Medicare Advantage

[Patty Hann]

So... it's that time of year again (already?!!).:eek:
My [snail] mail box is being inundated with offers from insurance companies to sign up for Medicare Advantage.
I'm on traditional Medicare (with parts A, B and D).

We all know that insurance companies never, ever pursue business where they cannot make a "Yuge" (channeling Jim B) profit.
Therefore (donning my Sherlock Holmes deerstalker) I deduce that taking over a Medicare account must be a very lucrative investment for them.

Curious as to others' thoughts on Medicare Advantage.
(I have my own thoughts about it, not a few gained by reading/hearing other folks' experience.)

Any under 65 "youngsters" out there reading this... it's OK to move on to more interesting posts :D

[Tom M King]

They tell you all the good things about it, but none of the limits. At the suggestion of Hospice, we changed my Mom's Medicare to include Advantage about six months before she died. No condolences needed. She had made a good start into her 108th year.

She broke a leg, and needed to go into a physical rehab place. Because we had changed her Medicare to a cheaper plan but also included Advantage for no cost, as suggested by Hospice, the amount of time she was allowed to stay at the rehab place was limited to way less time than she really needed. I forget what the number of days difference was, but it was about a factor of three less than the Medicare she had before. I don't know anything else about it, but thought I should pass on that experience.

[Brian Runau]

I went with A, B,G, and D versions. I was concerned about what and level of coverage. So far all I do is pay my premium, meet the deductible and Cover my portion of meds. Maybe more expensive now, but think as I get older it will be a blessing. Brian

[Ken Fitzgerald]

We went with a supplement program rather than the Advantage program because of the limitations in the coverage in the Advantage plan. IIRC, the Advantage program is usually cheaper but doesn't have as much coverage for major medical problems. IE, less liability for the insurance company.

We elected to go with a supplement program with plans A, B, D, and F.

[Jim Becker]

I chose an Independence Blue Cross Medicare Advantage Plan when I transitioned to actually using Medicare on 1 September after Professor Dr. SWMBO retired. The $248 per month I have to pay for Medicare out of SS is far less than the $700 per month I would have had to pay to stay on The Professor's retirement medical plan that she's essentially stuck with until she turns 65 mid next year. (I doesn't cover our younger daughter at all so she's scrambling trying to find affordable coverage at age 24). I chose the Advantage plan because it essentially was identical to the coverage I already have had for almost a decade plus with added benefits like $75 a quarter for OTC purchases, YMCA membership if I want it, eye, hearing and dental, etc. I have the same physician practice that I've been with since 1999 (although the closer location to our downsize home) and the same PA takes care of me. The hospital has a plethora of specialty practices so all the medical records are connected. It's a PPO so I'm not limited to specific providers and I'm covered anywhere in the US by just seeking care from whatever the local BCBS affiliate organization is. International coverage, too, although by reimbursement at out of network rates. My prescriptions and immunizations cost me exactly zero out of pocket. I like not paying out of pocket for things so the Advantage plan was more suitable to my personal preferences and personal needs than traditional Medicare and it was less money than bolstering traditional Medicare with Medigap and other coverages to get to the same place. Being able to use a plan from a provider that I've been with for many years certainly was a plus, too.

It was a no brainer for me given all that. But there certainly are situations where folks get into bad situations because they did not look carefully at the coverage and other parameters for where they live that each of the competing providers have in their plans. Working with an independent advisor can really help with that for anyone considering comparing traditional Medicare with Advantage plans. The devil is in the details.

[Patty Hann]

We went with a supplement program rather than the Advantage program because of the limitations in the coverage in the Advantage plan. IIRC, the Advantage program is usually cheaper but doesn't have as much coverage for major medical problems. IE, less liability for the insurance company.

We elected to go with a supplement program with plans A, B, D, and F.
F is the "Cadillac" Supplemental (medi-gap). Those that have it are "grandfathered" but it was no longer offered when I joined.
I went with the N supplemental

[Patty Hann]

I chose an Independence Blue Cross Medicare Advantage Plan when I transitioned to actually using Medicare on 1 September after Professor Dr. SWMBO retired. ... But there certainly are situations where folks get into bad situations because they did not look carefully at the coverage and other parameters for where they live that each of the competing providers have in their plans. Working with an independent advisor can really help with that for anyone considering comparing traditional Medicare with Advantage plans. The devil is in the details.

And that, boys and girls, is the biggest takeaway in this reply.
In AZ Advantage is probably the worst option available... unless you never need medical care outside of a yearly physical. Then it's great. :rolleyes:

[Jim Koepke]

We have had Kaiser for close to thirty years now. Fifteen of those have been in retirement. Candy is happy with it. My life has likely been extended by it from a triple bypass. I'm on track to get a replacement heart valve soon.

Plus the meds are mostly $10 or less for a three month prescription sent in the mail.

jtk

[Ken Fitzgerald]

F is the "Cadillac" Supplemental (medi-gap). Those that have it are "grandfathered" but it was no longer offered when I joined.
I went with the N supplemental

It's the only Cadillac I've ever had, including vehicles! Couldn't afford the vehicle if I wanted one!:eek::rolleyes:

[Bill George]

Well on A,B,D and F but good lord they raised my plan F by $45 this year as I turned 80! $365 per month. This of course in addition to paying what ever B is! Thinking of G or N will check the rates and coverage of course.

[Alan Rutherford]

We have a well-rated Advantage plan that has available, optionally, its own primary-care doctors, urgent care facility and a new geriatric-oriented primary care facility. We've been mostly happy with the coverage and love our primary-care doctor. On the other hand, they closed the urgent care facility and opened a new one several miles farther away. And sometimes we think we'd like to try out someone with more experience in our age bracket but it would have to be at their facility, which is twice as far as our primary care doc and don't think we could easily go back to the current doc. So not much flexibility.

[Earl McLain]

I retired on March 1 this year, and opted for traditional Medicare, Supp G and the thinnest Part D plan available. I had intended to switch my rheumatoid arthritis (RA) med from Humira to Remicade so it would be covered under Part B of Medicare, but was able to continue using the pharmacy at a FQHC (Federally Qualified Health Center) so cost of the specialty med is under $400/year.

My wife (aged 60) is Medicare eligible on 11-1 due to disability (dementia)--virtually no real choice of supplements to traditional Medicare under 65 in Indiana, so we're enrolling her in an Advantage plan with Anthem BCBS or UHC--need to make that decision by Tuesday. Like Jim Becker, whichever we choose it will be the PPO version with full national network (NOT an HMO or regional network). The docs we use for her are all in network, as is the neuro-clinic at Northwestern Memorial in Chicago. We shouldn't have any problem with that from not to age 65, and we'll reconsider traditional Medicare at that time.

Being sort of forced into an Advantage plan for her is a bit of a blessing--it will give me a chance to see how that works out in real life, and give me an opportunity to see if my personal prejudices against Advantage plans are correct. Seeing the tunnel-visioned marketing of Advantage plans being best for all raises my antennas, the ads tend to focus on the "feel good" parts (getting money back in your social security payments!!), trying to stimulate people to make decisions on the pennies, not on the pounds. We're blessed to have an agent we know is working to find what is best for us (and a long-time co-worker)--and watching her study her craft helps to confirm the study i've done.
Read, know and understand!!

[Bill Dufour]

Get a list from your pharmacy of all meds. Get a list from your doctor of which plans they accept. Then go to an insurance broker and let him decide for you. It is free and they will know all the plans in your area. Our broker narrowed it from 15 or so plans down to 4-5 appropriate ones in our region. Then he printed a summary of fees and coverage for each of those five plans. We went home and made a decision and called him back the next day.
There is no reason you and your spouse must be on the same plan. You can change plans every year if things change. In Caifornia all plans must cover pregnancy, substance abuse treatment, counseling etc regardless of age or gender. We really do not care about co pays for baby deliveries. We agreed we will not go crazy in our old age either. If you are not an alcoholic or drug addict at age 65 you probably will not become one in under one year
Bill D.

[Patty Hann]

Get a list from your pharmacy of all meds. Get a list from your doctor of which plans they accept. Then go to an insurance broker and let him decide for you. It is free and they will know all the plans in your area. Our broker narrowed it from 15 or so plans down to 4-5 appropriate ones in our region. Then he printed a summary of fees and coverage for each of those five plans. We went home and made a decision and called him back the next day.
There is no reason you and your spouse must be on the same plan. You can change plans every year if things change. In Caifornia all plans must cover pregnancy, substance abuse treatment, counseling etc regardless of age or gender. We really do not care about co pays for baby deliveries. We agreed we will not go crazy in our old age either. If you are not an alcoholic or drug addict at age 65 you probably will not become one in under one year
Bill D.

A couple caveats on these.

1) I would never let an insurance broker "decide" anything for me. No broker is a 100% "disinterested" party. *
When it was time for me to sign up I did all my research prior to contacting a broker who "partners" with my financial advisor.
I met with him, we sat down, and I spoke first (after the polite prelims):
"Not interested in Advantage so we can skip that right away. I think Plan N will work for me, but am open to discussing other Plans. I also think I need the most minimal (cheapest) Plan D out there. "

His answer: "I do not push Advantage, and you will find that I am in a minority of brokers on that. In AZ Advantage is probably the worst choice unless you absolutely cannot afford to pay premiums."**
Anyway, we agreed on what I had decided, Plan N and he found an even cheaper Plan D for me (I still pay less than $15 per month for it)

2) You can change plans every year if things change. Yes, but be aware that unless you are forced to change because of one of the specific Medicare designated "trigger events", there is no guarantee that you will be able to change Plans.
If you opt for Advantage and within a year of starting it you decide you dont' like it, you can go back to the Trad plan, and also buy Medigap.

However, if more than a year has passed and you decide you don't like Advantage, you can move to Trad medicare, but you may not be able to get a Medigap Plan because now new underwriting still has to take place.
That is, Aetna or Cigna or BCBS, or whatever Ins Co handles the Medigap Plan (G or H or N or whatever) that you want, may not accept you or may accept you only with exclusions on your coverage.

Same is true if you are on Trad Medicare with a supplement;during open enrollment you an change your coverage within your supplemental plan with no underwriting.
But you cannot change your Medigap Plan "letter" without new underwriting.
I have Plan N, and let's say that for 2024 I want to change my Medigap to Plan G.
It is possible that no insurance Co that has Plan G will accept me because of something in my medical History. So I'm stuck with Plan N.

The only time you can avoid the underwriting is in the initial enrollment period, when you first sign up for Medicare; you can change it in the following 6 months, still with no underwriting.
But any time after that, even during the annual enrollment period, if you change the Medigap Letter plan, you are subject to underwriting***
It's why they tell you to do your homework before deciding on which Medigap plan to buy, because you may be stuck with it.

Also the broker told me that many of his "Advantage" customers (now in their 80s) are unhappy with it and want to go back to Trad Medicare, but they can't because no Medigap insurer will accept them except by excluding coverage of the very conditions for which they can't get satisfactory care under Advantage. I.e., the company won't underwrite them for some pre-existing conditions.

Lots of fine print in all this ... get out the magnifying glass...

* "Most brokers and agents said they are paid more to enroll people in Medicare Advantage plans than in traditional Medicare. With some variation by geographic region, most focus group participants said, in general, they receive higher commissions for enrolling people in Medicare Advantage plans compared to Medigap supplemental plans for traditional Medicare. One broker recalled getting paid three times more to sell a Medicare Advantage plan. Even with the commission for stand-alone prescription drug plans added to the Medigap commission, most brokers and agents said Medicare Advantage commissions were much higher. Brokers and agents also said relative commissions differ for new enrollments versus renewals, with some reporting that the latter can be higher, and more reliable, for Medigap." Medicare broker commissions (https://www.commonwealthfund.org/publications/2023/feb/challenges-choosing-medicare-coverage-views-insurance-brokers-agents)

** At the time all Advantage plans that were available in my county were HMOs. No thanks.
There are now maybe 3 PPO Advantage Plans out there, none of which get higher than 3 stars on Medicare's rating of Advantage plans. Again, No Thanks.

*** A handful of states allow you to change your Medigap "Letter" policy during annual open enrollment with no underwriting.. I believe CA, OR and NV are three that allow it..cant recall the other few that also allow it.

[Rich Engelhardt]

Also the broker told me that many of his "Advantage" customers (now in their 80s) are unhappy with it and want to go back to Trad Medicare, but they can't because no Medigap insurer will accept them except by excluding coverage of the very conditions for which they can't get satisfactory care under Advantage. I.e., the company won't underwrite them for some pre-existing conditions.Exactly. This is something they don't make crystal clear in the promotionals for Advantage plans.

[roger wiegand]

Traditional Medicare plus a BCBS supplement policy. Virtually no additional out-of-pocket expenses for medical care and absolutely no hassles with pre-approvals, seeing specialists, etc. Unfortunately we've made pretty good use of the plan over the last several years. We do have significant co-pays for some drugs. Being able to see any doctor I choose for anything I choose without having to negotiate with an insurance company is very valuable to me. I've read the Advantage documentation of course, but don't see the point. I can't imagine they would be so anxious to sell me a policy if I weren't somehow ending up with less coverage for more money.

The drug plans all seem to be kind of a scam-- they will give you prescriptions that you can buy retail for under $10 for a buck or even free, but when your doctor says you need a $1000 drug it's "not on the formulary"; some person who has never seen you is empowered to overrule your physician.

[Patty Hann]

Traditional Medicare plus a BCBS supplement policy. Virtually no additional out-of-pocket expenses for medical care and absolutely no hassles with pre-approvals, seeing specialists, etc. Unfortunately we've made pretty good use of the plan over the last several years. We do have significant co-pays for some drugs. Being able to see any doctor I choose for anything I choose without having to negotiate with an insurance company is very valuable to me. I've read the Advantage documentation of course, but don't see the point. I can't imagine they would be so anxious to sell me a policy if I weren't somehow ending up with less coverage for more money.

The drug plans all seem to be kind of a scam-- they will give you prescriptions that you can buy retail for under $10 for a buck or even free, but when your doctor says you need a $1000 drug it's "not on the formulary"; some person who has never seen you is empowered to overrule your physician.

Do you have Plan F for your BCBS? (you don't have to answer that you you prefer no to)
If your only co-pays are for drugs I'm guessing you have Plan F.

Plan N has co-pays for specialists and regular office visits and ER visits. And there is an annual deductible of $300 (? I think)
So I do shell out for those but being fairly healthy, they don't break the bank (haven't gone to the ER in 30 years... urgent care only twice)
Plan N (w/ Aetna) I pay just under $125 a month.

[Bill George]

Its good Patty pointed out the agents get lots more for signing you up for one of those Advantage plans.... not the best idea for a lot of folks. Its all about profit for the Agent!! The real Deal website > https://www.medicare.gov/

[Edward Weber]

We have had Kaiser for close to thirty years now. Fifteen of those have been in retirement. Candy is happy with it. My life has likely been extended by it from a triple bypass. I'm on track to get a replacement heart valve soon.

Plus the meds are mostly $10 or less for a three month prescription sent in the mail.

jtk
+1, I've been happy with Kaiser

[Dave Anderson NH]

The nub of the matter is the ability (or lack thereof ) to change back from an Advantage plan to regular Medicare and get complete coverage. Our broker/advisor who underwrote the insurance my company bought for many years warned us of the pitfall of going back to a regular Medicare plan and being refused coverage for pre-existing conditions. Since my wife has cardiac issues and type 2 diabetes we went with the traditional Medicare with BC/BS medigap supplements and part D coverage. It has worked out well for us in spite of one very expensive co-pay for a particular drug. In my case after retiring I turned all my health care over to the Veteran's Administration. All services are covered except dental and my drug copays are minimal. I also get hearing aids if needed, a free pair of glasses each year and every one of my experiences have been exceptionally positive. I put off using them for many years because I thought I couldn't pass the means test since our income was too high. Turns out if you have one or more Purple Hearts (I have 2 ) you are exempt and could make millions per year and still qualify. If you are a vet, CHECK IT OUT.

[Stan Calow]

The one thing that is important but difficult to quantify when comparing plans, is the customer service. A parent had an advantage plan through their former employer. It was one of the bigger companies. The insurer liked to deny some medications, and I had to go through a whole research and documentation process by mail to prove that it was necessary for her condition and it was in fact in their formulary of approved medications (they said it wasn't). This soured me on the advantage plans so when my turn to choose, I stuck with a supplement plan. Bottom line, cost is not the most important way to compare.

[ChrisA Edwards]

My understanding, Medicare Insurance brokesr get paid a set amount of about $70 for each person they sign up. There is no benefit for them to upsell one policy over another. The end user does not pay that $70.

I used one, recommended by a friend, and all he did was show me the available plans, mostly directing me to a website where I could review these plans and which ones to stay away from. He explained all about the Donut Hole if you have expensive meds.

We went with a Plan G and a D for meds. The D is the more complicated of the two and you need to specify all you normal meds and then review the plans.

I highly recommend my guy, I've never met him, he lives in St Louis and me in Tennessee. I'll happily pass on his contact info via pm.

[Steve Demuth]

The whole system of choices, fees, etc, is so complex as to be a bad joke on retirees. My wife and I transitioned from my employer plan to Medicare in the same year. Our monthly premiums (for the two of us together ), went from about $150, to nearly $1000 for Medicare Part B, the IRMAA on top of that for both of us, plus Medigap). We can afford that, but it was a shock to discover it. After a year, we switched to an Advantage plan from United Health Group, and immediately my wife came into need for significant medical care (leukemia). Our experience with Advantage has been good. They didn't argue about her very expensive medications, and the reimbursement rate was reasonable. Never any issue on tests or appointments with her doctors (which is a bit of a pleasant surprise, because we chose to go to the Mayo Clinic in Rochester, MN, as I am an emeritus employee there, even though Mayo is in some kind of wierd limbo with UHG regarding being in or out of network).

The Advantage plan has no premium, so it was a big savings in that respect from traditional Medicare. Being sick is still expensive though, as co-pays for the drugs add up. By the time her treatment ends, we'll be out of pocket close to $15,000 for drugs and other co-pays, over two insurance years (12 months of actual treatment). Still less than our premiums alone would have been for traditional Medicare.

So, I am overall satisfied with Advantage.

[Mike Henderson]

I would never sign up for an Advantage plan. Stick with traditional Medicare unless you simply cannot afford the payments for Part B and D.

Mike

[Michael Weber]

My ex employer dropped their coverage for retired employees and replaced it with partially subsidized Medicare coverage. I chose to stay with traditional Medicare and opted for Plan G. I made sure that I chose a plan where the premiums were NOT age related. Never seriously considered an Advantage plan. Too many unknowns and frankly the way some are marketed really made my suspicious. Plan D options are too diverse and need to be standardized like the medical plans are at a minimum and that’s all I have to say about that.

[Ken Fitzgerald]

The nub of the matter is the ability (or lack thereof ) to change back from an Advantage plan to regular Medicare and get complete coverage. Our broker/advisor who underwrote the insurance my company bought for many years warned us of the pitfall of going back to a regular Medicare plan and being refused coverage for pre-existing conditions. Since my wife has cardiac issues and type 2 diabetes we went with the traditional Medicare with BC/BS medigap supplements and part D coverage. It has worked out well for us in spite of one very expensive co-pay for a particular drug. In my case after retiring I turned all my health care over to the Veteran's Administration. All services are covered except dental and my drug copays are minimal. I also get hearing aids if needed, a free pair of glasses each year and every one of my experiences have been exceptionally positive. I put off using them for many years because I thought I couldn't pass the means test since our income was too high. Turns out if you have one or more Purple Hearts (I have 2 ) you are exempt and could make millions per year and still qualify. If you are a vet, CHECK IT OUT.

Dave,

A neighbor across the street came over a couple months ago to ask advice about hearing aids. He had been using his string trimmer (electric) when he said the hearing in one ear diminished dramatically. I have both a cochlear implant on one side and a HA on the other. I asked him "Didn't you serve in Vietnam?" He said yes. I told him why don't you see if the VA will cover you. After he left, I immediately went online to confirm my suspicions. I was right. Those who served in country in Vietnam are covered. Those like me who served during the period ('68-76 in my case) but never served in Vietnam aren't covered. He called the VA, got all of his prescriptions tranferred to the VA, they assigned him a new primary care nurse practitioner and he has scheduled a hearing test. He came over a couple weeks ago to thank me for the information as it was saving him money.

[Jim Becker]

That's very true, Ken...my dad's aids were taken care of by the VA.

[Bill George]

Wow this is a great Thread, learned a lot

Even as I am classed as Vietnam vet never served in combat and make to much to get VA
benefits I am thankful for those who served and glad they are getting those benefit's now.

[Lee DeRaud]

+1, I've been happy with Kaiser
+2, from about six years before retirement, so the transition was seamless, to the point of being unnoticeable.

(I'm a big fan of vertical integration when it comes to medical stuff. None of the 'out-of-network' hassles, no driving over to some lab on the other side of town to get blood drawn, then yet another location for physical therapy etc. I've got primary doctor, lab, x-ray, P/T, optical, pharmacy, all in the same building about 2 miles from the house.)

[Brian Runau]

I wonder, based on our experiences if we would support Universal Healthcare here in America? Brian

[Patty Hann]

+2, from about six years before retirement, so the transition was seamless, to the point of being unnoticeable.

(I'm a big fan of vertical integration when it comes to medical stuff. None of the 'out-of-network' hassles, no driving over to some lab on the other side of town to get blood drawn, then yet another location for physical therapy etc. I've got primary doctor, lab, x-ray, P/T, optical, pharmacy, all in the same building about 2 miles from the house.)

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.
Optical might be really good but PT is sub par.
I've also had the experience with blood draws that yielded wildly inaccurate results'; bad enough that I stopped going to that particular lab.
No other labs ever had that problem with my "draws"...pretty consistent results.
Not saying I like driving hither and yon for medical stuff, but I'll do it if that's what it takes to get quality care.
Fortunately I don't have to do it too often, typically annually.

[Mike Henderson]

Dave,

A neighbor across the street came over a couple months ago to ask advice about hearing aids. He had been using his string trimmer (electric) when he said the hearing in one ear diminished dramatically. I have both a cochlear implant on one side and a HA on the other. I asked him "Didn't you serve in Vietnam?" He said yes. I told him why don't you see if the VA will cover you. After he left, I immediately went online to confirm my suspicions. I was right. Those who served in country in Vietnam are covered. Those like me who served during the period ('68-76 in my case) but never served in Vietnam aren't covered. He called the VA, got all of his prescriptions tranferred to the VA, they assigned him a new primary care nurse practitioner and he has scheduled a hearing test. He came over a couple weeks ago to thank me for the information as it was saving him money.

I'm not absolutely sure about this, but I think you have to have a certain level of disability to get completely free hearing aids from the VA, even if you served in Vietnam.

I get my hearing aids free from the VA, but I think my level of disability is high enough. If you were 20% disabled, for example, you probably could get your hearing aids from the VA but you would have to pay a co-pay.

Those of us who served in Vietnam have an "advantage" because it is assumed we were exposed to Agent Orange and that opens up coverage for certain medical issues (such as Type II diabetes).

I've been getting my hearing aids from the VA, but using Medicare for everything else. I'm going to see if I can start getting my prescriptions from the VA. My experience with the VA has been very positive.

Mike

[Patty Hann]

I wonder, based on our experiences if we would support Universal Healthcare here in America? Brian

Look at Britain... their Health care system is in a crisis mode.

https://www.cnn.com/2023/02/06/business/nhs-strikes-private-healthcare-uk/index.html

I wouldn't want modeled on Canada's system either https://www.caringsupport.com/blog/advantages-and-disadvantages-of-canadas-healthcare-system

Nor Europe's https://www.marshmclennan.com/insights/publications/2021/february/around-the-world-in-healthcare-systems-europe.html

What a lot people -- who like the idea of Universal Health care and point to the UK and Europe as "shining examples"-- don't know is that in both the UK and Europe the people who can afford to buy private insurance do buy it.
They buy it to avoid the problems mentioned in the articles, in particular long wait times, not getting the same Doctor if you use a clinic (UK).
I'm not certain but I don't think you can buy private health insurance in Canada.
What I do know is that there are winter visitors (here in AZ, we get a lot) from Canada will schedule medical procedures here and pay cash rather than endure the long wait times there.

There is no free lunch... you never get something for nothing.

I like being able to choose my doctors and specialists.**
I like being able to keep the same doctors and specialists.

I like that wait times for procedures are measured (at worst ) in a few months (and sometimes in only weeks) and not in 6+ months to two years (or more) .

** When I had my lumbar fusion done (L5-S1, w/ bilateral instrumentation) I got one of the very best neuro-surgeons in the state to do it; no complications, and a smooth recovery.
3-1/2 years later (my 60th B-day) I did solo Rim-to-Rim hike (N to S) of the Grand Canyon. Tiring, but the back gave me no problems at all. It still doesn't.
(But it's hard on the knees going down, very hard.. 4200ft drop over 6.5 miles; i.e., a little more than a 12% grade on average. It's steeper at initial descent, less so the farther down you go )

[Lee DeRaud]

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.
...
I've also had the experience with blood draws that yielded wildly inaccurate results'; bad enough that I stopped going to that particular lab.
No other labs ever had that problem with my "draws"...pretty consistent results.
I'm just not sure how having standalone specialists helps that problem, given that I've had similar experiences with traditional insurance. The problem was that sometimes "that particular" whatever was the only only one that was in-network without driving stupid distances. Or having them decide after the fact that, no, they actually aren't in-network for your particular combination of doctor/insurance.

The thing about Kaiser, at least here in SoCal, is that it's BIG. If a particular specialist is sub-par at a given location, there are others available, perhaps at some loss in convenience.

[Patty Hann]

I'm just not sure how having standalone specialists helps that problem, given that I've had similar experiences with traditional insurance. The problem was that sometimes "that particular" whatever was the only only one that was in-network without driving stupid distances. Or having them decide after the fact that, no, they actually aren't in-network for your particular combination of doctor/insurance.

The thing about Kaiser, at least here in SoCal, is that it's BIG. If a particular specialist is sub-par at a given location, there are others available, perhaps at some loss in convenience.

Kaiser was always big, and highly rated.
Unfortunately it does not operate in AZ.
And vertical integration is great, if it works, which it does for you.
I've just resigned myself to having to drive to various sites for different services.
But what I was saying (apparently not very well) is that there always seems to be at least one "specialized service" (of the Under One Roof group) that I 'm not happy with, and so have to drive anyway, at least for that service.
And with Trad Medicare, almost all doctors are "in network".

[roger wiegand]

For those who think the insurance companies are their friends, I'd just note that the US spends about twice as much per person as the other "wealthy industrialized countries" (about 20 countries in that group), and achieves the worst performance in terms of basic public health measures of any country in that group; e.g. the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, and the highest maternal and infant mortality.

[Dave Fritz]

Well said Roger, facts are facts. Look to Washington to see why this is the case.

[Ronald Blue]

I didn't read everyone's replies because everyone's location impacts the options available. Whichever version you choose I recommend you look at all the options. If you haven't established an online Medicare account you need to. Go there and it will show every option available to you in your location. In Illinois at least it can vary by which county you live in. So just because friend John Doe that lives an hour away has something available doesn't mean you will. On the Medicare website you can compare maximum out of pocket and prescription drug costs. There also are actual agents that will help you find what fits your needs honestly. I went with Medicare Advantage and thus far have been pleased with it. My agent advises to review the options every year because they can change. Standard Medicare might be the best option for you but until you compare you don't know. My particular plan gives $166 quarterly for OTCHS shopping. My medications cost me zero at this time. Educate yourself to what's available. You can also see if your Dr is "in network" by searching providers. I also have a $1500 Flex card to pay for medical services not covered.

[Dave Fritz]

Excellent advice Ronald. I volunteered for several years for the Aging and Disability Agency in our county helping folks select their best Medigap policy. Medicare has a fantastic website and clearly points out the various options available.

[Jim Becker]

I wonder, based on our experiences if we would support Universal Healthcare here in America? Brian
That's difficult to discuss without getting political and we can't do that here, but it doesn't take a rocket scientist to see that it might be a lot simpler. One of the biggest challenges with how things are currently done is that it's uber-complicated for both the patient and the provider. This thread is a good indicator about how complicated it is simply because there are so many choices and decisions that have to be made just to have coverage. And not having coverage is kinda a big problem. I hope as a society we can work this out for sure, but it may not be within some of our lifetimes.

Something that has to be clear based on other comments already recorded, however, is that Universal Healthcare is not "free". It's payed for in a different way that we currently experience for the most part here in the US. And that, unfortunately, is where the discussion would get political and we're not going there.

[Jim Becker]

"Jack-of-all-trades-Master-of-none"
My experience of "all under one roof" has invariably been that some specialties do what they do really well, and other ones don't.

I don't believe that's what Lee was referring to with his comments about the provider network he's in. There is great advantage in continuity of care when primary care as well as many of the specialties come from a related umbrella organization because it is easier to navigate. I'm doing the same here by staying within the same local provider network (I'm not required to as my plan is a PPO) which while being a smaller setup than what Lee is part of, is very comprehensive. Some of the specialties are directly associated with larger, world-class groups. An example is the ortho surgeon I'm soon seeing for my right wrist...he's part of the local hospital care network that I get most services from, but is also associated with Rothman which is a very large, well known orthopaedic organization in Philadelphia. Things like optcal are not normally part of the regular health insurance situation unless surgery is involved. (I have experience there, too)

[Bill Dufour]

One thing that national health care does is reduce the costs of all the insurance people. My doctor has 10% or more of his staff who just figure out how to bill the insurance companies. That is all they do all day long. I assume the insurance company has a similar number of employes on their end answering the staffs questions.
I remember decades ago reading about one insurance company who dropped the requirement for a second opinion before authorizing expensive procedures. they figured out most times the second opinion said go ahead and do the procedure. They calculated slightly more procedures would be paid for but 100% of the cost of second opinion doctor visits and more tests would disappear. They did this and found they saved money by dropping required second opinions..
Bill D

[Stan Calow]

This is a great book on the subject and clears up a lot of the misinformation out there: "The Healing of America" by T.R. Reid. Heck, I may have first seen it recommended here on SMC some time ago.

[James Cheever]

Another option for any retired military (active or reserve retired) is Tricare for Life (TFL).

With TFL, all you need to have is Medicare Part A and B coverage. Nothing else is needed and there's no Rx doughnut hole. There could be a cost impact for the Part B coverage, depending on your retirement earnings.

As an example, I have two advanced cancers (stage 3 melanoma and stage 4 colon) and have been on chemo for many years now. With TFL, there have been no copays or deductibles and all my meds are fully covered.

Your situation may vary (and cost could be a factor), but you should at least give TFL a look to see if would work for you.

[Mike Henderson]

Just FYI, TriCare does not cover hearing aids. You need a disability rating to get free hearing aids.

If you're retired military, you almost certainly have TriCare.

Mike

[Roger Feeley]

+1, I've been happy with Kaiser
What is your annual physical like with Kaiser? That was the big change for me. My annual “wellness check” is pretty much checking the blood pressure and listening to my heart and lungs.

[Patty Hann]

What is your annual physical like with Kaiser? That was the big change for me. My annual “wellness check” is pretty much checking the blood pressure and listening to my heart and lungs.

Yep, as much as I like My doctor I think the annual wellness test is a cash cow for him (or any MD).
It's probably the only Medicare in office service that they actually make money on because they hardly do anything and just ask questions, all of which can be done by and NP or PA, and it might take all of 10-15 minutes.

Speaking of physicals, I get a blood test annually, comprised of the 3 parts: a complete blood count, a metabolic panel and a lipid panel.
Unless you are a heart patient or the doctor specifically prescribes it, Medicare does not pay for the "lipid panel" (the cholesterol et al tests) except once every five years.
A lot can happen in 5 years (imo) if you don't keep tabs on your cholesterol, triglycerides, etc., so I pay the lipid panel part every year (approx $85).

[Bill Howatt]

I believe the trend is to ditch the annual physical exam and studies have shown it to not affect health outcome. Of course, if you have a problem then that will be followed but just to pop in once a year with no issues isn't seen as a valid use of resources.
My Dr. (a younger doctor) doesn't do them anymore but I do get calls to get my iron level checked, FIT (poop test), at intervals.

[Jim Becker]

For me, the annual physical/wellness exam has evolved to be more analytic using blood tests and then general conversation with my provider. (He's a very good PA...and Nat Guard medic in his "spare time"...in the big practice and I've been seeing him for over a decade) It's clear there is some careful structure in the conversation. He does some normal physician visit hands-on listening and looking, but we spend much more time talking things through. I like that, honestly. He also has me periodically do certain testing because of family history and the plan is for me to get a stress test once I deal with my right wrist which has become an issue like my left one was a few years ago.

[Mark Rainey]

A lot can happen in 5 years (imo) if you don't keep tabs on your cholesterol, triglycerides, etc., so I pay the liped panel part every year (approx $85).
Your cholesterol usually stays the same year to year. 30 years later mine changed by 2 points. Save your money. Don't get it every year. Eat good foods and stay active.

[Alan Rutherford]

Your cholesterol usually stays the same year to year. 30 years later mine changed by 2 points. Save your money. Don't get it every year...

Everyone is different. My total cholesterol went from 251 in 2011 to 294 less than a year later. There's a lot more I could say on this subject, but we're kinda getting off the subject.


... Eat good foods and stay active.

No argument there.

[Patty Hann]

Your cholesterol usually stays the same year to year. 30 years later mine changed by 2 points. Save your money. Don't get it every year. Eat good foods and stay active.

My total cholesterol changed 30 points in one year..from 200 to 170.
Other years it varies about +/- 15 points.

[Lee DeRaud]

My total cholesterol changed 30 points in one year..from 200 to 170.
Other years it varies about +/- 15 points.
Doesn't much matter, any number I get down to, my doctor will think it's too high. (grumble)

[Patty Hann]

Your cholesterol usually stays the same year to year. 30 years later mine changed by 2 points. Save your money. Don't get it every year. Eat good foods and stay active.

If you had your cholesterol checked on a specific date and didn't have it checked for another 30 years, and it was within 2 points of the original reading, that tells you nothing about what was going on with your cholesterol in those intervening 29 years. Maybe it stayed rock solid, maybe it did'nt.
But if sometime in those 29 years it hit, say 300 and stayed there for 15 years, well your heart may not be too happy about that.

[Bill George]

If you had your cholesterol checked on a specific date and didn't have it checked for another 30 years, and it was within 2 points of the original reading, that tells you nothing about what was going on with your cholesterol in those intervening 29 years. Maybe it stayed rock solid, maybe it didn't.
But if sometime in those 29 years it hit, say 300 and stayed there for 15 years, well your heart may not be too happy about that.

I agree 100% get it checked yearly things can change besides your diet, it would be foolish to think otherwise. I get a fasting blood profile once per year. Even if I had to pay for it and I do not.