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Medicare advantage plans?
Posted by: Mr Downtown
Date: July 21, 2022 08:23AM
Well, the long-awaited day is here this week, and I'll need to choose a Part B plan. Of course, I'm inundated by junk mail and robocalls, and have absolutely no idea of how to choose a plan. I'm generally active, healthy, and from long-lived ancestry. I take inexpensive maintenance meds for blood pressure. I have no physician to retain; no network I want to be part of.

If anyone wants to offer names of plans/providers, I'll check whether they're available in Illinois. Or an easy-to-use, trustworthy comparison website? Or do I just go with the one AARP has partnered with, figuring they did the analysis?
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Re: Medicare advantage plans?
Posted by: mspace
Date: July 21, 2022 08:35AM
Contact a medicare agent good for your state. Make sure they rep more than just one insurance company.

Agents are free to you. They get commissions from the insurance companies. All those rates are the same to prevent favoritism.

I use an agent and make sure to do all my sign ups through him so he can get paid, even if I could do it on line directly. He has been VERY helpful to solve a few confusing areas and worth working with.
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Re: Medicare advantage plans?
Posted by: MrNoBody
Date: July 21, 2022 08:51AM
Medicare Advantage is Part C, Part B is covered in the govt's.
deduction from your SS monthly benefit.

Forget AARP & the myriad of other data sellers, use Medicare's own
website. [www.medicare.gov]
(avoid any site that is not ".gov" unless it's a .gov referral link.)



39°36'17"N 75°44'43"W

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Burning Down The House by Merrick & The Goons
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Re: Medicare advantage plans?
Posted by: TL
Date: July 21, 2022 09:31AM
Illinois’ SHIIP program is a great resource for Medicare beneficiaries to get help finding plans, understanding costs, etc. it’s free to all Illinoisans. [www2.illinois.gov]

Just about every state has a similar program, and I highly recommend any Medicare beneficiary at least be aware of these programs so that if I future you, a friend, or family member need help you know where you can go b
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Re: Medicare advantage plans?
Posted by: JoeM
Date: July 21, 2022 09:33AM
Back when I first started with Medicare I used this site to learn basic information along with Medicare.gov.
I never contacted them, only read the info on their site:
[boomerbenefits.com]



JoeM
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Re: Medicare advantage plans?
Posted by: numbered
Date: July 21, 2022 09:42AM
Good advice above.

The one thing to be aware of is that Medicare Advantage plans are a different animal from Medicare supplementary plans. Advantage is cheaper and has more come-ons of various sorts...but they often do this by restricting access to networks/docs. They tend to have an HMO like process.

The key thing to know is that it is easy to go from supplementary plans to Advantage. It may not be possible to go the other way. Choosing an Advantage plan, then deciding to switch when you are sick may not work.

The main thing is the situation in your local healthcare market. Big cartels have formed everywhere. If you have competition, you can rest easier. Other markets with limited network/doc choices, will be more problematic.

The 'safe' thing is the standard supplements. They are priced within a few dollars of each other at similar levels of care. You can do/see whoever or whatever you want as long as Medicare covers it.

Of course YMMV.
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Re: Medicare advantage plans?
Posted by: wurm
Date: July 21, 2022 09:54AM
What everyone else said (but especially TL). There are also lots of YouTube videos out there mostly from the aforementioned brokers/agents. They can either enlighten you or make you more confused, but at least they all have pretty much the same information. And as MrNoBody suggested, the medicare.gov site is helpful. Don't just google Medicare; actually enter medicare.gov into your address bar. Good luck!
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Re: Medicare advantage plans?
Posted by: Michael
Date: July 21, 2022 10:04AM
I have no advice on how to pick a plan; we have to use Aon (now Alight) to get some money toward Medicare from our university system so I use them. But, when all was said and done we chose United Health Care. The plan we're using isn't one of those that provides money back to your Medicare account (if you've seen those ads on TV). One really important thing that I found is to look carefully at just what the plan pays. Aon has some of those plans that reimburse money back to a Medicare account but the hospital coverage is MUCH worse than the one we chose. We're paying $49 a month each for UHC. I take Flomax (generic) and it's completely covered by their associated drug company. They require a Primary Care Provider; I just let them choose one for me. I've never seen the person nor will I ever. My primary physician isn't in their network but I see him for annual physicals and it's completely covered. My wife's colonoscopy last year was completely covered, as well, even though the gastroenterologist isn't in their plan. The only difference between seeing somebody in network vs. out of network is that if I see a primary care provider, it's $5 in network and $25 out of network. If I see a specialist it's the same cost in or out of network. Same with hospitals and free standing clinics--same cost in or out of network.

One piece of advice that I can give is the the UHC supplemental dental policy just stinks. I can tell you a long story of my discovery of just how worthless it is if you want to hear it. Or you can just consider that we've ultimately ended up with Delta Dental for our dental coverage. We had a policy with them through work for 15 years and they were fine then so I assume they'll still be fine. We just had checkups a couple of days ago--we'll see if they cover the whole thing as they did when I was working. Anybody over 65 can take out a policy with them; it doesn't require being part of a work plan. I chose the expensive policy that's $43 a month. It covers cleanings immediately and major procedures after 12 months of coverage. It has a $2000 maximum per year. They cover implants (that's part of my story of how worthless UHC supplemental dental is).
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Re: Medicare advantage plans?
Posted by: Janit
Date: July 21, 2022 10:05AM
Quote
MrNoBody
Medicare Advantage is Part C, Part B is covered in the govt's.
deduction from your SS monthly benefit.

Forget AARP & the myriad of other data sellers, use Medicare's own
website. [www.medicare.gov]
(avoid any site that is not ".gov" unless it's a .gov referral link.)

The issue is in how you want your Part A, B, and D services administered/delivered.

Medicare Advantage (part C) is a way to package A, B (and often D) together to be administered/delivered by a commercial health insurance provider. MA premiums can be very attractive, but the plan value and coverage will vary widely by region. Some are very good, but some are horrid.

I am fortunate to live in an area where a Braven Medicare Advantage PPO plan is available in which BCBS providers in most states are considered to be in-network. Non-BCBS providers are covered as out-of-network as long as they participate in Medicare. Braven seems to have realized that retirees in north NJ like to travel a lot and is marketing to this demographic.



Edited 2 time(s). Last edit at 07/21/2022 10:18AM by Janit.
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Re: Medicare advantage plans?
Posted by: mattkime
Date: July 21, 2022 10:09AM
Quote
Michael
I chose the expensive policy that's $43 a month. It covers cleanings immediately and major procedures after 12 months of coverage. It has a $2000 maximum per year. They cover implants (that's part of my story of how worthless UHC supplemental dental is).

Is there a particular reason why you felt you needed dental insurance? At $516/year and a $2000 max it doesn't sound like a terribly good deal.
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Re: Medicare advantage plans?
Posted by: DeusxMac
Date: July 21, 2022 10:12AM
My personal experience with Medicare "Advantage" plans was that they are not that advantageous.

My father had an Advantage plan, and when he needed to go into a rehabilitation facility, the number which would accept Advantage plans was a fraction of those which took the base Medicare plan. When looking for an open bed upon release from the hospital, it severely limited his options.
The Social Worker who assisted us at the hospital told me she was going to insist that her father NOT get an Advantage plan when he went on Medicare.
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Re: Medicare advantage plans?
Posted by: Ammo
Date: July 21, 2022 10:54AM
Quote
numbered
Good advice above.

The one thing to be aware of is that Medicare Advantage plans are a different animal from Medicare supplementary plans. Advantage is cheaper and has more come-ons of various sorts...but they often do this by restricting access to networks/docs. They tend to have an HMO like process.

The key thing to know is that it is easy to go from supplementary plans to Advantage. It may not be possible to go the other way. Choosing an Advantage plan, then deciding to switch when you are sick may not work.

The main thing is the situation in your local healthcare market. Big cartels have formed everywhere. If you have competition, you can rest easier. Other markets with limited network/doc choices, will be more problematic.

The 'safe' thing is the standard supplements. They are priced within a few dollars of each other at similar levels of care. You can do/see whoever or whatever you want as long as Medicare covers it.

Of course YMMV.

This!

But another benefit is that a Medicare supplemental plan allows you to go to any doctor or clinic that you choose. Your situation may be different, but I live in a large metropolitan area with many different health care providers to choose from, so I’m not locked into just one. Good luck with your search!



Where is there dignity unless there is also honesty? - Cicero

Be kind, for everyone you meet is fighting a battle you know nothing about. —Wendy Mass



Edited 1 time(s). Last edit at 07/21/2022 11:01AM by Ammo.
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Re: Medicare advantage plans?
Posted by: Ombligo
Date: July 21, 2022 11:15AM
one thing to remember is that while an advantage plan sounds good because you are healthy now - you may not be that way in a few years. Think longterm, not immediate cash savings



“No persons are more frequently wrong, than those who will not admit they are wrong.” -- François de La Rochefoucauld

"Those who cannot accept the past are condemned to revise it." -- Geo. Mathias
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Re: Medicare advantage plans?
Posted by: graylocks
Date: July 21, 2022 11:51AM
If Kaiser is in your area take a look at them. I'd been satisfied with their Advantage plan. I'm in decent health.



"Success isn't about how much money you make. It is about the difference you make in people's lives."--Michelle Obama
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Re: Medicare advantage plans?
Posted by: Speedy
Date: July 21, 2022 12:20PM
Quote
mattkime
Quote
Michael
I chose the expensive policy that's $43 a month. It covers cleanings immediately and major procedures after 12 months of coverage. It has a $2000 maximum per year. They cover implants (that's part of my story of how worthless UHC supplemental dental is).

Is there a particular reason why you felt you needed dental insurance? At $516/year and a $2000 max it doesn't sound like a terribly good deal.

This ^ Pay dental out-of-pocket because over the long term you’ll be ahead.

We have a supplement and we will pay more in premiums than we will get in benefits UNTIL that bad diagnosis comes in.



Saint Cloud, Minnesota, where the weather is wonderful even when it isn't.
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Re: Medicare advantage plans?
Posted by: $tevie
Date: July 21, 2022 12:56PM
Quote
graylocks
If Kaiser is in your area take a look at them. I'd been satisfied with their Advantage plan. I'm in decent health.
I'm in the Kaiser MA as well. I'm happy with it. I'm also in decent health.
I do miss Johns Hopkins' MA, but they threw everyone in Baltimore City and Baltimore County off it. I still don't understand how they got away with that.



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Re: Medicare advantage plans?
Posted by: JoeH
Date: July 21, 2022 01:53PM
Quote
$tevie
Quote
graylocks
If Kaiser is in your area take a look at them. I'd been satisfied with their Advantage plan. I'm in decent health.
I'm in the Kaiser MA as well. I'm happy with it. I'm also in decent health.
I do miss Johns Hopkins' MA, but they threw everyone in Baltimore City and Baltimore County off it. I still don't understand how they got away with that.

Watch out for Kaiser doing the same thing. just over 20 years ago they exited health care in the entire Northeast on a few months notice. The last day of June that year they announced they were leaving at the end of the year, state employee plans for the coming year started July 1st. If I remember right they sold of the health care operations in NY and CT, but just abandoned what they had elsewhere to the medical groups.
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Re: Medicare advantage plans?
Posted by: Maddog
Date: July 21, 2022 01:59PM
Another thing to consider, many primary care docs will not accept a new patient who has just medicare. They lose money on every visit for those patients. With the advantage plans, the reimbursement for the doc is higher and most will accept those patients. One large multi-specialty clinic here in town will not accept any patients with medicare only, that includes primary care and specialty care.
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Re: Medicare advantage plans?
Posted by: Michael
Date: July 21, 2022 02:40PM
Quote
mattkime
Quote
Michael
I chose the expensive policy that's $43 a month. It covers cleanings immediately and major procedures after 12 months of coverage. It has a $2000 maximum per year. They cover implants (that's part of my story of how worthless UHC supplemental dental is).

Is there a particular reason why you felt you needed dental insurance? At $516/year and a $2000 max it doesn't sound like a terribly good deal.

Our 2 cleanings per year cost $450 a year for each of us. Those are covered at 100%. So, for the first year we'll lose $66 each since they don't cover major procedures in the first year. And we won't do any optional major things in the first year. In succeeding years, any procedures beyond cleanings will make the insurance a good deal. I keep track of our dental costs and we have major things done every couple of years (we are both children from the pre-flouride years so our teeth are crummy). So, dental insurance has paid off for us.

The interesting thing, to me, is that our insurance company charges $22 a month for coverage that is just for cleanings and (after 6 months) fillings. If somebody has 2 cleanings a year, the insurance company is losing money on that.
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Re: Medicare advantage plans?
Posted by: mattkime
Date: July 21, 2022 02:57PM
I'm convinced :-)



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Re: Medicare advantage plans?
Posted by: Buzz
Date: July 21, 2022 03:03PM
It’s all about where you live, and the levels of care that you need now, and will likely need in the future. The more good medical providers (companies) that are in your area to compete for business, the better care, and rates you’re gonna get. Basically they’re HMO’s, but with more competition, they’re more like PPO’s. As noted, Kaiser in most areas is a good choice. Caveat; the larger their area, and available facilities, the better. If Kaiser doesn’t have what you need available where you are, they will either send you to another Kaiser, possibly somewhere far away, or they’ll have to pay for you to see someone that isn’t part of Kaiser, and that can turn into a haggle that you didn’t plan for.

If you live in an area that one of the big guys has monopolized, your advantage choices will probably suck if you actually need healthcare. OTOH, if you’re super healthy, there are plans that will essentially rebate your Part B premium, so from an economic standpoint, that’s like a windfall. We live in the most competitive market in the country, so choices abound, but after having had great PPO coverage thru Mrs. Buzz’s work for years, our providers are spread across several of the big groups. To retain access to all of our specialists, we went with a straight medical supplement, which in our case, we choice F+ Extra, that’s not available any longer, and has been replaced by G plans. We pay a lot, but it covers everything, and I’m guessing it’s people like me as to why F+ was superseded; my IVIG infusions, and related care are >$500K/year, so whatever the premiums are, they’re a bargain.

My step-FIL opted for one of those premium rebate HMO’s, and they kicked him to the curb because he required too much care. His daughter, and one of his step-DIL’s had pretty much full time jobs keeping track of his care. He had to switch plans, read that; get a plan that he has to pay something for, but he’s still somewhat captive under an HMO umbrella. IOW, you really have to plan your selections according to your realistic needs. FIL thought he was getting a free lunch….. he just didn’t realize he was the main course. If he hadn’t had the support from the girls, he woulda been dead a couple of years ago; the big HMO’s just don’t care. Be aware!

There’s no one single/simple solution, despite what all those ads would like you to believe. Get some recommendations from friends, relatives, doctors to find someone to talk to. As noted, the .gov resources are a good place to start. Also, not all licensed agents are hooked up with all companies, so there’s always their desire to sell you a plan where they get a commish…. and it may not be the best plan for your needs. Find someone that knows the nuances of what’s available in your area if you’re going to go with anything other than a robust PPO plan.
Good luck.
==
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Re: Medicare advantage plans?
Posted by: MrNoBody
Date: July 21, 2022 03:36PM
Quote
$tevie
Quote
graylocks
If Kaiser is in your area take a look at them. I'd been satisfied with their Advantage plan. I'm in decent health.
I'm in the Kaiser MA as well. I'm happy with it. I'm also in decent health.
I do miss Johns Hopkins' MA, but they threw everyone in Baltimore City and Baltimore County off it. I still don't understand how they got away with that.
fyi, a Baltimore County address permits you to still get JHMA, just checked
using the 21222 (Dundalk?). Johns Hopkins Advantage MD (HMO)
$30/month & NO co-pay for Primary Doctor.
Hopkins can get away with it because they wouldn't agree to the
government's contract terms, same for UHC.

I too have KPMA. Just had a $7000+ five day; non-Kaiser hospital stay,
for cardio concerns. Kaiser/MC paid all but $594 so I'm OK with that!



39°36'17"N 75°44'43"W

DuckDuckGo
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DemComm Records 2021 Greatest Hits
includes:
Taxman by Joe & Nancy's Rich Ice Cream Band
The Humpty Dance by The Harris-Brown Hookup
Lets Spend The Night Together by The Fang-Swalwell Gang
Díaz-Canel Is A Friend of Ours by The AOC Squad
My Old Kentucky Retirement Home by MitchMcC & The Soggy Boxer Boys
Burning Down The House by Merrick & The Goons
Back In the USSR by Bernie's Red Square Trio

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Re: Medicare advantage plans?
Posted by: AllGold
Date: July 21, 2022 03:47PM
Use the plan finder at www.medicare.gov to see what's available in your area. Ask questions on things you don't understand. Find a good broker/agent in your area. I can probably recommend one if you'd like.
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Re: Medicare advantage plans?
Posted by: $tevie
Date: July 21, 2022 04:59PM
Quote
MrNoBody
Quote
$tevie
I'm in the Kaiser MA as well. I'm happy with it. I'm also in decent health.
I do miss Johns Hopkins' MA, but they threw everyone in Baltimore City and Baltimore County off it. I still don't understand how they got away with that.
fyi, a Baltimore County address permits you to still get JHMA, just checked
using the 21222 (Dundalk?). Johns Hopkins Advantage MD (HMO)
$30/month & NO co-pay for Primary Doctor.
Hopkins can get away with it because they wouldn't agree to the
government's contract terms, same for UHC.

I too have KPMA. Just had a $7000+ five day; non-Kaiser hospital stay,
for cardio concerns. Kaiser/MC paid all but $594 so I'm OK with that!
That Dundalk thing has me wondering if the parts of Baltimore County that got thrown off have a demographic similar to Baltimore City's, if you get my drift.



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Re: Medicare advantage plans?
Posted by: Bill in NC
Date: July 22, 2022 09:48AM
MA plans are mostly HMOs, so you're stuck with whatever network.

Some also have the reputation of denying you what I'd call 'high-touch' treatments like rehab.

E.g. standard of care might be a couple of weeks but they will only cover a couple of days.

Sure, there's an appeals process but most likely you've already just gone ahead & paid out of pocket...good luck winning your appeal & getting reimbursed.

IMHO, MA plans are for poor people who literally cannot afford the premium for Plan G-High Deductible plus the premium for a drug plan.

Sure, they might be cheaper when you're younger & healthier, but by the time you need more medical care you won't be able to pass underwriting to be able to switch back to Medigap.

Plus, MA is costing taxpayers billions more than forecast, so who knows if MA is a savings over traditional Medigap plans:

[publicintegrity.org]



Edited 2 time(s). Last edit at 07/22/2022 06:38PM by Bill in NC.
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Re: Medicare advantage plans?
Posted by: Ombligo
Date: July 22, 2022 11:18AM
What Bill said...



“No persons are more frequently wrong, than those who will not admit they are wrong.” -- François de La Rochefoucauld

"Those who cannot accept the past are condemned to revise it." -- Geo. Mathias
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Re: Medicare advantage plans?
Posted by: AllGold
Date: July 22, 2022 12:31PM
Quote
Bill in NC
Plus, MA is costing taxpayers billions more than forecast, so who knows if MA is a savings over traditional Medigap plans:

[publicintegrity.org]

That "article" is ancient. Need more up-to-date info. Not to mention, this is about cost for an individual person (the O.P.) not cost to taxpayers.

Plus, a lot of the other issues raised might not apply in 2022.

There is no doubt that generally, a Medicare Supplement Plan G with a stand-alone prescription drug plan is the best coverage you can buy, but it's also very expensive.

Medicare Advantage plans have improved immensely over the years, especially the last few years.
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Re: Medicare advantage plans?
Posted by: ka jowct
Date: July 22, 2022 01:08PM
I have a supplement plan. No problems with networks, etc., and the one I have would also apply if I went out of the country (fat chance with all the flying plague enthusiasts, though).



My life goes smoothly and in regular intervals
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Re: Medicare advantage plans?
Posted by: Bill in NC
Date: July 22, 2022 06:48PM
Quote
AllGold
Quote
Bill in NC
Plus, MA is costing taxpayers billions more than forecast, so who knows if MA is a savings over traditional Medigap plans:

[publicintegrity.org]

That "article" is ancient. Need more up-to-date info. Not to mention, this is about cost for an individual person (the O.P.) not cost to taxpayers.

Plus, a lot of the other issues raised might not apply in 2022.

There is no doubt that generally, a Medicare Supplement Plan G with a stand-alone prescription drug plan is the best coverage you can buy, but it's also very expensive.

Medicare Advantage plans have improved immensely over the years, especially the last few years.

For a 65-year-old here Plan G - High Deductible is ~$50/month (attained age), $75 (issue age)

Plan D starts under $10/month.

No matter how happy you are with your current MA plan keep in mind MA is incentivized to deny you care & keep more of the monthly capitation payment.

Is MA overall adding or subtracting PPO plans?

I bet it's the latter.



Edited 1 time(s). Last edit at 07/22/2022 06:49PM by Bill in NC.
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Re: Medicare advantage plans?
Posted by: Buzz
Date: July 22, 2022 11:28PM
Quote
Bill in NC
Quote
AllGold
Quote
Bill in NC
Plus, MA is costing taxpayers billions more than forecast, so who knows if MA is a savings over traditional Medigap plans:

[publicintegrity.org]

That "article" is ancient. Need more up-to-date info. Not to mention, this is about cost for an individual person (the O.P.) not cost to taxpayers.

Plus, a lot of the other issues raised might not apply in 2022.

There is no doubt that generally, a Medicare Supplement Plan G with a stand-alone prescription drug plan is the best coverage you can buy, but it's also very expensive.

Medicare Advantage plans have improved immensely over the years, especially the last few years.

For a 65-year-old here Plan G - High Deductible is ~$50/month (attained age), $75 (issue age)

Plan D starts under $10/month.

No matter how happy you are with your current MA plan keep in mind MA is incentivized to deny you care & keep more of the monthly capitation payment.

Is MA overall adding or subtracting PPO plans?

I bet it's the latter.

We were/are old/lucky enough to skate in on an old F+ $0 deductible PPO plan…. High monthly premiums (very, as noted), but at least we know what our expenses are going to be, so no healthcare surprises… either expense-wise or HMO bureaucrat denial-wise. Healthcare roulette is just one of the many joys of living past your prime.

The sheer delight of dealing with the mental gymnastics that go along with that, is just the added bonus icing on the cake.
You have to do some serious planning/number crunching unless you’re super-healthy and can actually benefit from a MA plan in your area, or you have health “issues” and know you need a full featured PPO.
Happy hunting, good luck.
cool smiley
==
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