you are responsible for 20% of Part B charges with no limit.InTheMidwest wrote: ↑Mon Oct 03, 2022 11:11 amYou are correct in your points. Confusion comes from the alphabet soup of available Medigap plans: A, B, D, G, High deductible G, K, L, M, N AND Plans C, F and High deductible F (if you were Medicare eligible before 2020). The Medigap Plans have various coinsurance, deductibles and out-of-pockets. The best time to choose a plan is when turning 65 as there will be no underwriting. If a plan is chosen later, underwriting may take place depending on the state.tallguy3891 wrote: ↑Sat Oct 01, 2022 1:09 pm Again, I think it is very important to define terms here due to the multitudes constantly reaching age 65 who might be following this.
"Original Medicare" is Parts A and B. Part D is prescription coverage with many choices available.
I don't know of anyone who recommends having parts A and B only, due to the amounts it covers by itself.
Medicare Advantage plans (Part C plans) are plans which, when one goes that route, the private company then "takes over" so to speak the gov't A and B and runs the insurance plan. One still pays Part B premiums (and Part A if required). There are numerous plans in this category with different drug coverage, copays, coinsurance, varying premiums to pay, and sometimes Medicare premium reimbursements, and catastrophic coverage limits.
Medigap plans are offered by private companies and supplement "Original Medicare" parts A and B. One has to pay the Parts A and B premiums and also pay the premium for the Medigap plan chosen. Most people I think also choose a Part D Medicare prescription plan separately to go along with this to cover their Rx. These plans' rules vary by state as far as getting in or changing options.
There is good info on these items at the Medicare.gov site. This is my understanding of these options. If anyone has info to add or clarify, please do so since this is a recurring hot topic.
As you stated everyone should have Original Medicare Parts A & B. But, these alone will not cover 100%. Thus, the donut hole.
To supplement A & B, one chooses a Medigap plan AND a Part D Drug Plan (many choices available depending on what meds are being taken at the time of enrolling and the Part D plan can be changed yearly)
OR
choose a Medicare Advantage (Part C) plan to coexist with the original Parts A & B. The confusion with Medicare Advantage Plans is once again the myriad of available companies.
Medicare.gov shows the Part D and MA plans available in the client's zip code.
Death is certain but the route is murky. Healthcare is an individual choice based on genetics, individual health conditions etc.
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Re: Original Medicare vs. Medicare Advantage
This is an oversimplification. You can always switch to any MA plan from another MA plan or from original Medicare. What you cannot do in most states is get a Medigap policy without medical underwriting just any time you want. When you turn 65 or I believe in the first 12 monthsoif the first MA plan you choose are when you can get a Medigap policy without clearing medical underwriting.michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
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Re: Original Medicare vs. Medicare Advantage
Fair enough. I probably didn't say what I wanted to correctly which is you can be locked into Original Medicare + Medigap the same way you can be locked into MA. Namely needing underwriting to switch/get a Medigap plan after the beginning whether that is to switch from Original Medicare+Medigap to Original Medicare+New Medigap or Medicare Advantage switching to Original Medicare+Medigap.Northern Flicker wrote: ↑Mon Oct 03, 2022 11:37 amThis is an oversimplification. You can always switch to any MA plan from another MA plan or from original Medicare. What you cannot do in most states is get a Medigap policy without medical underwriting just any time you want. When you turn 65 or I believe in the first 12 monthsoif the first MA plan you choose are when you can get a Medigap policy without clearing medical underwriting.michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Re: Original Medicare vs. Medicare Advantage
The ability to change your Medigap plan may be impacted by what state you are in. For example, in California, you can easily change your Medigap plan in your birthday month by calling the new plan you want.michaeljc70 wrote: ↑Mon Oct 03, 2022 11:42 am I probably didn't say what I wanted to correctly which is you can be locked into Original Medicare + Medigap the same way you can be locked into MA. Namely needing underwriting to switch/get a Medigap plan after the beginning whether that is to switch from Original Medicare+Medigap to Original Medicare+New Medigap or Medicare Advantage switching to Original Medicare+Medigap.
But there usually isn’t a need to change since they pretty much all work the same and just pay the 20% that Medicare notifies them of. There is no decision for them to make since they are already contracted with Medicare to pay the 20% amount.
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Re: Original Medicare vs. Medicare Advantage
If a Medigap provider became insolvent or otherwise stopped offering insurance in your area, I believe you would be able to get a new one with a different provider w/o underwriting.michaeljc70 wrote: ↑Mon Oct 03, 2022 11:42 amFair enough. I probably didn't say what I wanted to correctly which is you can be locked into Original Medicare + Medigap the same way you can be locked into MA. Namely needing underwriting to switch/get a Medigap plan after the beginning whether that is to switch from Original Medicare+Medigap to Original Medicare+New Medigap or Medicare Advantage switching to Original Medicare+Medigap.Northern Flicker wrote: ↑Mon Oct 03, 2022 11:37 amThis is an oversimplification. You can always switch to any MA plan from another MA plan or from original Medicare. What you cannot do in most states is get a Medigap policy without medical underwriting just any time you want. When you turn 65 or I believe in the first 12 monthsoif the first MA plan you choose are when you can get a Medigap policy without clearing medical underwriting.michaeljc70 wrote: ↑Mon Oct 03, 2022 8:39 am I didn't read every post, but most of the major issues have been addressed. It has been pointed out that if you go with Medicare Advantage it may be difficult/expensive to change plans. But if you go with original Medicare and Medigap, you have the same issue with the Medigap coverage. And the premiums for Medigap can get large as you get older as I've seen for relatives in their 90s.
Medicare claims processing drives Medigap claims. Generally, the only reason to be unhappy with a Medigap provider who supplies your insurance is if premium cost becomes too high or the company becomes insolvent. I think they have zero input into establishing the status of a claim.
Re: Original Medicare vs. Medicare Advantage
not sure what you mean by “ choose a Medicare Advantage (Part C) plan to coexist with the original Parts A & B”? you don’t choose ma and original part a and b.InTheMidwest wrote: ↑Mon Oct 03, 2022 11:11 amYou are correct in your points. Confusion comes from the alphabet soup of available Medigap plans: A, B, D, G, High deductible G, K, L, M, N AND Plans C, F and High deductible F (if you were Medicare eligible before 2020). The Medigap Plans have various coinsurance, deductibles and out-of-pockets. The best time to choose a plan is when turning 65 as there will be no underwriting. If a plan is chosen later, underwriting may take place depending on the state.tallguy3891 wrote: ↑Sat Oct 01, 2022 1:09 pm Again, I think it is very important to define terms here due to the multitudes constantly reaching age 65 who might be following this.
"Original Medicare" is Parts A and B. Part D is prescription coverage with many choices available.
I don't know of anyone who recommends having parts A and B only, due to the amounts it covers by itself.
Medicare Advantage plans (Part C plans) are plans which, when one goes that route, the private company then "takes over" so to speak the gov't A and B and runs the insurance plan. One still pays Part B premiums (and Part A if required). There are numerous plans in this category with different drug coverage, copays, coinsurance, varying premiums to pay, and sometimes Medicare premium reimbursements, and catastrophic coverage limits.
Medigap plans are offered by private companies and supplement "Original Medicare" parts A and B. One has to pay the Parts A and B premiums and also pay the premium for the Medigap plan chosen. Most people I think also choose a Part D Medicare prescription plan separately to go along with this to cover their Rx. These plans' rules vary by state as far as getting in or changing options.
There is good info on these items at the Medicare.gov site. This is my understanding of these options. If anyone has info to add or clarify, please do so since this is a recurring hot topic.
As you stated everyone should have Original Medicare Parts A & B. But, these alone will not cover 100%. Thus, the donut hole.
To supplement A & B, one chooses a Medigap plan AND a Part D Drug Plan (many choices available depending on what meds are being taken at the time of enrolling and the Part D plan can be changed yearly)
OR
choose a Medicare Advantage (Part C) plan to coexist with the original Parts A & B. The confusion with Medicare Advantage Plans is once again the myriad of available companies.
Medicare.gov shows the Part D and MA plans available in the client's zip code.
Death is certain but the route is murky. Healthcare is an individual choice based on genetics, individual health conditions etc.
Re: Original Medicare vs. Medicare Advantage
the benefits for plan g hi-deductible are the same as plan g.ModifiedDuration wrote: ↑Sun Oct 02, 2022 4:55 pmOnly a Medigap Plan F would cover all deductibles and co-pays and that plan is no longer available to newly-eligible Medicare participants.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
The closest policy would be Plan G, where you would be responsible for the $233 Part B deductible.
The two other Medigap plans that are the most popular with newly-eligible Medicare participants are Plan N and Plan G-HD, both of which have lower premiums as well as lower benefits.
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Re: Original Medicare vs. Medicare Advantage
I meant that your benefits are not the same because with a G-HD plan you have a $2,490 deductible that you don’t have with a G plan.gips wrote: ↑Tue Oct 04, 2022 4:56 amthe benefits for plan g hi-deductible are the same as plan g.ModifiedDuration wrote: ↑Sun Oct 02, 2022 4:55 pmOnly a Medigap Plan F would cover all deductibles and co-pays and that plan is no longer available to newly-eligible Medicare participants.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
The closest policy would be Plan G, where you would be responsible for the $233 Part B deductible.
The two other Medigap plans that are the most popular with newly-eligible Medicare participants are Plan N and Plan G-HD, both of which have lower premiums as well as lower benefits.
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Re: Original Medicare vs. Medicare Advantage
Here are a few important differences that I've encountered:
1) Medicare Advantage plans are either HMO or PPO networks, Medicare allows you to select any providers you choose nationwide without referrals.
2) Medicare Advantage plans have large copays if you have a serious health issue; for example you might pay $300+ for the first 5-6 days in a hospital, $200 for ER, $200 for ambulance, $250 for a CT Scan or MRI, etc. You have to closely check your plan. On the other hand, Medicare Supplement Plans (which pick up what Medicare doesn't pay) can have large premiums. But you can still end up paying more out of pocket for MA copays than for Medigap premiums.
3) Medicare Advantage plans usually pay just 20 days in a LTC or rehab facility; after that the copays can be in the neighborhood of $200/day for 21- 100 days. Medicare also pays just 20 days and the copay is similar for 21-100 days; however, your Medigap plan will pick up the copay so it costs you nothing for up to 100 days. Friend recently broke her leg and had to stay in rehab for 3 months; Medicare + Medigap covered it. If she'd been on an Advantage plan she would have paid $200/day for the next 80 days, or $16K. So, you're much better off on Medicare if you need a long stay in rehab or a LTC factility; but you need a 3 night prior stay in a hospital to qualify; most Medicare Advantage plans don't require the 3 might stay.
4) A little known Catch-22 with Medicare Advantage plans involves Hospice care. If you go on hospice, your MA plan is suspended and the hospice takes over payments. Not a problem, you say. Well, yes. It becomes a problem if you have to go to a hospital or be seen by a non-hospice provider during that time, because hospice will not pay for ER, hospital charges, non-hospice provider charges, etc. That's because hospice doesn't cover life-sustaining medical treatment. And, and it turns out, your MA plan won't pay either because it is suspended while you're on hospice. Unfortunately, this occurs on a monthly interval; you cannot switch back to your MA plan immediately if you are hospitalized; that can only occur at the end of the current month; so if you happened to, say, break your leg or hip during the month while you are on hospice and be sent to a hospital, hospice won't pay and your MA plan won't pay. Your claims revert to Medicare Part A and Part B, but that only pays 80% and you are stuck with the other 20%. This is not a theory -- it happened to us with our mother, exactly as I've described. Cost us thousands. Don't bother asking your MA advisor or agent about this -- they won't know. Nobody knows about this until it happens and you are screwed. IF you were on traditional Medicare with a Medicare Supplement this would not happen. The supplement remains in effect even if you are on hospice.
1) Medicare Advantage plans are either HMO or PPO networks, Medicare allows you to select any providers you choose nationwide without referrals.
2) Medicare Advantage plans have large copays if you have a serious health issue; for example you might pay $300+ for the first 5-6 days in a hospital, $200 for ER, $200 for ambulance, $250 for a CT Scan or MRI, etc. You have to closely check your plan. On the other hand, Medicare Supplement Plans (which pick up what Medicare doesn't pay) can have large premiums. But you can still end up paying more out of pocket for MA copays than for Medigap premiums.
3) Medicare Advantage plans usually pay just 20 days in a LTC or rehab facility; after that the copays can be in the neighborhood of $200/day for 21- 100 days. Medicare also pays just 20 days and the copay is similar for 21-100 days; however, your Medigap plan will pick up the copay so it costs you nothing for up to 100 days. Friend recently broke her leg and had to stay in rehab for 3 months; Medicare + Medigap covered it. If she'd been on an Advantage plan she would have paid $200/day for the next 80 days, or $16K. So, you're much better off on Medicare if you need a long stay in rehab or a LTC factility; but you need a 3 night prior stay in a hospital to qualify; most Medicare Advantage plans don't require the 3 might stay.
4) A little known Catch-22 with Medicare Advantage plans involves Hospice care. If you go on hospice, your MA plan is suspended and the hospice takes over payments. Not a problem, you say. Well, yes. It becomes a problem if you have to go to a hospital or be seen by a non-hospice provider during that time, because hospice will not pay for ER, hospital charges, non-hospice provider charges, etc. That's because hospice doesn't cover life-sustaining medical treatment. And, and it turns out, your MA plan won't pay either because it is suspended while you're on hospice. Unfortunately, this occurs on a monthly interval; you cannot switch back to your MA plan immediately if you are hospitalized; that can only occur at the end of the current month; so if you happened to, say, break your leg or hip during the month while you are on hospice and be sent to a hospital, hospice won't pay and your MA plan won't pay. Your claims revert to Medicare Part A and Part B, but that only pays 80% and you are stuck with the other 20%. This is not a theory -- it happened to us with our mother, exactly as I've described. Cost us thousands. Don't bother asking your MA advisor or agent about this -- they won't know. Nobody knows about this until it happens and you are screwed. IF you were on traditional Medicare with a Medicare Supplement this would not happen. The supplement remains in effect even if you are on hospice.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
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Re: Original Medicare vs. Medicare Advantage
I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
Last edited by protagonist on Tue Oct 04, 2022 11:14 am, edited 1 time in total.
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Re: Original Medicare vs. Medicare Advantage
In your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)benne77 wrote: ↑Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
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Re: Original Medicare vs. Medicare Advantage
You will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
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Re: Original Medicare vs. Medicare Advantage
I think you meant to say that:Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 11:26 amYou will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
Depending on the state you live in, you will probably have to undergo underwriting for a Medigap plan when you switch to original Medicare and you may be denied for a Medigap plan or your premium will be higher than you expect.
Re: Original Medicare vs. Medicare Advantage
Wrong, I believe.Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 11:26 amYou will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
There is no underwriting for original Medicare and premiums will be the same as if you were on Medicare to begin with.
If you switch back to Medicare and wish to purchase a Medigap supplement policy then the Medigap company may require underwriting and premiums may be higher for that policy than they would have been when your Medicare eligibility began.
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Re: Original Medicare vs. Medicare Advantage
I think you are probably correct. You can get back on original Medicare, but the Medigap policy is the problem. That's offered by an insurance company that will want to do medical underwriting to determine acceptance and the premium amount.MGBMartin wrote: ↑Tue Oct 04, 2022 11:42 amWrong, I believe.Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 11:26 amYou will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
There is no underwriting for original Medicare and premiums will be the same as if you were on Medicare to begin with.
If you switch back to Medicare and wish to purchase a Medigap supplement policy then the Medigap company may require underwriting and premiums may be higher for that policy than they would have been when your Medicare eligibility began.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
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Re: Original Medicare vs. Medicare Advantage
In my experience, neither I nor anyone I know has had a car accident in many years. But we still buy auto insurance.protagonist wrote: ↑Tue Oct 04, 2022 11:11 amIn your experience, how frequently do people need more than 20 days skilled nursing? And when they do, how often does Medicare deny coverage beyond 20 days? (curious....)benne77 wrote: ↑Sat Oct 01, 2022 10:49 am I am a physical therapist in the home health setting. With traditional Medicare patients are able to stay in skilled nursing for 50+ days. With Medicare advantage many times they don’t even get to go to rehab or are given max 20 days and are kicked out regardless. Then I go and see them in there home. If they are traditional Medicare it’s easy to justify 2 months of care for 10-16 visits. If Medicare advantage I’m lucky to get 4-6 visits approved. I strongly discourage Medicare advantage plans.
(OK, not the best analogy because we're required to do so by law; but we would anyway.)
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Re: Original Medicare vs. Medicare Advantage
In this case, the poster states they live in Massachusetts.Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 12:46 pmI think you are probably correct. You can get back on original Medicare, but the Medigap policy is the problem. That's offered by an insurance company that will want to do medical underwriting to determine acceptance and the premium amount.MGBMartin wrote: ↑Tue Oct 04, 2022 11:42 amWrong, I believe.Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 11:26 amYou will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
There is no underwriting for original Medicare and premiums will be the same as if you were on Medicare to begin with.
If you switch back to Medicare and wish to purchase a Medigap supplement policy then the Medigap company may require underwriting and premiums may be higher for that policy than they would have been when your Medicare eligibility began.
In Massachusetts, Medigap carriers are required to offer guaranteed issue from February 1st – March 31st of each year, with the policy’s effective date being June 1st. Carriers also have the option of continuous guaranteed issue year-round.
Massachusetts has its own Medigap plans - Core Plan, Supplement 1 Plan (similar to Plan F and only available to those eligible for Medicare prior to January 1, 2020), and Supplement 1A Plan (similar to Plan G).
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Re: Original Medicare vs. Medicare Advantage
Correct. My state, however, has their own exchange and does not permit underwriting, which is part of the flexibility that I alluded to above. In addition the premiums are not age dependent as they are in many states, and there are some other state-specific factors as well. So OP needs to research what the rules are in his/her state.MGBMartin wrote: ↑Tue Oct 04, 2022 11:42 amWrong, I believe.Fremdon Ferndock wrote: ↑Tue Oct 04, 2022 11:26 amYou will have to undergo underwriting when you try to switch to original Medicare and may be denied or your premium will be higher than you expect. Good luck.protagonist wrote: ↑Tue Oct 04, 2022 10:59 am I didn't read all the posts in this thread....does your mom-in-law have a supplement plan in addition to original Medicare?
At her age, I hope so, since at age 87 her health is vulnerable, and costs can really add up if she has a serious illness.
At age 87 I think Medicare plus Medigap plus drug coverage is a safer way to go than an Advantage plan if she can afford it. The dental benefits (usually quite limited) and other perks offered by the Advantage plans don't really amount to all that much compared with the potential cost of a serious illness, especially if forced to use out of network providers. Plus one must consider the hassle factor (getting referrals, are they in network, etc.)
I (age 70) have an Advantage plan but I am switching to original Medicare plus Medigap with drug coverage this next open enrollment period, though I have had no complaints about my Advantage plan to date.
That said, part of the reason is that I now leave my home state for the winter and am thus out of network for a large chunk of my life.
In additional, my home state (MA) offers certain flexibilities that most other states do not.
There is no underwriting for original Medicare and premiums will be the same as if you were on Medicare to begin with.
If you switch back to Medicare and wish to purchase a Medigap supplement policy then the Medigap company may require underwriting and premiums may be higher for that policy than they would have been when your Medicare eligibility began.
Re: Original Medicare vs. Medicare Advantage
you meant the g-high deductible plan has a high deductible if that’s how you measure benefits, isnt it worth pointing out that in some states, the lower premium plan g-hd guarantees that if you hit the deductible, your cost is no more than plan g and if you don’t hit the deductible, you can save over $1000?ModifiedDuration wrote: ↑Tue Oct 04, 2022 5:10 amI meant that your benefits are not the same because with a G-HD plan you have a $2,490 deductible that you don’t have with a G plan.gips wrote: ↑Tue Oct 04, 2022 4:56 amthe benefits for plan g hi-deductible are the same as plan g.ModifiedDuration wrote: ↑Sun Oct 02, 2022 4:55 pmOnly a Medigap Plan F would cover all deductibles and co-pays and that plan is no longer available to newly-eligible Medicare participants.Munir wrote: ↑Sun Oct 02, 2022 4:43 pm If one can afford it, the best coverage is a traditional "original" Medicare supplemented by a Medigap policy. Your policy will cover all deductibles and co-pays of charges approved by Medicare- the insurance company cannot deny anything approved by Medicare. Your care is determined by the patient and the physician with no insurance company intervening in deciding what or what cannot be done. I am a retired surgeon and I have had multiple major surgeries and hospitalizations and never paid anything out of pocket.
PS: Do not be fooled by the non-profit title of some insurance carriers. They call their profits "retained earnings" and they make just as much as their "for profit" cousins.
The closest policy would be Plan G, where you would be responsible for the $233 Part B deductible.
The two other Medigap plans that are the most popular with newly-eligible Medicare participants are Plan N and Plan G-HD, both of which have lower premiums as well as lower benefits.
Re: Original Medicare vs. Medicare Advantage
Excellent post.jabberwockOG wrote: ↑Sat Oct 01, 2022 10:07 am100% this.uaeebs86 wrote: ↑Sat Oct 01, 2022 9:31 am Clark Howard believes you should never do Medicare Advantage unless you can just not afford the premiums and costs from regular Medicare. He doesn't think the providers will be there for you if you have a major medical issue or need any advanced type of care.
The devil is in the details - there is no such thing as a free lunch particularly when it comes to healthcare.
Medicare advantage plans are heavily marketed by companies that will be making life or death decisions about your healthcare and treatment options based on their profit margin goals. The plans are designed to sound great in the brochures, and at the 60,000 foot level most function very well. They are usually significantly lower cost overall cost....until a person becomes seriously or chronically ill then costs may escalate sharply, especially if they need to see multiple out of network specialists, or travel out of network/region to join a trial, or to receive specialized care (places like MD Anderson, Sloan Kettering, Mayo, Cleveland Clinic) that may not be easily available locally.
Medicare Advantage plan companies may nickle and dime you to death, repeatedly denying claims, adding stress that a person who is seriously ill does not need.
Having said that if the total cost of paying Medicare part B along with an appropriate Supplement plan - like Plan G which is a good choice for most folks, is too much for a person's budget, a Medicare Advantage plan may be their best bet.
In some large urban areas - Chicago, New York, Minneapolis come to mind - a Medicare Advantage plan may have a large number of high quality providers and facilities.
Some patients understand that not all doctors are the same and would like to choose based on recommendations, special area of expertise, etc.
MA limits the choice. For me, that is a non-starter.
Re: Original Medicare vs. Medicare Advantage
There is a local agent who did a nice write-up on Medicare that you can read here.
Hope it helps others out
Best Wishes
Hope it helps others out
Best Wishes
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
Re: Original Medicare vs. Medicare Advantage
Someone above mentioned Plan N. A friend of mine, who is turning 65 soon, just signed up for Plan N. What are the benefits of Plan G over Plan N for the extra cost?