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Found and article about the advantage plans being sold on TV by Joe Namath, William Shatner and Jimmy Walker.
It tells how Medicare Advantage is the all in one alternative plan to original Medicare. Original Medicare is Part A for hospital, Part B for medical visits and procedures and for another cost, a Part D drug plan which you find by inputting all of your meds as well as each major pharmacy, CVS, Rite Aid and Walgreens because some plans have cheaper meds at one of them.
With an advantage plan you still have to pay the $148.50 for Medicare.
Advantage plans cover medical, hospital and drugs, some also feature other benefits that traditional Medicare does not offer such as dental, vision and hearing. Some as hawked by the actors, they may have free meal delivery and depositing money into your account which sounds too good to be true, so buyer beware because what they're saying comes extra, may not even be offered in your area.
It also says that the dental and vision coverage you think you're getting, may only be for a routine screening, not for more expensive things like eyeglasses or dental implants. The coverage could also only be limited to $1,000 to 1,300 if those doctors even accept the advantage plan.
While the help picking plans the companies in the commercials say they're giving you is free, they do not tell you they get paid by the government every month that you're on the plan they helped you find.
They may not even find you the best plan for your situation. I suggest that everyone go to the Medicare site, use the plan finder without logging in, enter your meds to make sure it's the advantage plan you want and that there isn't one that would cover you better. Don't forget to add each major pharmacy, CVS, Rite Aid and Walgreens because some plans have cheaper meds at one of them.
If you plan to get a vaccine such as the shingles vaccine, add that to your drug list when picking your plan because it could cost over $200.
You should also see about traditional Medicare with a Medigap and part D drug plan. It may cover your needs better.
Once you're on an advantage plan, it's harder to get into a medigap plan as you age. You'll be subject to underwriting.
What you quickly learn once you get into the Medicare maze is that there are a LOT of pitfalls.
For example, the Supplement idea sounds good at the outset. You pay a little higher premium every month based on the concept that the Supplement (like Plan G) will cover anything that Medicare doesn't.
The "gotcha" is that traditional Medicare does not cover a lot of things you might think they SHOULD cover.
For example, an annual physical exam and blood work. While your employer plan may have covered this every year - Medicare does not. Medicare only covers a "wellness check" which is about 10 questions the doctor asks you, as he checks a box. That is IT. This is the only preventative cost Medicare covers with your physician. Below is a link describing one patient's surprise when she got the bill for her annual physical.
This is as frustrating for the MD as it is for the patient. Basically, many Medicare patients don't ever get annual physicals because they can't afford them. And many conditions go undetected until that patient gets ill down the road. My MD takes Medicare patients but has total contempt for a system that keeps him from doing his job.
Next gotcha? That physical exam isn't covered at all by the "supplement" either, because that exam is not a Medicare approved event. MediGap only covers the gap for Medicare approved necessary care. So if you want a yearly (or biannual or whenever) physical exam you must plan to pay for all of that out of pocket.
Not sure about Medicare Advantage plans, maybe someone here has experience. But no matter whether it is Advantage or MediGap the lesson learned is to know up front whether the event/exam/treatment is truly a Medicare approved service, and then to find out if the secondary insurance company will pay what they don't cover. And be prepared to get out your wallet.
Fwiw, when I had a Physicians Mutual high-deductible Medigap that policy would pay for add'l exams for specific issues not covered by Medicare. But it didn't cover an annual physical. It really is unfathomable that an insurer - any insurer - wouldn't cover an annual physical which is the first line of defense. It's weird.
That said, some here have said they've had no trouble w/exams and blood work part of their annual physicals. Much depends on how the doc codes his services. Perhaps they're submitting the claim under "Annual Wellness Visit."
Quote:
Your doctor can develop a personalized health plan for you, check that you are up to date with preventive tests such as cancer screenings and flu shots, and may refer you for some tests, many of which Medicare provides for free.
Agent commission on an Advantage plan is about twice that for a Medigap:Article goes on to discuss multiple areas of conflict of interest created by this commission structure. It's all about the profit.
In short, Advantage plans are huge cash cows for the private insurance companies and their agents.
Govt pays insurers a capitation rate of anywhere between $10k-$13k a year per enrollee, depending on region. Out of that insurance company pays commission, oversees, approves and pays for medical services, and generates a profit. The insurers can request add'l funds from the govt if that capitation rate isn't sufficient.
Advantage is, of course, very helpful financially for those who can't afford the flexibility of a Medigap and the expense of Part D and are willing to put up with provider network restrictions and plan oversight on services.
I went to your links yesterday, one said that in NJ, the commission on an AARP/UH plan was $715. I was floored. I figured they got $100 or so....
Quote:
Originally Posted by The Very Man Himself
Thanks for starting, and to all who have contributed.
I'll be nearly 64 and a half soon, and am just starting to pay attention to medicare.
I'm naturally suspicious of those ads but wasn't looking forward to having to dig into the weeds.
I've been reading here for about 2 years now. My hub will file in January. He's going with AARP/UH (united healthcare) Medigap G with a $200 deductible. It goes up for inflation but not due to age.
I just posted a bunch of info in 2 or 3 other threads where I linked all of the threads I found helpful that made me decide what he's on.
The only thing I have to pick still is his part D plan. He will most likely go with whatever I'm going with, depending on the price. He has back issues, will be needing meds at least in the next year or so, so he will need a plan that will cover those meds. Not many do. Last year there were only 2 companies that did. I don't recall if there were 2 or 4 plans out of those 2 companies. I'm pretty sure clear springs $29.30 plan does not cover them this year so I will have to switch. I'm going to try to start working on it this week.
Quote:
Originally Posted by GearHeadDave
What you quickly learn once you get into the Medicare maze is that there are a LOT of pitfalls.
For example, the Supplement idea sounds good at the outset. You pay a little higher premium every month based on the concept that the Supplement (like Plan G) will cover anything that Medicare doesn't.
The "gotcha" is that traditional Medicare does not cover a lot of things you might think they SHOULD cover.
For example, an annual physical exam and blood work. While your employer plan may have covered this every year - Medicare does not. Medicare only covers a "wellness check" which is about 10 questions the doctor asks you, as he checks a box. That is IT. This is the only preventative cost Medicare covers with your physician. Below is a link describing one patient's surprise when she got the bill for her annual physical.
This is as frustrating for the MD as it is for the patient. Basically, many Medicare patients don't ever get annual physicals because they can't afford them. And many conditions go undetected until that patient gets ill down the road. My MD takes Medicare patients but has total contempt for a system that keeps him from doing his job.
Next gotcha? That physical exam isn't covered at all by the "supplement" either, because that exam is not a Medicare approved event. MediGap only covers the gap for Medicare approved necessary care. So if you want a yearly (or biannual or whenever) physical exam you must plan to pay for all of that out of pocket.
Not sure about Medicare Advantage plans, maybe someone here has experience. But no matter whether it is Advantage or MediGap the lesson learned is to know up front whether the event/exam/treatment is truly a Medicare approved service, and then to find out if the secondary insurance company will pay what they don't cover. And be prepared to get out your wallet.
Thanks Dave, I haven't run into that yet. Been on a medigap 10 years now, they've paid everything. I'm with BCBS who is one of the only companies to cover someone disabled under 65.
I've had one issue that took a year to pay. Medicare kept kicking the can, saying it was a car accident injury when it was not. The radiology company kept resubmitting the bill, eventually it some how did pay. Then the medigap paid too.
I'm fairly healthy except I'm on a few meds. They've never not paid my GP. I have to go every 3 months.
With being on pain meds, I get a drug screen every 3 months plus they run other blood work. They've always paid it.
I've had a lot of tests this year, colonoscopy, upper endoscopy, ENT who scoped me, vocal cord scope, swallow test scope. My GP has been running various blood work for 6 months now trying to figure out why my sodium and something else is off. Referring me to an endocrinologist. So far I have not seen a bill for anything.
My GP has given me a medicare packet twice or 3 times that medicare supposedly wants filled out, I'm supposed to get some sort of physical with it. COVID happened so I haven't do that yet to know what it's about. I'm not sure what I did with the packet or I'd look to see what they ask. Wonder if anyone else has seen that?
I went to your links yesterday, one said that in NJ, the commission on an AARP/UH plan was $715. I was floored. I figured they got $100 or so....
I've been reading here for about 2 years now. My hub will file in January. He's going with AARP/UH (united healthcare) Medigap G with a $200 deductible. It goes up for inflation but not due to age.
I just posted a bunch of info in 2 or 3 other threads where I linked all of the threads I found helpful that made me decide what he's on.
The only thing I have to pick still is his part D plan. He will most likely go with whatever I'm going with, depending on the price. He has back issues, will be needing meds at least in the next year or so, so he will need a plan that will cover those meds. Not many do. Last year there were only 2 companies that did. I don't recall if there were 2 or 4 plans out of those 2 companies. I'm pretty sure clear springs $29.30 plan does not cover them this year so I will have to switch. I'm going to try to start working on it this week.
Thanks Dave, I haven't run into that yet. Been on a medigap 10 years now, they've paid everything. I'm with BCBS who is one of the only companies to cover someone disabled under 65.
I've had one issue that took a year to pay. Medicare kept kicking the can, saying it was a car accident injury when it was not. The radiology company kept resubmitting the bill, eventually it some how did pay. Then the medigap paid too.
I'm fairly healthy except I'm on a few meds. They've never not paid my GP. I have to go every 3 months.
With being on pain meds, I get a drug screen every 3 months plus they run other blood work. They've always paid it.
I've had a lot of tests this year, colonoscopy, upper endoscopy, ENT who scoped me, vocal cord scope, swallow test scope. My GP has been running various blood work for 6 months now trying to figure out why my sodium and something else is off. Referring me to an endocrinologist. So far I have not seen a bill for anything.
My GP has given me a medicare packet twice or 3 times that medicare supposedly wants filled out, I'm supposed to get some sort of physical with it. COVID happened so I haven't do that yet to know what it's about. I'm not sure what I did with the packet or I'd look to see what they ask. Wonder if anyone else has seen that?
Haven't seen that packet but I am still a Medicare rookie. Chose the same plan as your hubby (AARP/UHC Plan G, and an AARP/UHC Walgreens Rx for Part D).
As far as the annual physical goes, apparently there is a "lot of data" out there that suggests the annual physical causes more harm than good, so there is little evidence to support the value of an annual physical exam/tests. This seems to be why Medicare does not cover the annual physical.
Maybe I have to rethink the value of the annual physical, because it is true that back when this was covered by employer's insurance I chased down things from that exam/tests that turned out to be non-issues (false positives for example). On the plus side, what the annual physical exam does do is establish a relationship with your GP and give him/her some actual data, which the 10-question 15-minute "wellness check" won't supply.
More to come, once I get the out of pocket cost for that physical I can decide if it is worth it. Or maybe it becomes biannual.
Last edited by GearHeadDave; 11-09-2021 at 03:40 PM..
Haven't seen that packet but I am still a Medicare rookie. Chose the same plan as your hubby (AARP/UHC Plan G, and an AARP/UHC Walgreens Rx for Part D).
As far as the annual physical goes, apparently there is a "lot of data" out there that suggests the annual physical causes more harm than good, so there is little evidence to support the value of an annual physical exam/tests. This seems to be why Medicare does not cover the annual physical.
Maybe I have to rethink the value of the annual physical, because it is true that back when this was covered by employer's insurance I chased down things from that exam/tests that turned out to be non-issues (false positives for example). On the plus side, what the annual physical exam does do is establish a relationship with your GP and give him/her some actual data, which the 10-question 15-minute "wellness check" won't supply.
More to come, once I get the out of pocket cost for that physical I can decide if it is worth it. Or maybe it becomes biannual.
Someone posted about the Medicare physical in another thread. It's not the same as a regular physical. I'm going to blow it off as long as I can.
I am fairly healthy and use some medication for sugar control. I have Part A + B.
My GP suggested to go for eye exam + foot exam, Shingle . I am not sure whether part A + B cover these
I find many suggest in this thread.
Quote:
For example, the Supplement idea sounds good at the outset. You pay a little higher premium every month based on the concept that the Supplement (like Plan G) will cover anything that Medicare doesn't.
I am fairly healthy and use some medication for sugar control. I have Part A + B.
My GP suggested to go for eye exam + foot exam, Shingle . I am not sure whether part A + B cover these
I find many suggest in this thread.
How do I know, what to pick ?
Why Plan G better than others?
How much will be extra premium ?
Thanks for sharing.
In the thread Looking for Insurance broker for Part D Prescriptions and Plan G, scroll to my reply where I posted the information I have saved for picking my hubs AARP/UH plan G. I have been researching here for almost 2 years now in order to know what plan to pick.
There are also a few medigap threads where people have also posted a lot of great info. They are easily scanned through to get to the replies that contain the "meat"
Shingles is part D drug plan. You have to see what insurer covers it or it could cost you $200
Medicare and medigap doesn't cover eye exam but it should cover an eye specialist if you had an actual issue not vision related. They did when they thought I had shingles in my eye.
It should cover a foot doctor. Make sure you go there for a foot issue.
I am fairly healthy and use some medication for sugar control. I have Part A + B.
My GP suggested to go for eye exam + foot exam, Shingle . I am not sure whether part A + B cover these
Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.
Medicare Part B will cover eye exams for diabetes, glaucoma, etc., disease of the eye. If your doctor codes the visit properly as potentially diabetic related, Part B should cover it. Ask your doctor. Links to coverage for diabetes, glaucoma, macular degeneration also on this page.
Your choices realistically are Medigaps G, N and high-deductible G (updated w/2022 numbers).
G - pays 100% after satisfaction of $233 deductible, includes excess fee coverage
N - pays 100% after payment of $233 deductible, up to $20 copay dr. visit, $50 ER; no excess coverage
HD-G - Medicare pays 80%, you pay 20% up to $2,490 deductible (2022); thereafter plan pays 100%, includes excess coverage
As you can see, there is very little difference between Plan G and N. If you don't require medical services from a specialty provider like Mayo Clinic (in some areas), Plan N will suit you just fine. The very small copays go a long way to providing a lower premium than Plan G - especially as you age. Many here have Plan N, have experienced cancer and other serious ailments and said the plan paid for everything.
For the healthy person, HD-G is cost-effective Medigap coverage at half to one-third the premium of a full Medigap. Keep in mind, Medicare copays are teeny. Unless you have a serious illness, you may not meet the deductible for a long time, so the plan will pay nothing. Be thankful for your good health. Meanwhile you are covered with all the flexibility of a Medigap should disaster befall. Many here have purchased the HD-G, including myself.
Last edited by Ariadne22; 11-13-2021 at 01:27 PM..
Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.
Medicare Part B will cover eye exams for diabetes, glaucoma, etc., disease of the eye. If your doctor codes the visit properly as potentially diabetic related, Part B should cover it. Ask your doctor. Links to coverage for diabetes, glaucoma, macular degeneration also on this page.
Your choices realistically are Medigaps G, N and high-deductible G (updated w/2022 numbers).
G - pays 100% after satisfaction of $233 deductible, includes excess fee coverage
N - pays 100% after payment of $233 deductible, up to $20 copay dr. visit, $50 ER; no excess coverage
HD-G - Medicare pays 80%, you pay 20% up to $2,490 deductible (2022); thereafter plan pays 100%, includes excess coverage
As you can see, there is very little difference between Plan G and N. If you don't require medical services from a specialty provider like Mayo Clinic (in some areas), Plan N will suit you just fine. The very small copays go a long way to providing a lower premium than Plan G - especially as you age. Many here have Plan N, have experienced cancer and other serious ailments and said the plan paid for everything.
For the healthy person, HD-G is cost-effective Medigap coverage at half to one-third the premium of a full Medigap. Keep in mind, Medicare copays are teeny. Unless you have a serious illness, you may not meet the deductible for a long time, so the plan will pay nothing. Be thankful for your good health. Meanwhile you are covered with all the flexibility of a Medigap should disaster befall. Many here have purchased the HD-G, including myself.
I'm always learning something from you. I have not needed an eye doctor except for when I had shingles on my eye lash lid, I know they paid it. I'm having weird issues with my eyes, I'm going to need an appointment but have been dragging my feet, hoping my eye issue clears up. It's probably been 2 months. I wasn't vaccinated until recently, didn't like going out unless I had to.
I went back to the medicare medigap plan finder to look at the 3 you listed, just to make sure I still want plan G for him. I thought I was on the C plan, I'm actually on D now. This year was the first year they allowed me to have it. I had the more expensive C plan, I'm 56. Those are my only options. Anyway, plan G is the same as my plan D, but for someone 65. My hub's body has been falling apart, he will most likely need at least 2 surgeries. His shoulder (possibly both) and at least one knee.
The Medigap Plan G-high deductible is tempting at a Premiums range from $51-$67, the high $2,370 deductible would be like having the plan he had from the ACA.
The base cost between the G and N is not that much. What makes me hesitate is the "some $20 and $50 copays" which could add up if you had a year like I had with all sorts of doctors and testing plus colonoscopy, upper endoscopy. My D plan has covered everything, even all of the blood work.
I'll add this to my email draft for when he and I sit down in January so that he knows why I'm suggesting the plan G. Maybe he wants to try plan N.
Medigap Plan N Premiums range from $106-$349 for a 65 year old Male that doesn't use tobacco
Copays/Coinsurance
$0 Generally your cost for approved Part B services with some $20 and $50 copays
Deductibles $203 Medical part B
Medigap Plan G Premiums range from $128-$454 for a 65 year old Male that doesn't use tobacco
$0 Generally your cost for approved Part B services
Deductibles $203 Medical part B
Medigap Plan G-high deductible Premiums range from $51-$67 for a 65 year old Male that doesn't use tobacco
Copays/Coinsurance - $0 Generally your cost for approved Part B services after you pay $2,370 deductible
Deductibles $2,370 total plan deductible. After, you pay: $203 Medical part B
The base cost between the G and N is not that much. What makes me hesitate is the "some $20 and $50 copays" which could add up if you had a year like I had with all sorts of doctors and testing plus colonoscopy, upper endoscopy. My D plan has covered everything, even all of the blood work.
The difference in premium between G and N widens as you age. In your case, because you doctor frequently, you could start out with Plan G. Two years ago, UHC was allowing people to downgrade from F to G without health underwriting. With F closed to new enrollees, UHC no longer does this, BUT they are, last I read, instead allowing a downgrade from G to N without health underwriting. Should things stabilize for you or the premium spread make G no long cost-effective for you, you may be able to downgrade to N at a later time. In your case, it may be better to play it safe with G and see how things go.
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and am just starting to pay attention to medicare. 
