Thoughts on straight Medicare

[shcisamax]

Is there an "advantage" of going on an advantage plan or does straight medicare cover expenses as well? When I spoke to medicare they said that although you have to pay 20%, they negotiate the costs so low that it works out the same. Does this sound right?

[champion6]

That could probably be considered a true statement. However, "the rest of the story" is that Medicare has no annual cap - that 20% could become very large - think cancer treatment, for example.

Coverage with an annual cap can be accomplished two ways: Either go with Medicare and add a Medicare Supplement plan, or replace Medicare with Medicare Advantage plan.

I haven't even mentioned prescription drug coverage.

Please don't rely on this forum to make your decision - this stuff is very complicated. Your health (and the associated costs) is not the same as anyone else's.

If you are in TV, schedule a visit with a SHINE rep for helpful, unbiased information. They are terrific!

[CFrance]

I would not want to pay 20% of cancer treatment, joint replacement, any major surgery. How can they say it works out the same if you don't know what medical even is going to happen to you somewhere down the line? How many inexpensive payments do you have to make to an Advantage plan to cover 20% of a $40,000 surgery? And will you keep all that $ in the bank just in case?

I may be missing something, but it doesn't sound like a good idea to me.

[GatorFan]

You purchase a Medicare supplement to take care of cost not paid by Medicare

[shcisamax]

They inferred they negotiate the rate so low that it doesn't work out to be much. Sounded a little iffy to me so that is why I was asking for opinions, comments, experience. Thanks.

[billethkid]

They inferred they negotiate the rate so low that it doesn't work out to be much. Sounded a little iffy to me so that is why I was asking for opinions, comments, experience. Thanks.

not only iffy.....it is also relative to the procedures, doctors, hospitals and all other so called providers.

Straight medicare with AARP supplement will cover 99% of billing by any of them.

[CFrance]

Again, if you get a catastrophic illness, they're not going to be able to negotiate so low that 20% of it does not wipe you out. How many medicare people told you this? No one in medicare ever told us any such thing.

I'd call someone else or go up to the SHINE people here in TV and ask for a second opinion on that.

I thought the medicare rates were fixed for a specific item in a specific area. That they don't "negotiate" each time for each person. You should be able to check what they pay for, say, open heart surgery or some other large procedure just to check how much your 20% would be and decide from there.

[LoriAnn]

There are 2 category's of Medicare. There is traditional Medicare which you are calling straight Medicare and everything else is a replacement policy. There are many many replacement policies. It's important to remember that replacement policies were designed to decrease costs for the government. Traditional Medicare pays the exact same payment for a procedure or medical visit anywhere in the United States. Replacement policies require a provider of medical care to negotiate and sign a contract that agrees to much lower payments for visits and procedures than traditional Medicare pays. Usually 25 -30% lower. That is why many providers do not accept replacement policies. Every provider accepts Traditiondal Medicare. When a person who has Traditional Medicare requires a referral to a specialist or requires a medical procedure, they have access to the best specialists. A person on a replacement policy only has access to the specialist that have agreed to take the much lower rate of payment. Obviously, the best Specialist are in such demand they are not willing to work for a 30% reduced rate. The person who holds a replacement policy often does not know they are not receiving the best treatments and do not have access to the best specialists. They just accept the referral offered to them. Replacement policies might seem like a good option until you get sick and need a specialist or need a surgical procedure that is in high demand. Traditional Medicare combined with a gap policy is the best insurance coverage available.

[justjim]

That could probably be considered a true statement. However, "the rest of the story" is that Medicare has no annual cap - that 20% could become very large - think cancer treatment, for example.

Coverage with an annual cap can be accomplished two ways: Either go with Medicare and add a Medicare Supplement plan, or replace Medicare with Medicare Advantage plan.

I haven't even mentioned prescription drug coverage.

Please don't rely on this forum to make your decision - this stuff is very complicated. Your health (and the associated costs) is not the same as anyone else's.

If you are in TV, schedule a visit with a SHINE rep for helpful, unbiased information. They are terrific!

Excellent advise. There are many different Medicare Advantage plans. One plan does not fit all. Get some good advise and then a second advise on what plan fits your situation best.

[Marilyn1009]

In my opinion the Medicare and supplement plan is the way to go. What everyone needs to remember that those docs that take Medicare are also on a percentage, albeit higher than a replacement plan. So if your cancer treatment costs $10,000 dollars and medicare only approves $5,000.00 you will be responsible for the 20% of the 5,000. For those of you that would like to see What Medicare will pay your Doc go to www.fcso.medicare.gov. We are in area 99 and you can look codes up on Google. (My son is an insurance agent). Many doctors don't like the replacement plans because they get paid less money for more work which means terrible service for us.

[pbkmaine]

My husband decided on Medicare with the F supplement. He did not like the very limited access to specialists with The Villages Medicare Advantage plan. We moved here from Maine, where the Medicare Advantage plan called Martin's Point seems to have every MD in the state on its list. In the two years we lived there, we never found an MD or hospital that did not take it. So it was quite a shock to see how limited The Villages plan was.

[mtdjed]

There seems to be some inference that Medicare and Medicare advantage plans are comparable. My understanding is that the true comparison should be 1/ Medicare and a Supplement to 2/ Medicare Advantage. True , that if you have Medicare Part A and B only, you then have to pay the extra 20%. That is why most go beyond and get one of the several options for a supplement or opt for Medicare Advantage. The Supplement options vary and you really need understanding of the plans and your position in life to choose the best options. For this you need knowledgeable advice from an expert
Take comments from TOTV posters as opinions (including mine). As an example, one poster inferred that all Doctors must take straight Medicare. That is not so. Most may, but that is by choice.

Remember, that your choice is a gamble. Medicare part A alone is normally a benefit you have paid for and get at no cost. Need additional services then you pay about $100 per month to get Part B. Still at risk for the 20%, then consider a Supplement or Medicare Advantage. Medicare Advantage may limit access but cost less. Medical Drugs a concern, consider Medicare Part D.

If you say , I am in good health and will wait, you are often limited as to when you can activate and then charged more.

Talk to an expert before you make a decision. That expense will pay off in short order.

[ditka41]

Also important is that Advantage plans are usually HMO which means you are only able to go to doctors and facilities that are within their plan and at specific locations. More preferable to me, although a little more expensive is Medicare and the supplement that is PPO, allowing you more choices of where to obtain help

[Carla B]

Also important is that Advantage plans are usually HMO which means you are only able to go to doctors and facilities that are within their plan and at specific locations. More preferable to me, although a little more expensive is Medicare and the supplement that is PPO, allowing you more choices of where to obtain help

My understanding is, if you have Traditional Medicare plus a "supplement," that supplement is not a PPO. You are not limited in your choices. There is no "network." You are free to go to any doctor in the U.S. who accepts Medicare. However doctors don't have to accept Medicare patients at all (those 65+ or on Medicare disability) but most do, at least in this area. Otherwise, their clientele would be severely limited in number.

My experience: if you don't enroll in a supplement plan within six months of turning 65, and you apply later, you will have to answer certain health "questions" to be accepted for supplemental insurance. You are guaranteed acceptance within the six-month period. We waited until after the six-month period expired to ditch our unsatisfactory employer plan (PPO) network and enroll in supplement Plan "F." We also waited until we were able to answer the health questions satisfactorily. Since being enrolled, we've never received a medical bill.

Personally, I'd rather cut back on a few discretionary spending items and subscribe to traditional Medicare, plus a supplement, than rely on an Advantage (replacement) plan run by an insurance company with a network of physician subscribers that seem to change regularly.

[shcisamax]

Lots of good points and interesting opinions. Thanks.