Medicare Advantage

[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