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Old 10-12-2018, 03:54 AM
 
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my wife and i pretty much have the same level drug plan , about 29 a month or so . she has aetna and i have humana . humanna is owned by aetna .

we got the same generic antibiotic yesterday at the same drug store because she gave me her germs . i got girl cooties .

hers was .89 cents and mine was 7 bucks .
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Old 10-12-2018, 03:57 AM
 
85,810 posts, read 83,304,960 times
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Quote:
Originally Posted by BBCjunkie View Post
Sorry about that. :-( I didn't mean to muddy the waters. :-)

My use of the word "coverages" may have been the culprit. Back in the day I worked in the insurance industry, first as an underwriter and then in claims, and so I differentiate between "coverage" and "policy" out of habit. When I wrote "Medicare coverages" what I meant was that Advantage policy cannot offer less benefits than traditional Medicare does -- for example, if traditional Medicare covers a colonoscopy every X years, an Advantage plan must cover it that often as well. But the Advantage policy CAN put restrictions on where you can go to get that colonoscopy in order for them to pay for it.

I probably should have written it like this:

"You can have any one of the following combinations:

* Traditional Medicare Parts A and B; and a Part D drug plan
or
* Traditional Medicare Parts A and B; a Part D drug plan; and a Medigap supplement policy
or
* an Advantage plan"

But those are your only choices (for most people anyway.)
plus the advantage plan can deem an mri not warranted in a particular situation , medicare may very well say no problem , we agree , do it.

that is the battle that goes on between advantage plan holders and their gate keepers far to often .

advantage plans claim they cover the same things as not for profit medicare and that may be true in a broad sense . but that does not mean they approve the same things when the insurer has to act in gate keeper mode .

if anyone had claims with a home insurer after a storm you understand the differences between insurers and types of insurance . broadly the policies say they cover this and that . but once you have a claim you find that as gate keepers the amounts you would get from each company is very different .
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Old 10-12-2018, 04:11 AM
 
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My mother was in an advantage plan for 5 years. Very low cost & a free drug plan, but knowing the pitfalls these plans have I was able to get her back in original Medicare without underwriting because Massachusetts allows it. One of only 3 states that do this I believe.

People don't know that if you leave Medicare in most states & have a bad medical history you can't get back in....you are stuck with the advantage plan for good.
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Old 10-12-2018, 07:59 AM
 
2,759 posts, read 1,235,073 times
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Quote:
Originally Posted by mathjak107 View Post
advantage plans claim they cover the same things as not for profit medicare and that may be true in a broad sense . but that does not mean they approve the same things when the insurer has to act in gate keeper mode .
Exactly.The devil is in the details with the Advantage plans, just as in homeowners insurance. So a customer may read a coverage outline for an Advantage plan and think "okay, great, it says here they will cover X service every X years" and not realize that if a claim is actually made there may well be additional hoops that it has to jump through compared to traditional Medicare. And the claim may well not make it through those hoops (by design.)

But because the Advantage company can technically-but-truthfully say "We cover this", they can't be accused of shortchanging the coverage compared to Medicare. (even though they often do)
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Old 10-12-2018, 08:02 AM
 
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Advantage plans give the agents the most commissions for a reason. That is why they push them so hard. As usual for the benefit of the seller not the buyer.
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Old 10-12-2018, 08:38 AM
 
Location: Charleston, SC
2,068 posts, read 1,177,886 times
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Quote:
Originally Posted by BBCjunkie View Post
Sorry about that. :-( I didn't mean to muddy the waters. :-)

I probably should have written it like this:

"You can have any one of the following combinations:

* Traditional Medicare Parts A and B; and a Part D drug plan
or
* Traditional Medicare Parts A and B; a Part D drug plan; and a Medigap supplement policy
or
* an Advantage plan"

But those are your only choices (for most people anyway.)

I believe there's one more combo --

Traditional Medicare Parts A and B; and a Medicare Advantage Plan from a reputable Carrier.


My Carrier has a $0 monthly premium, and my Primary Doc is in the Network. The 2 generic pills I pop are both Tier 1 and a 90-day supply costs $0. I'll stick with this setup for another year or two, but will eventually move to a Medigap Plan G at that time.

I check all of Ariadne's boxes.....

You need to evaluate 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)


Now -- to really muddy the waters.......could I pay the Plan G premium out of a HSA Account ??
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Old 10-12-2018, 09:24 AM
 
2,759 posts, read 1,235,073 times
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Quote:
Originally Posted by FiveLoaves View Post
I believe there's one more combo --

Traditional Medicare Parts A and B; and a Medicare Advantage Plan from a reputable Carrier.
No, that combo is not possible. From page 5 of the 2019 "Medicare and You" handbook from CMS, headed "Your Medicare Options":

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare:


Below that paragraph are two columns. One is headed "Original Medicare" and displays Part A, Part B, Part D, and "You can also add Supplemental Coverage."

The other column is headed "Medicare Advantage (also known as Part C)" and says this: (bold type mine)

Medicare Advantage is an "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D
.

Then on page 55 begins Section 4 which deals with Advantage plans specifically: (again, bold is mine)

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan you'll still have Medicare but you'll get your Medicare Part A and Medicare Part B coverage from the Medicare Advantage Plan, not Original Medicare.


The phrase "another way" is meant in the sense of "an alternate way".

You cannot have "traditional" (aka Original... means the same thing) Medicare PLUS an Advantage plan. That is not an option. It would be a duplication of coverage. A Medigap (supplement) policy is NOT duplication of coverage, it is an addition of coverage, i.e., coverage that another policy does not provide at all.

ETA: To answer your question about whether an HSA can be used to pay Medigap premiums, the answer is no you cannot (unless this rule was changed within the recent Trump tax bill, which I don't think it was.) Medigap premiums have been specifically excluded from HSA eligibility so far.

Last edited by BBCjunkie; 10-12-2018 at 09:47 AM..
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Old 10-12-2018, 10:06 AM
 
Location: Charleston, SC
2,068 posts, read 1,177,886 times
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I'm not being stubborn here, but the words are getting in our way.

I was told that you cannot get a Medicare Advantage Plan without paying premiums for Original Medicare Part A and B. I just now called Medicare 1-800-633-4227 and they re-confirmed that for me.

You cannot have a standalone Medicare Advantage Plan.

This stuff is confusing enough that we shouldn't let semantics confuse it even more.
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Old 10-12-2018, 11:58 AM
 
2,759 posts, read 1,235,073 times
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Ah, I see where the confusion is. :-) It's the use of the word "and" , as if an Advantage Plan could be a stand-alone ... which of course it cannot be.

When you have an Advantage plan, your Part B premium becomes your Advantage Plan premium, because the Advantage carrier is accepting that as their payment for the coverage they are providing to you.

You pay $0 only because your carrier is satisfied with just the $134 that they get from CMS/Medicare (instead of Medicare itself keeping that money.) That is why you must pay that $134 by having it taken out of your social security check. If that didn't happen, the Advantage carrier would be giving you the policy for free. That is why the Medicare rep said that you "must have Medicare", meaning that you must be part of the Medicare system and thus are paying that $134 via a deduction from your Social Security benefit.

The people who are paying, say, $50 a month for their Advantage plan are making up the difference between the $134 the carrier gets from Medicare, and how much their carrier actually charges per month for the policy they provide. In that case the carrier's real premium is $184, but it's obtained from two sources: CMS ($134) and the customer ($50.)

So when you wrote "Traditional Medicare Parts A and B; and a Medicare Advantage Plan from a reputable Carrier", it looked like you were saying that your $134 would be going into and remaining in Medicare's pocket instead of being sent to the Advantage Plan's pocket. "And" looks like "plus" in that sentence.
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Old 10-12-2018, 01:14 PM
 
Location: Wisconsin
23,556 posts, read 50,162,029 times
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Quote:
Originally Posted by BBCjunkie View Post
You pay $0 only because your carrier is satisfied with just the $134 that they get from CMS/Medicare (instead of Medicare itself keeping that money.) That is why you must pay that $134 by having it taken out of your social security check. If that didn't happen, the Advantage carrier would be giving you the policy for free. That is why the Medicare rep said that you "must have Medicare", meaning that you must be part of the Medicare system and thus are paying that $134 via a deduction from your Social Security benefit.

The people who are paying, say, $50 a month for their Advantage plan are making up the difference between the $134 the carrier gets from Medicare, and how much their carrier actually charges per month for the policy they provide. In that case the carrier's real premium is $184, but it's obtained from two sources: CMS ($134) and the customer ($50.)
To expand on this - Advantage plans receive from Medicare FAR MORE than $134.

CMS/Medicare pays Advantage carriers a capitation rate per enrollee in the area of $800 per month, depending on region.

https://www.cms.gov/Medicare/Health-...hmarks2019.pdf

So, FiveLoaves, your Advantage carrier is collecting from Medicare about $10k/year just to cover you. Advantage plans have been huge cash cows for the insurers for years which is why they push them so hard.

Other source materials, here:

https://www.cms.gov/Medicare/Health-...Dir=descending

This is a really wonky discussion of how CMS calculates:

https://www.cms.gov/Medicare/Health-...cement2019.pdf

Last edited by Ariadne22; 10-12-2018 at 01:23 PM..
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