We've had many discussions on this forum on the pros and cons of either a Medigap + Part D, or an Advantage plan which includes drugs. A quick search should turn up many threads.
You need to valuate these four criteria -
- your health
- your need/desire for doctor/provider flexibility
- your ability to pay Medigap (and Part D) premiums
- carrier reliability (especially true for Advantage and some Part D plans)
If you have a lot of chronic health issues or foresee serious issues - and can afford it - then a
Medigap G or F - provides the most flexible, worry-free, and trouble-free choice. You can see
any provider anywhere in the country who accepts Medicare, no gatekeepers on treatment approval, no provider networks. Bills go to Medicare and your Medigap.
Generally, with a Medigap F/G, your Medicare-approved expenses will be paid 100%. For the most part, medical expenses are pretty much limited to Medigap premium (and Part D premium and copays if you take medication).
There are less expensive (premium) cost-sharing Medigap plans available, as well, but often these prove to be a false economy when managing chronic illness or worse. Copays and hospital deductibles can eat up any premium savings in short order.
If you are reasonably healthy and can afford some premium and the very low 20% not paid by Medicare the few times you doctor - then a
high-deductible Medigap F, which, again, provides the most
provider flexibility and
caps your annual max out-of-pocket (your 20%) at $2,180,
worst case scenario, all at one-half to one-third the cost of a regular Medigap F. Bills go to Medicare and your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2,180. Thereafter, the Medigap pays 100%.
If you're healthy, over a period of years, you'll probably be much further ahead financially with an hd-F. (
If you haven't done so, as yet, strongly recommend you read this: //www.city-data.com/forum/health-insurance/2129000-help-texas-thinking-original-medicare-hi-2.html)
If you are cost-conscious, then an
Advantage (aka Medicare health plan) (if you're healthy - or, even if you're sick - depending on plan) can be an appropriate choice, as it bundles docs and drugs, for a low or zero premium. Pay close attention to:
- copays and max out-of-pockets, especially if you're sick
- restricted networks - an issue if you need specialty care or if you travel a lot
- drug formulary (tiers and copays)
For the chronically ill, annual Advantage copays could exceed twice the cost of a Medigap F, as max out-of-pockets can be set at $5-$8.
If you travel a lot or snowbird,
unless it is a PPO with out-of-network coverage, Advantage is
not an appropriate choice.
If you choose
Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means
for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, slow pays, denials they've received the provider claims, customer-service run-around, and more.
Check with network providers and providers' billing people on ease of use, timely payment, preapprovals, insistence on use of generic drugs, talk to people you know.
My personal experience with United Health Advantage was unnecessarily problematic the two times I used it - claim denials, "they didn't get paperwork" (an outright lie), useless phone reps, UHC's standard MO for its MA's - so I dropped them; now have an hd-F through Physicians Mutual.
Other threads, here:
//www.city-data.com/forum/healt...e-medigap.html
//www.city-data.com/forum/healt...tage-plan.html
//www.city-data.com/forum/healt...advantage.html
//www.city-data.com/forum/healt...e-medigap.html