Need A Suggestion About Medical Insurance: Original Medicare or Advantage Plan

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plantcityguy

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Jul 2, 2012
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Plant City, FL
If things go like I plan, this 72-year-old guy will be full-timing beginning this summer. Am I right to assume that I should change from my current Advantage plan to an original medicare plan? I have a short period of time to do so if I want to make the change.

I appreciate any help you can give me.
 
Most of the "Advantage" plans I looked at were HMO style. While these generally have provisions for emergency coverage while traveling, they are restricted enough that we chose to go with the "original" Medicare with a supplement that also had national coverage.

That said we still maintain our primary Doctor relationships at our winter base in Phoenix, so I am not all that sure we couldn't actually get away with an advantage plan - I just personally don't want to take a chance.

ken
 
 
Thanks, Ken. Good information. I am getting ready to call my Advantage company, perhaps tomorrow, to get some advice. Also, they are apparently the ones who can switch you to the original medicare plan.

I appreciate your help.

Larry
 
Plantcityguy,

When we did our research before signing up for Medicare, I checked into several of the "Advantage" plans and found they had limited, restricted or no coverage out of my area. So, like Ken we went with the original Medicare.  If you are able to switch over via your Advantage provider, after the enrollment period, that would be some good information to know for folks with Advantage programs.

Marsha~
 
Thanks, Marsha. The reason I am asking the question now is that you have a window from January 1 through February 14 (called the Medicare Advantage Disenrollment Period) when you can move from an Advantage Program to Original Medicare. If I were to request to be disenrolled in January, they would move me off the Advantage Program on the 1st of February - in other words at the beginning of the next month.

After talking to the people at my Advantage Plan this week, I probably will make the move. If so, I'll post what happens.

Thanks again for your help.

Larry
 
Larry, thanks for the info.  That's nice to know.  I guess since I had not deal with the Advantage programs, I didn't know you could switch. 

Marsha~
 
It really depends on your particular Advantage Plan and your travel intentions. My Advantage Plan, an Aetna PPO type, covers me nationwide and gives access to any Medicare-qualified provider. The reimbursement rate is the same for their network providers or an out-of-network provider who accepts Medicare (in other words, they pay the Medicare rate to both), so I have no problem at all getting medical care wherever Medicare is available. But not all Medicare Advantage plans are like that, so you need to investigate yours. If yours is an HMO type, you need to think carefully about the number and location of its HMO providers vs your travel itinerary.

Traditional Medicare (Part A + Part B) gives you more assured access to treatment wherever you go, but almost always provides less benefits than any Advantage Plan. Terefore there is a tradeoff between what you get and accessability.
 
Obama care is eliminating the 14 billion $ per Federal subsidy the Advantage plans have had and that will have some impact on the plans. For that reason I guess I would opt for regular Medicare.

The excerpt below is from this site HERE

"Even though the companies that offer Advantage plans have said they will keep the impact to a minimum  , it  is improbable that most Medicare Advantage members won?t be affected in  one way or the other.  However, changes will be gradual and it?s unclear  what the long-term effects will be as Medicare Advantage plans continue  to compete for business and other healthcare reform requirements (such  as having to spend 85% of payments on actual benefits) kick in."
 
The first step of the changes to PArt C (Advantage plans) was applied in 2013 and my premium didn't change. The federal formula for Advantage plans is extremely complex and the adjustments being made are no less so. Still, eventually that $14B has to come out of somewhere, assuming it ever actually materializes. Some experts think it will not. In any case, I wouldn't base any near term decisions on that - 2013 is a known situation and we all get a chance to re-evaluate Medicare options again in 2014 - and each and every year thereafter.
 

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