Original Medicare vs. Medicare Advantage

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fishandgolf
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Original Medicare vs. Medicare Advantage

Post by fishandgolf »

Greetings Fellow BH's:

My mother-in-law (87 years old and very healthy.....with some exceptions) has been on Original Medicare for many years. She's a very active social person and recently several of her "social acquaintances" initiated a discussion on the subject of "Original Medicare vs. Medicare Advantage".

Many of these folks are on "Medicare Advantage Plans" and have been giving her a hard time about the costs she incurs on "Original Medicare" (she can easily afford the cost). They have nearly convinced her that she needs to change her plan......and she's in a serious quandary about doing so and has reached out to us. It's been a long time since my wife and I have researched the pros and cons of each plan. One of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details. I would appreciate it if there are any BH's intimately familiar with this subject and could offer a few pros and cons of each program; it would be very helpful to put my her mind at ease..... :?:
jebmke
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Re: Original Medicare vs. Medicare Advantage

Post by jebmke »

All I can contribute is that it seems like comparisons between MA and Traditional Medicare are very location specific.

At one extreme is my area -- Medicare Advantage isn't even available.

Based on discussions with a sibling and reading prior threads on this subject, my impression is that MA plans can vary a lot depending on where you live. Some places seem to be more restrictive (smaller networks) but others seem to be as "open" as Traditional Medicare.

edit: as an aside, I'm always fascinated at how many people have conversations in their social circles about their personal financial situations. I know a lot of retirees and it almost never comes up (except taxes -- but that is because I volunteer with TaxAide).
Don't trust me, look it up. https://www.irs.gov/forms-instructions-and-publications
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

My wife and I have Medicare Advantage plans, different ones.
We are very happy with them but we live in Florida and things are different here with MA plans. Many plans in Florida refund some or all of your Part B premium, all of my wife’s and $124 of mine.

I don’t know what you read about not being able to change plans but as far as I can understand you can change to a different MA plan or back to original Medicare every year during the annual change period.

I’ve read on here how some people don’t like Medicare Advantage because they won’t cover certain things or won’t pay.
My experience is the opposite. Last year I had to have surgery due to a sudden spine issue. My insurance paid everything and all I had to pay was $165 for 1 night hospital stay copay and a specialist doctor visit copay. I didn’t have to worry about pre authorization etc as my insurance and my doctors are all part of the same organization. They basically said once you are seen by a BayCare doctor everything is authorized, so MRI and surgery etc approved just on the doctors findings and treatment plan.
I don’t have chronic health issues but the things that have come along have been covered without question or fuss.
The local BayCare surgery center even refunded the copayment they mistakenly charged me when I went for a colonoscopy. The refund just showed up in the mail about 2 weeks after without me even asking. Last time I was owed money from a hospital I had to fight them for months to get a refund.

Bottom line, do some research into both sides .
Every year more folks sign up for MA plans, I think it is close to 50% now.
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chemocean
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Re: Original Medicare vs. Medicare Advantage

Post by chemocean »

Advantage plans are private insurance, so the insurance company is making the decision about treatment. You can appeal, but the first two levels of appeal are within your advantage system. Only at the third level of appeal so you get an impartial Medicare administrative judge. This condition is especially important with skilled nursing after hospitalization . Some insurance companies are notorious for denying further needed skilled nursing after hospitalization. I plan on switching to the Original Medicare during the open season the year before I need skilled nursing after hospitalization
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uaeebs86
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Re: Original Medicare vs. Medicare Advantage

Post by uaeebs86 »

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.
"Things work out best for those who make the best of the way things work out." ― John Wooden
jebmke
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Re: Original Medicare vs. Medicare Advantage

Post by jebmke »

chemocean wrote: Sat Oct 01, 2022 9:29 am Advantage plans are private insurance, so the insurance company is making the decision about treatment. You can appeal, but the first two levels of appeal are within your advantage system. Only at the third level of appeal so you get an impartial Medicare administrative judge. This condition is especially important with skilled nursing after hospitalization . Some insurance companies are notorious for denying further needed skilled nursing after hospitalization. I plan on switching to the Original Medicare during the open season the year before I need skilled nursing after hospitalization
What are the chances that the underwriters would refuse to take you?
Don't trust me, look it up. https://www.irs.gov/forms-instructions-and-publications
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fishandgolf
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Re: Original Medicare vs. Medicare Advantage

Post by fishandgolf »

The agent for our supplemental insurance (Physicians Mutual) said that if a person needs chemotherapy, Medicare Advantage only cover 80%.....you would be responsible for the other 20%. I don't know if this is fact or fiction but I've been receiving chemo for the past 6 months (and continue to do so).....however, I have Original Medicare and have not had to pay a single penny for any of my treatments, scans, hospital stays, etc. I have never had to receive pre-approval for anything....nothing. I do have a major surgery (The Whipple Procedure) scheduled for December and I'm told it's all covered.

What I do have to be aware of is what type of drugs I'll need going forward, then find a good drug plan that will provide the best coverage.
Last edited by fishandgolf on Sat Oct 01, 2022 9:58 am, edited 1 time in total.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

chemocean wrote: Sat Oct 01, 2022 9:29 am Advantage plans are private insurance, so the insurance company is making the decision about treatment. You can appeal, but the first two levels of appeal are within your advantage system. Only at the third level of appeal so you get an impartial Medicare administrative judge. This condition is especially important with skilled nursing after hospitalization . Some insurance companies are notorious for denying further needed skilled nursing after hospitalization. I plan on switching to the Original Medicare during the open season the year before I need skilled nursing after hospitalization
That’s not my experience.
My insurance and providers are all BayCare.
I’ve been told by both the insurance and by the providers that once I’ve been seen by a BayCare provider or facility everything is automatically authorized.
I’m not naive and understand that insurance companies will try to wriggle out of things but I had way more trouble with health insurance companies in the 40 years of private employer based insurance than I’ve had on my MA plan. One thing is certain, I don’t get bills from people or providers I’ve never heard of anymore.

Medicare Advantage may not be for everyone but I usually do my own research rather than taking blanket statements from the likes of Clark Howard.
The almost 50% of the Medicare community who use MA plans can’t all be doing it wrong.
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MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero
You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
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DetroitRick
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Re: Original Medicare vs. Medicare Advantage

Post by DetroitRick »

To start off, I would grab the answers to a few basic questions:
1)Does your mother-in-law live in one of the minority of states where she can, if she later chooses, go back to Medigap without medical underwriting? That is, beyond the trial rights that are available when you first switch. This makes the decision a bit easier if she can "go back", even much later, if dissatisfied. Of course she can always choose to switch BETWEEN Medicare Advantage providers during annual enrollment down the road.
2)Are the Medicare Advantage networks good, readily available where she lives, and acceptable to her. If her current choice of doctors are important, see what specific Medicare Advantage plans they are in.
3)Compare her premium history and out of pocket costs to current Medicare Advantage offerings. If you are comfortable, you can readily do this using the tools on Medicare.gov. If not, find a good broker to help you (it will be free, but emphasis is on finding a "good" broker").

Answers to these 3 might push you more strongly in the direction of staying put or changing.

The few people that I've talked to about Medicare in my area have been pretty ignorant of the whole decision making process, and seem to be swayed by whatever somebody tells them and the extended benefits (dental, hearing, health memberships typical of MA plans). On the other hand, I don't have many of these discussions so my sample is small. That being said, people I talk to generally have a feel for whether a particular MA network does or doesn't meet their needs (quality doctors and facilities, mainly), and whether premiums and out-of-pockets are or could be a burden. In the end, when making my own choice, I ignored all "friend" input except those two factors. While my personal choice was a Medicare Supplement, I'm confident either alternative would have worked for me.

The potential decision is worth a look, but don't jump before taking a deep look first (as you are!).
Last edited by DetroitRick on Sat Oct 01, 2022 10:05 am, edited 1 time in total.
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Watty
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Re: Original Medicare vs. Medicare Advantage

Post by Watty »

fishandgolf wrote: Sat Oct 01, 2022 9:00 am 87 years old and very healthy.....with some exceptions

(she can easily afford the cost)
A huge disadvantage of changing is that she would need to change all of her doctors and get new prescriptions from all her doctors and likely move all the prescriptions to different pharmacies.

It is not to suggest that the Medicare Advantage plan might not have good doctors but she may also find that she does not like her new doctors or the new doctors might want to redo lots of tests and have her try out different medications if any of her current medication are not in the MA plan formulary. At the very least she will need to have an extra "meet and greet" appointment with each of her doctors too. The doctors will also all be in a new location which may or may not be as convenient.

It could easily take six months or more to get established her new doctors and there is also a risk that something could come up during that transition period.

That is not specifically with Medicare Advantage, if she was looking at going the other way and going from Medicare Advantage to Traditional Medicare she would need to go through the same process and deal with all the mechanics of changing all her doctors.

There is an old saying, "If it ain't broke, don't fix it!".

If she was short of money, unhappy with her current doctors, or younger then looking into switching might make sense but there are just so many ways that switching could cause problems I would not suggest doing it without a better reason.

Note: I am using Medicare Advantage and I think it is a good choice for many people but it really depends on what is available in your area. I am not saying that there is anything wrong MA plans.
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jabberwockOG
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Re: Original Medicare vs. Medicare Advantage

Post by jabberwockOG »

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.
100% this.

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.
bradinsky
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Re: Original Medicare vs. Medicare Advantage

Post by bradinsky »

MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero

You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
MGB,
Did you not choose a MA plan over a supplemental plan? I have a G plan & recently had a hip replacement. My total out of pocket for that procedure was zero($0). I believe most people choose based on their personal health situation. We pay a monthly premium & are responsible for our yearly part B deductible. MA subscribers pay a much smaller premium & in some cases get their part B premiums refunded, while incurring more bills if a medical procedure is required.
Rex66
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Re: Original Medicare vs. Medicare Advantage

Post by Rex66 »

I plan to stay with regular Medicare when the time comes
jebmke
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Re: Original Medicare vs. Medicare Advantage

Post by jebmke »

bradinsky wrote: Sat Oct 01, 2022 10:24 am
MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero

You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
MGB,
Did you not choose a MA plan over a supplemental plan? I have a G plan & recently had a hip replacement. My total out of pocket for that procedure was zero($0). I believe most people choose based on their personal health situation. We pay a monthly premium & are responsible for our yearly part B deductible. MA subscribers pay a much smaller premium & in some cases get their part B premiums refunded, while incurring more bills if a medical procedure is required.
I think that varies. I know my sister has a MA plan and pays a smallish premium and zero after that. No restrictions on network. in her locale, it works quite well.
Don't trust me, look it up. https://www.irs.gov/forms-instructions-and-publications
WillRetire
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Re: Original Medicare vs. Medicare Advantage

Post by WillRetire »

At her age, she should stay put. With original medicare + medigap, she has access to the widest possible network of doctors and hospitals with 0 or minimal claims work.

Yes, there are people who love their medicare advantage (MA) plan, and maybe they love it because it's cheap and they are happy with the network doctors. Or maybe they love it because there's no going back to medigap without medical underwriting and/or medigap plans are too expensive for them. So, human nature being what it is, they want to persuade all their friends to do what they did to rationalize it.

With medigap, the insurer has near 0 decision making logic when processing a claim. If medicare accepted it, so must they.

With MA, claims processing is more complex and claims can be denied. A service may not be covered (think rehab # weeks), or doctor is not in network and does not accept the plan (have experienced this). While it is true that some MA plans allow you to go out of network, realize that the provider *must* accept the plan; accepting medicare alone is not sufficient.

Do you really want your mother to have to perform a check as to whether the provider is *still* in-network, and if not, determine whether they accept that particular MA plan? Before receiving treatment each time? Then monitor claims & phone the insurer when one is denied? That's OK when you are on regular insurance from an employer. Not much fun when you are elderly, frail and/or sick.

The MA plans offer many perks like some limited dental and/or vision coverage. This makes the plans very attractive. However, those benefits are limited and do not help for serious medical treatment. Think cancer, open heart surgery, organ transplant, joint replacement, and followup rehab care for all those things.

Some retirees are severely budget constrained and cannot afford medigap premiums. Thank goodness MA plans exist for them. Also, I have heard excellent things about Kaiser Permanente's MA plans (and their non-medicare HMO plans). If I lived in an area that had KP and knew I'd never leave that area, I'd seriously consider it.

In many states, you cannot easily switch back to your old medigap plan at the same pricing level once you leave it. There is something about an allowance for switching back within 12 months but don't know if you qualify for same pricing you had before. Different people pay different premiums for the same medigap plan, depending on when they enrolled and other factors. Some pricing is "preferred". If someone switches to MA then back to medigap within 12 months, I don't know what pricing group the medigap insurer will put them in.

MA plans can (and do) change from year to year. Networks change. Coverage changes. An MA plan might sound good now, but what if they change it in a year or so?

MA plans are available to everyone to switch to once a year during annual enrolllment. Your mother should take her time and get all the facts. No rush. She can switch next Fall if she really wants to.

Perspectives from Clark Howard and Investopedia:

https://clark.com/insurance/health-insu ... age-plans/

https://www.investopedia.com/articles/p ... better.asp
prd1982
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Re: Original Medicare vs. Medicare Advantage

Post by prd1982 »

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?
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

bradinsky wrote: Sat Oct 01, 2022 10:24 am
MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero

You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
MGB,
Did you not choose a MA plan over a supplemental plan? I have a G plan & recently had a hip replacement. My total out of pocket for that procedure was zero($0). I believe most people choose based on their personal health situation. We pay a monthly premium & are responsible for our yearly part B deductible. MA subscribers pay a much smaller premium & in some cases get their part B premiums refunded, while incurring more bills if a medical procedure is required.
Yes, we did choose MA over a supplement plan.
I had looked at all options and several reasons helped us decide to go with MA plans.
Where we are located has about 20 different companies offering MA plans and some of them advertise on TV to the point of being annoying. Most of these companies I wouldn’t touch as their networks are skimpy, providers too far away and I lack confidence in some. Most of them do the Part B give back, being Florida that is more prevalent here than others places I believe.

The company I chose is also the largest healthcare provider in the area and you can’t swing a dead cat without hitting a doctor or facility in my area and I don’t just mean network doctors or providers but actual BayCare offices or facilities. My wife’s plan is not so good and she may switch this year.
I really don’t worry about in or out of network because it is so easy to find a BayCare doc or facility.
If I lived in a different area with smaller networks or options I may be so keen and maybe choose a different option.

Our healthcare use is low and I expect it to stay that way for some time but I wasn’t expecting to need spinal surgery last year.
My wife and I both worked in healthcare for 40 years so that helped in some of the understanding of the various options.

If one thing stands out it is the absence of surprise bills, insurance telling me it’s not covered, even BCBS clawing back a previously paid claim almost 3 years after paying it; that in itself is a breath of fresh air.
Last edited by MGBMartin on Sat Oct 01, 2022 10:53 am, edited 1 time in total.
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benne77
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Re: Original Medicare vs. Medicare Advantage

Post by benne77 »

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.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

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?
Any insurance can deny service or payment for a service

In my case thy make it super easy to get service.

If they reimburse medical facilities at a lower rate that is between them and the facility.

Maybe the MA companies don’t have to deal without all the Medicare fraud so that don’t have that financial burden to add to their costs.
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tallguy3891
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Re: Original Medicare vs. Medicare Advantage

Post by tallguy3891 »

fishandgolf wrote: Sat Oct 01, 2022 9:00 am Greetings Fellow BH's:

My mother-in-law (87 years old and very healthy.....with some exceptions) has been on Original Medicare for many years. She's a very active social person and recently several of her "social acquaintances" initiated a discussion on the subject of "Original Medicare vs. Medicare Advantage".

Many of these folks are on "Medicare Advantage Plans" and have been giving her a hard time about the costs she incurs on "Original Medicare" (she can easily afford the cost). They have nearly convinced her that she needs to change her plan......and she's in a serious quandary about doing so and has reached out to us. It's been a long time since my wife and I have researched the pros and cons of each plan. One of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details. I would appreciate it if there are any BH's intimately familiar with this subject and could offer a few pros and cons of each program; it would be very helpful to put my her mind at ease..... :?:
I might have missed something here but I didn't see if you mentioned she has "original Medicare" (Parts A and B) only, or "original Medicare + Medigap." The latter combo--Parts A and B plus Medigap--is excellent coverage. I think most would agree having "original Medicare" only, i.e., Parts A and B only with no supplement, could be disastrous under certain circumstances.
WillRetire
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Re: Original Medicare vs. Medicare Advantage

Post by WillRetire »

MGBMartin wrote: Sat Oct 01, 2022 9:27 am ...
I don’t know what you read about not being able to change plans but as far as I can understand you can change to a different MA plan or back to original Medicare every year during the annual change period.
...
MA yes. Original medicare: yes, but not necessarily medigap.
WillRetire
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Re: Original Medicare vs. Medicare Advantage

Post by WillRetire »

MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero
You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
A medigap plan covers some or all of the 20%. The OP's mother's decision here is whether to switch from Original Medicare+medigap to an MA plan her friends like. Original medicare alone is not a recommendation.
fposte
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Re: Original Medicare vs. Medicare Advantage

Post by fposte »

There's a kerfuffle in my university town because the state has just signed a new contract for Medicare Advantage, and the only PPO option isn't contracted with the huge provider in the area. While it seems probable it will work out as a passive PPO (since that's how the previous provider successfully operated), that's still a lot of state retirees who are freaked out that their insurance may not cover them at their regular doctors.

So I definitely agree with "if it ain't broke, don't fix it" on this. She's got something she can afford that works well for her. I would hang on to that with both hands.
WillRetire
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Re: Original Medicare vs. Medicare Advantage

Post by WillRetire »

MGBMartin wrote: Sat Oct 01, 2022 10:48 am
bradinsky wrote: Sat Oct 01, 2022 10:24 am
MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero

You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
MGB,
Did you not choose a MA plan over a supplemental plan? I have a G plan & recently had a hip replacement. My total out of pocket for that procedure was zero($0). I believe most people choose based on their personal health situation. We pay a monthly premium & are responsible for our yearly part B deductible. MA subscribers pay a much smaller premium & in some cases get their part B premiums refunded, while incurring more bills if a medical procedure is required.
Yes, we did choose MA over a supplement plan.
I had looked at all options and several reasons helped us decide to go with MA plans.
Where we are located has about 20 different companies offering MA plans and some of them advertise on TV to the point of being annoying. Most of these companies I wouldn’t touch as their networks are skimpy, providers too far away and I lack confidence in some. Most of them do the Part B give back, being Florida that is more prevalent here than others places I believe.

The company I chose is also the largest healthcare provider in the area and you can’t swing a dead cat without hitting a doctor or facility in my area and I don’t just mean network doctors or providers but actual BayCare offices or facilities. My wife’s plan is not so good and she may switch this year.
I really don’t worry about in or out of network because it is so easy to find a BayCare doc or facility.
If I lived in a different area with smaller networks or options I may be so keen and maybe choose a different option.

Our healthcare use is low and I expect it to stay that way for some time but I wasn’t expecting to need spinal surgery last year.
My wife and I both worked in healthcare for 40 years so that helped in some of the understanding of the various options.

If one thing stands out it is the absence of surprise bills, insurance telling me it’s not covered, even BCBS clawing back a previously paid claim almost 3 years after paying it; that in itself is a breath of fresh air.
MGBMartin: Glad you had a great MA experience with a serious health condition. You & spouse are very knowledgeable and you did your homework before making a selection.
nanciT
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Re: Original Medicare vs. Medicare Advantage

Post by nanciT »

I do think this is area specific. As mentioned above some people are very happy with Medicare Advantage and often there are additional benefits with vision and dental.

I have been researching Medicare as my husband and I will retire in the next year and switching over. The information I am getting from our county is that once you are on Medicare Advantage, it is often difficult to make any other choice. During yearly sign up, if I was to try and switch from an Advantage plan there is a time limit ( I believe 6 months). If not in that timeline, you can switch but there may be underwriting and Pre Existing illness may not be covered.

I would look carefully at this in your area. I have had patients in the past( I am a nurse) who have gotten stuck and unable to change.

I personally would not choose an Advantage plan, I am currently on a PPO and have all options especially specialty care I feel is really important.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

nanciT wrote: Sat Oct 01, 2022 11:27 am I do think this is area specific. As mentioned above some people are very happy with Medicare Advantage and often there are additional benefits with vision and dental.

I have been researching Medicare as my husband and I will retire in the next year and switching over. The information I am getting from our county is that once you are on Medicare Advantage, it is often difficult to make any other choice. During yearly sign up, if I was to try and switch from an Advantage plan there is a time limit ( I believe 6 months). If not in that timeline, you can switch but there may be underwriting and Pre Existing illness may not be covered.

I would look carefully at this in your area. I have had patients in the past( I am a nurse) who have gotten stuck and unable to change.

I personally would not choose an Advantage plan, I am currently on a PPO and have all options especially specialty care I feel is really important.
Some MA plan companies have a PPO option, 22 such plans in my area.
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Limoncello402
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Re: Original Medicare vs. Medicare Advantage

Post by Limoncello402 »

I'm new to Medicare as of this year, and I did a ton of research--too much in fact. I looked at Advantage plans carefully side by side with Original Medicare. Given what I learned I would never chose an Advantage plan. There were far too may loopholes and restrictions. I'd far rather pay higher prices for the best care/best options possible. Health can change on a dime.
notBobToo
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Re: Original Medicare vs. Medicare Advantage

Post by notBobToo »

To the OP, I recommend staying with the Original Medicare. Even if your relative is in one of the areas with good MA coverage (CA, CO, FL, DC, others?), why change if she can afford what she has and is satisfied with what she has?

I was recently notified that starting in 2023, my ex-employer would like all of its Medicare eligible retirees to move to a new group MA program. One can apparently stay with Original Medicare, but would lose the stipend that the company provides to pay for health care costs. (Which currently covers about nine months of Plan G premiums for DW and I.) The notification stated that 99.9% of retirees would continue to have access to their chosen providers. I ran a quick check and found that none of my providers are in network, although both of our prescription sets are fully covered, most at Tier 1 or Tier 2. So good news, bad news I guess. That would be my fear in switching to a MA program -- outside of the geographies that have very good MA coverage.
tallguy3891
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Re: Original Medicare vs. Medicare Advantage

Post by tallguy3891 »

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.
tunafish
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Re: Original Medicare vs. Medicare Advantage

Post by tunafish »

MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero
You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
The 80% is why people have Medigap plans which pay the 20% automatically, no effort on the patient's part. I would never have a MadicareAdvantage plan, where an insurance company decides if I get care or not. I went through enough of that as a young or middle aged person.
ModifiedDuration
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

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.
There is a Bogleheads wiki on Medicare:

https://www.bogleheads.org/wiki/Medicare

Also, the Federal Government’s “Medicare and You” publication is very good:

https://www.medicare.gov/publications/1 ... nd-You.pdf

In addition, books like Medicare for Dummies and Medicare Demystified.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

tunafish wrote: Sat Oct 01, 2022 1:21 pm
MGBMartin wrote: Sat Oct 01, 2022 9:55 am
fishandgolf wrote: Sat Oct 01, 2022 9:47 am POST A REPLY

py treatments, Medicare Advantage only cover 80% so you are responsible for the other 20%. I don't know if this is fact or fiction but I've been getting chemo treatments for the past six months (and continue to do so) but I have Original Medicare and PM The agent for our supplimental insurance policy (Physicians Mutual ...PM) said that if a person required chemothero
You’ve got that backwards.
Original Medicare only pays 80% for Part B and you are responsible for the other 20% and the is no maximum out of pocket.
My MA plan is 0 deductible, copay for some things with a maximum out of pocket of about $4000, my wife’s max out of pocket is even less.
So, if you run up $100,000 of Part B charges on original Medicare you would have to pay $20,000, my MA plan would be $4000 maximum.
The 80% is why people have Medigap plans which pay the 20% automatically, no effort on the patient's part. I would never have a MadicareAdvantage plan, where an insurance company decides if I get care or not. I went through enough of that as a young or middle aged person.
I was just correcting the statement that MA only pays 80% as that was incorrect.
Medigap is very good and if I had chosen original Medicare I would certainly include a Medigap supplement.
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Northern Flicker
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

I've framed my decision as original Medicare with supplemental insurance or a 5-star-rated MA plan (not considering lower rated plans). I generally trust the 5-star MA providers in my area to base care decisions on medical and not financial criteria. This is from familiarity with the systems, not based on their star ratings. I view a 5-star rating as a necessary condition of choosing a plan, but not by itself a sufficient condition for choosing a plan.

I have significant resistance to MA because if the selected plan degraded in quality, it would not be possible to switch to original Medicare with supplement without clearing underwriting for the supplement or moving to a different plan area. Having more than one 5-star MA plan to choose from mitigates the risk some, but I may only learn of the problems as a result of being in the midst of needing major care when it is too late to switch.

Not sure if the comment about switching back to original Medicare during the open enrollment the year before needing post-hospitalization rehab was a joke. The year cannot be predicted. And you would most likely not pass underwriting for a supplement. Even if you could predict the year, the lack of supplement would mean paying 20% of outpatient care in a year when it will be high. Those funds could instead be applied to self-paying for additional rehab time.
Last edited by Northern Flicker on Sat Oct 01, 2022 2:54 pm, edited 1 time in total.
cashmoney
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Re: Original Medicare vs. Medicare Advantage

Post by cashmoney »

WillRetire wrote: Sat Oct 01, 2022 10:32 am At her age, she should stay put. With original medicare + medigap, she has access to the widest possible network of doctors and hospitals with 0 or minimal claims work.

Yes, there are people who love their medicare advantage (MA) plan, and maybe they love it because it's cheap and they are happy with the network doctors. Or maybe they love it because there's no going back to medigap without medical underwriting and/or medigap plans are too expensive for them. So, human nature being what it is, they want to persuade all their friends to do what they did to rationalize it.

With medigap, the insurer has near 0 decision making logic when processing a claim. If medicare accepted it, so must they.

With MA, claims processing is more complex and claims can be denied. A service may not be covered (think rehab # weeks), or doctor is not in network and does not accept the plan (have experienced this). While it is true that some MA plans allow you to go out of network, realize that the provider *must* accept the plan; accepting medicare alone is not sufficient.

Do you really want your mother to have to perform a check as to whether the provider is *still* in-network, and if not, determine whether they accept that particular MA plan? Before receiving treatment each time? Then monitor claims & phone the insurer when one is denied? That's OK when you are on regular insurance from an employer. Not much fun when you are elderly, frail and/or sick.

The MA plans offer many perks like some limited dental and/or vision coverage. This makes the plans very attractive. However, those benefits are limited and do not help for serious medical treatment. Think cancer, open heart surgery, organ transplant, joint replacement, and followup rehab care for all those things.

Some retirees are severely budget constrained and cannot afford medigap premiums. Thank goodness MA plans exist for them. Also, I have heard excellent things about Kaiser Permanente's MA plans (and their non-medicare HMO plans). If I lived in an area that had KP and knew I'd never leave that area, I'd seriously consider it.

In many states, you cannot easily switch back to your old medigap plan at the same pricing level once you leave it. There is something about an allowance for switching back within 12 months but don't know if you qualify for same pricing you had before. Different people pay different premiums for the same medigap plan, depending on when they enrolled and other factors. Some pricing is "preferred". If someone switches to MA then back to medigap within 12 months, I don't know what pricing group the medigap insurer will put them in.

MA plans can (and do) change from year to year. Networks change. Coverage changes. An MA plan might sound good now, but what if they change it in a year or so?

MA plans are available to everyone to switch to once a year during annual enrolllment. Your mother should take her time and get all the facts. No rush. She can switch next Fall if she really wants to.

Perspectives from Clark Howard and Investopedia:

https://clark.com/insurance/health-insu ... age-plans/

https://www.investopedia.com/articles/p ... better.asp



"MA plans can (and do) change from year to year. Networks change. Coverage changes. An MA plan might sound good now, but what if they change it in a year or so?"

Not advocating Medicare Supplement or MA but the argument that a big pitfall of MA plans vs Medicare Supplement is the changes possible goes both ways.Medicare supplements almost always will increase premiums annually due in part to the part A and B deductible increases each year and also the part D plan premiums usually increase.The trend for the last 8 years or so in many markets has been that MA plans have been improving each year in both benefits and provider networks and the trend continues for 2023.(i.e many plans including PPO's in 2023 are offering 1500-2500 in dental at 100% with almost no restrictions as well as lowered medical copayments and out of pocket maximums)If there was a seismic shift in funding to the MA program that could affect it obviously but that seems politically unlikely since most people on MA like their plans.The single biggest differentiator IMO between Med supp and MA in areas where good MA plans are available is not so much financial worst case scenario but willingness to accept managed care vs fee for service medicare to get a plan with 0 premium and possible very little out of pocket medical cost with all the extra benefits not covered by original Medicare and supplement.Many people here wince at the word managed care but believe it or not some people actually like it and some people would be worse off if they didn't have it.



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MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

cashmoney wrote: Sat Oct 01, 2022 2:47 pm
"MA plans can (and do) change from year to year. Networks change. Coverage changes. An MA plan might sound good now, but what if they change it in a year or so?"

Not advocating Medicare Supplement or MA but the argument that a big pitfall of MA plans vs Medicare Supplement is the changes possible goes both ways.Medicare supplements almost always will increase premiums annually due in part to the part A and B deductible increases each year and also the part D plan premiums usually increase.The trend for the last 8 years or so in many markets has been that MA plans have been improving each year in both benefits and provider networks and the trend continues for 2023.(i.e many plans including PPO's in 2023 are offering 1500-2500 in dental at 100% with almost no restrictions as well as lowered medical copayments and out of pocket maximums)If there was a seismic shift in funding to the MA program that could affect it obviously but that seems politically unlikely since most people on MA like their plans.The single biggest differentiator IMO between Med supp and MA in areas where good MA plans are available is not so much financial worst case scenario but willingness to accept managed care vs fee for service medicare to get a plan with 0 premium and possible very little out of pocket medical cost with all the extra benefits not covered by original Medicare and supplement.Many people here wince at the word managed care but believe it or not some people actually like it and some people would be worse off if they didn't have it.



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Your last sentence is spot on in my case.
I’m not afraid of managed care. My care has been managed very well and I feel my current choice is doing a better job of it than any other insurance I’ve had in the past.
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JoeRetire
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Re: Original Medicare vs. Medicare Advantage

Post by JoeRetire »

fishandgolf wrote: Sat Oct 01, 2022 9:00 amOne of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details.
Depends on the state.

Some are more lenient in switching, others are not.
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JoeRetire
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Re: Original Medicare vs. Medicare Advantage

Post by JoeRetire »

fishandgolf wrote: Sat Oct 01, 2022 9:47 am The agent for our supplemental insurance (Physicians Mutual) said that if a person needs chemotherapy, Medicare Advantage only cover 80%.....you would be responsible for the other 20%.
Remember that supplemental insurance is not Medicare Advantage.

When I had my chemotherapy treatments, my Medicare Advantage plan (not Physicians Mutual) covered them completely. It's important to read and understand your prospective plan's list of benefits.
Last edited by JoeRetire on Sat Oct 01, 2022 4:11 pm, edited 1 time in total.
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MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

JoeRetire wrote: Sat Oct 01, 2022 3:47 pm
fishandgolf wrote: Sat Oct 01, 2022 9:47 am The agent for our supplemental insurance (Physicians Mutual) said that if a person needs chemotherapy, Medicare Advantage only cover 80%.....you would be responsible for the other 20%.
Remember that supplemental insurance is not Medicare Advantage.

When I had my chemotherapy treatments, my Medicare Advantage plan (not Physicians Mutual) covered them completely.
Agents may just be sales people and they may be leading you to something that earns them commission or more commission.
I am sure there are some good agents but like anything I like to go in understanding as much as possible.
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Northern Flicker
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

The study of outcomes reported on here is interesting. The study was funded by the Better Medicare Alliance, which I believe is an organization that advocates for Medicare Advantage, so not an unbiased source of funding.

The study would be more useful if it separated original Medicare subscribers by whether or not they have supplemental insurance and reported the outcomes for each group.
jmw
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Re: Original Medicare vs. Medicare Advantage

Post by jmw »

If you are broke in retirement, choose MA. If you are so hard up for money that you need the lower cost and part B refund, then do it. Just realize at age 87, it's an almost guaranteed one way trip. When she finds out later she is better off with original, she probably can't pass medical underwriting to go back. I know about the "secret" tricks to going back to original Medicare, but for the sake of discussion on this particular forum let's pretend that they don't exist and an 87 year old person shouldn't have to jump hoops like that. There is also the hassle of dealing with a new pharmacy plan, a different and less generous formulary, and possibly restarting step therapy due to lack of history.

Otherwise stop being cheap and keep Original Medicare with Medigap. She needs to quit listening to financial advice from broke people at her place.
TheGiantess
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Re: Original Medicare vs. Medicare Advantage

Post by TheGiantess »

Mt mom is 90 and has original Medicare and supplement and pays about $400 a month for all parts A, B, D. She has had two major hospitalizations over the past few years and both times she was able to go from the hospital to acute rehab because she had original Medicare. She also received 3 months of home healthcare after and the OT and PT told her that MA plans would only allow a few weeks of in home therapy. If your mom can afford it, I think she should keep it. My mom has many friends who are on MA plans and they pay very little and sometimes she wonders if she's a fool but then when she really needs it, it is there and she pays nothing out of pocket except some drug copay. Not saying MA plans are bad but several medical people told us that since she had original Medicare, she received more extensive services. No one knows in the long run what is best, most cost effective. A friend on Medicare told me that you can try out MA for one year and then go back to original Medicare but if you go longer than a year you would have more problems going back to it.
TG
billfromct
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Re: Original Medicare vs. Medicare Advantage

Post by billfromct »

I didn’t see any mention of contacting your local state SHIP (State Health Insurance Assistance Program, I guess leaving out the “A” makes it easier to remember) office for specific local Medicare information.

I believe that every state has a SHIP office but my understanding is that the contact is done over the phone.

They are unbiased & know about the local Medicare Advantage & Medigap offerings.

bill
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fishandgolf
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Re: Original Medicare vs. Medicare Advantage

Post by fishandgolf »

Thank you BH's for all your comments. I decided to pose this question to this group knowing I would get the correct answer.

Based on her age an potential complications that could arise by switching plans, DW and I will recommend that she stays with her
current plan, which is Original Medicare and a supplemental insurance plan.

I do appreciate all your comments and suggestions. We decided to do the right thing and go with the recommendation: "If it ain't broke, don't fix it!".
chemocean
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Re: Original Medicare vs. Medicare Advantage

Post by chemocean »

jebmke wrote: Sat Oct 01, 2022 9:33 am
chemocean wrote: Sat Oct 01, 2022 9:29 am Advantage plans are private insurance, so the insurance company is making the decision about treatment. You can appeal, but the first two levels of appeal are within your advantage system. Only at the third level of appeal so you get an impartial Medicare administrative judge. This condition is especially important with skilled nursing after hospitalization . Some insurance companies are notorious for denying further needed skilled nursing after hospitalization. I plan on switching to the Original Medicare during the open season the year before I need skilled nursing after hospitalization
What are the chances that the underwriters would refuse to take you?
None. My understanding is moving to Original Medicare from an advantage plan does not require underwriting. The issue is finding providers that accept Medicare, as I have read in the media.
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Sandtrap
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Re: Original Medicare vs. Medicare Advantage

Post by Sandtrap »

fishandgolf wrote: Sat Oct 01, 2022 9:00 am Greetings Fellow BH's:

My mother-in-law (87 years old and very healthy.....with some exceptions) has been on Original Medicare for many years. She's a very active social person and recently several of her "social acquaintances" initiated a discussion on the subject of "Original Medicare vs. Medicare Advantage".

Many of these folks are on "Medicare Advantage Plans" and have been giving her a hard time about the costs she incurs on "Original Medicare" (she can easily afford the cost). They have nearly convinced her that she needs to change her plan......and she's in a serious quandary about doing so and has reached out to us. It's been a long time since my wife and I have researched the pros and cons of each plan. One of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details. I would appreciate it if there are any BH's intimately familiar with this subject and could offer a few pros and cons of each program; it would be very helpful to put my her mind at ease..... :?:
This might be a useful example:
(dis laimer): that applies only to DW and I in our area and coverage, etc.

We have "Original Medicare" with Part F Supplemental, plus additional supplementals.
The distinguished "Mayo Medical Centers" take our coverage. They do not take "Medicare Advantage".

Also: (in our area and our coverage etc) "Medicare Advantage is an "HMO" so you have to work with the "network". . . whereas "Original Medicare" is more open and choices and so forth can be to your benefit, sometimes greatly.

"Original Medicare" is federal. . per se. .
"Medicare Advantage" is private. . per se. . (some higher deductables and coverage limits, etc, than "Original". . but. . it depends).

To OP:
*** It is very important that you try to get a good comprehensive look at your present and future health care needs, and then get the plan/s that will fit your best as far as medical coverage, finances, etc.
(what might be excellent for someone in great health and continues that way might be terrible for someone in other circumstances.)

I hope this is helpful
j :D
dislaimer: many ways to do things and opinionizations based on nil to zero to extensive experience.
This is only one that applies only to DW and I.
Everyone is different.
Last edited by Sandtrap on Sun Oct 02, 2022 10:09 am, edited 1 time in total.
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Good Listener
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Re: Original Medicare vs. Medicare Advantage

Post by Good Listener »

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.
In my opinion he's absolutely right. I suppose if you can't afford the two or $300 a month for the supplement then I suppose you do Medicare advantage. But otherwise as you get to be 80 and 90 do you really want prior authorizations? And whoopee they throw in a couple hundred bucks worth of dental and a gym membership which you probably won't use. They're making a bundle and as an investor that's great but as a patient why bother?
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dodecahedron
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Re: Original Medicare vs. Medicare Advantage

Post by dodecahedron »

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.
I don't know who Clark Howard is, but I am uninterested in his opinion because I don't think he has a clue about my circumstances.

Medicare Advantage is great for me. I have a nationally top-ranked five star Medicare Advantage PPO plan with a great network and the docs in my area love it. The PPO option allows me to see any out-of-network physician who accepts Medicare, but so far every provider I have wanted to see has been in network.

And--in my state (NY), if I should ever develop a major issue I am unconditionally allowed to switch back to Traditional Medicare plus Medigap pretty much any time I want to, with as little as a month's notice or less.

So, to the OP's question, it is impossible to give a generic answer. Some places have no Medicare Advantage plans, some only have mediocre or poor options, some have great ones. And in most states (fortunately not mine!) you have only a limited window of time to switch back to traditional Medicare plus Medigap without the risk of underwriting being required.
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AnnetteLouisan
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Re: Original Medicare vs. Medicare Advantage

Post by AnnetteLouisan »

I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
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