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Originally Posted by MSGirl
What is the "advantage" to have an advantage plan over Plan F?
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We have advantage plans and they are not "free". The premium is paid monthly from our SS to the tune of $104.90 each. Just because you do not sit down and actually write a check or have a draft drawn does not make anything free when it is deducted from your check be it a SS check or a paycheck with a deduction for company insurance. There are co-pays for doctors, hospitals, ambulance, etc. Does not translate to "free", either. Even with the co-pays, it is still a better deal than traditional Medicare plus supplements, which continue to rise each year you are enrolled.
Now to the difference. I used to have traditional Medicare and a supplement plus a drug plan. The Medicare deduction was taken from my SS then, too. I also paid almost $200 a month for my supplement and almost $50 a month for Part D (mandated drug coverage). They do allow for balance billing in most instances (not allowed with our plans). That means that if everything is not allowed, you often get stuck for the extra. The Plan F only pays for the 20% that Medicare picked up the 80% on. If you are billed $120 and Medicare approves $100, then they pay $80 and Plan F pays $20. Sometimes, not always, you get to pay a portion of the other $20.
Now with the advantge plan, the drug coverage is included and the out-of-pocket expense caps at $10,000 if you use both in and out of network (drugs do not count toward this). Medicare has no cap and there is a big deductible everytime you are hospitalized, which in turn will drive up the cost of your supplement over time.
Mine is a PPO, not HMO. PPO you get to choose your doctors as long as they accept your plan and do not have to get a referral from your primary (I call those referral plans Mother-May-I plans).
My husband and I have advantage plans with the same company. Before that, he did not have a supplement to his traditional Medicare and guess who got to pick up the 20+ percent? Everytime he was hospitalized, there was a deductible of $1684.00 which is not a yearly deductible. It is an event deductible. He did not have to have a Part D plan because most of his meds came from the VA. If he could not get them from the VA (very few he couldn't, thank goodness), then it was full price unless the pharmacy offered a senior discount. With the advantage plan, the co-pay is so much per day for the first 5 days in the hospital. The Medicare deductible applied regardless of how many days, even just one.
Wordy, I know, but hope it helped to explain the differences.