Supplemental vs. Advantage

[Miguel 1952]

I would like input as to these two choices for Medicare. I have been to Shine, but I would like practical experience from you who have used these two choices. Thank you!

Also, what about dental and vision!

[Avista]

We,ve used both--Medicare Supplemental Plan F and the Villages Advantage Plan. We are comparitively healthy. The supplemental plan was quite expensive for us vs what we received. Mine was about $110 per month plus pharmacy which ran about $50/ month (Don't remember exact amounts). Added to,this we had to pay a copay each month for each of our meds. It was expensive, but had no medical bills.

This year we are on The Villages Advantage Plan. Have paid nothing. Plus not even a copay for meds. There is a $25 copay for visiting specialists. We're pleased with this plan. Specialists seem top notch and Villages Health Centers are great.

We've been pleased, but everyone must make their own decision.

We visited the Medicare Store in Sumpter and found there are two different Advantage Plans. Might be best to,pay them a visit before you decide either way.

We do not use dental part of their plan. Vision worked out great. Dr Orr at Walmart on 466 did a good eye exam with my husband and we were able to get glasses there.

[villagetinker]

We had both, and dropped the Advantage plan due to the need to change doctors. IMHO, call SHINE Contact SHINE 1-800-96-ELDER (1-800-963-5337)
SHINE - Home (http://www.floridashine.org), they will give you an unbiased information.

[alwann]

As another mentioned, the key is your state of health. There is a risk factor.

I've had Advantage for a couple of years All was good. No premiums. Low co-pays to visit the primary doc and Rx. This year, spouse and I both needed surgeries. 20% upfront co-pays for surgeons and hospital can eat a hole in your pocket really fast. With Supplemental, the out-of-pocket costs for co-pays would have been minimal or nothing.

So, it's really a choice between pay it forward or pay it when it happens.

[Avista]

As another mentioned, the key is your state of health. There is a risk factor.

I've had Advantage for a couple of years All was good. No premiums. Low co-pays to visit the primary doc and Rx. This year, spouse and I both needed surgeries. 20% upfront co-pays for surgeons and hospital can eat a hole in your pocket really fast. With Supplemental, the out-of-pocket costs for co-pays would have been minimal or nothing.

So, it's really a choice between pay it forward or pay it when it happens.

What we did when we went on Villages Health was to,put away each month the amount of money we were paying for supplemental and pharmacy program. For two,of us this was about $$320/ month. In case of unexpected medical needs the most we could be charged is $4500. We have never come near this but keep $4500 in the money we have put away in the event we need it.

[2BNTV]

If one has an ongoing medical condition that requires continuing doctor care with the strong possibility of being hospitalized, original medicare with the supplemental plans is a better choice.

If one is relatively healthy, the Advantage plans may work better for you.

As one person said before, if one goes several years without a major episode, the OOP maximum will have been saved, by choosing an Advantage plan. The "advantage" plans do cover a lot of preventive procedures.

Another factor is peace of mind. Some people always want that peace of mind and are willing to pay for it with getting original medicare and a supplemental plan and not worrying about ever seeing a bill.

I personally haven't had an hospitalization in seven years so far, I have been lucky and I am ahead with less medical expenditures. At some point in the future, I may switch, if I feel that, hospitalizations may occur.

It's a personal decision one has to make, as we all don't know if we are going to get sick.

[vorage]

Here's our perspective. Otherwise healthy hubby was hit with medical disaster toward the end of our first year on the Advantage plan. He should have gone to Shands or Moffitt Tampa, but could not because neither was covered on the Advantage plan. We ended up at Ocala Regional and, happily, the treatment there was successful. Knowing that his problem would be recurring, and since it happened be open enrollment, I was able to change his coverage to a supplemental plan (still UHC) effective in January of the following year - so just a few months from his original treatment.
We were very fortunate that the timing was such that we could make this change. We probably could not have changed to any other plan, but UHC has a provision (or did at that time) that allows one to change from Advantage to Supplemental within the first two years.
So, yes, the copays were substantial for the first few months and non-existent once he was on the supplemental plan. But the primary reason for our change was the freedom to see any doctor, anywhere, anytime. He would not have been able to get the kind of treatment he is now receiving if that was not the case. None of us knows when something like that might happen.
(Don't take my word for the ability to switch; that was some time ago and may or may not still be the case.)

[Miguel 1952]

For those that have the supplemental, which plan do you have and why (plan F, F with high deductible, G or N)?

What about dental and vision?

[Miguel 1952]

For those that have the supplemental, which plan do you have and why (plan F, F with high deductible, G or N)?

What about dental and vision?

[vorage]

We went with F, which has the best coverage for us. But that's where you really need to talk to the folks at SHINE to help determine your own needs.
The UHC dental is minimal, but covers cleaning twice annually. Ophthalmology is covered under medical for such things as cataracts, injuries, etc. Other than dime store readers, neither of us wears glasses, so can't speak to that.

[jojo]

We went with F, which has the best coverage for us. But that's where you really need to talk to the folks at SHINE to help determine your own needs.
The UHC dental is minimal, but covers cleaning twice annually. Ophthalmology is covered under medical for such things as cataracts, injuries, etc. Other than dime store readers, neither of us wears glasses, so can't speak to that.

We have the UHS Supplement Plan N which has a small copay for doctors and are happy with it. Question - I did not think anything dental was included in the Supplement plans?

[spuds51]

We chose Plan F high deductible. The premiums are low and the coverage is there after the deductible. It's $2,180. You have to pay for the plan B deductible, which is around $166., than 20% of of plan B costs up to the deductible. Most years you will save money, if you have a really bad year it will cost you $2180.

The cost is not the biggest reason I went with original Medicare and a supplement. With Advantage plans the insurance company makes the final decision on what is Medically Necessary, not your doctor.

If you go with the Advantage plan and you remain healthy you're going to save some money. The problem is we can't predict the future.

[Miguel 1952]

I am thinking Plan F-HD. It's an excellent plan for FL residents and will save money. You really will have to have a bad medical year and then as you said is $2180 out of pocket, but the savings in premiums is great. In 2020 Plans F & C will be done away with, but those of us that have it before this date are grandfather in.

By the way, look in YouTube at Matthew Claassen videos, very knowledgable in the Medicare area. (Thank you spuds51 for the link)

Thank you, everyone! Is good to hear different experiences.

[Miguel 1952]

I too think dental is out of the supplemental plans. What do you have for dental insurance?

[virgind]

I have a Humana Med advantage PPO. Had a hip replaced in 2014 basically cost me 300.00. I can go to specialists with no referral and have dental and optical and drug coverage. PCP copy 15.00 (reasonable) 50.00 copy for specialist not to bad. Accepted at all hospitals. Didnt really care for The Villages health. As everyone has said it's what is good for you. Of course everything changes year after year.

[wendyquat]

We have had UHC plan F for several years and couldn't be more satisfied. I need the peace of mind knowing we can see any doctor anywhere without being at the mercy of an insurance company! i think the Advantage Plan might be ok for healthy people but I can assure you that your health status can change very quickly!

[Miguel 1952]

I agree 100% that your health status could change very quickly and then I think the Advantage Plan is problematic. Listening to the link I stated above the F-HD is an attractive choice and saves a lot of money plus the benefits of the F plan.

[spuds51]

I too think dental is out of the supplemental plans. What do you have for dental insurance?

I have a family dental plan I got through Blue Cross. Doesn't cost much but it doesn't cover much either. Thinking of changing..esurance has several plans. Find a dentist you like, call their office and ask what they accept and go from there.

You have to be careful about your plan D drug plan too. There are several plans, some are pretty high. You can call Mr. Claasen and he will tell you what you need.

[Miguel 1952]

Thank you spuds, very, very helpful.