Medicare Advantage or Medigap/Supplemental

Medicare Advantage or Medigap/Supplemental

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  #11  
Old 08-08-2019, 03:49 PM
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rexxfan rexxfan is offline
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Originally Posted by rustyp View Post
The Villages Medicare Complete 2 advantage plan has a passport system. This allows one to go to areas outside of their local coverage and find an in network doctor or facility and be charged the same as in network.The $80 / month covers (amongst other items) an In Network Out Of Pocket max of $1900 and an Out of network Out Of Pocket max of $7500. True not all areas of the U.S. are covered under the passport plan but a large percentage is. Example all counties in New York State are covered. FYI I recently needed a short trip to emergency in New York the bill was $2500(highway robbery) and my total part was the $90 deductible. For those areas not covered like Colorado (I assume - did not look it up) you are still covered but at out of network rates with a max out of pocket of $7500. This would probably work for most people if traveling to Colorado is a vacation short term but probably not the right plan for you if you are a Colorado snowbird.
Actually, the passport feature is available with both Villages 1 and Villages 2 and if you travel to an area that has coverage, you are able to use the UHC doctors and hospitals there just as if they were in network (e.g. anywhere in NY state, but as VT has reported, not in Colorado).

The Villages 2 plan adds coverage for areas where there are no in-network providers, albeit at a reduced rate (e.g. instead of insurance paying, say, 80% for an in-network provider, it might only pay 45%). The $80/month also buys you some reduced copays versus the Villages 1 plan.
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  #12  
Old 08-08-2019, 05:02 PM
rustyp rustyp is offline
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Originally Posted by rexxfan View Post
Actually, the passport feature is available with both Villages 1 and Villages 2 and if you travel to an area that has coverage, you are able to use the UHC doctors and hospitals there just as if they were in network (e.g. anywhere in NY state, but as VT has reported, not in Colorado).

The Villages 2 plan adds coverage for areas where there are no in-network providers, albeit at a reduced rate (e.g. instead of insurance paying, say, 80% for an in-network provider, it might only pay 45%). The $80/month also buys you some reduced copays versus the Villages 1 plan.
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bc
Yes I agree the passport is available with both 1 and 2. However it is my understanding the $1900 and $7500 OOP is part of the 2 plan only ($80/mo). I've been wrong before.
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  #13  
Old 08-08-2019, 07:25 PM
Tom52 Tom52 is offline
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I never understood the idea that if you are healthy an advantage plan might be better because you save some money. Your health can change very quickly for the worse. Maybe their crystal ball works better than mine. Just based on both my parents experience, they had significant hospital bills, well in excess of $500,000 each in perhaps the last five years of life. They had BCBS F medigap plans and they paid absolutely zero beyond their monthly premium.

Even though it is more difficult to find a Dr in TV who accepts medicare plus suppliment, We would never consider an advantage plan. Outside the bubble I would believe most doctors accept medigap. That makes it much less of a concern when traveling. Concerning The Villages hospital I have spent 5 days there plus emergency room visits and my medicare plus BCBS medigap supplement covered all costs 100%.

Of course if the budget is tight going with an advantage plan is understandable. I justify the monthly premium as protection against catastrophic expenses. As an added benefit I don't have get a referral to see a specialist.
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  #14  
Old 08-08-2019, 08:51 PM
valuemkt valuemkt is offline
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I started off with a supp plan when i retired and still lived in georgia. For whatever reason, the county i lived in did not have the passport / advantage plan. Moving to the villages has allowed me to drop down to the advantage w passport with a relatively low out of pocket max at $80 / month. I did quite a bit of research and found most of the places out side the villages that i might go w serious issues were covered as in network. I'll be giving the villages health system a try. If you switch from supp to advantage you can switch back within a year w no problems.. Also, since wife has decided to continue working, I might suspend medicare and go under her corporate plan, saving $$$ from IRMAA
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  #15  
Old 08-09-2019, 06:25 AM
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Originally Posted by valuemkt View Post
I started off with a supp plan when i retired and still lived in georgia. For whatever reason, the county i lived in did not have the passport / advantage plan. Moving to the villages has allowed me to drop down to the advantage w passport with a relatively low out of pocket max at $80 / month. I did quite a bit of research and found most of the places out side the villages that i might go w serious issues were covered as in network. I'll be giving the villages health system a try. If you switch from supp to advantage you can switch back within a year w no problems.. Also, since wife has decided to continue working, I might suspend medicare and go under her corporate plan, saving $$$ from IRMAA
Just to be clear - you can switch back at reup time always. You are not locked in forever. There are extenuating circumstances that you can switch in mid year. I do remember seeing something about the first year switch but can't remember what it was. I am long past the first year. There is something about you may pay a higher supplemental with medicare and supplemental because they can charge the supplemental based upon your age Vs if you had been in from day 1.
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  #16  
Old 08-09-2019, 11:41 AM
Dan9871 Dan9871 is offline
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Just to be clear - you can switch back at reup time always. .
I think what you are talking about is what medicare "Guaranteed Issue Right". Switching from Advantage to regular Medicare is not a problem.

What might be a problem is picking up a Medigap, i.e. supplemental, policy. If you have the Guaranteed Issue Right then any insurance company that offers a Medigap policy must accept you without any conditions.

Here is the Medicare page that explains when you have a Guaranteed Issue Right:

https://www.medicare.gov/find-a-plan...otections.aspx

Even if you don't have a Guaranteed Issue Right an insurance company may accept you anyhow, but they don't have to and may charge you extra over their regular rates.
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  #17  
Old 08-09-2019, 01:03 PM
Tom52 Tom52 is offline
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Just to be clear - you can switch back at reup time always. You are not locked in forever. There are extenuating circumstances that you can switch in mid year. I do remember seeing something about the first year switch but can't remember what it was. I am long past the first year. There is something about you may pay a higher supplemental with medicare and supplemental because they can charge the supplemental based upon your age Vs if you had been in from day 1.
I just read online that if you have had an advantage program for over a year you will be subject to medical underwriting if you wish to change to a more comprehensive medigap policy. There are a few exceptions but this can be risky. I would link to this information but I don't know how to do it.
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  #18  
Old 08-09-2019, 02:35 PM
rustyp rustyp is offline
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I just read online that if you have had an advantage program for over a year you will be subject to medical underwriting if you wish to change to a more comprehensive medigap policy. There are a few exceptions but this can be risky. I would link to this information but I don't know how to do it.
OK now I am confused. What is the difference between Medicare with a supplemental and medigap?
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  #19  
Old 08-09-2019, 02:54 PM
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OK now I am confused. What is the difference between Medicare with a supplemental and medigap?
Medigap is the supplemental insurance policy which picks up some or all of the costs that medicare does not cover. It does not cover prescription drugs. That requires a separate part D drug plan.
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  #20  
Old 08-09-2019, 03:29 PM
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I just read online that if you have had an advantage program for over a year you will be subject to medical underwriting if you wish to change to a more comprehensive medigap policy. There are a few exceptions but this can be risky. I would link to this information but I don't know how to do it.
Talk to SHINE, we were almost in this position, found out you have to change back to Medicare after 50 weeks or less (if my memory is correct) and are guaranteed supplemental coverage WITHOUT medical questions, etc., after that you can get back to medicare, BUT you may be subjected to medical questions, and possible additional charges for supplemental due to preexisting medical conditions. SHINE was very helpful in this area.
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