Medicare Advantage Plans

LVSteve

LVSteve

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Been researching the subject. Boy, what a minefield. It's not made any easier by some extremely poorly written websites. Some sites seem to go out of their way to make it hard to determine if your existing doctor is covered. The other gag is to try and hide your maximum out-of-pocket (MOOP) until the last minute. Oh, and some of those MOOP numbers are eye watering.

Any tricks I am missing?
 
Went through this a few years ago as I approached 65. Have some friends that agonized over it for months before they made a decision. I too was pretty overwhelmed by the options so I ended up calling one of the outfits advertising assistance on the tube. They laid things out clearly enough, free of charge, to where I made a decision in about an hour. Haven't had a reason to question that path yet. And I believe plans can be changed annually is something doesn't work out.
 
Yes, Medicare Advantage Plans are a minefield. They brag about covering glasses, hearing aids and all that stuff to cover up what they don't cover. And always touting their low premiums. Myself, I never considered one. I pay a LOT for a Medicare supplement insurance plan but I have the peace of mind knowing that it is accepted everywhere Medicare is accepted.
 
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I find it hilarious that if you watch channels like MeTV, Grit, Insp (basically all the great TV shows from the 50s thru 70s) the commercials are all Medicare Advantage Plans, followed by a testosterone booster commercial, followed by a whole life insurance commercial, a hearing aid commercial, and finishing up with a generic viagara commercial. Do they know their demographics or what?!
 
Medicare advantage plans vary by what county you live in. Find a licensed medicare broker in your area and consult with them. They get a commission no matter what plan you choose, but they are experienced and know how to evaluate plans depending on what is important to you. (E.g., we like to travel, both domestically and internationally. And we want to be able to go to out of network providers if we choose to do so. Further, as a cancer survivor, I want access to MD Anderson, Mayo and Sloan.)
 
My doctor said get regular Medicare and a Supplement and that's what I've had for the last 8 years. No complaints. The Government pays companies to offer advantage plans. So as long as you don't develop any major illness advantage plans work. Heard to many horror stories of what happens and you need a specialist not in the network. Medicare Plan G is the only plan I would recommend. When you enter Medicare you don't need a physical and existing conditions are covered. But switching plans afterwards can be extremely difficult.
 
I've dealt with my folk's health care issues for a long time and I'd advise finding a health insurance broker. They will answer any questions and point you to the best plan and advise you of yearly changes and benefits you didn't know you qualified for. If you have prescriptions they'll give you a rundown on all the tiers and all the changes to copays. They will even come to your house!

Tell them the Docs you see, the meds you take and go from there. Shop around for a pharmacy as different pharmacies have different copays.

My Mom is 93 and I have broker come by every year to go over stuff with her. It's free for my Mom.

If you lived in ABQ I'd give you contact info for the one I use.

My folks have had BCBS and have taken care of EVERYTHING with no questions. I've not had ANY problems dealing with them. My dad had cancer and my mom has an autoimmune disorder - no problems with coverage. none.
 
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Onomea said:
Medicare advantage plans vary by what county you live in.
Click to expand...

No kidding.

For whatever reason, the doctors here do not seem to be fans of Aetna. The BCBS plans seem oddly lacking here, too.

United Healthcare seem to rule the roost here in terms of acceptance by doctors and choice of different plans. This lines up with what my eye doctor told me Monday.

Humana used to be the name I heard bandied around a lot by ma-in-law #1. Seems that the doctors here are picky about which of their plans they will take. To keep my eye doctors I would need to accept a MOOP of $4900 or $6k. Ouch.
 
I have an Aetna Advantage plan , Mrs has a supplemental. I evaluated the total out of pocket and decided that based in my good health, i could accept that risk. Mrs has ongoing health issues so the supplement works for her. With her plan, we need another plan for prescription coverage, and it does not cover as well as my advantage plan. Fortunately the gubment just changed the max out of pocket for scripts to $2000 per year. She is already there

I got help setting up out plans thru AMAC (Assoc of Mature American Citizens). They are more in line with my beliefs than the other old folks group. They evaluated all of my wife's meds to help determine which plan would cover best.

All in all I think we made the right choice, you can change each year and if you move you can change as well. I have been told by some friends that once you choose an advantage plan, you cannot go back to a supplemental plan. I dont know if that is true or not. .

Robert
 
Timely subject for me as I will be turning 65 in August thus losing a retirement benefit from the City including vison and dental for us both. MsNative experienced a seamless transition from my Cigna to Humana in the midst of knee replacement. I've been impressed with the level of care and the extensive PT visits allowed.


Attempting to narrow down supplement options to find adequate coverage that can handle the odd visit from an out of network practitioner while sedated is not fun.
 
In my honest opinion, vision and dental are payable out of pocket.

The broker is the way to go.
 
Looked into them this year, and found out the one that the state offers for stat employees/retirees covers drugs, but only those drugs administered in the hospital. Took awhile to find that small print.

Also discovered if you had their plan and then bought a separate plan only for drugs, you got penalized. Found this really irritating.
 
Every state that I know of has a SHIIP (Seniors Health Insurance Information Program), which is free and staffed by volunteers. The ones I have dealt with have been outstanding, and you can set up an appointment by phone or in person. I personally know two retired Social Security Administration District Managers who do that volunteer work, and they were excellent at their jobs before they retired.
 
My understanding of the "you can't go back" issue:

You can switch back to original Medicare from the Advantage Plans during the annual enrollment period.

The problem is obtaining the supplemental plan. If you have serious health problems you may not find it. Once you go to Advantage, the Supplemental plans are not required to take you if you didn't enroll when you first got Medicare. You are "subject to underwriting". That supplemental plan that wasn't too bad when you first looked at Medicare now gets to be repriced based on your risk.

I like the Advantage Plan but I was kind of forced into it. The HMO I use here in Houston only accepts certain Advantage Plans, they won't accept regular Medicare. In addition, if you're really sick, the Advantage Plans have an annual max out of pocket. Regular Medicare does not. Mine is $3,500.
 
I started with an Advantage program and loved it.

My all knowing wife decided I needed to go to Bosstown for a possible hip joint surgery, as thats where the "good" doctors are..like hers..only using her DR would require me to go with an alternate health insurance provider. So I swapped. It cost me an additional $230/month for this "better" plan.
Her doctor and I did NOT see eye to eye. $1,380 mistake.Plus it took an act of GOD to unenroll from the Tufts plan. Nightmare!
I swapped back after 6 months.

I'm glad to be back to my Advantage plan. Free..with really good local Drs.
 
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