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Medicare supplemental or advantage advice?

zsazsa1
Posts: 539
Joined: Oct 2018

Well, I've defied the odds for long enough that I will be going on Medicare as of March.  I live in CT, and would like to have access to Dana Farber and/or Sloan Kettering.  Annual medical bills are likely to be high (although who knows, with no recurrence of uterine, and if the lymphoma stays in remission, all I'd have is some quarterly bloodwork and an annual MRI to watch the pre-cancerous pancreatic cysts).  But I have to assume that I'd have high to astronomical medical costs. 

Anyone have advice regarding medicare supplemental insurance?  It's kind of overwhelming - there are so many options, it appears.

Kaleena's picture
Kaleena
Posts: 2053
Joined: Nov 2009

Just wanted to respond to your post.   I am not at that phase yet so I am unable to give you any advice on this at this time.   And besides that, I would also like to know!

oldbeauty
Posts: 286
Joined: May 2012

I recommend you pick up a copy (Amazon or Library) of the latest edition of Philip Moeller's "Get What's Your From Medicare--Maximize Your Coverage and Minimize Your Costs."  It is a comprehensive and unbiased review of original Medicare, Medicare Advantage, the alphabet soup of Medigap policies and Part D Pharmaceutical benefits.

After reading it twice, I stuck with my original plan, which was to go with original Medicare and the most comprehensive Medigap policy (which now is Plan G, I believe).  I do not believe in the benevolence of private insurance companies so I did not think a Medicare Advantage Plan was a good fit.  By law, they must provide all the coverage of original Medicare, but then they can do all these add-ons.  To me, a skimpy dental and/or vision benefit, or a Silver Sneakers gym membership is a nothing-burger.  You can purchase equivalent dental plans at your dentist's office, which will give you about the same benefit.  My ophthamologist can find a way to charge some of my vision check to Medicare, leaving me a small out of pocket, and I'm not limited to certain frames.  Part D is the most frustrating.  The pharmacy benefit with a Medicare Advantage plan may be "better," but I doubt it.  Most of these companies offering MA, also have Part D plans and I would imagine all customers get put in the same risk pool as their equivalent Part D plan.  My issue this year with Part D is trying to get a handle on what drugs my doctor may put me on for another recurrence and to see which plan will cover these best.  The difficulty in trying to discover the answer is too much for me.  But the biggest decider, is the fact that many MA plans require you to stay within a network, whereas original Medicare is nationwide with any provider that accepts Medicare.  And, more importantly, the only time you can guarantee access to your preferred Medigap plan without medical underwriting is when you are first eligible for Medicare.  This is important because you may find that a MA plan, in the future, will drop some discretionary benefits to the point where you might decide it no longer is a better deal, but then you are rejected for a Medigap plan.  To me, it's not worth the risk.  But Moeller's is a good book; he also has one about "getting the best" out of Social Security.  He used to author fact/advice columns on both subjects that were posted on the PBS.org website, but no longer.

Isn't is great to live long enough to get on Medicare?  I know I did a big happy dance on that birthday, and no longer had to sweat through the assaults on the ACA.

Best wishes. Oldbeauty

 

Forherself's picture
Forherself
Posts: 464
Joined: Jan 2019

Advantage plans are PPO's.   They do have drug coverage and other perks.  We had an Advantage Plan when I was diagnosed with cancer cells.  The first gynecologist I was referred to did not accept our Advantage Plan, so the gyne making my diagnosis was not my first choice and I had a long wait to get in.  The other gynecologist would have seen me in a week.  Anyway, after the diagnosis the preferred cancer center did not accept my Advantage plan either.  I was sent to the U of Washington, and did get excellent care.  BUT then the next year the Advantage plan was not contracting with the gyneoncologist, although they did contract with the U of Washington.  I had quite enough of that and we went in and switched.  It was hard to switch to a supplemental plan after buying an Advantage plan but we made it.  The Supplemental insurance pays what Medicare does not pay.  But to the physician or facility, you are a plain medicare patient.  Specialists and facilities usally all accept medicare will accept. you.  The trouble is primary care, becuase Medicare reimbursement to primary care is quite low.  AS long as you have a primary care you like they will keep you.  We do buy additional drug coverage.   The other thing about Advantage is you can go to an ER.  The facilyty accepts your insurance but some of the doctors don't. You are not covered for thier services.  I am happy with my insurance now. We can go to the doctor we choose. 

 

zsazsa1
Posts: 539
Joined: Oct 2018

That's what I suspected.  I guess it's a supplemental plan for me!  Now comes trying to find out what would be best in my state.

 

oldbeauty
Posts: 286
Joined: May 2012

Zsazsa, all medigap plans with the same letter have identical benefits.  If you can afford it, "G" is most comprehensive.  It costs you only the few hundred dollar annual deductible before everything is covered.  Like others, I have received no bills for imaging or blood work or anything in the 2 years I've been on Medicare.  Just be sure you check the financial strength of the medigap insurer first.  A.M.Best is one of the leading analyzers/raters of financial ability.  I went with Physicians Mutual, out of Omaha, NE, because that's what my parents had; I handled their finances after my father became ill.  He had two surgeries for cancer.  All in all, I think we had a bill for $500, and I think that was for hospice care.  They are "A" rated and have been around a long time.  I suggest you narrow it down to a few companies and then speak to a rep at each one.  My experience is that they compete on price.  Maybe not a lot, but enough to make it worth your while.  It helped that my husband and I each turned 65 in the same month so we got a "volume" discount.  Also, not that it is reliably predictive, ask about their % rate increases in the past few years to see if there is one that is better than another at managing rates.  Best wishes, Oldbeauty.

els19
Posts: 78
Joined: Jun 2014

Yes, my research and previous job experience working with ill seniors showed me that traditional Medicare with a MediGap plan is the best way to go and currently plan G is the best. The drug plans are confusing especially since you can't predict what you might need for a recurrence. But I found that most of the main plans had similiar coverage. Medicare D has actually improved since first implemented. I was at legislative conferences when the goal was to get it implemented. The plan was to get it started and then improve it and I think they've made inroads.

alicia2020
Posts: 64
Joined: Sep 2020

I'm no expert, but I had to make these decisions in June....BEFORE I knew I was headed for a cancer diagnosis. What I did know: 1) having taken care of both my father and my uncle and their finances before their deaths, they both had AARP supplemental plans with United Healthcare & despite huge medical bills & services, I NEVER had to write checks to pay for things not covered by insurance, and 2) my in-laws also had same coverage and experience. They have "Plan F," which is not available for people joining in 2020. 
So....best I could tell... "Plan G" was closest thing to it

i said to the sales guy...."This is what I know I want: 1) I currently don't have any medical issues,but if/when I do, I do NOT want to have to be in the hospital or have huge medical bills for some reason, and then get some bill for thousands of dollars. 2) I also do NOT want my insurance dictating what doctors I see." All total, my Medicare, plus supplemental, plus Part D costs less than $350 a month.

So... best I know...all these commerdials you see....oh  Great! $O this & $0 that! for Medicare Advantage plans? That sounds good until you've got an expensive problem like cancer. To the best of my knowledge....I still hold my breath a little every time the mail arrives....With 2 major surgeries & 2 procedures in the hospital (in 3 1/2 months), well over $250,000 has been billed through my Medicare and supplemental and the only bill I've received is from my incompetent GYN for $75 (which I am seriously considering not paying, simply as a matter of principle!).

That's my $.02!!
Best of luck!

alicia2020
Posts: 64
Joined: Sep 2020

I'm not positive, but my understanding is that if you start out with the "Advantage" option originally, if you later want to switch to a supplemental plan, not only is it difficult (as Forherself mentioned above), but can also be more expensive...I.e., now they're not just charging you the rate they would have originally, but adding costs based on what's occurred since you made that original decision! 

You could ask about this!

Molly110
Posts: 182
Joined: Oct 2019

Yes. If someone chooses Medicare Advantage initially -- or switches from original Medicare to Meidcare Advantage -- and then wants to switch to original Medicare, the insurance companies that sell Medigap plans are allowed to charge higher prices for aMedigap plan based on medical underwriting. 

 

Anyone with a history of cancer or other serious chronic illness should consider very carefully before enrolling in Medicare Advantage.

 

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