Medicare with Medigap or Medicare Advantage?

[LDB]

With my supplement I can go see any "ologist", or anyone else, I want without going to my PCP first and I'm covered. No screenings or pre-approval or whatever. If they take Medicare I'm good to go. I have to pay the $250 or whatever it is for the year deductible and after than not a penny. And no several thousand dollars more out of pocket above the Medicare deductible. I pay $140 a month for it but that's far less than the several thousand out of pocket most of the advantage plans seem to have.

 

[drfeelgood]

alarmguy, I knew someone would quote that. I wish I was wrong, but I am not. You can look at what the plans or fed gov't says but the fact is the Advantage plans have their own internal coverage policies and will usually follow these. Believe me, I literally deal with this on a daily basis. If I were a multi million dollar healthcare facility, maybe I could sue them and get it before an administrative law judge. However, even that usually doesn't work as one of the device companies has spent millions doing just that to get there product/treatment covered by the Advantage plans and they ultimately gave up. Just something to keep in mind when considering Advantage plans, as most physicians eventully give up trying and so Advantage patients often never find out about these noncovered treatments that are covered by regular Medicare

I understand your are a doctor but you are wrong. Advantage C plans must cover everything that Medicare covers.
Yes, prior authorizations maybe needed but can not be denied if covered by medicare.

Here it is, right from your Medicare insurance company
https://www.medicare.gov/medicare-advantage-plans-cover-all-medicare-services

'Medicare Advantage Plans provide all of your Part A and Part B benefits, including new benefits that come from laws or Medicare policy decisions. Plans must cover all emergency and urgent care (both physical and mental), and almost all medically necessary services Original Medicare covers."

 

[drfeelgood]

So the additional cost of the premium is not considered "out of pocket"?

Good to get your perspective.

Yes, the cost of the supplement premium needs to be accounted for. That is why I noted "if you can afford it". However, there is often a premium for the Advantage plan, also , if you go that way. As an example,my in-laws are retired state employees and have UHC as their Advantage plan but they pay a premium for that

 

[Pablo]

With my supplement I can go see any "ologist", or anyone else, I want without going to my PCP first and I'm covered. No screenings or pre-approval or whatever. If they take Medicare I'm good to go. I have to pay the $250 or whatever it is for the year deductible and after than not a penny. And no several thousand dollars more out of pocket above the Medicare deductible. I pay $140 a month for it but that's far less than the several thousand out of pocket most of the advantage plans seem to have.

I made an appointment with my dermatologist. Got my hide checked. I go every 2 years. Yes, $10 co-pay. But did not require pre-approval. Did you have Medicare Advantage before? Or are you stating what you THINK the facts are?

 

[LDB]

I'm saying what I was told by a provider I use. The discussion was for cardiologist and needed a referral if advantage. Maybe a difference between HMO and PPO advantage plans, I don't know. I got Medicare about 20 months ago and based on advice from a well-recommended agent went with supplement. Fully satisfied and glad I did. A few weeks ago I went to a seminar on a lark. Had some 1-1 time with the presenter and after discussing my specifics he said I made the correct choice and should stick with what I have. And he was presenting a specific advantage plan so it was only to his interest to switch me. Made me feel even better about my decisions so far.

 

[samven]

I am now collecting SS early but not Medicare eligible yet. Been doing a lot of reading on Medicare and plans. It appears to me that if you are a healthy person an advantage plan might be the way to go. However if you have health issues and forsee lots of tests, labs, doctors visits or hospital stays a Medigap would be the better choice.

What kind experience have BITOG members had?

Let me start by saying I have not read all the previous posts. I got a part G because during my employment days we were forced into HMO plans at work and when I got sick my Dr could not find the problem and referred me to a specialist. The problem came when I found out there was only 1 in the plan area and the soonest I could get in was a 6 mo wait. I would have been dead in 6 mos so I went outside the plan. That not only cost out of pocket but started a back a forth discussion on covered treatment that went on for weeks and ended up with me getting partial coverage. Friends dont let Friends join HMO's if you have any choice.

 

[alarmguy]

Yes, the cost of the supplement premium needs to be accounted for. That is why I noted "if you can afford it". However, there is often a premium for the Advantage plan, also , if you go that way. As an example,my in-laws are retired state employees and have UHC as their Advantage plan but they pay a premium for that

To me, it’s not a matter of affording.
Whatever your experiences is not mine or anyone I know, but I’m not saying you were lying.
OK back to a matter of affording I am not going to throw away $75-$100 a week on a suspicion of something I’ve never experienced.
In fact, I’ve had nothing but the best of care, including doctors, who have been interned at the Cleveland clinic, another family member in the cardiac unit at Charleston. I just don’t understand where some of the comments come from and I’m not singling you out.
Clearly with 51% of the population now in advantage plans they certainly are not what some people infer that they are inferior.

 

[alarmguy]

Let me start by saying I have not read all the previous posts. I got a part G because during my employment days we were forced into HMO plans at work and when I got sick my Dr could not find the problem and referred me to a specialist. The problem came when I found out there was only 1 in the plan area and the soonest I could get in was a 6 mo wait. I would have been dead in 6 mos so I went outside the plan. That not only cost out of pocket but started a back a forth discussion on covered treatment that went on for weeks and ended up with me getting partial coverage. Friends dont let Friends join HMO's if you have any choice.

This is 100% incorrect for advantage plans but buy whatever you like it’s a free world

 

[alarmguy]

With my supplement I can go see any "ologist", or anyone else, I want without going to my PCP first and I'm covered. No screenings or pre-approval or whatever. If they take Medicare I'm good to go. I have to pay the $250 or whatever it is for the year deductible and after than not a penny. And no several thousand dollars more out of pocket above the Medicare deductible. I pay $140 a month for it but that's far less than the several thousand out of pocket most of the advantage plans seem to have.

I have an advantage c plan and like you, I don’t have to see a primary doctor to go to a specialist. In fact, I have never gone to a primary doctor to see a specialist. I speak from experience and have previously posted by medical bills for the year 2022 totaling roughly $130,000 of cardiac testing and procedures never was there a denial for any treatment procedures, and I never even went to my primary care doctor for any type of referral
You can go look yourself at United healthcare, Medicare advantage plan and go look yourself at Aetna Medicare plans and go look yourself at Humana plans most clearly state that you don’t need a referral. In the evidence of coverage but it’s always smart to read if that is some that would bother you because there are some out there somewhere possibly one of the humana plans


Furthermore, my drug plan may be better than yours if you even have one because you’re not saying you do.

$140 a month is really $315 a month but even then in time as you age you’ll be up to $475 a month plus you pay your own eyecare, you pay your own dental care, if you need hearing aids down the road, you will pay for that too
You also pay for all over-the-counter medical supplies
Chances are your out of country emergency care amount will be lower than my advantage plan
So you pay a minimum of $315 a month for a plan that you’re not mentioning and you don’t say if that includes your drug prescription coverage and another plan.

I pay $175 a month but I get all that back in additional benefits that you don’t get.

I’m not having a debate with you, but it seems like in this thread those posting against an advantage C plan, leave out their exact plans and what they are paying.
I find that ironic. The people with Medigap are unable to tell me what Medicare plan they have and what prescription drug plan they have, and the cost for both.
The numbers are thrown around way way too loosely.

But it doesn’t matter we all choose what’s good for us. We all go with what we are comfortable with and for me pretty much free care with the best doctors and medical facilities available anywhere then throw in free dental free, free eye care, free hearing, free over-the-counter products, free prescription coverage and free outdoor activity coverage of $1200 a year.

All for 175 a month compared to your current $315 a month and we still don’t know what you have.
I have no problem with anything except the constant pervasive misinformation of those referring to advantage plans.
The misinformation completely discredits the reasons why some people have Medigap plans.
I wonder if they had the correct information if they themselves wouldn’t have an advantage c plan

 

[Jdeere562]

Go visit a local insurance agent. They can explain and help you make a decision.

Best advice: Throw all that junk mail insurance crap away! Don't even open or read it.

 

[LDB]

I have an advantage c plan and like you, I don’t have to see a primary doctor to go to a specialist. In fact, I have never gone to a primary doctor to see a specialist. I speak from experience and have previously posted by medical bills for the year 2022 totaling roughly $130,000 of cardiac testing and procedures never was there a denial for any treatment procedures, and I never even went to my primary care doctor for any type of referral
You can go look yourself at United healthcare, Medicare advantage plan and go look yourself at Aetna Medicare plans and go look yourself at Humana plans most clearly state that you don’t need a referral. In the evidence of coverage but it’s always smart to read if that is some that would bother you because there are some out there somewhere possibly one of the humana plans


Furthermore, my drug plan may be better than yours if you even have one because you’re not saying you do.

$140 a month is really $315 a month but even then in time as you age you’ll be up to $475 a month plus you pay your own eyecare, you pay your own dental care, if you need hearing aids down the road, you will pay for that too
You also pay for all over-the-counter medical supplies
Chances are your out of country emergency care amount will be lower than my advantage plan
So you pay a minimum of $315 a month for a plan that you’re not mentioning and you don’t say if that includes your drug prescription coverage and another plan.

I pay $175 a month but I get all that back in additional benefits that you don’t get.

I’m not having a debate with you, but it seems like in this thread those posting against an advantage C plan, leave out their exact plans and what they are paying.
I find that ironic. The people with Medigap are unable to tell me what Medicare plan they have and what prescription drug plan they have, and the cost for both.
The numbers are thrown around way way too loosely.

But it doesn’t matter we all choose what’s good for us. We all go with what we are comfortable with and for me pretty much free care with the best doctors and medical facilities available anywhere then throw in free dental free, free eye care, free hearing, free over-the-counter products, free prescription coverage and free outdoor activity coverage of $1200 a year.

All for 175 a month compared to your current $315 a month and we still don’t know what you have.
I have no problem with anything except the constant pervasive misinformation of those referring to advantage plans.
The misinformation completely discredits the reasons why some people have Medigap plans.
I wonder if they had the correct information if they themselves wouldn’t have an advantage c plan

I don't add the $175 because everyone pays that so it's a wash. And yes, advantage gets various things. All paid for by the advantage holder who often pays several thousand out of pocket that I do not pay. Advantage is great for some people. Supplement for others. One has to make their own choice based on their own priorities.

 

[Pablo]

Go visit a local insurance agent. They can explain and help you make a decision.

Best advice: Throw all that junk mail insurance crap away! Don't even open or read it.

Some agents are good and give you ALL the options they broker

BUT yeah...........seems like they ALL know you are headed to 65 at the time. Trash the junk!

 

[Pablo]

I don't add the $175 because everyone pays that so it's a wash. And yes, advantage gets various things. All paid for by the advantage holder who often pays several thousand out of pocket that I do not pay. Advantage is great for some people. Supplement for others. One has to make their own choice based on their own priorities.

Sure and you pay for drug coverage. It always seems like you pile on one side and sorta ignore the other side. It's natural to do that.

And we are all too lazy to make and post a comparison table. Bunch of geezers.

 

[Nukeman7]

Sure and you pay for drug coverage. It always seems like you pile on one side and sorta ignore the other side. It's natural to do that.

And we are all too lazy to make and post a comparison table. Bunch of geezers.

The monthly cost for my 2024 WellCare Value Script Part D prescription plan is $0.00 per month. The basic comparison table below is copied directly from the United Health Care website.

As with auto & home insurance, each subscriber's medical needs and financial risk tolerance is unique. A Medicare plan that makes financial sense for a relatively healthy 65 y.o. male living in an area that has a vast network of state-of-the art medical resources (e.g., research triangle region of N.C., Houston Medical Center, etc.) might be completely disastrous for a female that has chronic, debilitating conditions residing in rural America. As we love to say on BITOG, YMMV.

 

[LDB]

Sure and you pay for drug coverage. It always seems like you pile on one side and sorta ignore the other side. It's natural to do that.

And we are all too lazy to make and post a comparison table. Bunch of geezers.

Yes, I do have to pay $6 a year for the drug plan. And truthfully that 50c a month really hurts.

 

[Pablo]

The monthly cost for my 2024 WellCare Value Script Part D prescription plan is $0.00 per month. The basic comparison table below is copied directly from the United Health Care website.

View attachment 199286
As with auto & home insurance, each subscriber's medical needs and financial risk tolerance is unique. A Medicare plan that makes financial sense for a relatively healthy 65 y.o. male living in an area that has a vast network of state-of-the art medical resources (e.g., research triangle region of N.C., Houston Medical Center, etc.) might be completely disastrous for a female that has chronic, debilitating conditions residing in rural America. As we love to say on BITOG, YMMV.

Well OK, 75% credit for copying and posting a table.

All the Part D's are free now? Sweet.

I will say even that table says the medigap premium is IN ADDITION TO PART B PREMIUM. So everyone is getting that for free now? Or something else is going on? Taking the B premium from SS, normal. Then how is the G billed?

 

[LDB]

From AARP so presumably well informed and accurate.

Does Medicare Advantage have out-of-pocket limits?​

Yes. If you choose to have coverage from a private Medicare Advantage plan instead of original Medicare, you’ll have a maximum out-of-pocket spending limit. Federal law requires Medicare Advantage plans to have an out-of-pocket limit of $8,300 or less for covered in-network services in 2023; $12,450 or less for covered in-network and out-of-network services combined. Those numbers rise to $8,850 and $13,300, respectively, in 2024.

Using their link and checking my own zipcode the plans show a minimum out-of-pocket of $3450 based on checking the first 20 results, several having that same figure. That is $287.50 monthly against my $145 monthly, or basically double the monthly premium. Those plans also have copays I do not have. Also restrictions on provider choices I do not have. Choose a doctor not on their A list and the OOP double or greater.

And for some people it is the perfect choice. Based on their needs/wants/preferences. I'm satisfied with my $145 a month, all done, and make any choice I want at any time I choose.

 

[Pablo]

From AARP so presumably well informed and accurate.

Does Medicare Advantage have out-of-pocket limits?​

Yes. If you choose to have coverage from a private Medicare Advantage plan instead of original Medicare, you’ll have a maximum out-of-pocket spending limit. Federal law requires Medicare Advantage plans to have an out-of-pocket limit of $8,300 or less for covered in-network services in 2023; $12,450 or less for covered in-network and out-of-network services combined. Those numbers rise to $8,850 and $13,300, respectively, in 2024.

Using their link and checking my own zipcode the plans show a minimum out-of-pocket of $3450 based on checking the first 20 results, several having that same figure. That is $287.50 monthly against my $145 monthly, or basically double the monthly premium. Those plans also have copays I do not have. Also restrictions on provider choices I do not have. Choose a doctor not on their A list and the OOP double or greater.

And for some people it is the perfect choice. Based on their needs/wants/preferences. I'm satisfied with my $145 a month, all done, and make any choice I want at any time I choose.

So you DO pay an additional premium for G. You made it seem like you didn't. You pay $145. I don't.

I can tell you straight up I have not paid even your total annual premium of $1740 if I total everything I have spent on weights, pickleball gear and venues, tournaments, supplements, BITOG fee, doc visits, ND visits, Amazon strips and pokers......I won't count my ebike, that's not exercise. And then, let's say something bad does happen. I can afford the max. I am not worried even $8K. I planned for a lot more.

I'm glad your attitude changed, that's for sure.

 

[alarmguy]

...As an example,my in-laws are retired state employees and have UHC as their Advantage plan but they pay a premium for that

Huh?
and what is that "premium"? I can tell you right now,
This is misleading whatever you are implying.
Anyone can check what their Advantage C plan would cost right here without me going off the rails *LOL* with another insane long post.
https://www.uhc.com/medicare?WT.mc_id=8031053

Ps, one thing I did learn from this thread is I just put in my old town on Long Island NY where costs for everything is insane and found out how much less expensive even medial care is here. An example is MAX out of pocket cost for the same Advantage C plan here in the Carolinas is $3,000 less than Long Island NY and some of their plans up north do have a small premium from $0 to $50 a month.
I would suggest most lower cost areas outside NY Metro areas and places in CA would be like I have here, stupid cheap.

 

[LDB]

So you DO pay an additional premium for G. You made it seem like you didn't. You pay $145. I don't.

I can tell you straight up I have not paid even your total annual premium of $1740 if I total everything I have spent on weights, pickleball gear and venues, tournaments, supplements, BITOG fee, doc visits, ND visits, Amazon strips and pokers......I won't count my ebike, that's not exercise. And then, let's say something bad does happen. I can afford the max. I am not worried even $8K. I planned for a lot more.

I'm glad your attitude changed, that's for sure.

Nothing changed. I just typed more than usual.