Medicare Advantage

[Patty Hann]

So... it's that time of year again (already?!!).
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

[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.

[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!

[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

** 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.