Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Not all Advantage plans are troublesome. If you're dealing with an agent, talk very frankly about your concerns. Does he have customers who are pleased with the Advantage plan he is selling, can he refer you to satisfied customers?
MA, iirc, has several medical providers who also offer Advantage plans. I, personally, would only consider a provider-based plan in my state.
Thanks for your reply - no, I am not in Mass any longer, we're in Florida now. My brother who lives in St. Petersburg FL has an advantage plan that he's been happy with for many years and he's had a lot of major health problems but as you've said, each area has different plans available with different benefits and out-of-pocket max, etc. and we are not in the St. Petersburg area. There are definitely no provider based plans in my area. My husband has part B and a Medigap plan along with a part D but he has a lot more health issues than I do and I'm still feeling like we can't afford two set-ups like his. I'm still looking at them as I won't need coverage until January 1st (when I semi-retire) but find the landscape amazingly confusing. I've spoken with a SHINE counselor but they won't discuss specifics of plans, just give you the overall intro to how to choose.
Thanks for your reply - no, I am not in Mass any longer, we're in Florida now. My brother who lives in St. Petersburg FL has an advantage plan that he's been happy with for many years and he's had a lot of major health problems but as you've said, each area has different plans available with different benefits and out-of-pocket max, etc. and we are not in the St. Petersburg area. There are definitely no provider based plans in my area. My husband has part B and a Medigap plan along with a part D but he has a lot more health issues than I do and I'm still feeling like we can't afford two set-ups like his.
Again, if it fits in the budget, consider a high-deductible plan. Medicare pays it's 80%, you pay Medicare copays which are teeny. If you're healthy, the plan may not pay anything for years. Meanwhile, you have all the flexibility of a Medigap.
Does the company which offers a plan in St. Peterburg also offer Advantage where you live? If so, your choice would be easy. Provider networks often determine if a company goes into an area or not.
Also, know that if you first enroll in Advantage when 65, you are given a Trial Right for one year to return anytime to Original Medicare and purchase a Medigap without health underwriting. So, your initial decision is not cast in stone as to guaranteed issue.
Of course, you can always move to Medigap later, but be subject to health underwriting.
So, maybe enroll in an Advantage now and think about it for a year. I've found in retirement as the years go on, the budget gets better. You may be able to see your way clear to a HD plan at least, especially if you are not happy with the Advantage plan doctors.
Last edited by Ariadne22; 11-18-2021 at 02:16 PM..
This year I had Medicare Advantage which was great. But this coming year (2022) I will need cataract surgery and the agent for Advantage told me that I could be paying around $1000.00 out of pocket or more.
I'm thinking of going back to Medicare and getting Plan N Supplement so I don't have to pay for the surgery. My cost would be $119.00 a month. I think that's a good plan.
There are many downsides to Advantage as I watched some youtube video's to learn what they were. For example: if I needed to go to a hospital and stay there Advantage would not pay for that.
Seeing my primary care doctor would cost about $10.00 each visit with Medicare and Plan N so that's nothing. I don't see the dentist because I wear dentures.
Quality of care isn't the issue. ACCESS TO CARE is. Some MAs put hurdles to access. People with experience with certain advantage plans call them DIS-advantage plans.
Not all perform this way, but many do. If one is the unlucky enrollee of an MA which is a bad actor, too bad for you.
This does not happen with a Medigap.
One again, Lillie, is yours a retiree Advantage plan? Retiree Advantage plans usually perform better. If not a retiree plan, who is the carrier and what state are you in? I think you currently live in FL? I have asked you this at least three times. Either you don't revisit the threads on which you post or for some reason you are ignoring the question.
Quality of care isn't the issue. ACCESS TO CARE is. Some MAs put hurdles to access. People with experience with certain advantage plans call them DIS-advantage plans.
Not all perform this way, but many do. If one is the unlucky enrollee of an MA which is a bad actor, too bad for you.
This does not happen with a Medigap.
One again, Lillie, is yours a retiree Advantage plan? Retiree Advantage plans usually perform better. If not a retiree plan, who is the carrier and what state are you in? I think you currently live in FL? I have asked you this at least three times. Either you don't revisit the threads on which you post or for some reason you are ignoring the question.
Some advantage plans are awful. My husband had one from United Health Care 6 or 7 years ago, it was really bad. His dentist diagnosed him with a small tumor in his salivary gland and referred him to an ENT. The insurance company would not approve it and said that they would only pay for him to see an oral surgeon, but the only one in their network was in San Francisco (at the time we lived in Reno). He drove there (a four hour drive) and the oral surgeon said he wouldn't treat it and referred him to an ENT. United again refused to process the referral. I finally had to call medicare and within a few days United relented and scheduled an appointment with a local ENT.
Again, if it fits in the budget, consider a high-deductible plan. Medicare pays it's 80%, you pay Medicare copays which are teeny. If you're healthy, the plan may not pay anything for years. Meanwhile, you have all the flexibility of a Medigap.
Does the company which offers a plan in St. Peterburg also offer Advantage where you live? If so, your choice would be easy. Provider networks often determine if a company goes into an area or not.
Also, know that if you first enroll in Advantage when 65, you are given a Trial Right for one year to return anytime to Original Medicare and purchase a Medigap without health underwriting. So, your initial decision is not cast in stone as to guaranteed issue.
Of course, you can always move to Medigap later, but be subject to health underwriting.
So, maybe enroll in an Advantage now and think about it for a year. I've found in retirement as the years go on, the budget gets better. You may be able to see your way clear to a HD plan at least, especially if you are not happy with the Advantage plan doctors.
Thanks Ariadne - I'm still slogging through the mud on this lol. When you say the Medicare copays are teeny, can you give me an example? Say for a typical primary care visit? I can't for the life of me find a published list of any kind of what Medicare pays for different types of routine visits. Primary care, specialist visits (various types) etc. I did find coverage amounts for surgical procedures but it's annoying that the info is not more accessible.
Between Medicare and my supplement I don’t pay any copays. I think it’s only plan N that allows small copays such as 20 for a doctor.
Yes, Plan N has small copays for your primary care doctor that costs between $10 and $20.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I've spoken with a SHINE counselor but they won't discuss specifics of plans, just give you the overall intro to how to choose.
