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Old 02-24-2020, 05:18 AM
 
Location: Colorado Springs
6,078 posts, read 6,393,791 times
Reputation: 21059

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https://www.nytimes.com/2020/02/21/b...gtype=Homepage

Medicare’s Private Option Is Gaining Popularity, and Critics

As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients.


"When Ed Stein signed up for Medicare eight years ago, the insurance choice seemed like a no-brainer.

Mr. Stein, a Denver retiree, could choose original, fee-for-service Medicare or its private managed-care alternative, Medicare Advantage. He was a healthy and active 65-year-old, and he picked Advantage for its extra benefits.

“The price was the same, I liked the access to gyms, and the drug plan was very good,” he recalled. After a pause, he added: “Never in my wildest dreams did I think I’d be facing a crisis like the one I’m having now.”

In November, at age 72, Mr. Stein received a diagnosis of aggressive bladder cancer that would require chemotherapy and a complex surgical procedure. The doctor who he determined was the best local specialist for his condition was not in his network, so Mr. Stein decided to switch to original Medicare for 2020 — a move that would allow him to see nearly any health care provider he chose.

That was when he ran up against one of the least understood implications of selecting Advantage when you enroll in Medicare: The decision is effectively irrevocable.

Most enrollees in traditional Medicare buy supplemental coverage to protect them from potentially high out-of-pocket costs. In 2016, out-of-pocket spending in the program averaged $3,166, excluding premiums, according to the Kaiser Family Foundation.

Supplemental coverage sometimes comes from a former employer, a union or Medicaid, although many people buy a commercial Medigap plan. But the best, and sometimes only, time to buy a Medigap policy is when you first join Medicare."

"During the six months after you sign up for Part B (outpatient services), Medigap plans cannot reject you, or charge a higher premium, because of pre-existing conditions. After that time, you can be rejected or charged more, unless you live in one of four states (Connecticut, Massachusetts, Maine and New York) that provide some level of guarantee to enroll at a later time with pre-existing condition protection.

Mr. Stein’s cancer diagnosis made the switch to original Medicare virtually impossible. “We were just shocked to learn that,” he recalled."
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Old 02-24-2020, 05:39 AM
Status: "No longer very optimistic." (set 22 days ago)
 
Location: Coastal Georgia
41,205 posts, read 51,004,455 times
Reputation: 71252
I cannot wade through everything again, but in my experience you get what you pay for. I had an Advantage Plan with Medicare when I first turned 65. It was not Medicare that some of my doctors had a problem with, but it was the fact that the plan paid so little that they stopped accepting it.

DH and I went to a supplemental Plan F and D through AARP. Since then, Plan F has been eliminated in my state, so we have switched to Plan N. We also saved about $100 a month by leaving AARP and going with Aetna.

We have each had surgeries, physical therapy, and multiple kinds of drugs, and the most we’ve ever paid out of pocket is about $200. deductible.

Aside from the cost of straight Medicare, I believe Part D costs about $25. and N costs us about $90.@.

Something else to consider is that once you get accepted to the supplimental, you are in. There are certain chronic illnesses that will cause you not to be accepted later.
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Old 02-24-2020, 01:31 PM
 
Location: Wisconsin
23,560 posts, read 50,186,667 times
Reputation: 18217
Quote:
Originally Posted by gentlearts View Post
DH and I went to a supplemental Plan F and D through AARP. Since then, Plan F has been eliminated in my state, so we have switched to Plan N. We also saved about $100 a month by leaving AARP and going with Aetna.
Afaik Plan F, which provides first dollar coverage and coverage for excess fees, has not been eliminated in any state. Those already covered under Plan F can keep it. The change occurred in 2020 in every state - those first eligible for Medicare in 2020 no longer have the option of Plan F. Otherwise current holders of Plan F can keep it. In other words, they are grandfathered. Even in states which allow a switch without underwriting, those eligible for Medicare before 2020 can switch to another F. And, in all states, those moving from Advantage to Medigap can purchase an F if they can pass underwriting or are in GI states - again provided their eligibility for Medicare began before 2020. So, assuming you could pass health underwriting, you could switch back to an F in the unlikely event you wished to.

Yes, you would have seen a significant difference in premium downgrading from Plan F (again, first dollar coverage - always more expensive) to an N which requires small copays of up to $20 for office visits, does not cover excess charges, and requires payment of $198 Part B deductible before plan pays. The copay feature appears to be the primary reason for the significant premium reduction. Others believe the fact that Plan N is not a "guarantee issue" option under CMS rules under certain circumstances also lowers the premium. Imo, the copay and guarantee issue factor probably are equally weighted in N's pricing, with lack of excess fee coverage less significant.

Curious, how does the AARP Plan N pricing compare to Aetna's Plan N pricing? Both companies should be using issue-age pricing in Georgia. Just doing a quick check, AARP Plan for a 68 y/o in the Savannah area is priced at $111.75, with AARP discount for two in household price would be about $105, or $15 less than Aetna per person. Of course, if you're younger or older than 68 or living in a different zipcode those numbers change. UHC can be priced, here:

https://www.uhcmedicaresolutions.com...ent-plans.html

Last edited by Ariadne22; 02-24-2020 at 02:06 PM..
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Old 02-24-2020, 01:51 PM
 
33,037 posts, read 22,073,757 times
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Advantage plans have gatekeepers while traditional doesn’t. When my mom was in rehab for the first time, it was after a hospitalization for cellulitis, a very common ailment. She’d been living alone, walked without as assistive device, drove, went up and down stairs etc.

After 4 days in rehab, her Advantage plan (Blue Cross of PA plan) tried to cut her stating “we don’t think it’s realstic that your mom will walk again”. What??? Are you nuts???? From cellulitis????

We appealed and she was allowed to stay and returned home as independent as before. A few weeks later we got her bills from co-pays which totaled almost $5000.00. Her plan only paid 100% for a week or so then it dropped off further and further. They didn’t pay for her ambulance to the hospital at all.

They are also state specific. So if you live in NJ but get sick visiting your son in Denver, only your ER care will be covered.

As soon as open enrollment came, I switched her to traditional with supplemental. I can’t recall which letter but it was also a Blue Cross plan and we paid about $350 a month. But no more gatekeepers and no more copays, and if she was in Jersey with me we didn’t have to worry that she would t be covered if she got sick.
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Old 02-24-2020, 04:20 PM
Status: "No longer very optimistic." (set 22 days ago)
 
Location: Coastal Georgia
41,205 posts, read 51,004,455 times
Reputation: 71252
Quote:
Originally Posted by Ariadne22 View Post
Afaik Plan F, which provides first dollar coverage and coverage for excess fees, has not been eliminated in any state. Those already covered under Plan F can keep it. The change occurred in 2020 in every state - those first eligible for Medicare in 2020 no longer have the option of Plan F. Otherwise current holders of Plan F can keep it. In other words, they are grandfathered. Even in states which allow a switch without underwriting, those eligible for Medicare before 2020 can switch to another F. And, in all states, those moving from Advantage to Medigap can purchase an F if they can pass underwriting or are in GI states - again provided their eligibility for Medicare began before 2020. So, assuming you could pass health underwriting, you could switch back to an F in the unlikely event you wished to.

Yes, you would have seen a significant difference in premium downgrading from Plan F (again, first dollar coverage - always more expensive) to an N which requires small copays of up to $20 for office visits, does not cover excess charges, and requires payment of $198 Part B deductible before plan pays. The copay feature appears to be the primary reason for the significant premium reduction. Others believe the fact that Plan N is not a "guarantee issue" option under CMS rules under certain circumstances also lowers the premium. Imo, the copay and guarantee issue factor probably are equally weighted in N's pricing, with lack of excess fee coverage less significant.

Curious, how does the AARP Plan N pricing compare to Aetna's Plan N pricing? Both companies should be using issue-age pricing in Georgia. Just doing a quick check, AARP Plan for a 68 y/o in the Savannah area is priced at $111.75, with AARP discount for two in household price would be about $105, or $15 less than Aetna per person. Of course, if you're younger or older than 68 or living in a different zipcode those numbers change. UHC can be priced, here:

https://www.uhcmedicaresolutions.com...ent-plans.html
Yes, you are right. Our plan F required us to go to one certain hospital, and that hospital decided not to participate anymore. That was why we went to N. When we switched from AARP, we saved over $100. a month. The Aetna agent said that AARP gets a kickback that Aetna does not. I do not have the exact numbers in front of me but one on us is $90. and one of us is just over $100.
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Old 02-24-2020, 06:08 PM
 
Location: Wisconsin
23,560 posts, read 50,186,667 times
Reputation: 18217
Quote:
Originally Posted by gentlearts View Post
Yes, you are right. Our plan F required us to go to one certain hospital, and that hospital decided not to participate anymore. That was why we went to N. When we switched from AARP, we saved over $100. a month. The Aetna agent said that AARP gets a kickback that Aetna does not. I do not have the exact numbers in front of me but one on us is $90. and one of us is just over $100.
The 'kickback' isn't what added $100 to the cost. The first dollar coverage of Plan F did. Differential on identical plans for AARP v. other companies is usually not more than $20 or so. Over time, in other states with its community rating, AARP narrows that gap. But, Georgia is an issue-age state, so comparing plans should be comparing apples and apples.

Downgrading to N accounts for the big premium saving. Did you price AARP Plan N v. Aetna Plan N - essentially comparing apples and apples?

Premium difference shouldn't have been more than $15 more for AARP per person w/household discount. (Upthread I said "less" - "less" should be "more"). I'm always curious on plan costs. As I said, AARP UHC Plan N in Savannah area of Georgia for a 68 y/o is $111.75, household discount brings that down to $105. Not significantly more than the $90 you are currently paying.
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Old 02-24-2020, 07:04 PM
Status: "No longer very optimistic." (set 22 days ago)
 
Location: Coastal Georgia
41,205 posts, read 51,004,455 times
Reputation: 71252
Quote:
Originally Posted by Ariadne22 View Post
The 'kickback' isn't what added $100 to the cost. The first dollar coverage of Plan F did. Differential on identical plans for AARP v. other companies is usually not more than $20 or so. Over time, in other states with its community rating, AARP narrows that gap. But, Georgia is an issue-age state, so comparing plans should be comparing apples and apples.

Downgrading to N accounts for the big premium saving. Did you price AARP Plan N v. Aetna Plan N - essentially comparing apples and apples?

Premium difference shouldn't have been more than $15 more for AARP per person w/household discount. (Upthread I said "less" - "less" should be "more"). I'm always curious on plan costs. As I said, AARP UHC Plan N in Savannah area of Georgia for a 68 y/o is $111.75, household discount brings that down to $105. Not significantly more than the $90 you are currently paying.
We first went to AARP N, and then to Aetna N two years later.
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