Medicare or Medicare Advantage? (medical, plan, hospital, doctor)
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I will retire by the end of October so I must decide if I go either to traditional Medicare A/B, including a supplemental plan (F) plus drug coverage (D)
OR
Medicare Advantage from a company such as United Health.
What are the benefits and costs of a Medicare Advantage plan?
One disadvantage that comes to mind is that Medicare does not have a drug formulary which prevents you from getting a particular prescription. Are there others?
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 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.
I think you have gotten some really good advice here. I have a medical eye condition and I knew I had to have eye surgery. Advantage plan while monthly payments were less the co-pays were much higher plus with an advantage plan everything has to be by done by their doctors or you are going pay. I had cataract surgery and because the hospital listed the nurse anethists inside of the doctors she works under they refused to pay it because she was not listed as one of their doctors. So before you have surgery be sure that they are on your plan as a doctor.
I have United Health care and I love it. No referrals needed. I can go to any doctor I choose. It is more expensive monthly but I would rather have the freedom to choose.
Interesting the opinions negative about MA plans. Love mine. Premium thus far has been zero; just pay the B part premium. Not a heavy consumer of healthcare, at all. Got just the dr I wanted, plenty of specialist to choose from.
Have had one emergency room trip; kidney stone(s) passing, while out of town. First time ever. Wow, what a surprise. No billing problems, though. Recently went to an ENT; no referral needed.
Plan is a PPO by aetna. I'm in a major metro area.
I have United Health care and I love it. No referrals needed. I can go to any doctor I choose. It is more expensive monthly but I would rather have the freedom to choose.
Just to clarify - for others reading this thread - it appears you now have a United Healthcare Medigap - not its Advantage plan, correct?
As I've said on others threads, I would have no hesitation enrolling in a UHC Medigap F. I would not, never again, enroll in the UHC Advantage.
There is a night and day difference between the two.
Medigap plan F will be retired in 2020. This will create a closed block of business for plans issued prior to 2020 consisting of a group of people getting older and sicker. Rates on existing plans F quite possibly will progressively increase at a higher rate than other plans.
Could you explain this a bit more ?
It is my understanding that the only change is that Plan F (and, I assume, the F-HD version) would no longer cover the Part B deductible (currently $147/year).
Could you explain this a bit more ?
It is my understanding that the only change is that Plan F (and, I assume, the F-HD version) would no longer cover the Part B deductible (currently $147/year).
Expectations are premiums for F will go up quite a bit b/c after 2020 Medigap F will only be insuring existing book of business who are getting older and sicker.
Quote:
if you currently have a Plan F Medigap policy you should be able to keep your policy because it is guaranteed renewable. However, it may become so unattractive due to high premiums that you will wish you didn’t have a Plan F.
Cost of insurance is based on location and insurance provider. Quality of coverage can also be impacted by where you live and your insurer.
There is a volunteer organization that can answer most of your Medicare questions. SHINE counseling centers are located all over the country. These trained volunteers will not steer you to one type of coverage or another but offer suggestions based on your specific needs.
There is also a guide called "MEDICARE AND YOU" which should be downloaded and read by every person turning 65.
The government decided not to give retirees a COL increase in 2016. The last 2 increases paid bupkis. They insist there's no inflation, but I guess nobody in Washington has bought eggs lately.
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