Medicare Advantage Plans

[Dusty_Star]

An interesting article about Medicare Advantage plans. "It's one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing," says Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

"But it's when they actually need to use it for these bigger issues," Huberty says, "that's when people realize, 'Oh no, this isn't going to help me at all.'"

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR (https://www.npr.org/sections/health-shots/2024/01/03/1222561870/older-americans-say-they-feel-trapped-in-medicare-advantage-plans)

[villagetinker]

AMEN, we were lucky enough to realize the problem and get back to traditional Medicare before the cutoff, and this was years ago.

Remember Medicare is health coverage you are in charge of, Advantage plans are MANAGED plans, and you are no longer in charge of your health care.

[Altavia]

I can tell horror stories of chemo patients where their hospital and Doctors dropped our of their Advantage plan and they had find and switch to someone new.

[tophcfa]

An interesting article about Medicare Advantage plans. "It's one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing," says Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

"But it's when they actually need to use it for these bigger issues," Huberty says, "that's when people realize, 'Oh no, this isn't going to help me at all.'"

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR (https://www.npr.org/sections/health-shots/2024/01/03/1222561870/older-americans-say-they-feel-trapped-in-medicare-advantage-plans)

And that’s exactly why there are stipulations in place that require no medical underwriting when one initially signs up for a supplemental plan, but subjects one to medical underwriting if they later attempt to switch from an advantage plan to a supplemental plan. Otherwise, it would be a no brainer for healthy people to simply select a cheap to no cost advantage plan and then switch to a supplemental plan when their health care needs become costly.

[Michael 61]

Not 65 yet, but doing the homework now - when that time comes I think Original Medicare + Supplement will be the way to go. I’m healthy now, but who knows what the future holds - need to plan long-term. Don’t want my health “managed” by a medical insurance claims adjuster.

[gatorbill1]

Have had advantage plans since I went on Medicare. Various plans. Never had anything denied, and I have had a LOT of stuff done.

[Dusty_Star]

Not 65 yet, but doing the homework now - when that time comes I think Original Medicare + Supplement will be the way to go. I’m healthy now, but who knows what the future holds - need to plan long-term. Don’t want my health “managed” by a medical insurance claims adjuster.

I too did research before I turned 65, visited the library & read books about Medicare. I was really glad I took that approach. When you near 65 the Advantage plans bombard your mail with glossy, sophisticated, entreaties to purchase their plans. Due to my research, I decided on original Medicare with a supplement plan & plan D, the drug plan. I am in good health, & take no medications. But signing up for a plan D is crucial as the government penalizes those who don't sign up & the penalty is lifelong. I felt that without doing the research it would have been really easy to join an Advantage plan, & that would not have been in my long term best interests.
Good luck with your homework 👍

[NotGolfer]

We're on Florida Blue and haven't regretted it once. NO issues with it so far and it's been two years---we're coming up on three. But that's just us!! When we moved here 14 yrs ago it was a nightmare---especially if hospitalized I went in and they'd never heard of my primary. To fill out all the paperwork at each clinic was another issue (for me at least). I like having a patient portal where all my providers have access. Did I mention we're a part of TVH? LOVE that too....

[Danth1980]

My wife and I both have Advantage plans (from different companies), I have had heart and pancreas issues that have plagued me. She has had breast cancer and now lung cancer. These advantage plans have been wonderful for both of us. I was twice in the hospital with pancreas issues $90 bill after all kinds of procedures and test. My wife has had more test than I can count and 3 surgeries in the last 2 years with at least one coming next month an MRI yesterday and another MRI plus a biopsy next week. We have had no problem with doctors and minimal expenses. We are staying with the Advantage Plans.

[RPDaly]

///

[rustyp]

In 2023, 51% of Medicare beneficiaries were enrolled in Medicare Advantage plans instead of Original Medicare

[melpetezrinski]

An interesting article about Medicare Advantage plans. "It's one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing," says Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

"But it's when they actually need to use it for these bigger issues," Huberty says, "that's when people realize, 'Oh no, this isn't going to help me at all.'"

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR (https://www.npr.org/sections/health-shots/2024/01/03/1222561870/older-americans-say-they-feel-trapped-in-medicare-advantage-plans)


My father in law has United Health Medicare Advantage and his bill for stays at The Villages Hospital, Shands and two facilities in Ocala totaled over $700,000. This was over the course of a few months for a significant stroke. He also incurred 10's of thousands of additional expenses for treatment. All he had to pay was his out of pocket max of $2,700. At one facility, he tried an experimental, robotic device to help with his walking. Nothing was denied and this is why we just switched my mother in law to an advantage plan. We all live in TV.

[Rainger99]

Remember Medicare is health coverage you are in charge of, Advantage plans are MANAGED plans, and you are no longer in charge of your health care.

So does that mean that Medicare will pay any medical bill - or is there some oversight?

[kkingston57]

We're on Florida Blue and haven't regretted it once. NO issues with it so far and it's been two years---we're coming up on three. But that's just us!! When we moved here 14 yrs ago it was a nightmare---especially if hospitalized I went in and they'd never heard of my primary. To fill out all the paperwork at each clinic was another issue (for me at least). I like having a patient portal where all my providers have access. Did I mention we're a part of TVH? LOVE that too....

Also have Florida Blue. Was told that I could see any doctor but would have to pay out of network price. Noted that a lot of Advantage plans are paying for unusual items like groceries, These are health insurances.

[Rainger99]

Best Medicare Advantage Plans in 2024 - NerdWallet (https://www.nerdwallet.com/article/insurance/medicare/best-medicare-advantage-plans)

[Babubhat]

United healthcare has been excellent. All claims paid promptly

[tophcfa]

Not 65 yet, but doing the homework now - when that time comes I think Original Medicare + Supplement will be the way to go. I’m healthy now, but who knows what the future holds - need to plan long-term. Don’t want my health “managed” by a medical insurance claims adjuster.

I’m in the same boat you, turning 65 soon. I have a habit of researching the hell out of things I deem important, and making the correct Medicare decisions was high on my list. I have recently read two updated books from highly regarded sources on making the best Medicare decisions and have also concluded that selecting original Medicare with a supplemental Medigap plan is the best way to go. I’m planning on getting a Part G Supplement plan and a Part D prescription plan. Unfortunately, I’ll be out of pocket for dental, vision, and hearing unless original Medicare is someday revised to include those. There is no way I want to go with an Advantage plan and be constrained by a limited network of providers, be out of network when at one of our two homes, have to get referrals to see a specialist, and deal with deductible and co-pays every time I go to the doctors. For me, the decision is a no brainer.

[tophcfa]

I too did research before I turned 65, visited the library & read books about Medicare. I was really glad I took that approach. When you near 65 the Advantage plans bombard your mail with glossy, sophisticated, entreaties to purchase their plans. Due to my research, I decided on original Medicare with a supplement plan & plan D, the drug plan. I am in good health, & take no medications. But signing up for a plan D is crucial as the government penalizes those who don't sign up & the penalty is lifelong. I felt that without doing the research it would have been really easy to join an Advantage plan, & that would not have been in my long term best interests.
Good luck with your homework 👍
Totally agree

[Smalley]

Totally agree

Traditional Medicare with CareFirst supplement and Part D was our decision as well. We need all the freedom possible as we are in the old years when things deteriorate if they haven't already!

[villagetinker]

So does that mean that Medicare will pay any medical bill - or is there some oversight?

NO, you or your doctor will contact Medicare if there is an unusual treatment required, many treatments are typical and are covered. my previous point was there are situations where Medicare would be covered, but an advantage plan MAY require additional reviews and possible delays.

[OrangeBlossomBaby]

Also have Florida Blue. Was told that I could see any doctor but would have to pay out of network price. Noted that a lot of Advantage plans are paying for unusual items like groceries, These are health insurances.

They're not "paying for" those items. If you qualify due to being low-income and a senior, they provide you with a modest stipend intended to help you pay for food. Many low-income seniors eat less in order to keep their heat on in the winter and AC running in the summer. It's a pretty big deal in this country. Nutrition is a health matter, and the insurance companies want their members to be healthy. The healthier the member is, the less likely the member will need expensive care that the insurance has to cover.

It's cheaper to let a low-income senior buy a bag of groceries every month courtesy of the insurance company, than it is to treat the senior for illnesses caused by malnutrition.

[Hape2Bhr]

I’m in the same boat you, turning 65 soon. I have a habit of researching the hell out of things I deem important, and making the correct Medicare decisions was high on my list. I have recently read two updated books from highly regarded sources on making the best Medicare decisions and have also concluded that selecting original Medicare with a supplemental Medigap plan is the best way to go. I’m planning on getting a Part G Supplement plan and a Part D prescription plan. Unfortunately, I’ll be out of pocket for dental, vision, and hearing unless original Medicare is someday revised to include those. There is no way I want to go with an Advantage plan and be constrained by a limited network of providers, be out of network when at one of our two homes, have to get referrals to see a specialist, and deal with deductible and co-pays every time I go to the doctors. For me, the decision is a no brainer.

If you've had cataract surgery, Medicare/supplemental will cover annual checkups with the ophthalmologist.

[kingofbeer]

An interesting article about Medicare Advantage plans. "It's one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing," says Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

"But it's when they actually need to use it for these bigger issues," Huberty says, "that's when people realize, 'Oh no, this isn't going to help me at all.'"

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR (https://www.npr.org/sections/health-shots/2024/01/03/1222561870/older-americans-say-they-feel-trapped-in-medicare-advantage-plans)
If you have chronic conditions, you should consider a Medicare supplement, if you are able to afford it. I do not have chronic conditions and will be selecting a Medicare Advantage plan when I turn 65. The Villages Health system does not accept traditional medicare. They do accept certain advantage plans. And I want to use the Villages Health system.

[kingofbeer]

So does that mean that Medicare will pay any medical bill - or is there some oversight?
There is oversight. Your advantage plan would need to pre-approve certain procedures. You might need referral to go to specialists.

[gatorbill1]

NO, you or your doctor will contact Medicare if there is an unusual treatment required, many treatments are typical and are covered. my previous point was there are situations where Medicare would be covered, but an advantage plan MAY require additional reviews and possible delays.

Medicare Advantage plans must cover whatever regular Medicare covers - no exceptions

[rustyp]

Medicare Advantage plans must cover whatever regular Medicare covers - no exceptions

Can you imagine that - As us north country boys say driving in a snowstorm - hold my beer and watch this !

[Debfrommaine]

Also have Florida Blue. Was told that I could see any doctor but would have to pay out of network price. Noted that a lot of Advantage plans are paying for unusual items like groceries, These are health insurances.

Regarding the groceries, our plan does not specifically pay for groceries in particular. For example, incentives can be earned monthly (it's a very small AMT but nonetheless) for completing exercise programs and such. Members can "spend" the earned money at Publix, Walgreens, Walmart or other participating vendors.

[villagetinker]

Medicare Advantage plans must cover whatever regular Medicare covers - no exceptions

I agree completely, but (big but) you must use THEIR doctors and you must go by their schedule. Under the heading of been there done that, this did not work for us. Remember, yes you are covered, BUT under their schedule, this is a managed care system. This woks for a lot of people, but IMHO you need to see more than one specialist you may want to consider regular Medicare, this also applies if you already have a specialist and want to stay with the doctor.

[tophcfa]

I agree completely, but (big but) you must use THEIR doctors and you must go by their schedule. Under the heading of been there done that, this did not work for us. Remember, yes you are covered, BUT under their schedule, this is a managed care system. This woks for a lot of people, but IMHO you need to see more than one specialist you may want to consider regular Medicare, this also applies if you already have a specialist and want to stay with the doctor.

Absolutely agree, and Advantage plans have their managed care networks limited to a specific geographic region. Original Medicare, with a Medigap Supplemental plan, are accepted throughout the USA without the need for a referral. This is extremely important for those who travel frequently or have two homes in different states.

[mtdjed]

Not 65 yet, but doing the homework now - when that time comes I think Original Medicare + Supplement will be the way to go. I’m healthy now, but who knows what the future holds - need to plan long-term. Don’t want my health “managed” by a medical insurance claims adjuster.

For some people it may truly an economical decision to get the Advantage program. For those who can afford a supplement, congratulations if you make the decision treat yourself to the best you can afford.

[OrangeBlossomBaby]

For some people it may truly an economical decision to get the Advantage program. For those who can afford a supplement, congratulations if you make the decision treat yourself to the best you can afford.

This, in spades. We're both using the Marketplace on a bronze plan, and there's a 9450 out of pocket expense for /each/ of us. This year hubby will get an Advantage plan - which will mean $174/month less in his social security check. Our bronze plan is much less than that for the two of us as long as we stay relatively healthy and don't need to see specialists too often (it's $85 co-pay per specialist visit), so we're already going to be paying more this year. Not a hardship, but that's 2 weeks worth of groceries. It's a lot of money for those of us who rely on our social security checks and a very modest pension to cover all our expenses.

In three years, I'll have to do the same, and it'll cost however much out of -my- social security check, significantly more than I'm paying now (more than ten times that).

There's no way we can afford part B, plus drug coverage, plus medigap. Just affording part B for two of us will make things tight.

[eweissenbach]

We took care of my father the last four years of his life. I took over his finances and he had Medicare and AARP United Healthcare plan F. He had numerous health problems and hospitalizations and never incurred an out of pocket expense. When I turned 65 and my wife a few months later we both enrolled in the same thing. (Plan F is no longer an option but we were grandfathered in it). My wife passed away four months ago and incurred several million dollars of health care expenses over the last three years with nary a penny owed by us. The premiums for the supplement are the best investment I have ever, or will ever, make.

[GoRedSox!]

For those who spend time in two different states, doesn't United Healthcare Medicare Advantage have a national provider network and you are covered under the in-network benefits in both states?

[rustyp]

For those who spend time in two different states, doesn't United Healthcare Medicare Advantage have a national provider network and you are covered under the in-network benefits in both states?

YES. You probably want the PPO plan Vs HMO plan. Of course the Medicare with supplemental crowd has no idea what I'm talking about. Seven years plus now living your dual lifestyle with no issues of no coverage, needing to get a referral, or even being out of network for any procedure in either location (with 100's of thousands of dollars of claims).

[Indy-Guy]

Medicare plans explained in a 10 minute video


https://www.youtube.com/watch?v=oHdPlLUxx6I

[Indy-Guy]

Video about Medicare Advantage Plans. (may not start at beginning just reset back to beginning)

https://www.youtube.com/watch?v=ifkUn3NOT9w&t=520s

[rustyp]

Medicare plans explained in a 10 minute video


https://www.youtube.com/watch?v=oHdPlLUxx6I

Video about Medicare Advantage Plans. (may not start at beginning just reset back to beginning)

https://www.youtube.com/watch?v=ifkUn3NOT9w&t=520s


Marvin Musick - 5 reasons not to get a Medicare Supplemental Plan
https://www.youtube.com/watch?v=gNzqGYctWis

[gatorbill1]

NO, you or your doctor will contact Medicare if there is an unusual treatment required, many treatments are typical and are covered. my previous point was there are situations where Medicare would be covered, but an advantage plan MAY require additional reviews and possible delays.

This, in spades. We're both using the Marketplace on a bronze plan, and there's a 9450 out of pocket expense for /each/ of us. This year hubby will get an Advantage plan - which will mean $174/month less in his social security check. Our bronze plan is much less than that for the two of us as long as we stay relatively healthy and don't need to see specialists too often (it's $85 co-pay per specialist visit), so we're already going to be paying more this year. Not a hardship, but that's 2 weeks worth of groceries. It's a lot of money for those of us who rely on our social security checks and a very modest pension to cover all our expenses.

In three years, I'll have to do the same, and it'll cost however much out of -my- social security check, significantly more than I'm paying now (more than ten times that).

There's no way we can afford part B, plus drug coverage, plus medigap. Just affording part B for two of us will make things tight.

There are a lot of people in TV with more money than they know what to do with. I am with you as far as what is affordable. Supplement plan not in my budget.

[Justputt]

Medicare Advantage plans must cover whatever regular Medicare covers - no exceptions

That's not the case. We have Advantage plans say no to what Medicare would say yes to all to often.

[Justputt]

A lot of guesswork in these posts. The best thing is to sit down with someone that does this for a living. Rusty Nelson did a YouTube chat with someone that specializes in this near TV. There are a lot of if/and/but to what is best. IMO, if you are at TV fulltime, an Advantage Plan (limiting your referring physicians to local) may be a better bet, since they also cover eye, dental, gym, hearing aids. However, if you are a snowbird, your local Advantage Plan isn't going to cover you in-network in PA, MI, CO, etc. Also, Medicare doesn't require you to get a referral to a specialist, whereas Advantage plans do. Most patients we treat with Advantage Plans require preauthorization, when Medicare doesn't, and sometimes what the Advantage Plan authorizes isn't in the best interest of the patient, e.g. accelerated treatments so the plan doesn't have to pay for as many. You really should consult a specialist in these insurance products because they are very dependent on what you need.

[RPDaly]

///

[Jayhawk]

That's not the case. We have Advantage plans say no to what Medicare would say yes to all to often.


Someone is not being honest with you.

https://www.medicare.gov/sites/default/files/2018-07/11474.pdf

What do Medicare Advantage Plans cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers
except hospice care

[Dusty_Star]

Someone is not being honest with you.

Medicare Advantage Plans must cover all of the services that Original Medicare covers
except hospice care

& what they SHOULD & what they DO, are sometimes two very different things. Abuses often enough that Congress has started paying attention.

Bipartisan anger aimed at Medicare Advantage care denials

'''It was stunning''': Bipartisan anger aimed at Medicare Advantage care denials - POLITICO (https://www.politico.com/news/2023/11/24/medicare-advantage-plans-congress-00128353)

[gatorbill1]

A lot of guesswork in these posts. The best thing is to sit down with someone that does this for a living. Rusty Nelson did a YouTube chat with someone that specializes in this near TV. There are a lot of if/and/but to what is best. IMO, if you are at TV fulltime, an Advantage Plan (limiting your referring physicians to local) may be a better bet, since they also cover eye, dental, gym, hearing aids. However, if you are a snowbird, your local Advantage Plan isn't going to cover you in-network in PA, MI, CO, etc. Also, Medicare doesn't require you to get a referral to a specialist, whereas Advantage plans do. Most patients we treat with Advantage Plans require preauthorization, when Medicare doesn't, and sometimes what the Advantage Plan authorizes isn't in the best interest of the patient, e.g. accelerated treatments so the plan doesn't have to pay for as many. You really should consult a specialist in these insurance products because they are very dependent on what you need.

UHC Advantage does not require referral for specialist. And Advantage plans must pay for anything Medicare pays for. That is facts.

[upstate]

We have traditional Medicare with a supplemental plan. No referrals are needed and we can choose our doctors and hospitals. Is it cheap, no, but for us it’s worth it. I should note, we are seasonal residents.

[kingofbeer]

We have traditional Medicare with a supplemental plan. No referrals are needed and we can choose our doctors and hospitals. Is it cheap, no, but for us it’s worth it. I should note, we are seasonal residents.
I am going with a Medicare advantage plan because I want to use the Villages Health primary doctors. They do not accept traditional Medicare or supplement. Only select Medicare Advantage plans.

[MX rider]

For those who spend time in two different states, doesn't United Healthcare Medicare Advantage have a national provider network and you are covered under the in-network benefits in both states?

Yes. We both have AARP UHC Advantage. Our policies are from Indiana but we can use their huge network anywhere we go. We did a ton of research, even talked with people on UHC and chose this plan. Works well for us.

[MX rider]

A lot of guesswork in these posts. The best thing is to sit down with someone that does this for a living. Rusty Nelson did a YouTube chat with someone that specializes in this near TV. There are a lot of if/and/but to what is best. IMO, if you are at TV fulltime, an Advantage Plan (limiting your referring physicians to local) may be a better bet, since they also cover eye, dental, gym, hearing aids. However, if you are a snowbird, your local Advantage Plan isn't going to cover you in-network in PA, MI, CO, etc. Also, Medicare doesn't require you to get a referral to a specialist, whereas Advantage plans do. Most patients we treat with Advantage Plans require preauthorization, when Medicare doesn't, and sometimes what the Advantage Plan authorizes isn't in the best interest of the patient, e.g. accelerated treatments so the plan doesn't have to pay for as many. You really should consult a specialist in these insurance products because they are very dependent on what you need.

UHC Advantage is totally portable. They have a nationwide network you can use anywhere. We know, we've used it.

[OrangeBlossomBaby]

I am going with a Medicare advantage plan because I want to use the Villages Health primary doctors. They do not accept traditional Medicare or supplement. Only select Medicare Advantage plans.

This is another important consideration. My doctors are with the Villages Health. My PCP, audiologist, OB/Gyn. They're basically across the street from me, and I've been with them since we moved in 4 years ago. Assuming each of those specific doctors are still working for TVH, I might not have any choice but to select Advantage, when I'm eligible for Medicare in 3 years. Unless I'm willing to get all new doctors.

I love having everything I need on a single campus only 10 minutes away by golf cart, AND right next door to the hospital, cancer center, the MRI/mammography center - would really prefer to keep it that way as long as possible.

[RICH1]

i'll stick with my Original Medicare and my F PLAN ...Now is not the time to Get Frugal...