Medicare Advantage vs. Traditional Medicare

[Curt Harms]

I think this is legit, it says it's from medicare.gov. Some think that if you choose Medicare Advantage, you're stuck with it for life. I was pretty sure I was offered a choice of Traditional Medicare but am happy with my Humana plan so didn't follow up. According to this you can switch from Medicare Advantage to traditional medicare if you choose to. The only thing that seems a little odd is receiving this now instead of during or just before open enrollment.


If you or someone in your household has a Medicare Advantage Plan, you can make a coverage change during the Medicare Advantage Open Enrollment Period, which runs from January 1–March 31 each year.

You can:

Switch to a different Medicare Advantage Plan; or
Switch to Original Medicare (and join a separate Medicare drug plan).

Explore Your Options

You can switch only once during the Medicare Advantage Open Enrollment Period. Any changes you make will be effective the first of the month after you request to join the new plan.

There's no need to take any action if you're happy with the plan you have. But, if you want to find a plan that better fits your needs and budget this year, now's your chance to shop for a new plan.

Sincerely,

The Medicare Team

[Patty Hann]

Notice that it DOESN'T SAY there will be underwriting...only that you can switch.
But there will be underwriting** which can affect the price of your part B and any Supplemental (Medigap) you get.

**There are 7 states where there is no underwriting if you switch, but I can't recall which ones.

[Mike Henderson]

Patty's right. The problem with many of the Advantage plans is that they work well until you get a serious event. People might want to go back to original Medicare because they can go to just about any doctor and they don't need a referral.

The problem they encounter at that point is the supplemental plan. Medicare pays for 80% and the supplemental plan pays for the rest. But in many places, you have to go through underwriting to get the supplemental plan and since you have a serious event, the supplemental plan will be expensive. So, they're pretty much stuck with the Advantage plan.

I'm not a big fan of Advantage plans because I knew two people who had the same problem. Once they had a serious event, they couldn't get in to see a specialists for a long time. I'll stay with original Medicare and keep my freedom to choose my doctors and to be able to get the next available appointment.

Mike

[Lisa Starr]

I believe the underwriting ONLY applies to the Medigap policy. You can switch between an Advantage plan and traditional Medicare during enrollment periods without penalty. You're getting the notice now because the is a 3 month "grace period" to go back to your prior year's plan.

[Patty Hann]

I believe the underwriting ONLY applies to the Medigap policy. You can switch between an Advantage plan and traditional Medicare during enrollment periods without penalty. You're getting the notice now because the is a 3 month "grace period" to go back to your prior year's plan.

Oh... no underwriting for Part B... OK... my mistake.

[Jim Becker]

I'm using an Advantage Plan from the same BCBS provider I've had for years...and no longer need referrals like I did with Professor Dr. SWMBO's university sponsored plan from the same company. Don't assume that Advantage plans always require referrals. HMOs do, but PPOs like I have may not. One still needs to pay attention to in-network, of course, even without referrals, but the network is "yuge". I've already used my plan for surgery, as a matter of fact. I frankly can't wait to get The Professor on to the same or similar coverage mid-year when she finally turns 65. Her current insurance as a retiree is costing $711 a month. Even with my currently inflated Medicare monthly cost due to income my insurance cost for the same coverage plus things she doesn't get on the university plan is a third of that. (That's going to change real soon now when I appeal it due to status change and significant income drop)

I respect that some folks are more comfortable with traditional Medicare and some feel more comfortable with the Advantage Plans, especially when they have a good one available to them. (many of them suck "those things"...fine print matters) Franky, I sincerely hope that in my lifetime everyone gets universal health care coverage for being human, but I'm not going to hold my breath, nor am I going to say more 'cause that goes into things we can't discuss here.

Oh, and the email is legitimate. It went out to all current Medicare participants.

[Thomas McCurnin]

We concluded that the Advantage Program has a big advantage, but if one doesn't like it, it nearly impossible to switch back as pointed out above. So we declined the Advantage Program.

[Bill Dufour]

Go to your doctor(s) and ask for a printout of which plans they take. Then get a list of all medications you and spouse take from the drugstore. Contact a insurance broker who specializes in medicare and let them do the work for you at no cost.
Bill D

[Patty Hann]

I'm using an Advantage Plan from the same BCBS provider I've had for years...and no longer need referrals like I did with Professor Dr. SWMBO's university sponsored plan from the same company. Don't assume that Advantage plans always require referrals. HMOs do, but PPOs like I have may not........
I respect that some folks are more comfortable with traditional Medicare and some feel more comfortable with the Advantage Plans, especially when they have a good one available to them. (many of them suck "those things"...fine print matters) Franky, I sincerely hope that in my lifetime everyone gets universal health care coverage for being human, but I'm not going to hold my breath, nor am I going to say more 'cause that goes into things we can't discuss here.

You are fortunate that in your state (PA) Advantage plans have PPO options.
In my county for certain (and possibly all of AZ) all Advantage plans are HMOs that are worse than useless. (Only talking about the HMO's here in AZ)

[Jerome Stanek]

Go to your doctor(s) and ask for a printout of which plans they take. Then get a list of all medications you and spouse take from the drugstore. Contact a insurance broker who specializes in medicare and let them do the work for you at no cost.
Bill D

And I am sure that they will recomend an advantage plan. They get no money if they don't sell a plan.

[Bob McBreen]

I went through a broker & after looking at my situation they recommended not to purchase an advantage plan


And I am sure that they will recomend an advantage plan. They get no money if they don't sell a plan.

[Ronald Blue]

I think one of the biggest things is everyone has a friend of a friend or a 3rd cousin etc. that had some big out of pocket on an advantage plan. They don't know any facts beyond how terrible an Advantage plan is. I've said over and over do your own research on Medicare.gov and see what is available for you. WHERE you live matters on your options. Look at your needs and situation and decide. A broker can't do anything you can't do yourself. Straight Medicare might be the best fit for you. I have a maximum out of pocket of $4000 like a regular insurance plan but my primary care is zero cost and specialists are $30. I have a yearly flex Visa card I can use towards most out of pockets. I have vision and dental coverage. Your straight Medicare supplemental coverage will increase in cost. It might not be yearly but the "savings" you believe you have upfront will dissolve if you are blessed with long life. Bob McBreen you had an honest broker then. If they are trying to push something on you then they have an incentive to push a certain plan.

[Jim Becker]

You are fortunate that in your state (PA) Advantage plans have PPO options.
In my county for certain (and possibly all of AZ) all Advantage plans are HMOs that are worse than useless. (Only talking about the HMO's here in AZ)
And that's why one has to be a savvy shopper including sometimes using a third party resource to help with checking the details. Location does matter. It's a shame that we have to do all this juggling just to have quality healthcare, but again, that's something we can't get into here because it crosses into discussion territory that's not permitted. (And for good reason)

[Bernie Kopfer]

I'm using an Advantage Plan from the same BCBS provider I've had for years...and no longer need referrals like I did with Professor Dr. SWMBO's university sponsored plan from the same company. Don't assume that Advantage plans always require referrals. HMOs do, but PPOs like I have may not. One still needs to pay attention to in-network, of course, even without referrals, but the network is "yuge". I've already used my plan for surgery, as a matter of fact. I frankly can't wait to get The Professor on to the same or similar coverage mid-year when she finally turns 65.

Have to suggest you get the best insurance available after telling the whole world your wife is “finally” turning 65.

[Jim Becker]

Have to suggest you get the best insurance available after telling the whole world your wife is “finally” turning 65.
ROFLOL! No worries...I beat her there by a couple of years.

[Jerry Bruette]

Go to your doctor(s) and ask for a printout of which plans they take. Then get a list of all medications you and spouse take from the drugstore. Contact a insurance broker who specializes in medicare and let them do the work for you at no cost.
Bill D

Sounds like a plan except I don't know which oncologist, orthopedic surgeon, etc. I or my wife might need in the future.

[Bill George]

Sounds like a plan except I don't know which oncologist, orthopedic surgeon, etc. I or my wife might need in the future.

You do not want an Advantage plan, go with regular Medicare Supplemental and I have Plan F I do not pay anything out of pocket, its no longer available but I think G is very close.

[Lisa Starr]

As several have already said, do your own homework. In some areas, such as mine, there are very good Advantage plans available. I have an Aetna PPO plan with a very inclusive network, some plans do not. To me, one of the most important things to look at is the Maximum Out of Pocket (MOOP) for the plan you are considering. My particular plan has no deductible (including drugs) and a $5900 MOOP, which I consider reasonable. There is no additional premium over the Medicare amount deducted from the SS check.

[Patty Hann]

And I am sure that they will recomend an advantage plan. They get no money if they don't sell a plan.
NOt sure, but I think a broker gets a commission no matter what plan they sell (talking of the supplements/medigap).
They just get more if they sell the Advantage Plan.

[John M Wilson]

As several have already said, do your own homework.

Lisa, I couldn't agree more!

Every time this subject comes up, we get a lot of opinions from a lot of well-meaning folks, but these things vary so much depending on a myriad of factors, including health, age, location, doctors & networks, prescriptions, and so on.

We might as well be talking about each person's dental work, taxes, or the fastest route to Wal-Mart!

One person's plan & experience, even if it's perfect for them, might not work out for someone else. This is one of those topics that wide-ranging rules of thumb & advice based on generalities may be worse than no advice at all.

At least Bevel Up / Bevel Down only has two choices! :D

[Bill George]

Once your on a Advantage Plan there is usually no one will take you back on a Standard Medicare plan if they do it will be a major jump in price.

[Jimmy Harris]

There are some Medicare Advantage plans that will be better than traditional Medicare. There are also some that are worse. There's no easy answer.

Your best bet is to sit down and expect to spend several hours, if not days, educating yourself on everything you need to know. You can pay someone to help you, but can you trust them? Maybe. But maybe not. It depends on who else is paying them. Even asking a friend won't do you much good, as they may not know, yet think they do. Or they might live in a different state so will have different options. So you really have to rely on yourself and prepare to go back to school with this.

If you're not going to put in the effort to figure it out on your own, then stick with traditional Medicare. It's going to be the safe choice. It won't be the best, but it also won't be the worst.

[Bill Dufour]

Before I went to the broker for regular health insurance I tried to do it myself. I settled on a plan. Low copays, covered my meds, good reviews etc. Turns out it was based in San Francisco about 90 miles away. Okay they must deal with doctors near me right?
Turns out they were based in SF Chinatown and only doctors there deal with them. A clue should have been all the mentions of many in network doctors spoke Chinese. The only in network hospital was in Chinatown.
Bill D

[Ken Fitzgerald]

I haven't researched Medicare/Medigap vs Medicare Advantage plans since I went on Medicare some years ago. At the time, the traditional Medicare - Medigap insurance had better coverage in the event of a major illness. Medicare Advantage plans had lower premiums and might offer some special benefits but in the event of a major illness, they reached their maximum payout a lot quicker than Medigap plans. Medicare Advantage plans may work better in metropolitan areas. In rural areas, they may not work as well.

What is important. Before making any radical changes investigate how it will affect you in both the short term and long term. Then decide what type of coverage is right for you.

We have the original Medigap "Plan F". We get a bill and the insurance pays our portion. Yes we have higher monthly premiums and yes we have a Plan D prescription plan but the long term coverages are more to our comfort levels.

Investigate,research, talk to friends and decide what is right for you.

[Rich Engelhardt]

The simple fact that they push Advantage plans on TV as hard as they do, tells me the Advantage plans are good for the insurance company pushing them and not so good for me.

[Stan Calow]

The simple fact that they push Advantage plans on TV as hard as they do, tells me the Advantage plans are good for the insurance company pushing them and not so good for me.

Amen to that

[Bill Dufour]

Consider buying a carehome policy. If you get too bad it pays for a care home and services. I can not remember the actual name of the policy type. A decent care home will run 3,000-5,000 a month and up. This insurance is not medicare covered at all. It is a stand alone policy. Most payout a max of 3-5 years. The average patient who has to go into a old folks home lives three years there.
My mother lived there three years gradually needing more and more help. as more staffing was needed the payout went up. I twas never nough to cover the full cost. Cost her estate about 1,000-1,500 a month more then the insurance paid.
Bill D
Bill D

[Mike Henderson]

The simple fact that they push Advantage plans on TV as hard as they do, tells me the Advantage plans are good for the insurance company pushing them and not so good for me.

The theory of the Advantage plans was that they would cost the government less than traditional Medicare. Didn't work out that way. The Advantage plans find all kinds of medical issues that you (might) have and they tend to upgrade the reported severity of those issues. The net result is that it cost Medicare more for Advantage plans than for traditional Medicare.

Mike

[Patty Hann]

Consider buying a carehome policy. If you get too bad it pays for a care home and services. I can not remember the actual name of the policy type. A decent care home will run 3,000-5,000 a month and up. This insurance is not medicare covered at all. It is a stand alone policy. Most payout a max of 3-5 years. The average patient who has to go into a old folks home lives three years there.
My mother lived there three years gradually needing more and more help. as more staffing was needed the payout went up. I twas never nough to cover the full cost. Cost her estate about 1,000-1,500 a month more then the insurance paid.
Bill D
Bill D

"Long term Care Insurance".
I have something along this line from Pacific Life: https://www.forbes.com/advisor/life-insurance/long-term-care-hybrid/

[Stan Calow]

We had long term care insurance for a while, before the rates jumped up dramatically as we got older. I think it's best not to think of it as medical insurance, but as insurance for your income & savings. It doesnt directly pay for medical services, just provides you some money to pay for some nursing home care so you dont have to pay out of pocket.