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Old 04-25-2016, 07:45 PM
Ariadne22
 
Location: Wisconsin
24,062 posts, read 51,958,626 times
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Quote:
Originally Posted by JonahWicky View Post
Now I'm trying to decide on a Medigap supplemental plan or a Medicare Advantage plan.

Can anyone do a basic pro/con summary of one vs. the other? At the moment, I think I'm leaning toward a Humana Gold Plus advantage plan
My basic response to this Q:

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 evaluate these four criteria -
  1. your health
  2. your need/desire for doctor/provider flexibility
  3. your ability to pay Medigap (and Part D) premiums
  4. 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:
  1. copays and max out-of-pockets, especially if you're sick or anticipate health issues.
  2. restricted networks - an issue if you need specialty care or if you travel a lot.
  3. 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-$7k, or more.

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, onerous oversight on long-term therapies and preapprovals, etc., 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, verify with the provider that provider is, in fact, in that network - insurance reps and websites often are wrong - and talk to people you know who have the same plan.

Unless you are in a guaranteed issue state, know that once past the Initial Open Enrollment, you will not be able to switch to a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another Advantage plan during Annual Open Enrollment.

So, choose carefully, because there may not be a do-over if you decide later you prefer a Medigap.


Last edited by Ariadne22; 04-25-2016 at 08:00 PM..
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