Traditional Medicare (TM) or Medicare Advantage (MA)

[Rainger99]

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

[LuvtheVillages]

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

[tophcfa]

For those with TM, what additional benefits would you need to switch to MA?

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

[retiredguy123]

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.
It sounds like you want to abolish advantage plans altogether.

To me, the biggest difference between an advantage plan and traditional Medicare is that advantage plans are managed by a private company with a profit incentive. If they deny claims or prevent you from using a doctor or other provider who charges too much or performs unnecessary procedures, they can increase their profit. By contrast, traditional Medicare claims are managed by Federal employees who have no profit incentive. I don't trust the Government's accounting costs for these programs, but it seems that advantage plans should cost less than traditional Medicare. But for the patient, it appears as though traditional Medicare would be a better choice.

[Bemabound]

TM does not cover out of country needs. TM consistently reduces what they cover, especially for quality rehabilitation - which is a high need in elderly populations. TM does not meet criteria to retain certain retiree federal health care benefits, but MA does. MA have some plans which reduce TM premium costs. MA - PPO plans let you see docs in other areas of the country (TM does but the clinic may cap their new pts, unlikely for MA to be capped). Many reasons to go with MA depending on your specific health needs.

[tacostello]

Good points made above. Here are some other thoughts:
TM subscribers often get a supplemental which will increase in price with age. Supplementals don't include Part D - which must be purchased separately. The better the supplemental and Part D, the higher the price. Both supplemental and Part D providers are private for profit companies. TM doc's and facilities don't have a common integrated health info network, so each time you change either, get ready to provide your health history all over again.
Apart from the above issues, TM would seem to provide the most health flexibility independent of cost.
MA (aka Part C) comes in many forms including HMO, in network only, out of network optional and PPO. All include Part D. I currently have HMO and am satisfied with it with two exceptions - speed of service for anything other than ordinary care and the potential for disagreeing with a doc and having little recourse. The integrated health info system is very good - no time wasted in providing health history or dealing with billing.
I'm glad we have choices. And I would be interested in hearing from anyone who is very pleased with their health care choices - and what those choices are.

[CrazyTiki]

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

[tophcfa]

It sounds like you want to abolish advantage plans altogether.

No, that’s not necessarily true. MA plans don’t suit my wife and my needs, but that doesn’t mean they don’t work for others. I was simply answering the OP’s question regarding what it would take to get us to switch from Traditional Medicare, with a supplemental plan, to MA.

That being said, I would be in favor of abolishing them if the powers that be can’t get their act together and revise MA plans so the cost to the Medicare Fund is the same or less than traditional Medicare. By costing Medicare 22% more per subscriber than Traditional Medicare, MA plans are bleeding the rapidly dwindling Medicare Fund dry even faster, which is not a good thing for anyone involved. Plus, their excessive costs are causing everyone’s Part B premiums to increase more rapidly.

I would add that I get the appeal of MA plans for healthy subscribers, since they are much less expensive (to them, not the government) and come with benefits that Traditional Medicare subscribers don’t get. But I also worry for those people as they get older and develop potentially very expensive medical conditions. At that point, they will have a pre-existing condition and very well might not be able to switch to Traditional Medicare with a supplemental plan, since they won’t pass medical underwriting.

[tophcfa]

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

Recently went through all that as well, and came up with the exact same conclusion.

[Rainger99]

Before I went on Medicare a few years ago, I thought that Medicare was free. People were always saying that the answer to the health problems in this country was “Medicare for All.” So after paying into Medicare for about 55 years, I expected that I would not have to worry about ever paying for medical coverage again.
To my surprise, I found out that even though I had retired and was not making much money, I still had to pay for Medicare.

I was also surprised to learn that the amount you pay for Medicare depends on how much money you make. The more you make the more you pay.

Married Filing Jointly:
$212,000 or less: Standard premium ($185 in 2025)
Above $212,000 to $266,000: $74.00 surcharge
Above $266,000 to $334,000: $185.00 surcharge
Above $334,000 to $400,000: $295.90 surcharge
Above $400,000 to $750,000: $406.90 surcharge
Above $750,000: $443.90 surcharge

I have learned a lot about Medicare since I retired.

[mtdjed]

Good points made above. Here are some other thoughts:
TM subscribers often get a supplemental which will increase in price with age. Supplementals don't include Part D - which must be purchased separately. The better the supplemental and Part D, the higher the price. Both supplemental and Part D providers are private for profit companies. TM doc's and facilities don't have a common integrated health info network, so each time you change either, get ready to provide your health history all over again.
Apart from the above issues, TM would seem to provide the most health flexibility independent of cost.
MA (aka Part C) comes in many forms including HMO, in network only, out of network optional and PPO. All include Part D. I currently have HMO and am satisfied with it with two exceptions - speed of service for anything other than ordinary care and the potential for disagreeing with a doc and having little recourse. The integrated health info system is very good - no time wasted in providing health history or dealing with billing.
I'm glad we have choices. And I would be interested in hearing from anyone who is very pleased with their health care choices - and what those choices are.

Take part D out of the equation. There are zero cost options by Well Care.

[HappyTraveler]

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

You forgot to mention what your monthly premiums are for the TM plan and the Medigap plan? Costs vs benefits are one of the most relevant equations.

[HappyTraveler]

My original comment here was not accurate therefore is no longer needed. Cheers....

[Rainger99]

You left out a few relevant details. What you're referring to above is Part A - hospital coverage. Yes? And the costs noted above are monthly.

Having Medicare medical insurance is different and, depending on the plan, may have its own monthly premiums in addition to the above.

I think Part A is free and the monthly premium is for Part B (TM) or Part C (MA).

[tophcfa]

You forgot to mention what your monthly premiums are for the TM plan and the Medigap plan? Costs vs benefits are one of the most relevant equations.

I’m paying $185 for part B, $189 for the absolute best Blue Cross Blue Shield Medigap plan available (which includes a year 1,2,3 discount of 15, 10, and 5% respectively, and also includes an annual vision and hearing exam and $150/year for corrective eyeglasses or contacts), and $12 for a WellCare part D prescription plan that covers both of my scripts for no cost via mail order. That’s a grand total of $386 for outstanding insurance with about a $250 annual deductible/max out of pocket plan. How sweet is that after having to pay over a grand per month through Obamacare for a high deductible and max out of pocket plan with a limited network and having to get a referral for everything. Although I hate getting older, becoming eligible for Medicare has helped mute the pain : ) I am well aware I could have saved a couple hundred bucks per month with a MA plan, but the piece of mind of a national network with no referrals, and more importantly, knowing if I ever need major medical care I’m totally covered after a $250 annual deductible, is priceless. Also, knowing both a hip and another knee replacement are in my future, that $200 per month MA savings would more than disappear very quickly.

[Rainger99]

I like not needing a referral to see a specialist if I feel something needs attention.

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

[tophcfa]

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor. You can talk with friends and family for references, coupled with your own research, and make an appointment with the doctor you feel is the best for your health issue at hand. As long as the doctor accepts traditional Medicare, which is just about everyone, you’re good to go. Plus, you never have to worry about them being out of network. You can’t just order your own MRI if you injure your knee, but you can determine who is the best orthopedic doctor specializing in knees and make an appointment to see him/her, and if they feel it’s necessary they can order it.

[Rainger99]

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor. You can talk with friends and family for references, coupled with your own research, and make an appointment with the doctor you feel is the best for your health issue at hand. As long as the doctor accepts traditional Medicare, which is just about everyone, you’re good to go. Plus, you never have to worry about them being out of network. You can’t just order your own MRI if you injure your knee, but you can determine who is the best orthopedic doctor specializing in knees and make an appointment to see him/her, and if they feel it’s necessary they can order it.

I can sort of see the MRI. But if you go to a specialist and they don’t think the MRI is necessary but you do, are you out of luck?

How about the other appointments? Can you make them without any problem?

For example, years ago I severely sprained my ankle. Sometimes my ankle still bothers me. I don’t know if that is caused by the original injury or just old age. I would like to see a specialist but with MA, my doctor won’t refer me for a specialist.

I have a lot more aches and pains than when I was younger. It would be nice to see a specialist every time one acts up.

It would be great to be my own primary care physician so that I could take charge of my health care.

[sdeikenberry]

TM does not cover out of country needs. TM consistently reduces what they cover, especially for quality rehabilitation - which is a high need in elderly populations. TM does not meet criteria to retain certain retiree federal health care benefits, but MA does. MA have some plans which reduce TM premium costs. MA - PPO plans let you see docs in other areas of the country (TM does but the clinic may cap their new pts, unlikely for MA to be capped). Many reasons to go with MA depending on your specific health needs.

A supplemental plan along with TM covers all of the above concerns. Advantage plans are geared towards profit in spite of the sales hype…patient care does suffer. No way do you want someone weighing the cost of your care over what’s best for you.

[dewilson58]

.......................

For those with MA, at what point would you drop it because there is no advantage.



Never was an advantage.

:ho:

[Lynnesail]

In addition to that, if you should get some rare tumor or disease..places like Mayo do not take advantage plans.

[bowlingal]

I have traditional Medicare and would NEVER switch to Medicare Advantage. I can go anywhere in the US, all lab fees are covered, no deductible, no referrals, no charges whatsoever. Yes, I have a supplement, but that monthly payment enables me to sleep at night and not have to worry about charges occurring if I get sick, car accident, cancer, surgery. That to me is worth every single penny.

[MX rider]

We're on UHC Advantage and are happy with it. They have a large nationwide network and we use the wellness benefits, as well as the dental and vision. Choice is a good thing.

We did our research and even talked with people on our plan. SHINE also said it was a good option for us.
Medicare is not a one size fits all. It's about what works best for you.

[Rwirish]

My MA provides all the above.

[tacostello]

Happy Traveler - thanks for sharing your specifics. Very helpful.
One question - have your supplemental premiums increased over time?
And I'll look into Well Care - and Part D $$.

[tophcfa]

I can sort of see the MRI. But if you go to a specialist and they don’t think the MRI is necessary but you do, are you out of luck?

How about the other appointments? Can you make them without any problem?

For example, years ago I severely sprained my ankle. Sometimes my ankle still bothers me. I don’t know if that is caused by the original injury or just old age. I would like to see a specialist but with MA, my doctor won’t refer me for a specialist.

I have a lot more aches and pains than when I was younger. It would be nice to see a specialist every time one acts up.

It would be great to be my own primary care physician so that I could take charge of my health care.

Yes, you can make an appointment with any specialist that accepts traditional Medicare. You can’t order your own imaging or other diagnostic tests, that’s up to the specialist. If you’re unhappy with the treatment from a specialist, you can make your own appointment with a different one for a second opinion.

[oneclickplus]

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

I just wanted to "second" your statement. I have exactly the same position. I'm not lured by "free this and free that" with MA plans. It's not free if you give up something (autonomy to make decisions about when / where of care when needed).

[RoboVil]

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?
You normally cannot drop Advantage plans. You can always change from traditional Medicare to an Advantage plan but not vice versa. Advantage plans are great until you need an expensive treatment and then the insurance companies will delay the treatment using prior authorization delays or denials. With traditional Medicare there is no prior authorization and you get your treatment right away.

[RoboVil]

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.
Don't ever leave traditional Medicare. Your life may depend upon it.

[RoboVil]

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?
If you have chest pain and want to be examined by a cardiologist you just call the office and make an appointment. No referrals needed.

[RRGuyNJ]

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.

[CoachKandSportsguy]

Just a moment... (https://www.fiercehealthcare.com/payers/elevance-health-lowers-2025-guidance-amid-cost-pressures-aca-medicaid-markets)

key statement:

She added that the company has also already repriced its ACA plans to account for the higher costs.

analysts have forecasted / predicted the increases will be greater than 20% my comments to regain the profitability growth needed for corporate bonus plans. . and to keep their jobs with the stock market price trend. .

But remember, the out of pocket costs if you get approved has a limit with most MA plans, and medicare does not, so be sure to include a medigap plan for the out of pocket costs which can soar with a prolonged stay in the hospital. .

[kingofbeer]

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.
Holy smokes. I assume that Medicare supplements might have an out of pocket limit.

[retiredguy123]

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.
I thought that the ACA required all health insurance plans to have unlimited coverage upper limits. That is, there can be no lifetime cap on coverage. A plan can have an annual catastrophic limit, but no lifetime coverage limit.

[LuvtheVillages]

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

Yes, within the Medicare guidelines.
Yes for cardiologist.
Yes for neurologist.
I think the colonoscopy guideline is every 5 years.
I think the skin check guideline is once per year.
For lab work you need an order from a doctor. Go to the appropriate doc first.

[retiredguy123]

Holy smokes. I assume that Medicare supplements might have an out of pocket limit.
As I understand it, if you don't have a supplement plan, you are responsible for 20 percent of all health care costs under Medicare Part B, with no limit, and about $1,500(?) copay per hospital stay under Medicare Part A. If you have a supplement, the supplement will pay the 20 percent Part B cost and the Part A hospital copays.

[SoCalGal]

Medicare Advantage plans don’t suit my wife and my needs, but that doesn’t mean they don’t work for others.

For me, Medicare Advantage works beyond satisfaction. I'm facing a life-threatening illness. I've seen more medical specialists in the past year than in my previous 74 years combined. The medication alone costs $16,000/month; I haven't paid a dime. Without exception, the specialists I've seen are highly qualified. After exhaustive analysis, I would have selected the specialists assigned to me. I feel blessed to have MA coverage.

[SoCalGal]

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor.

People who think this believe that the "gatekeeper" system--where you see your primary care doctor who refers you to a specialist within the system--is filled with incompetent specialists who couldn't otherwise attract patients. I live in a large metropolitan area. I get exposed to the cream of the crop. If, for some reason, an assigned specialist doesn't click, I simply ask for another referral. Has happened to me once, and it was no big deal.

[SoCalGal]

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests.

I have Medicare Advantage through Aetna. Aetna hasn't denied a single test or procedure since I've been under its coverage for 13 months.

[HappyTraveler]

Happy Traveler - thanks for sharing your specifics. Very helpful.
One question - have your supplemental premiums increased over time?
And I'll look into Well Care - and Part D $$.
I think you meant this comment for someone else. I didn't describe any of my specifics.

[BrianL99]

Choice A:

The government will provide you with reasonably priced healthcare. You can see most any doctor you want, at any time, without our approval. We'll pay for any recognized treatment you want, for any ailment you have. For about $150/month, you can buy additional coverage that will cover most deductibles and ancillary costs.

Choice B.

A private, profit-making company will manage your healthcare, within the bounds of what they think is reasonable, to insure they make a profit. They'll give you a free gym membership (that everyone wants, of course) and maybe 2 dental cleanings. In exchange, you save about $100/month on medical cost. In exchange for that $100, most Dr visits will be handled by a nurse or PA. You can't see any other Doctor, unless the Nurse/PA/Dr says you absolutely need to. If you need any special procedures or treatments, send them a message and they'll let you know if it fits into their business/profit model.

For the price of Cable TV, you can get the best healthcare available in the world or you can opt to save yourself $150/month.

Tough choice.

[kingofbeer]

Choice A:

The government will provide you with reasonably priced healthcare. You can see most any doctor you want, at any time, without our approval. We'll pay for any recognized treatment you want, for any ailment you have. For about $150/month, you can buy additional coverage that will cover most deductibles and ancillary costs.

Choice B.

A private, profit-making company will manage your healthcare, within the bounds of what they think is reasonable, to insure they make a profit. They'll give you a free gym membership (that everyone wants, of course) and maybe 2 dental cleanings. In exchange, you save about $100/month on medical cost. In exchange for that $100, most Dr visits will be handled by a nurse or PA. You can't see any other Doctor, unless the Nurse/PA/Dr says you absolutely need to. If you need any special procedures or treatments, send them a message and they'll let you know if it fits into their business/profit model.

For the price of Cable TV, you can get the best healthcare available in the world or you can opt to save yourself $150/month.

Tough choice.
Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium

[jminnis]

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

MA is being hugely over-billed. If someone wants to look at government benefit cheats, start there.....

[retiredguy123]

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium
The Part B premium is $185 per month, unless you are under IRMAA, in which case the monthly premium can be more than $600 for the exact same coverage.

[Pat2015]

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?
You have to go through your primary care doctor and they get referrals sent out for you for specialists and tests that are required.

[retiredguy123]

You have to go through your primary care doctor and they get referrals sent out for you for specialists and tests that are required.
Traditional Medicare does not require a referral, but some specialists may. If you have an advantage plan, the plan may require a referral before going to a specialist. That is the difference.

Also, with traditional Medicare, you may be able to get 2 or 3 second opinions without a referral, but your advantage plan may not allow a second opinion at all.

[BrianL99]

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten.


There's nary a person in the United States of Medicare age, that isn't overweight, has high blood pressure, heart issues or all 3.

There's hardly a 65 year old in America, who's not taking medication of some sort, on a regular basis.

There's one and only one reason for have a Medicare Advantage Plan and that's COST.

Everyone is entitled to get whatever kind of Medicare or Insurance plan they want, but the folks who come on here and promote Advantage Plans because they're a "better plan", are simply disingenuous.

People are entitled to make a value decision, based on a cost/benefit analysis ... that's their right. Anyone who argues Medicare Advantage Plans offer better healthcare, are simply rationalizing their cost saving decision.

[CoachKandSportsguy]

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium

LOL! that belief will work until it doesn't! anyone can develop a chronic illness between 65 and whenever, after they chose a plan, through no fault of their own Anyone can get into an accident requiring lots of medical care, though no fault of their own. .

Thinking if you are healthy today and will stay that way forever is hopium. . so do healthy people who believe that then know how they will die?
will it be a golf cart accident? someone else's fault? a tree falling? a lightning bolt? dementia/Alzheimers, which can result in a long life needing assisted living or in home care?
but never needing any thing else but an annual physical and a gymn membership?

[tophcfa]

As I understand it, if you don't have a supplement plan, you are responsible for 20 percent of all health care costs under Medicare Part B, with no limit, and about $1,500(?) copay per hospital stay under Medicare Part A. If you have a supplement, the supplement will pay the 20 percent Part B cost and the Part A hospital copays.

That is my understanding as well.

[Snowbirdtobe]

Yes, within the Medicare guidelines.
Yes for cardiologist.
Yes for neurologist.
I think the colonoscopy guideline is every 5 years.
I think the skin check guideline is once per year.
For lab work you need an order from a doctor. Go to the appropriate doc first.

I have a Plan F sup. I go to an ER they take me, no bill.
My wife had 3 ER visits and 2 admissions, 3 cardiac procedures and a pacemaker. No bills.
My plan has 50,000 in out of country coverage.
We were lucky when we ran away from TVH 10 years ago because we passed the screening to change to BCBS TM sup Plan F.
Now they would have rejected us for medical reasons.
If you have a MA plan you might not be able to switch if you are ill.

[HappyTraveler]

There's nary a person in the United States of Medicare age, that isn't overweight, has high blood pressure, heart issues or all 3.

There's hardly a 65 year old in America, who's not taking medication of some sort, on a regular basis.

There's one and only one reason for have a Medicare Advantage Plan and that's COST.

That post didn't end where I first thought it was headed (I guess I was hopeful). I thought you were going to say what I'll go ahead and add.

THE BEST health insurance costs very little. It is simply this:
-- Eat primarily high-quality and healthy food (Mediterranean diet is still the best)
-- Get regular exercise with stretching and keep your weight in check
-- Quality sleep and enough of it is important
-- Have people in your life who routinely cause you stress? Ditch them. Not kidding, you want to be healthy or not? Eliminate stress.

Brian, there are many people of young Medicare ages that are healthy and who very intentionally take care of themselves. I'm one of them and know others. They don't have need to see Doctors because they live like the above. So, some of them choose Advantage plans because why wouldn't they? Over a decade it's quite a lot of money saved (for a couple probably $40,000+). Plus they can switch plans every year in the 4th quarter.

Of course, those healthy people could be in a bad car accident or get a serious disease -- guess what will happen then? They will get medical care.

I hear and read a lot of justification from people about the premiums they pay for traditional Medicare - which I find interesting. If it's worth it to them, that's all that matters. But, I think some are convincing themselves that they're getting more than they actually are and they seem to need to convince others too.

[collie1228]

I’ve been on Medicare Advantage for over ten years (Careplus each year) and do you know how much I’ve saved over regular Medicare? Over that ten years I’ve paid a total of less than $3,000 out of pocket for my health care. I’ve had one major surgery, a sleep study with a CPAP machine prescription, the usual prescriptions for fairly routine issues, and great doctors, nurses and support. I really love my Medicare Advantage. Maybe I’ve been lucky, but I don’t see where traditional Medicare with a supplement plan could have been any better for me.

[Dexterconfetti]

All my gym memberships, through the local YMCA’s and Lifetime, are free with my Medicare Supplement Plan. Mine is Renew Active. There is also Silver Sneakers.

[Rainger99]

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

[Mrprez]

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

Never denied anything in 5 years.

[CoachKandSportsguy]

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

Mass has had to propose new / change laws to bring MA into reasonable behavior due to their delaying / denial behavior. The hospitals were complaining because it was costing them money and backing up beds, resulting in delayed healthcare due to lack of beds

[Michael 61]

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TM vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they choose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TM + Medigap. Even though I’m healthy and prescription-drug free at this time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

[CoachKandSportsguy]

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TA vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they chose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TA+Medigap. Even though I’m healthy and prescription-drug free at his time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

Had dinner with high school / college friends/couple where one is a doctor. She would never take MA, too many rejections from a doctor's point of view. The point to remember, which I would wager that most don't realize, that MA private insurers,don't make procedure decisions on medical need/basis, they make their decisions based on corporate policies.

good luck with that . .

[tophcfa]

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TA vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they chose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TA+Medigap. Even though I’m healthy and prescription-drug free at his time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

Smart. Wait until you get about 5 months before turning 65 and have two files handy, one very large file labeled “Medicare Advantage” and another much smaller one labeled “Medicare Supplement”. You will begin to get a steady avalanche of mail right up until your 65th birthday. You will be absolutely amazed at how much marketing stuff you get for Medicare Advantage plans, relative to information brochures related to Supplemental Plans. The amount of MA marketing materials you will get from AARP in conjunction with United Healthcare alone will practically fill up your large file. Take all that for what it’s worth, but it was easy for me to interpret it.

[kingofbeer]

Had dinner with high school / college friends/couple where one is a doctor. She would never take MA, too many rejections from a doctor's point of view. The point to remember, which I would wager that most don't realize, that MA private insurers,don't make procedure decisions on medical need/basis, they make their decisions based on corporate policies.

good luck with that . .
of course, the doctor makes a big salary and can afford the supplement. The average person chooses MA.

[Michael 61]

of course, the doctor makes a big salary and can afford the supplement. The average person chooses MA.

I’m an “average” person, and I won’t be going MA.

I’m 63, and am paying almost $1000 a month for a solid health insurance policy. So, once I turn 65, and only paying for traditional Medicare + Supplement, I’ll be saving quite a bit in monthly health cost premiums.

I understand those on tight, fixed incomes may have no other alternative than to go with MA. But I think most Villagers have a few extra dollars to invest in obtaining the best possible medical coverage available.

[Mrprez]

I’m an “average” person, and I won’t be going MA.

I’m 63, and am paying almost $1000 a month for a solid health insurance policy. So, once I turn 65, and only paying for traditional Medicare + Supplement, I’ll be saving quite a bit in monthly health cost premiums.

I understand those on tight, fixed incomes may have no other alternative than to go with MA. But I think most Villagers have a few extra dollars to invest in obtaining the best possible medical coverage available.

It isn’t always about money. Some people have existing health issues that prevents them from passing through the underwriting.

[Michael 61]

It isn’t always about money. Some people have existing health issues that prevents them from passing through the underwriting.

Yes, it is necessary to go through medical underwriting if after the age of 65, one wishes to move from MA to TM, however, there is no medical underwriting to initially enroll in TM at age 65.

That is why it’s so important to make the correct decision when turning 65.

[tophcfa]

I would highly recommend reading this book to anyone getting close to turning 65. I ordered it on Amazon, and after reading it passed it along to two of my good friends. We all signed up for the exact same plans (except for part D) after reading this book. Good luck to everyone navigating this very important decision.

[tophcfa]

Yes, it is necessary to go through medical underwriting if after the age of 65, one wishes to move from MA to TM, however, there is no medical underwriting to initially enroll in TM at age 65.

That is why it’s so important to make the correct decision when turning 65.

True, unless you buy your policy from Connecticut, Massachusetts, Maine, or New York. Note, one of those states has to be your primary residence in order to purchase your policy there.

[Rainger99]

True, unless you buy your policy from Connecticut, Massachusetts, Maine, or New York. Note, one of those states has to be your primary residence in order to purchase your policy there.

So if getting on TM were crucial, someone could move to one of those states for three months and then move back to the villages?

[tophcfa]

So if getting on TM were crucial, someone could move to one of those states for three months and then move back to the villages?

Never thought of that, but I suppose. You would have to establish that state as your primary residence before the annual enrollment period. Would probably take more than three months, and then you would have to pay state income tax in that state and you would lose your Florida homestead exemption.

[Mrprez]

Yes, it is necessary to go through medical underwriting if after the age of 65, one wishes to move from MA to TM, however, there is no medical underwriting to initially enroll in TM at age 65.

That is why it’s so important to make the correct decision when turning 65.

At the time I was covered on my wife’s Federal health care. Over the years the self plus one became too expensive.

[kingofbeer]

I’m an “average” person, and I won’t be going MA.

I’m 63, and am paying almost $1000 a month for a solid health insurance policy. So, once I turn 65, and only paying for traditional Medicare + Supplement, I’ll be saving quite a bit in monthly health cost premiums.

I understand those on tight, fixed incomes may have no other alternative than to go with MA. But I think most Villagers have a few extra dollars to invest in obtaining the best possible medical coverage available.
54% of Medicare beneficiaries are enrolled in Medicare Advantage plans. I enrolled in Medicare Advantage because I wanted to be able to see Villages Health primary doctors. I was not impressed with any local primary doctors who where not part of Villages Health. IHMO, MA is perfect for those without chronic illness or conditions. High blood pressure, obese, heart condition, obese etc. You will see how expensive a gold Medicare supplemental plan is and then you will decide for yourself.

[kingofbeer]

I’m an “average” person, and I won’t be going MA.

I’m 63, and am paying almost $1000 a month for a solid health insurance policy. So, once I turn 65, and only paying for traditional Medicare + Supplement, I’ll be saving quite a bit in monthly health cost premiums.

I understand those on tight, fixed incomes may have no other alternative than to go with MA. But I think most Villagers have a few extra dollars to invest in obtaining the best possible medical coverage available.
Don't forget about the required Medicare premium which will probably be over $200 when you are enrolled.

[Rainger99]

For those with a medigap plan, how much does it cost? And how much does it usually go up each year?

[biker1]

$189 per month for UHC Plan N. How much it goes up varies. The premium varies with age and some other factors.

For those with a medigap plan, how much does it cost? And how much does it usually go up each year?

[biker1]

What is a "gold Medicare supplemental plan" ?


54% of Medicare beneficiaries are enrolled in Medicare Advantage plans. I enrolled in Medicare Advantage because I wanted to be able to see Villages Health primary doctors. I was not impressed with any local primary doctors who where not part of Villages Health. IHMO, MA is perfect for those without chronic illness or conditions. High blood pressure, obese, heart condition, obese etc. You will see how expensive a gold Medicare supplemental plan is and then you will decide for yourself.

[tophcfa]

What is a "gold Medicare supplemental plan" ?

Plan G in most states for new enrollees. In Massachusetts it’s called Supplement 1A. It basically pays for 100% of everything not covered by Traditional Medicare, after about a $250 annual deductible. I have the Blue Cross and Blue Shield Sapphire Supplement 1A plan with a monthly premium of $189. It’s absolutely the best Supplemental plan available.

[tophcfa]

$189 per month for UHC Plan N. How much it goes up varies. The premium varies with age and some other factors.

All premiums go up because of inflation. It depends on the state you purchase your policy from if/how much your premium will go up every year based on age. Some states use attained age ratings, some use issue age ratings, and other states use community age ratings. My state of primary residence uses community age ratings, so my policy doesn’t increase as I get older because of my age. That being said, I pay more when I’m younger than in many other states, but less as I get older.

[Rainger99]

Some states use attained age ratings, some use issue age ratings, and other states use community age ratings. as I get older.

I didn’t know age was so variable.

Attained Age Ratings premiums are based on the policyholder's current age at the time of renewal or premium calculation.
- Premiums increase as the policyholder ages, reflecting the higher risk associated with older age.

Issue Age Ratings Premiums are based on the policyholder's age at the time the policy is purchased.
- Premiums remain constant based on the issue age and do not increase as the policyholder gets older, though they may rise due to inflation or other factors.

Community Ratings Premiums are the same for everyone in a specific geographic area or "community," regardless of age or other individual risk factors like health status.
- Premiums may vary by location or plan type but not by individual age or health.

In Sumter County, most insurers use attained age.

[kingofbeer]

Before I went on Medicare a few years ago, I thought that Medicare was free. People were always saying that the answer to the health problems in this country was “Medicare for All.” So after paying into Medicare for about 55 years, I expected that I would not have to worry about ever paying for medical coverage again.
To my surprise, I found out that even though I had retired and was not making much money, I still had to pay for Medicare.

I was also surprised to learn that the amount you pay for Medicare depends on how much money you make. The more you make the more you pay.

Married Filing Jointly:
$212,000 or less: Standard premium ($185 in 2025)
Above $212,000 to $266,000: $74.00 surcharge
Above $266,000 to $334,000: $185.00 surcharge
Above $334,000 to $400,000: $295.90 surcharge
Above $400,000 to $750,000: $406.90 surcharge
Above $750,000: $443.90 surcharge

I have learned a lot about Medicare since I retired.
It's a stupid rule to charge extra if you have higher income. The medicare premium should be zero for all.

[kingofbeer]

What is a "gold Medicare supplemental plan" ?
The best plan with the most coverage.

[retiredguy123]

Before I went on Medicare a few years ago, I thought that Medicare was free. People were always saying that the answer to the health problems in this country was “Medicare for All.” So after paying into Medicare for about 55 years, I expected that I would not have to worry about ever paying for medical coverage again.
To my surprise, I found out that even though I had retired and was not making much money, I still had to pay for Medicare.

I was also surprised to learn that the amount you pay for Medicare depends on how much money you make. The more you make the more you pay.

Married Filing Jointly:
$212,000 or less: Standard premium ($185 in 2025)
Above $212,000 to $266,000: $74.00 surcharge
Above $266,000 to $334,000: $185.00 surcharge
Above $334,000 to $400,000: $295.90 surcharge
Above $400,000 to $750,000: $406.90 surcharge
Above $750,000: $443.90 surcharge

I have learned a lot about Medicare since I retired.
Note that the "surcharge" is added to the standard $185 rate. The actual rates are:

Part B IRMAA:

Single:
$106,000 or less: $185.00 (standard premium)
$106,001 - $133,000: $259.00
$133,001 - $167,000: $370.00
$167,001 - $200,000: $480.90
$200,001 - $500,000: $591.90
Over $500,000: $628.90

Married Filing Jointly:
$212,000 or less: $185.00 (standard premium)
$212,001 - $266,000: $259.00
$266,001 - $334,000: $370.00
$334,001 - $400,000: $480.90
$400,001 - $750,000: $591.90
Over $750,000: $628.90

[Blueblaze]

Every time this thread is restarted, it degenerates into the same few folks defending their decision to stay with TM, for reasons easily debunked, such as doctor availability and costs. I think people just tend to defend their choices, regardless of what they are. So I'm going to defend mine, right now.

We've been on Medicare Advantage since we became elgible, and have never had anything we needed rejected, including my wife's week in the hospital from a stoke last year, or any of the dozens of tests that followed.

Yes, I complain about the lousy primary care doctors that are available here in-network, but I'm not convinced that paying an extra $1000/month between the two of us would improve our choices much in this healthcare desert, 45 minutes from the nearest city. We had great in-network doctors in Houston on the Kelsey-Seybold Medicare Advantage plan.

Our current Humana "Giveback" PPO plan is free and even refunds the Social security deduction for Medicare. It includes Moffit Cancer Center in Tampa in-network. Even our great Kelsey plan in Houston didn't include MD Anderson, in-network. But either way, since we always choose a PPO, we can see any doctor we want if we don't like the in-network doctors, and it still covers 80%. That's the same as my old employer's United insurance, that cost me $500/month.

I confess, I don't understand how MA stays in business giving insurance way for free. I suspect it has something to do with those $500 office call visits they bill the gooberment, that used to only cost me $25, back before doctors started billing insurance companies instead of patients. But after paying 3% of my wages for 50 years on a promise to get some back if I lived to 65, I see no reason to shell out $1000/mo of my life savings at the back end of this scam, for the same thing I can get for free.

[Rainger99]

Our current Humana "Giveback" PPO plan is free and even refunds the Social security deduction for Medicare.


What is your current plan?

[HappyTraveler]

What is your current plan?
He mentions the very name which you posted.
It's probably either the second or third one down, here: https://plans.humana.com/plans
Like with all of them sort by zip code and county for your options.

[Aces4]

I confess, I don't understand how MA stays in business giving insurance way for free. I suspect it has something to do with those $500 office call visits they bill the gooberment, that used to only cost me $25, back before doctors started billing insurance companies instead of patients. But after paying 3% of my wages for 50 years on a promise to get some back if I lived to 65, I see no reason to shell out $1000/mo of my life savings at the back end of this scam, for the same thing I can get for free.

Do some indepth research on how private insurance companies are reimbursed for each MA individual and you may see the correlation between how they are making their money by trumping up a patient's conditions that allow for greater reimbursement. And all those goodies you tout, don't get used to them because the insurance companies profits are being eaten into and there is talk of cutting some bennies MA individuals now receive.

Don't trust a forum, do research.. past AI, and put in some of the questions you have. It makes me laugh when MA recipients state they have never had anything rejected. That is because you don't know what tests that should have been performed for you and maybe for your wife prior to her stroke, which may have ameliorated that incident for her.

[HappyTraveler]

Replying to comment #80. Good comment overall.


Yes, I complain about the lousy primary care doctors that are available here in-network, but I'm not convinced that paying an extra $1000/month between the two of us would improve our choices much in this healthcare desert.....

I am unconvinced of this also. Just because a claim is made with TM that you can choose whatever specialist you want doesn't mean that Doc is taking new patients. Many of the experienced ones aren't; they're full.


I confess, I don't understand how MA stays in business giving insurance way for free. I suspect it has something to do with those $500 office.....
If I understand what you're saying here... you mean how does the insurer stay in business? It is as follows (I'm no expert here if anyone wants to provide more detail on this).

The Fed Gov pays insurers approx $1000 monthly for each Advantage plan enrollee they have. So, Humana is getting about $12,000 p/year for you. BCBS gets the same for me. They're insurers so, they know how to manage risk, benefit and P&L. So, they can offer benefits back to enrollees from the money they're taking in every month.

In the plan you chose, they kick back part of the $1000 to you as reimbursement for what you mandatorily pay into Medicare each month ($180 or so). I could have chosen one of those plans but, decided to pick a BCBS plan that, instead of that, offers a generous allowance - $3500 p/yr - that can be used for dental (no implants), vision or hearing -- or any combo of those. I was anticipating dental work this year so....

I'm trying to use some of that this year but, haven't been happy with the periodontal practice I chose. So, am going to go to another one. But, here I can answer the question posed in comment #54 - asking whether others have had treatments denied by an MA insurer. It's a classic example of the devil is in the details.

I had one denied by BCBS related to this dental work. But, guess what? It was the vendors fault, they installed something in the treatment plan that is not covered and that exception (bone grafting, implants) is fully disclosed up-front in the plan so, I don't know why they did that. That part of the authorization was denied, of course. So, it makes you wonder how many of the denials of treatment related to MA plans are actually screw-ups by the med practices? Either erroneously filed outright (like my case) or the wrong procedure codes were used causing a denial. See?

Two more things to add: I do see in the details of the work I want to have done that the insurer isn't going to cover every aspect of the procedure - some aspect codes I would have to pay out-of pocket. So, for the total procedure, I may have to pay for about 40% of it. I don't love that and it feels a little like a bait-and-switch but, I also get that they're not going to let someone just easily blow that $3500 - they want them to have skin in the game and that probably helps keep the medical provider from simply selling a patient on anything to get their piece of that allowance.

Also, the other allowances related to my plan are $135 p/quarter to spend on OTC items (via a loaded debit card), Silver Sneakers membership, regular annual dental care, eye exam and new glasses every year, no cost for Tier 3 and 4 prescriptions. No monthly premium for the plan.

I mention all that because it's not just the lack of paying a monthly premium that is saved, BCBS is actually paying me. If I use all of the allowances provided, it will net me over $4000 p/yr.

Lastly, I would caution anyone, regarding any life issue against making a decision today for a 'maybe' of what might happen a two decades from now. That could cost a boatload of money over time and many things are going to change anyway, that's guaranteed.

[Aces4]

Replying to comment #80. Good comment overall.



I am unconvinced of this also. Just because a claim is made with TM that you can choose whatever specialist you want doesn't mean that Doc is taking new patients. Many of the experienced ones aren't; they're full.


If I understand what you're saying here... you mean how does the insurer stay in business? It is as follows (I'm no expert here if anyone wants to provide more detail on this).

The Fed Gov pays insurers approx $1000 monthly for each Advantage plan enrollee they have. So, Humana is getting about $12,000 p/year for you. BCBS gets the same for me. They're insurers so, they know how to manage risk, benefit and P&L. So, they can offer benefits back to enrollees from the money they're taking in every month.

In the plan you chose, they kick back part of the $1000 to you as reimbursement for what you mandatorily pay into Medicare each month ($180 or so). I could have chosen one of those plans but, decided to pick a BCBS plan that, instead of that, offers a generous allowance - $3500 p/yr - that can be used for dental (no implants), vision or hearing -- or any combo of those. I was anticipating dental work this year so....

I'm trying to use some of that this year but, haven't been happy with the periodontal practice I chose. So, am going to go to another one. But, here I can answer the question posed in comment #54 - asking whether others have had treatments denied by an MA insurer. It's a classic example of the devil is in the details.

I had one denied by BCBS related to this dental work. But, guess what? It was the vendors fault, they installed something in the treatment plan that is not covered and that exception (bone grafting, implants) is fully disclosed up-front in the plan so, I don't know why they did that. That part of the authorization was denied, of course. So, it makes you wonder how many of the denials of treatment related to MA plans are actually screw-ups by the med practices? Either erroneously filed outright (like my case) or the wrong procedure codes were used causing a denial. See?

Two more things to add: I do see in the details of the work I want to have done that the insurer isn't going to cover every aspect of the procedure - some aspect codes I would have to pay out-of pocket. So, for the total procedure, I may have to pay for about 40% of it. I don't love that and it feels a little like a bait-and-switch but, I also get that they're not going to let someone just easily blow that $3500 - they want them to have skin in the game and that probably helps keep the medical provider from simply selling a patient on anything to get their piece of that allowance.

Also, the other allowances related to my plan are $135 p/quarter to spend on OTC items (via a loaded debit card), Silver Sneakers membership, regular annual dental care, eye exam and new glasses every year, no cost for Tier 3 and 4 prescriptions. No monthly premium for the plan.

I mention all that because it's not just the lack of paying a monthly premium that is saved, BCBS is actually paying me. If I use all of the allowances provided, it will net me over $4000 p/yr.

Lastly, I would caution anyone, regarding any life issue against making a decision today for a 'maybe' of what might happen a two decades from now. That could cost a boatload of money over time and many things are going to change anyway, that's guaranteed.

Ouch... I hope all those considering signing up for Medicare Advantage read this!

[HappyTraveler]

Ouch... I hope all those considering signing up for Medicare Advantage read this!
Ouch, I also hope they recognize that you make no argument at all in that obtuse comment.

But, I will point something out from your comment further up;
That is because you don't know what tests that should have been performed for you and maybe for your wife prior to her stroke, which may have ameliorated that incident for her.
Indeed, that might be the case....or not.

What people also need to consider is, no matter their insurance plan, whether the surgery or procedure a specialist is recommending is actually needed? It's estimated than 12%+ of surgeries/procedure in the USA every year are unnecessary. That is something like 2.5 million+ people undergoing the knife who don't need to be. Think about that. How many of them died b/c of it? How many suffered adverse outcomes?

I know countless stories of people who later realized they didn't need the surgery they had gotten (me also) and some who realize that they didn't seek less invasive options before agreeing to be cut into. So, the easier it is for many Docs to sell you something, well, that's what they're going to do. KA-CHING!

[Rainger99]

He mentions the very name which you posted.
It's probably either the second or third one down, here: https://plans.humana.com/plans
Like with all of them sort by zip code and county for your options.

There are two that seem to fit his description. I am trying to find out which one he recommends.

HumanaChoice Florida Giveback H5216-452 (PPO)

Humana Full Access Giveback H5216-393 (PPO)

[HappyTraveler]

There are two that seem to fit his description. I am trying to find out which one he recommends.

HumanaChoice Florida Giveback H5216-452 (PPO)

Humana Full Access Giveback H5216-393 (PPO)
Definitely best for you to choose yourself.
There are literally no blanket recommendations in these matters given the particulars for every one of us are different.
Btw, other insurers offer reimbursement plans like that....BCBS has at least one that does.
Do some keyword searching on it and you'll likely find a list of all insurers that do.

[biker1]

The majority of people have Plan G, Plan F, or Plan N. The coverage is essentially the same with the exception that Plan F covers the Part B deductible and Plan N may have up to $20 copays and excess charges (which are pretty rare). For these differences in costs, Plan N typically has the lowest premiums and Plan F the highest. For our area, you may find that the differences in premiums between Plan F and Plan G (or Plan N) is greater than the Part B deductible. Many people would save money by switching to Plan G (or Plan N) from Plan F if they can do so without having to go through underwriting. Some providers allow you to switch between plans without underwriting. Folks now enrolling in Medicare for the first time at age 65 are not eligible for Plan F. There are also other plans including some high deductible options.

The best plan with the most coverage.

[Aces4]

Ouch, I also hope they recognize that you make no argument at all in that obtuse comment.

But, I will point something out from your comment further up;

Indeed, that might be the case....or not.

What people also need to consider is, no matter their insurance plan, whether the surgery or procedure a specialist is recommending is actually needed? It's estimated than 12%+ of surgeries/procedure in the USA every year are unnecessary. That is something like 2.5 million+ people undergoing the knife who don't need to be. Think about that. How many of them died b/c of it? How many suffered adverse outcomes?

I know countless stories of people who later realized they didn't need the surgery they had gotten (me also) and some who realize that they didn't seek less invasive options before agreeing to be cut into. So, the easier it is for many Docs to sell you something, well, that's what they're going to do. KA-CHING!

Research regarding your MD may be the answer if you've run into a "cut happy Dr". I am sure I am not the only person not to have Drs. that try to sell me something. I'm talking about tests that could help with the prevention of strokes, heart attacks, aneurysms, etc. for which the elderly have a propensity. Ct scans, MRIs, Doppler ultrasound testing are great tools for diagnosis without a scalpel in sight. As far as the KA-CHING for Drs. treating Medicare patients, have you ever seen a traditional Medicare statement? Yeah, those Drs. are rolling in the dough, lol.

[tophcfa]

It's a stupid rule to charge extra if you have higher income. The medicare premium should be zero for all.

Agree, especially considering those are the same people that typically have been paying more towards Medicare during their working careers since there is no cap on working income like there is for social security.

[HappyTraveler]

Research regarding your MD may be the answer if you've run into a "cut happy Dr". I am sure I am not the only person not to have Drs. that try to sell me something. I'm talking about tests that could help with the prevention of strokes, heart attacks, aneurysms, etc. for which the elderly have a propensity. Ct scans, MRIs, Doppler ultrasound testing are great tools for diagnosis without a scalpel in sight. As far as the KA-CHING for Drs. treating Medicare patients, have you ever seen a traditional Medicare statement? Yeah, those Drs. are rolling in the dough, lol.
Everyone who has reached a mature age has run into "cut happy" Doctors whether they comprehend that or not. (Plenty don't) You can't have upwards of 2.5 million+ unnecessary surgeries/procedures every year in this country without that being the case. It happens in the dentistry and the veterinary realms too. Caveat emptor.

The last couple sentences are a good indicator that you weren't employed in the business arena during your working career. The evaluation criteria you used isn't accurate or complete.

My Mother was on TM for 30 years and she mused to me why her Doc would tell her to come back and see him for some minor thing she went in for. She'd say, "I healed fine and there are no problems so why does he need me to come back?" I replied, "For the billing, so he can fill the calendar and get paid." She'd be in there all of 2 to 3 minutes for the return visit and Medicare got billed. She stopped going back when she knew there was no need. She lived until one week shy of 98.

[Aces4]

Everyone who has reached a mature age has run into "cut happy" Doctors whether they comprehend that or not. (Plenty don't) You can't have upwards of 2.5 million+ unnecessary surgeries/procedures every year in this country without that being the case. It happens in the dentistry and the veterinary realms too. Caveat emptor.

The last couple sentences are a good indicator that you weren't employed in the business arena during your working career. The evaluation criteria you used isn't accurate or complete.

My Mother was on TM for 30 years and she mused to me why her Doc would tell her to come back and see him for some minor thing she went in for. She'd say, "I healed fine and there are no problems so why does he need me to come back?" I replied, "For the billing, so he can fill the calendar and get paid." She'd be in there all of 2 to 3 minutes for the return visit and Medicare got billed. She stopped going back when she knew there was no need. She lived until one week shy of 98.

Yes, because a Dr was thrilled to make the $3.00 off your mother's visit. It never occurred to you that her Dr. was following up to insure her issue was completely recovered. On the other hand, it does sound like the Drs that the two of you had chosen may not have been vetted by you. :icon_bored:

Hate to disturb your visions but I have worked in healthcare, dentistry, the health insurance and LTDB arena. Why do you think physicians don't want to work in Florida, old people aren't as profitable for them.

[CoachKandSportsguy]

Expect MA price increases coming to your account:

https://www.bizjournals.com/stlouis/news/2025/07/18/centene-requests-double-digit-obamacare-increases.html

when asked about a subscription, just click on the No Thanks link to continue reading. .
Does not discuss your MA plan, just and example of MA companies needing large price increases to maintain solvency. .

good luck to us!

[Rainger99]

Expect MA price increases coming to your account:

https://www.bizjournals.com/stlouis/news/2025/07/18/centene-requests-double-digit-obamacare-increases.html

when asked about a subscription, just click on the No Thanks link to continue reading. .
Does not discuss your MA plan, just and example of MA companies needing large price increases to maintain solvency. .

good luck to us!

If they cut back and there is no financial advantage - no dental, vision, or OTC products - there does not seem to be much of an advantage to pick MA.

[elevatorman]

We have TM. I was given a stress test about a year ago all was fine. Recently I went in for my annual cardiologist check up. I told the doctor I was having shortness of breath. After his exam he said everything sounds good and he gave me some options. 1.) loose weight. 2.) get a pace maker device (my pulse has always been very low). 3.) Get a heart catheterization. I told him I would try to loose weight first and see if that helps. But when I got home my wife said I should get the catheterization as well. loosing weight does not happen over night so try everything to see if there are other problems. I called the doctor back and told him to schedule the catheterization. So a week later I had it done and the doctor found a 95% blockage. Placed a stent and I went home.
So my question is: Would a cardiologist have given me the same choices on a MA plan? Or would I have had to lose weight and when I got to the proper weight see how I felt. For that matter would my GP have even sent me to a cardiologist if I was on an advantage plan?

[elevatorman]

Expect MA price increases coming to your account:

https://www.bizjournals.com/stlouis/news/2025/07/18/centene-requests-double-digit-obamacare-increases.html

when asked about a subscription, just click on the No Thanks link to continue reading. .
Does not discuss your MA plan, just and example of MA companies needing large price increases to maintain solvency. .

good luck to us!
I think the article is talking about Medicaid not Medicare.

[HappyTraveler]

Yes, because a Dr was thrilled to make the $3.00 off your mother's visit. It never occurred to you that her Dr. was following up to insure her issue was completely recovered. On the other hand, it does sound like the Drs that the two of you had chosen may not have been vetted by you. :icon_bored:

Hate to disturb your visions but I have worked in healthcare, dentistry, the health insurance and LTDB arena. Why do you think physicians don't want to work in Florida, old people aren't as profitable for them.
Doc made more than $3...that is just silliness. He told her to come back for the billing.

I guess you'd also be shocked to hear that the Medical Director at the nursing facility where she later lived for a few years into her 90s isn't primarily there for the patients/residents - he's there for the owners of the facility. And his starting point in making decisions is what benefits them (and his monthly or annual bonus). The real world....

[Aces4]

Doc made more than $3...that is just silliness. He told her to come back for the billing.

I guess you'd also be shocked to hear that the Medical Director at the nursing facility where she later lived for a few years into her 90s isn't primarily there for the patients/residents - he's there for the owners of the facility. And his starting point in making decisions is what benefits them (and his monthly or annual bonus). The real world....

Talk about silliness, traditional Medicare allows VERY little for a brief office visit. The physician has booked time that could have gone to a patient who pays a normal fee plus he has overhead for the medical assistant or nurse, room set up and cleaning afterward, office rent, malpractice insurance, supplies and on and on. If one feels their Dr. or their mother's Dr. are fake billing shysters, why would one continue or allow their mother to continue with that physician? I am sorry to hear your mother ended up in a skilled nursing facility but if you felt she was being poorly served by the Medical Director, why wasn't she removed from the facility? THE REAL WORLD... BTW, we also were fortunate to have a parent live into their nineties but we constantly advocated for this parent. We wouldn't think of leaving them in an unsavory medical situation.

[HappyTraveler]

.... traditional Medicare allows VERY little for a brief office visit. The physician has booked time that could have gone to a patient who pays a normal fee plus he has overhead for the medical assistant or nurse, room set up and cleaning afterward, office rent, malpractice insurance, supplies and on and on.
Yes, indeed.....you made my point. It's like empty airplane seats are 100% lost revenue for the airline just as the open calendar spots are lost $$ for a Doc.

If one feels their Dr. or their mother's Dr. are fake billing shysters, why would one continue or allow their mother to continue with that physician?
She chose her Doctor, lived hours away from me and he was otherwise capable. Maybe you would force your parent to do something but, I would not unless it was a danger. I got no indication of that. She solved it by not returning for unneeded follow-ups. (Plus, who says the next Doc wouldn't do the same?)

I am sorry to hear your mother ended up in a skilled nursing facility but if you felt she was being poorly served by the Medical Director, why wasn't she removed from the facility?
And I am sorry that you continue to conflate things erroneously. It seems to be a habit and only creates negative interactions and faulty assumptions.

Here's the reality, she DID get pulled from there when I figured out what was going on. While my 3 brothers were clueless about it all and the one that was her caretaker and had all the POAs was largely AWOL. (Note to all: don't ever give one person all the POAs) They overbilled her for 10s of thousands and were feeding her too many sedatives - like they do most of the inmates. He never got the $$ back. It was atrocious.

We can end this here. I'm not interesting in dialoguing with anyone who wantonly conjures and believes things that aren't factual.

[Aces4]

Yes, indeed.....you made my point. It's like empty airplane seats are 100% lost revenue for the airline just as the open calendar spots are lost $$ for a Doc.


She chose her Doctor, lived hours away from me and he was otherwise capable. Maybe you would force your parent to do something but, I would not unless it was a danger. I got no indication of that. She solved it by not returning for unneeded follow-ups. (Plus, who says the next Doc wouldn't do the same?)


And I am sorry that you continue to conflate things erroneously. It seems to be a habit and only creates negative interactions and faulty assumptions.

Here's the reality, she DID get pulled from there when I figured out what was going on. While my 3 brothers were clueless about it all and the one that was her caretaker and had all the POAs was largely AWOL. (Note to all: don't ever give one person all the POAs) They overbilled her for 10s of thousands and were feeding her too many sedatives - like they do most of the inmates. He never got the $$ back. It was atrocious.

We can end this here. I'm not interesting in dialoguing with anyone who wantonly conjures and believes things that aren't factual.

Yup, it's ending here. Holding all physicians up to the same light because of bad choices on the patient's end and then concluding Drs. are all getting rich off of traditional Medicare because of an appointed followup office visit doesn't float
the rational boat. :shrug: (BTW, nothing was conflated, comments were based on the information that was provided.)

[HappyTraveler]

Yup, it's ending here. Holding all physicians up to the same light because of bad choices on the patient's end and then concluding Drs. are all getting rich off of traditional Medicare because of an appointed followup office visit doesn't float
the rational boat. :shrug: (BTW, nothing was conflated, comments were based on the information that was provided.)
Good grief, that entire comment ^^^ is nothing other than a complete conflation and assignment of views that are not mine. Simply mind-boggling and shocking that you don't grasp that! Adios....smh.

[Rainger99]

We have had more than 5,000 views and more than 100 replies.

Although a lot of people have said MA is bad because it denies necessary treatment, I don’t think a single person has provided one example where that happened to them.

[Blueblaze]

There are two that seem to fit his description. I am trying to find out which one he recommends.

HumanaChoice Florida Giveback H5216-452 (PPO)

Humana Full Access Giveback H5216-393 (PPO)

We're on the 1st one, but that's not a recommendation. You need to do your own research. I'm just saying I don't understand why people defend paying twice what they probably paid for their employer's insurance for a Medicare add-on, after paying 3% of their income for their entire career towards Medicare. The result they get seems no different than what they'd get for free, so far as I can tell.

I chose the "giveback" deal because Humana is the only one offering it, and I'd rather have the money in hand than beg for it through the various gimmicks United was doing, like free "stuff" from some weird online store that mostly had "stuff" I don't need.

I apply that same logic concerning the $1000/mo it would cost for a Medicare supplement. $12K/yr in the bank buys a lot of healthcare that I probably won't even use, anyway. I buy insurance for disasters, not groceries. My "free" MA plan (that I already paid for) pays at least 80% of the disaster costs, and I've saved $12K/yr towards the 20%, in the meantime.

[Rainger99]

the various gimmicks United was doing, like free "stuff" from some weird online store that mostly had "stuff" I don't need.

The free stuff you are referring to is over the counter products like toothpaste, sunscreen, bandaids, aspirin, etc. it is stuff that I would buy anyway.

You can buy it online but you can also buy it at many stores including Sam’s Club, Walmart, CVS, Walgreens, etc. I find that easier.

[biker1]

I don't know anyone paying $1000/month for a Medicare Supplement. I do know a lot of people, including myself, who are paying less than $200/month. Regarding your "free MA plan", you are still paying the Medicare Part B premium of $185.00/month.

We're on the 1st one, but that's not a recommendation. You need to do your own research. I'm just saying I don't understand why people defend paying twice what they probably paid for their employer's insurance for a Medicare add-on, after paying 3% of their income for their entire career towards Medicare. The result they get seems no different than what they'd get for free, so far as I can tell.

I chose the "giveback" deal because Humana is the only one offering it, and I'd rather have the money in hand than beg for it through the various gimmicks United was doing, like free "stuff" from some weird online store that mostly had "stuff" I don't need.

I apply that same logic concerning the $1000/mo it would cost for a Medicare supplement. $12K/yr in the bank buys a lot of healthcare that I probably won't even use, anyway. I buy insurance for disasters, not groceries. My "free" MA plan (that I already paid for) pays at least 80% of the disaster costs, and I've saved $12K/yr towards the 20%, in the meantime.

[Rainger99]

It would be interesting to hear from the foreigners on TOTV on the medical care in their country.

We always hear how much better healthcare is in Europe or Canada or Cuba.

Are there a lot of options and plans?

How is it? How is it paid for? Are there long waits to see a doctor?

Is it as great as we hear?

[tophcfa]

I don't know anyone paying $1000/month for a Medicare Supplement. I do know a lot of people, including myself, who are paying less than $200/month. Regarding your "free MA plan", you are still paying the Medicare Part B premium of $185.00/month.

Totally agree, I’m paying less than $200 per month for what I believe is the best Medicare Supplement plan money can buy. Perhaps they are confusing Medicare with Obamacare? Last year I was paying over $1,000 per month for a far inferior health care plan through Obamacare.

[Aces4]

54% of Medicare beneficiaries are enrolled in Medicare Advantage plans. I enrolled in Medicare Advantage because I wanted to be able to see Villages Health primary doctors. I was not impressed with any local primary doctors who where not part of Villages Health. IHMO, MA is perfect for those without chronic illness or conditions. High blood pressure, obese, heart condition, obese etc. You will see how expensive a gold Medicare supplemental plan is and then you will decide for yourself.

We don't have those issues you listed but our "expensive in your eyes" Medicare supplemental plan is working for us. We pay our monthly premium and that is it for medical care. No deductible or co-pay to mess around with and we self insure for dental care which is a small amount tucked away every month since we've never had dental insurance and that kitty is in very nice shape. We've had cataract surgery and use dimestore, (for those of you who remember them), readers are about $10. a pair. Checkups with our opthamalogist are covered so no money there. Most importantly, we have great physicians and access to great medical coverage should the occasion arise. Our medical philosophy is if ain't broke, don't fix it so we don't overuse the system. Healthy eating, skipping the mind altering substances and no smoking helps with our goals. We love the simplicity of health care at our ages but as always, to each their own.

[Rainger99]

Totally agree, I’m paying less than $200 per month for what I believe is the best Medicare Supplement plan money can buy.

What is the best Medicare Supplement plan??

[tophcfa]

What is the best Medicare Supplement plan??

I guess it’s a matter of opinion, but in my opinion it’s plan G through Blue Cross and Blue Shield (or it’s equivalent if it’s from a state with a different naming convention). Plan F is also good, but not available unless you turned 65 before 1/1/2020. Plan N is also good, it’s a bit less per month than G, but has a small co-pay for part B doctor visits. All lettered Medigap Plans are identical regardless of the provider, which is required by law. I prefer Blue Cross because of the combination of their outstanding reputation, our long time positive experience with them, and their competitive pricing.

[kingofbeer]

I don't know anyone paying $1000/month for a Medicare Supplement. I do know a lot of people, including myself, who are paying less than $200/month. Regarding your "free MA plan", you are still paying the Medicare Part B premium of $185.00/month.
Regarding your "Medicare Supplement plan", you are still paying the Medicare Part B premium of $185.00 month. You are paying approx $385 for your medical insurance.

[kingofbeer]

Totally agree, I’m paying less than $200 per month for what I believe is the best Medicare Supplement plan money can buy. Perhaps they are confusing Medicare with Obamacare? Last year I was paying over $1,000 per month for a far inferior health care plan through Obamacare.
You are also paying the Medicare Part B premium of $185.00/month.