Have you signed up for Medicare yet?

[Kirk]

Due to a discussion of regular Medicare versus Medicare Advantage plans, I dis some research on ways to compare the two plans. The Medicare website has a very basic comparison chart for the two but with very little indepth information and so many of the more easily found sources are from insurance companies that also sell Advantage and/or Medigap plans. For that reason I am going to share the article from Consumer Reports as it might be helpful.

The Pros and Cons of Medicare Advantage​

 

[Boat Bum]

I just signed up, they don't make it easy to understand it all.

 

[Larry N.]

A nice article, Kirk- thanks for posting. It confirms (for me) my decision to avoid the Advantage plans, since there are too many possible traps that could turn expensive.

 

[UTTransplant]

I was lucky enough the company I retired from had an excellent Medicare counseling service. a few months before I was eligible they set up a phone call. Asked all the pertinent questions about health and our plans for retirement, then went through a few options before they got us signed up. Very easy and extremely helpful. For the record, i have a Medicare H supplement through BC/BS and a prescription plan. Kevin is on a Medicare G supplement that wasn’t available when I signed up. So far so good - 5 years for him and almost 3 for me using it all across the country. Travel coverage is a really big deal for RVers, and a lot don’t consider that.

 

[PaulBates]

My initial signup date is next July; I‘ve been looking for experience vs ads and really appreciate this post and watching more with interest, @Kirk !

 

[Kirk]

I‘ve been looking for experience vs ads and really appreciate this post and watching more with interest

Here are two more that I found which should be pretty much unbiased.
From Web MD How Original Medicare And Medicare Advantage Differ
From Nerd Wallet Medicare vs. Medicare Advantage: Which Should I Choose

 

[Larry N.]

For the record, i have a Medicare H supplement through BC/BS and a prescription plan. Kevin is on a Medicare G supplement that wasn’t available when I signed up.

We were forced into this individual plan structure when the med stuff changed (we were already on Medicare with a company supplement), so are using a Medicare F supplement (grandfathered) with a company limited reimbursement for the cost.

 

[docj]

As we age, we are all increasing subject to one or more of the health issues common to the elderly. (Gee, I really hate to think of myself as "elderly". LOL) Many of these will be common problems the treatment for which is relatively straightforward. In this category I include things such as Type II diabetes, high blood pressure, etc.

But sometimes we draw a card for a condition for which the treatment is a bit more complicated. Six months ago my wife was told she had an epiretinal membrane which needed to be removed. Anyone who wishes can read about that condition, but the treatment for it involves having a surgeon stick instruments into your eye (while you are awake, of course), remove the liquid in the eye, and then very, very carefully peel a membrane off the surface of the retina. After the membrane has been removed, saline is squirted into the eye to "fill it up."

I don't know about anyone else, but the first time I read this description I nearly tossed my cookies! LOL

Because of the delicateness of the procedure we wanted to find a top-notch surgeon. Our ophthalmologist referred us to one of his colleagues, who, I'm sure would have done a totally acceptable job. But we wanted the best for my wife so we searched for a retina surgeon with the best set of credentials. We found one in a practice in Houston that does nothing BUT retinal surgery.

I prefer our Medigap plan because I knew that, no matter what surgeon we selected, the out-of-pocket cost to us would be the same---zero and we didn't have to worry about a referral to an out of network provider. That's why we will always use Medigap. JMO

 

[Tom]

Thanks Kirk. We had a couple of threads on this subject several years ago; Doesn't look like much has changed.

When Chris first became eligible for Medicare, we signed her up for a Humana advantage plan. The first year, she fell and broke her leg while we were at our second home in Ohio. That's when we found that the advantage plan didn't cover her because we were out of our home state (CA) and out of network, and it cost us a bunch of $$$$. When the next year's open enrollment came around, we switched her to the same Blue Shield supplemental plan I was on, and we've both had expensive procedures covered.

 

[Gary RV_Wizard]

Most of the complaints & traps in Advantage plans derive from many of them being HMO-type policies with regional restrictions or limited access to doctors and facilities. PPO-type Advantage plans have almost none of that. I've been on an Aetna nationwide PPO for a decade and never had a problem getting coverage or access to medical help even as we traveled across the country. I'll be switching to an MA plan from UHC for 2023 due to a change in my IBM retirement healthcare plan, but it is very similar.

That said, people with chronic diseases (cancers, COPD, kidney failure, etc) are generally better off under regular Medicare plus a Medigap Supplement and a Part D drug plan. You will pay more in premiums but offset that with no copays.

If premium costs are of little concern, you can always buy better coverages than any Medicare Advantage plan. It's the folks who have to consider out-of-pocket expense vs access to care that have to make possibly tough decisions.

Nowadays people are falling for the flood of tv advertising that promises oodles of give-backs and extras (all legit) without looking into the details of co-pays, in-network vs out-network, regional restrictions, etc. It should be obvious that the insurer can't give you big refunds of the Part B premium without limits elsewhere, but they see a "free lunch" and grab for it. The shortcomings aren't apparent until they have a serious health problem. You still have to do your "due diligence" when you select a healthcare plan. Medicare isn't perfect either, starting with its low payout (80% of the billed amount).

 

[chuckbear]

My biggest concern has been that these so called "plans" can deny coverage that my plain old medicare would cover. I use my VA coverage as my supplement. Chuck

 

[Gary RV_Wizard]

They can't actually deny anything that Medicare would have covered, but they can make your doctor jump through hoops that many of the docs simply refuse to do. Doctor's don't like anybody second-guessing them (including their patients)! So yeah, you will hear war stories about denials. I had an spinal MRI denied last year when my Pain Management doctor ordered it. He ordered it because he was pretty sure I would need surgery in addition to his injections, but my insurer challenged it because it is not normally needed for pain management therapy. Two weeks later I met with the neuro-surgeon and he immediately ordered the same MRI and it was approved right away. My point is that treatments that are considered standard medical practice don't get frivolously denied, but exceptions can be difficult to justify.

I don't want to come across as a champion of MA plans for everybody, but I see a lot of scare stories being spread, by both medical professionals and the media.

 

[Oldgator73]

We have “plain ole Medicare“ and Tricare for Life. No copays except if we get prescriptions at a on off base (Dover AFB) pharmacy. Where you run into problems with Medicare is if you need treatment out of the country. Medicare doesn’t cover anything out of country. We were in that position when my wife took ill on a cruise and got sick in Barcelona. We had trip insurance and coupled with Tricare Overseas. The $2000 bills ended up to $200 out of pocket.

 

[JudyJB]

I have had traditional Medicare with a grandfathered Plan F for 10+ years. One of the things I REALLY like about the supplement plan is that I can decide to go to a specialist and not have to get permission or a referral to anyone. I had/have CLL (Chronic Lymphatic Leukemia) since 2016. I had some time to choose a specialist and decided on one in Eugene, Oregon because he did research and saw mostly CLL patients. (Many oncologists will treat this disease, but most see only a few CLL patients each year.) He also managed several research programs so I would get top-of-the-line treatment.

Living in a motorhome full time made it easy to head to Oregon for treatment when I needed it. I am in remission, but I still get blood work done and have a telephone conference with my Oregon oncologist every 4-6 months. My oncologist is probably one of the top 10-15 in the country, and I was able to do my own research and make my own decision of who to go to for treatment!! No bureaucratic hoops to jump through, which is priceless. (Part of my decision, by the way, was climate since I knew I would have to stay there for 3-4 months, and did not want to stay in my RV in a very cold or very hot place, which eliminated MD Anderson for heat and Ohio State for cold! I eliminated Boston and Stanford on the basis of traffic.)

I got brand-new targeted medication treatment, by the way, not chemo, and while I had several monoclonal antibody infusions, I had no side effects from that or the pills I took for a year. Platelets dropped a bit, but no nausea, hair loss, weight loss, or anything else. If I go out of remission, I will head right back to Eugene!!

I chose my supplement through United Health Care and have had exactly 0 copays in 10+ years. That has included several kidney stone procedures, two cataract surgeries, CLL treatment, and a bunch of odds and ends over the years. It also makes it easy to hop into an emergency room or urgent care place with no worries about being covered, assuming they accept Medicare.

 

[Tom]

Some years ago I visited a new-to-me chiropractor. When I subsequently received an EOB (explanation of benefits), it listed a number of denials. I promptly went to the chiropractor and said "it looks like I owe you some money". He explained that, for the same procedure, Medicare randomly approved/paid under different codes; So, he had to bill Medicare under various codes for a single visit, and they (Medicare) would decide which one they'd pay for this week/month. Bottom line, the chiropractor got paid and I didn't owe him anything.

Some time later, I mentioned this to a couple of chiropractors, friends I hadn't seen for a number of years (they'd moved across country), and they confirmed that they experience the same thing in their practice.

 

[JudyJB]

Also, those Advantage plans can afford all that constant advertising because they are somehow making big profits on these plans! So how are they doing that??? Limiting coverage, which is what none of want when we are really sick.

 

[Deb&RickTX]

A timely discussion for us! We're on my company plan for now, but researching what we need to do when I retire. Medicare eligibility is driving that date.

 

[jubileee]

My wife and I are the same age and have been on Medicare for about 17 years.
We figure we blew between $20 and$30 thousand on medigap ( schedule F) payments before we went with Medicare Advantage.
Every year you age,those medigap payments go up.
We love the Advantage plan. It just keeps getting better and better. Hardly any copays at all any more, now have dental and vision at no cost.
We have never had any issues at all with the advantage plan and have had some serious medical issues.

 

[John From Detroit]

I just signed up, they don't make it easy to understand it all.

Well the more confusing they make it the more they can bilk you for
in my case I get a Mediare advantage plan as a benefit of having worked for the State of Michigan long enough.. No charge.. Kind of hard to beat no charge. (Not impossible, just hard).

 

[Utclmjmpr]

The wife and I ( her 78 me 81 have been on an Advantage plan for ten years,, the county that we live in has a large area but a small population (Cedar City has 28K and the largest in Iron county)
As a result we often don't have much choice in Advantage plans.. So we have been on Molina and Humana,, both have treated us very well considering the choices we have.. With Humana , (PPO) we are at a point where we don't pay "out of pocket" for drugs or doc visits and only $25.00 for a specialist..>>>Dan