Medicare advantage plans to good to be true.. (medical, doctor, supplement)

[Pattyswind]

I currently have medicare with no secondary insurance. I talked to an agent today who told me the United Healthcare advantage plan was perfect for me. PPO that included dental, eye, prescription.
There is no monthly cost. Supposedly medicare pays United Healthcare the $148 a month. Doesn't sound legit to me.
Wouldn't everyone be signing up for this if there is no extra cost instead of looking for a medigap plan?
I'm really confused!

[Ariadne22]

Yes, if there wasn't a catch, everyone would be signing up. In a nutshell, the primary catches are lack of provider flexibility, onerous oversight on medical procedures, expensive copays should you encounter a serious medical issue - all discussed in the links at the end of this post.

The Advantage plan UHC agent is discussing pays the Part B Medicare premium. Not all plans offer this benefit, but some do. You should know, Advantage plans are huge cash cows for the private insurer which receives an average stipend of about $10k a year (varies by region) from Medicare for each enrollee to pay for Medicare services. Advantage plans use significantly more oversight on benefits administered - i.e, approvals etc. - in order to remain profitable because Medicare is no longer paying for the services - in this case, United Healthcare is. Essentially, you are divorced from Medicare when you enroll in Advantage plan.

Further, there are extra costs with Advantage - usually copays to see a specialist, copays for a variety of services, etc. Because this is a PPO, you can see other Medicare providers, but if they are out-of-network, those copays can often be higher. Because of the copays, all Advantage plans have maximum annual out-of-pocket limits which can be as high as $7,000 or more should you encounter serious health issues. The plans are "free" until they aren't.

If you currently have original Medicare without any supplement, you have an unlimited exposure on the 20% Medicare won't pay, which can become problematic should you encounter a serious medical issue. For that reason, most Medicare recipients either purchase a Medigap supplement or enroll in Advantage.

For in-depth discussion in the differences, pricing, etc., the following links cover the issue in detail.

Read all the links in this post:

https://www.city-data.com/forum/59629701-post2.html

And, then, read this thread for additional discussion:

https://www.city-data.com/forum/heal...l#post59629701

[mojo101]

You can try it for one year,if you dont like it,then switch back to Medicare and Medigap.
One cool thing mine offers this year is that they are using LYFT to give us ride to doctor office.

[mojo101]

like the other said,you still have to pay when you see a doctor and some tests are free,some are not.

[Teacher Terry]

In order to go back to regular Medicare you need to pass medical underwriting once you leave it. I would just purchase a Medicare supplement.

[Ariadne22]

Originally Posted by mojo101

You can try it for one year,if you dont like it,then switch back to Medicare and Medigap.

Probably not available at her. That trial right only applies if you sign up when first eligible for Medicare at age 65.

You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)

You have the right to buy any Medigap policy that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy:

• As early as 60 calendar days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Sounds like OP has been on Medicare for a while. If she is past her initial enrollment period, she will need to undergo health underwriting for a Medigap.

[Pattyswind]

Thanks for the replies. I discovered all the links after I posted. Lots of good info, enough to make me say no thanks. I think what drew me in was the dental and vision.

[athena53]

Originally Posted by Ariadne22

Probably not available at her. That trial right only applies if you sign up when first eligible for Medicare at age 65. Sounds like OP has been on Medicare for a while. If she is past her initial enrollment period, she will need to undergo health underwriting for a Medigap.

My Dad was aggressively sold a Medicare Advantage policy when he was in his late 80s. He did have 3 months to switch back without re-underwriting and that was all it took for him to decide he didn't like Medicare Advantage! He switched back easily. This may vary by program or by state.

Originally Posted by Pattyswind

Thanks for the replies. I discovered all the links after I posted. Lots of good info, enough to make me say no thanks. I think what drew me in was the dental and vision.

I'm guessing that those coverages are pretty limited- dental will have a network and a max they'll pay out every year regardless of how much work you need. Even private plans have annual limits of $1,500-$2,000 and that includes cleanings. I'm not an expert on Medicare Advantage vision care but when I had vison care with an employer it mostly sent you to the chain places and gave you "discounts" off crazy-high prices for glasses.

A friend who works for the hotline Medicare beneficiaries can call with questions really hates Joe Namath and his commercials for Advantage Plans, since he gets the calls after people find out what it doesn't cover!