I pay no premium to United Healthcare for the Medicare Advantage Plan which replaces Medicare , my supplemental plan and my prescription plan . I think I paid around 200 monthly for the supplemental and Rx plan. So I save 2400 annually. I guess the supplemental would cover the %20 co-pay if I switch back . Co-pays on Advantage plan are 26 X 60 = 1560 . The Advantage plan has 6700 cap on catastrophic expenses which Medicare doesn’t have. How do I figure out where’re to stay or go back to Medicare ?
Also , someone mentioned not being able to get a supplemental plan again due to pre-existing conditions . Thanks in advance for any advice .
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I've thought about this scenario as well, but in the context of $40 copayments for physical therapy. It looks like you'd be at about 65% of the $2400 if you stay with the advantage. Also unless you're in a "guaranteed issue" state you may not be able to pass underwriting for a supplement. Good luck with the radiation.
I'm not on Medicare yet (I have 2 years to go) but have been researching the options so I'm very interested in this post. The links provided by cesces above will be helpful for you in determining if you can switch back to a medigap supplimental plan without having underwriting done by the insurance company which could deny you coverage or greatly increase the monthly amount. I wasn't aware of the "guaranteed issue" state thing mentioned; I live in Georgia so I seriously doubt that would be an option for me in the future. One of the main reasons I believe I will go with original Medicare and a part D and supplemental (Plan G) is with an Advantage plan you are limited to the doctors "in network" for the plan. In your local area or state I'm sure the United Health Care has many great doctors (I currently have UHC through my employer and am happy), but if my case goes bad and I want to go to a MO that is a national known specialist (like the Mayo Clinic or similar), as long as they accept Medicare I can see them if I'm on original Medicare. I'm curious, on your old supplemental plan was there an out-of-pocket max that you would spend?
Big +1. Considering the relentless advertising the insurance companies do every fall - I'll receive 2 to 3 mail items for "save money" "get what you deserve!" per day for about 2 months, and at least 1 sometimes more phone calls (to my unlisted number) - it would lead one to believe there are some large profits to be made via "Advantage" plans.
We have this discussion every Thanksgiving dinner between those of us on regular Medicare (Part D and Plan G) and the advantage fans. Thing is - the advantage users either don't look outside the plan network for service or have never actually been sick and needed medical services.
As cesces said "no one here" - I'd agree with him.
There has never been any issue about coverage for wherever I wanted to go for treatment. 2nd and 3rd opinions - just make an appointment, no permission needed from anywhere. Physical therapy - you can go about 8 weeks 2x-3x/week or so with no prescription needed, just walk in and hand them your card. If you then need PT for something different - walk in again - no prescription needed. If you need to continue the PT past the Medicare allocated amount without a prescription - if you get an MD prescription for PT, those limits disappear. The prescription has to be renewed every 8 or 10 weeks I believe, but it's never been an issue. When I sent my biopsy samples to Epstein at JH for a 3rd opinion - Medicare paid - no questions.
The "Advantage" plans tout things like "Silver Sneakers" gym memberships - out of curiosity I looked into what that actually means. In my case - with multiple gyms within 5 miles of me - the nearest gym that accepted their Silver Sneakers coverage was about 25 miles away and it was a very limited program. The eye care seemed to be a discount on glasses (pretty easy to beat just with some of the big chain eye places) and dental was limited on what was covered, what was covered the first year (quite limited) and who would accept their plan. I've asked the people sitting around my dining room table at Thanksgiving how many of them had taken advantage of any of the "features" like these - and so far - none of them have.
I imagine if you never get sick, and plan on suddenly keeling over someday a Medicare Advantage plan might work well for you. In my case I'd rather pay the extra to stay on regular Medicare and never worry about paying for treatments that an insurance company decides I don't need or aren't ready for.
YMMV.. and I'm sure some of you are happy with advantage plans.
But major treatment and expensive end of life stuff, maybe not.
I think I prefer AARP United Healthcare because that's likely the last one private equity will buy up to then improve it's profitability at the expense of the captive insureds.
That sounds like the voice of experience . I hope you’re wrong . Based on those links you kindly posted I don’t qualify for a supplemental without underwriting if I wanted to quit my Advantage plan and go back Medicare.
My Medicare Advantage plan is a PPO which allows me to see doctors at Sloan Kettering in NYC and be covered even though I am a SCarolina resident. Sloan K doesn’t participate with Advantage plans but they bill them as if they were plain old Medicare. It paid for doctors at Johns Hopkins in Md. United Healthcare even paid for about half of my PSMA -PET SCAN in Virginia. ( I paid 1500 out of pocket )
I don’t remember the details of my supplemental plan . There doesn’t seem to be an issue with my PPO Medicare Advantage plan about seeing doctors out of my geographical area. They have paid for Johns Hopkins and MSK in NYC
In December, I signed up for PartB, plus PartF-HIghDeductable ($42/mo) with Cigna with a yearly deductible of $2450, and the cheapest PartD I could find ($7/mo). Total OOP is about $220/mo. Not on any treatment now, rolling the dice that when I do, lower premiums will make up for the higher deductible. Saving about $150/mo with the Hi-Deduc, so that's about 16 months to breakeven.
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