Medicare vs Medicare advantage

[gamby]

Does anyone have medicare advantage plan and if so are you OK with it ?
Someone I know who is healthy , at least for now ! Wants to use this instead of reg. medicare.

Thank you for any input .

G

[l2ridehd]

Most advantage plans require you to have Medicare A and B and the advantage plans cover what medicare A and B do not. More of a cover the gap plan.

[Floridagal]

Have Medicare Advantage since the beginning of this year and am very happy with it. Taking it for 2013.

[jblum315]

Does anyone have medicare advantage plan and if so are you OK with it ?
Someone I know who is healthy , at least for now ! Wants to use this instead of reg. medicare.

Thank you for any input .

G

Check with your doctor first Mine does not accept Medicare Advantage.

[Avista]

We have had both original medicare with supplement and currently Medicare Advantage (Preferred Care Partners). We paid over $300/month for our supplement, plus our RX drugs another $80. Came close to $400/ month. Now we do not pay that plus get back $90.90 into,our Social Security. We save about $500/ month or $6000 per year. We like our doctors.

[rhood]

I saved over $3000 this year after going to an advantage plan.

[Bobcuse]

I had Original Medicare and employer group plan for years. This year I dropped employer plan and switched to Preferred Care Partners Advantage plan and saved $4200 in premiums plus another $600 at least by not having the many deductibles in the prior plans for my wife and myself. It's almost unbelievable but true. We don't go to doctors frequently but would save even more if we did.

[aljetmet]

There is a world of difference of having medicare alone vs having a policy in addition to it. It could be an Advantage plan or a Supplemental plan.
Here is the rub. If you have an Advantage plan, you are limited to the Doctors and facilities that your plan allows. So the most important aspect to check is if your Doctors are on the plan or not. You say your healthy so you may just have an internist. If he's accepted by the plan your ahead of the game. Most Advantage plans are absolutely free. Although you may have to pay for dental and vision. Besides covering you for hospitalization and medical it also includes a free drug plan.

Therefore a relatively healthy person should probably choose an Advantage plan because it covers a lot more than Medicare alone covers just in case. If your healthy and never see a Doctor you have piece of mind if something went wrong you would not be out a lot of money.

Remember you can change plans every year.

Lastly, most plans show you side by side the differences between having just Medicare vs. having their Advantage plan.

Good Luck!

[KayakerNC]

Check with your doctor first Mine does not accept Medicare Advantage.
:agree:
Maybe not the Doctor, but that last person you see before you leave his office, you know, the one that submits the bills and sets up your next appointment? He/she would be the one to ask about the best (or worst) companies for medical coverage and quick payments.

[CFrance]

Another thing to consider: Do you live here full time, or do you go back to a home state in the summer? Advantage plans are only good for the area of your permanent residence. For instance, we maintain a home residence in MI, and would pay mucho deductibles if we used an advantage plan and had to go to a doctor here in FL, because we would be out of the Advantage plan's network area. So we have a supplemental plan instead. It could work out to be the same either way, but we like being able to use any doctor anywhere who takes Medicare and not be nickle and dimed to death with deductibles.( BCBS Advantage plan in MI was the worst on this--there was a deductible for eating breakfast in the morning.) All our excellent doctors are at University of Michigan, so it is important to us to be able to still use them without deductibles.

And there's no such thing as a free Advantage plan in MI.

You must use an Advantage plan in your permanent residence area, whereas a supplemental is good anywhere. And we travel a lot. Our drug plan is $24/mo through Coventry (online). It's exactly the same coverage as our insurance broker was going to sell us for $80/mo. Do a lot of research!

[Hal :-)]

This is just my hunch, but we should probably enjoy Medicare Advantage while we have it. It's a win-win for everyone but the taxpayer. A win for the insurance industry, the healthcare industry, and the patients. But I'd guess it may be the largest cause of Medicare going broke, and it can't last.

I don't know how the system works. But, it's intuitively obvious that Advantage plans are way over funded. They'll give you back your $99/mo, provide silver sneakers programs, free transportation to doctor and pharmacy, include drug coverage, dental, vision, etc. Given how far they'll go to get your business, it's apparent that the premiums and service fees from Medicare must be very lucrative. That's even considering they are covering the cost for the most expensive subset of the population.

[Cantwaittoarrive]

Have Medicare Advantage since the beginning of this year and am very happy with it. Taking it for 2013.

:agree::agree:

[Deerfly]

This is just my hunch, but we should probably enjoy Medicare Advantage while we have it. It's a win-win for everyone but the taxpayer. A win for the insurance industry, the healthcare industry, and the patients. But I'd guess it may be the largest cause of Medicare going broke, and it can't last.

I don't know how the system works. But, it's intuitively obvious that Advantage plans are way over funded. They'll give you back your $99/mo, provide silver sneakers programs, free transportation to doctor and pharmacy, include drug coverage, dental, vision, etc. Given how far they'll go to get your business, it's apparent that the premiums and service fees from Medicare must be very lucrative. That's even considering they are covering the cost for the most expensive subset of the population.
I agree that Advantage plans may not last as long as I do. Politicians seem to agree that "entitlements" have to be dealt with and my guess is that Advantage plans are expensive to Medicare.
One other thing to consider when choosing an Advantage plan is the plan's formulary. Most plans have drugs partitioned into Tiers. Your contribution for Tier I drugs are usually $0 and go up for each Tier. There are differences in plans as to which drugs are classified into which tier so that there could be a big difference in your contribution from plan to plan. Might be Tier II in one plan and Tier III in another. Also the plans that refund some of your Medicare Part B contribution are HMO's and their networks of doctors are usually somewhat smaller. A straight Advantage plan has no refund and any doctor that takes Medicare has to take you.
Many plans and many decisions.

[mac9]

The Advantage programs make some of their money because they are paid the last day of the quarter BEFORE and are able to keep that money and the interest accrued by it before they have to make any payments. Doesn't sound like it would be much to you or me, but it is garnering them millions. Also, not all Advantage programs are localized. Many of the larger insurance companies (Aetna, for instance) are nationwide as you can purchase an HMO version which is local, but they also have a PPO that is usually accepted by any Medicare certified physician throughout the country.

[Hal :-)]

I agree that Advantage plans may not last as long as I do. Politicians seem to agree that "entitlements" have to be dealt with and my guess is that Advantage plans are expensive to Medicare.
One other thing to consider when choosing an Advantage plan is the plan's formulary. Most plans have drugs partitioned into Tiers. Your contribution for Tier I drugs are usually $0 and go up for each Tier. There are differences in plans as to which drugs are classified into which tier so that there could be a big difference in your contribution from plan to plan. Might be Tier II in one plan and Tier III in another. Also the plans that refund some of your Medicare Part B contribution are HMO's and their networks of doctors are usually somewhat smaller. A straight Advantage plan has no refund and any doctor that takes Medicare has to take you.
Many plans and many decisions.

Drugs are more of the same. I'll bet taxpayers overpay considerably. Many of the most popular generic drugs are $0 for the purchase, but Medicare will pay much more than you would if you bought out-of-pocket. I've seen some offered free, and many are $4/mo, $10/90-day supply. You know Medicare is paying much more when you flash your third-party Advantage card.

[CFrance]

The Advantage programs make some of their money because they are paid the last day of the quarter BEFORE and are able to keep that money and the interest accrued by it before they have to make any payments. Doesn't sound like it would be much to you or me, but it is garnering them millions. Also, not all Advantage programs are localized. Many of the larger insurance companies (Aetna, for instance) are nationwide as you can purchase an HMO version which is local, but they also have a PPO that is usually accepted by any Medicare certified physician throughout the country.

Yes, but the PPO part that you can buy is the supplemental, and it is the much higher price. My plan is Priority Health. The Advantage plan under Priority Health is specific to the Michigan area. The Priority Health Plan that I signed up for is actually a supplemental and is the PPO. It is a much higher price, and you have to buy your drug plan and dental plan separately, plus no silver sneakers, etc. But you can walk into any doctor anywhere who takes Medicare without a referral from a primary physician, and you won't be assessed a deductible like you would with a doctor out of your HMO in your advantage plan. Since we live in two different states and travel a lot, it's a price we choose to pay for peace of mind.

[wendyquat]

I think "healthy" is the key word! Keep in mind that at our age that can change overnight! I went from taking no meds at age 60 to 4 meds upon being diagnosed with type 2 diabetes! Maybe as a result of the diabetes (although I have always watched my diet and kept it under control) I have been diagnosed with a couple if other things that require doctor visits every few months. With everything under control I decided to look into a Medicare Advantage plan last year. I went to three different presentations and no one could answer my question, "if it doesn't work well for me and I need to change back to Medicare plus a supplement, will I be penalized for a pre-existing condition?" I can't afford to make that change not knowing if I would have to pay more if I needed to switch back. I finally asked one of my doctors about it and was told, "No, you don't want to do that!" I decided not to do it last year and am still undecided if it is for me. Keep in mind also that doctors can go off and on the provider list at will so you need to be flexible about changing doctors should this happen. I kind of like to stick with the same doctor. All this being said I think the Medicare Advantage plans work well for a relatively healthy person.

[Scott8147]

Best example I've heard is that supplemental programs are like buffets whereas Advantage plans are like a-la-carte. You pay one price for the buffet whether you eat a little or a lot, but you can have as much as you want (or need). The Advantage plans are cheaper if you don't go to the doctor or need other services much, but will cost you more if you "over order". Same as an a-la-carte restaurant. One other point: you can use Advantage plans out of your area, but then you are "out of network" and your co-pays and/or co-insurance will be more. It comes down to how much you are willing to insure yourself vs. paying the insurance company to take the risk. Tough call no matter which way you go. Do your research!

[Carla B]

A couple of years ago we decided to go from an employer-sponsored PPO plan to a supplemental plan. We dropped the employer plan due to the fact that we were out of network by living in FL. Anyway, in order to enroll in the Medigap we had to be able to answer certain health questions. It's my opinion (but I don't know for sure) that if someone wanted to switch from an Advantage plan back to Medigap they'd have to be able to answer those same health questions.

[CFrance]

A couple of years ago we decided to go from an employer-sponsored PPO plan to a supplemental plan. We dropped the employer plan due to the fact that we were out of network by living in FL. Anyway, in order to enroll in the Medigap we had to be able to answer certain health questions. It's my opinion (but I don't know for sure) that if someone wanted to switch from an Advantage plan back to Medigap they'd have to be able to answer those same health questions.

I believe you are correct about that. Our insurance broker told us that if we went with an advantage plan first upon turning 65, then tried to switch to a supplemental plan, the insurance companies could underwrite us, which means they could consider existing conditions and charge more than normal. This is supposed to end in 2014 under Obamacare, though, providing Obamacare is not repealed.

[Dr Winston O Boogie jr]

We have had both original medicare with supplement and currently Medicare Advantage (Preferred Care Partners). We paid over $300/month for our supplement, plus our RX drugs another $80. Came close to $400/ month. Now we do not pay that plus get back $90.90 into,our Social Security. We save about $500/ month or $6000 per year. We like our doctors.

I just signed up for that plan and will be on it as of Jan 1, 2013. It sounds too good to be true, but I know a lot of people who are on it and they are very happy with it.

[Shirleevee]

Check with your doctor first Mine does not accept Medicare Advantage.

We had Preferred Care Partners.........my husband is keeping it for 2013 and I am NOT! I have health issues that require certain specialists. Not one of those specialists here in The Villages accepted PCP......I had to go way out of the Villages for care.......so Medicare and Medigap policy is my choice.

[Shirleevee]

Best example I've heard is that supplemental programs are like buffets whereas Advantage plans are like a-la-carte. You pay one price for the buffet whether you eat a little or a lot, but you can have as much as you want (or need). The Advantage plans are cheaper if you don't go to the doctor or need other services much, but will cost you more if you "over order". Same as an a-la-carte restaurant. One other point: you can use Advantage plans out of your area, but then you are "out of network" and your co-pays and/or co-insurance will be more. It comes down to how much you are willing to insure yourself vs. paying the insurance company to take the risk. Tough call no matter which way you go. Do your research!

Correct......loved your analogy