Off Topic: Medicare Classic or Medicare Advantage?

[Bolt_Upright]

My wife needs to sign up for Medicare. I figure there are some Americans on here that have an opinion on going with Medicare Classic plus Medigap supplement and Part D, or just going with Medicare Advantage. Watched a webinar yesterday and they made Medicare Advantage look really good.

[wifeofparky]

I've had a Medicare Advantage plan since I was eligible for Medicare. So did my husband who had PD. I currently have a $0 premium plan and my copays are reasonable. It also includes my drug coverage.The plans have really evolved over the years. I strongly suggest you find a Medicare Broker who operates in your area. DO NOT call one of the 800 numbers you see on TV. They may not give you the best recommendation. I'm not sure where you live as each State has National as well as local insurance companies and the benefits can vary from State to State.

[Bolt_Upright in reply to wifeofparky]

Thank you so much for the advice. My wife has the number of the Medicare broker her sister used. They are in state. Thanks!

[KERRINGTON in reply to wifeofparky]

We have Medicare Classic. Ask the providers you're interested in what limitations there are on doctor and hospital selections.

[laglag in reply to wifeofparky]

I had 17 phone calls a couple of days ago and not one left a message.

[Jeannieo in reply to wifeofparky]

Excellent advice! I have a Medicare advantage plan and I love it

[Lizzy9]

I don’t know if this helps or not ~ we have just an”regular” Medicare plan with a deductible. We also have a supplemental plan that allows us to see any doctor anywhere (at least in the US). That was super important to me. I didn’t want to be locked into only a few “acceptable” providers. We also have to pay for our prescription plan. At the time we weren’t on any meds so got the cheapest. We’re ok with that.

Good luck deciding & have a fabulous day!!!

[Bolt_Upright in reply to Lizzy9]

Thanks Lizzy9!

[Lizzy9 in reply to Bolt_Upright]

You’re welcome!!!

Blessings ~ Gail

[park_bear]

Strongly recommend classic. Why Medicare Advantage is unsuitable for anyone:

Friend of mine had brand X Medicare Advantage from a brand X integrated healthcare provider. She went to a regularly scheduled doctor visit at their clinic debilitated with the flu. The doctor ordered her to the ER. She went to the brand X ER, whereupon she was revived with a saline IV, plus was given an MRI over her protests.

Subsequently the brand X Medicare Advantage health insurer declared the visit was "unnecessary", even though it had been mandated by one of their very own doctors. She received a bill for $19,000 - for $10 worth of saline and an unnecessary MRI. It took getting the state's commissioner of insurance involved to get this reversed.

Medicare Advantage is private insurance and they will try to screw you to increase their profits. There is no penalty for this behavior - the worst that can happen is they will be forced to make it right, as they should have done in the first place. So there is every incentive to continue.

[wifeofparky in reply to park_bear]

Not sure where you live but my husband and I never had a problem getting what we needed or seeing who we want to see. Out of pocket costs are predictable. No deductible and we only paid a reasonable copay. With straight Medicare there is a deductible and you pay 20% of the charges so you have little knowledge of the cost till the bill arrives. Supplemental plans are costly and if you add up all those costs it is not cost effective. Our Medicare Advantage plan has a $0 premium and includes drug coverage.

[kgold]

My husband (PWP) has Humana Medicare Advantage and I have Anthem BCBS Medicare Advantage. We have been generally happy with both. They are PPO not HMO. I broke my wrist while travelling and wound up in an ER. No problems with payment. I then had to have surgery when I returned home. That was out of network so I did have to pay a bit more. My TOTAL bill was close to 20K of which I paid a little over 1K. For the low premium I pay every month, I didn't think that was too bad. For me, I look at my coverage as major medical because I tend to go outside of traditional medicine. My husband just the opposite. I would also recommend you talk with a broker who deals specifically in Medicare.

[Madame-Mango]

I have to make that same decision choice later this year and am now sorting through the confusing options.

Super-helpful: the YouTube videos from Boomer Benefits.

They are a broker with licensing in 48 states (not MA or NY) with > 3200 five-star Google reviews. (I have no affiliation with them.)

youtube.com/c/BoomerBenefits

For example, I learned that if I choose an Advantage plan in the first few years, but later, want to expand my options for care by switching to Original Medicare + a Medigap plan, the Medigap insurance providers can ask health questions (medical underwriting).

With a diagnosis of PD, I can be denied coverage or charged a higher-than- usual premium. (It seems Medigap plans are exempt from ACA's coverage terms regarding "pre-existing conditions.")

I could go without a Medigap plan coverage, but then I'd be responsible for the 20% of expenses that Original Medicare doesn't cover--and there's no cap on that.

BUT if I choose (and stay) with a Medigap plan from the start (enrolling within 6 months of being eligible for Plan B, if I recall correctly), that is the ONE and ONLY time I can't be denied (no health underwriting). This bit of info I find VERY important to know from the get-go!

As a result, I'm leaning toward Original Medicare + Medigap + Plan D so I won't feel stuck in an Advantage plan for the long-term.

[Bolt_Upright in reply to Madame-Mango]

Yes, we had read about that only getting one shot at a Medicare supplement. Trying to balance that against no premiums. Thanks!

[Ucheecha]

I am a volunteer Medicare counselor. We’re all over the country, and are unbiased resources with information and advocacy to answer questions, help figure out costs and help you get financial help if you qualify. We’re not allowed to give advice but we can explain some of the differences between Medicare options. There’s no one right choice for everyone but as was mentioned in another post, if you forgo classic/original Medicare when you first enroll it may be too late later, unlike Medicare Advantage. Medicare Advantage is doing heavy advertising to dominate the market share. Please don’t listen to the marketers, get information from neutral sources. To find these volunteer counselors google SHIP Medicare in your state. One more tip: make sure you enroll when you turn 65 unless you or your partner are still working and are covered by current employer insurance. If you’re not one of the few exempt folks, you may have a financial penalty for waiting, even if you’re getting retiree insurance.

[Jana86]

As the plans available depend on geography, (different sets of plans are offered in different states depending upon which private insurers are operating near you). The decision is really about risk tolerance within your specific health care situation. From our research: (1) Medicare Advantage offers a wider array of partial pay benefits with a one sign up point of sale. (2) Traditional Medicare requires two additional policies, one to cover the 20% that traditional Medicare does not pay, and one for prescription coverage.

I created a spreadsheet for each option based upon our health history, hospital use, and projected need for care. Given our ages and health issues (me: heart problems and PD; husband: heart problems and diabetes); we chose a higher cost monthly pay out for traditional Medicare and supplemental insurance that leaves us paying no deductibles or co-pays. We felt we both had higher than normal risk for hospitalization and in the Medicare Adv plan available in our area, the deductibles for hospitalization were very high....about 35% of the cost. One hospital visit of 3 days would wipe out the partial benefit payments from Med Adv. for an entire year. As well, our adult children and their families are in multiple states so portability is important to us and we have traveled outside the US (pre COVID) and our insurance includes medical care in other countries.

As it turned out, we were right. My husband had two major hospitall stays the following year...cost was about $250,000; 35% under Med Adv would have been more than $80,000. Actual cost to us: $0 beyond our normal monthly premium.

I look forward to your posts...you seem to be a person that does good due diligence. Those skills will come in handy as you figure this out.

[Bolt_Upright in reply to Jana86]

Thank you so much Jana86! I watched a webinar on Medicare Advantage and got the impression there was a cap. Time to dig in more. Thanks!

[Agnes1234]

I am a Medicare counselor like ucheecha and can vouch for everything they say about speaking with a neutral party like a SHIP counselor in your state to get free, unbiased and confidential information. Personally, if finances are not a huge issue for you, the Original Medicare, Medigap Supplement and Part D drug plan is the best option. Yes, there is a fee for the supplement and Part D plans, but the flexibility of choosing providers (and by providers I mean doctors, hospitals, skilled nursing, home health) is of utmost importance when one has a chronic illness. And, as mentioned, there is a finite window of time or conditions when you are allowed to enroll in a Medigap plan without undergoing medical underwriting. If paying these premiums are just not financially feasible, then a Medicare Advantage PPO will offer the next most flexible choice within their panel of providers--however the Maximum Out of Pocket (MOOP) for a PPO is around $5-7K per year. If you have a bad year, then you will need to fork out this maximum amount for that year--and it resets to zero the next year. If you see alot of different doctors right now, you must make sure that they all take the XYZ plan, otherwise you might have to find a new provider within that network. Talk to your SHIP counselor and they can really help sort things out based on your situation.

[Bolt_Upright in reply to Agnes1234]

Thank you. We will find a SHIP Counselor!

[park_bear]

Medicare part D is also relevant. This is handled entirely by for-profit insurance interests. I picked the provider that seemed to be optimum for my meds. Until they arbitrarily raised prices for me in the middle of the year. It turned out to be cheaper to pay cash at Costco mail-order pharmacy.

[faridaro]

I would suggest a great book "Get What's Yours for Medicare" by Phillip Moeller. It's very well written, provides different case scenarios and good explanation of "the alphabet soup" of 10 medigap plans if someone choses to go that route.

[Bolt_Upright in reply to faridaro]

Thanks!

[LindaP50]

Both my husband and I have Humana Medicare Advantage and Humana for drugs as well. We have a plan with $0 premium. With our plan we use the doctors listed in network. There are other plans with both original Medicare and Medicare supplement which offer the opportunity to visit any doctor of your choice - I review our records and needs each year to see if we would need to change our plan for a wider network of doctors. Open enrollment - you have a choice each year from early October to early December to change your plan.

We verify our doctors are on the plan and for the RX we verify that our current meds are on the plan and are $0 or very low copay. At some drug stores we use GoodRX instead of our plan if a doctor is giving a med for just a few weeks.

I'm in NYS. On medicare.gov there is a list of all the Medicare insurance companies and you can do a comparison. medicare.gov/

Then I also called a SHIP counselor. Especially the first 2 years with Medicare. After that I can compare on medicare.gov. They are pros, get guidance from the counselors.