[JMintzer]

Originally Posted by Mrprez

Medigap is not Medicare. I am talking about the often repeated misinformation that once on MA, you can’t go back to Medicare. Patently false. Medigap is a whole other subject.

Wrong...

Originally Posted by Mrprez

Again, you are talking about Medigap. I am talking about Medicare. Huge difference.

And wrong again...

No one is confusing a Medigap policy with a Medicare Advantage Plan (except for you...)

If you choose a Medicare Advantage Plan, yes, you can switch to regular Medicare (with no penalty), BUT ONLY WITHIN THE FIRST THREE MONTS OF YOUR INITIAL ENROLLMENT.

After that tine period, if you want to switch back the regular Medicare, YOU MUST go thru an underwriting process... PERIOD.

[JMintzer]

Originally Posted by Mrprez

True, but that’s beside the point. I’m merely refuting her statement that once you sign up for MA you are stuck for life and can’t go back to Medicare.

The statement you are attempting to refute is true. UNLESS you go thru an underwriting process...

[Sabella]

Maybe you need to do more research

[Caymus]

Originally Posted by JMintzer

Wrong...



And wrong again...

No one is confusing a Medigap policy with a Medicare Advantage Plan (except for you...)

If you choose a Medicare Advantage Plan, yes, you can switch to regular Medicare (with no penalty), BUT ONLY WITHIN THE FIRST THREE MONTS OF YOUR INITIAL ENROLLMENT.

After that tine period, if you want to switch back the regular Medicare, YOU MUST go thru an underwriting process... PERIOD.

Depends on your official state of residence. Massachusetts (and I think) a few others do not require underwriting for supplement plans.

[golfing eagles]

Originally Posted by tophcfa

Totally true. But that $3,000 in savings will rapidly disappear, and then possibly way more, if/when the MA insured individual has a medical event that requires more than basic wellness medical care. There are easily many real world scenarios where spending the $3 grand on a supplemental plan will indeed appear like chump change at the end of the year compared to TOTAL health care expenditures if one opts to choose a MA plan.

Choosing a MA plan, versus Medigap, is akin to gambling one’s finances on their future health care needs. The biggest problem with MA plans is that when you win the gamble, you can save around $3 grand per year, when you loose the gamble it can be catastrophic. That’s not a risk/reward scenario I’m willing to take.

Interesting, since my Florida Blue MA plan has a MAXIMUM $2,400 out of pocket expense. Not much of a gamble.

[nn0wheremann]

Originally Posted by Dusty_Star

Some say that Medicare Advantage is a failed experiment. Patients get delayed & denied care, the taxpayers are paying mightily for the winners: the insurance company executives. They also say it should be discontinued or dramatically reformed.

MA was sold heavily to Congress by insurance company lobbyists on the basis that it would save money over traditional Medicare.

Is Medicare Advantage a Failed Experiment? Experts Debate - MedCity News

Like many insurance plans, these are a great success until you need them.

[JMintzer]

Originally Posted by Caymus

Depends on your official state of residence. Massachusetts (and I think) a few others do not require underwriting for supplement plans.

And the 4 States that are exceptions to the rule have been mentioned, multiple times...

Picking a few nits doesn't change my point, since the person to whom I responded never brought up those 4 States...

[GoRedSox!]

There are some terms which have been used interchangeably throughout this thread which are not necessarily interchangeable.

Traditional Medicare: This is standard Medicare, around since the mid-60's when the program was created. There is a Medicare Part B premium of $174.70 in 2024 that is deducted from your Social Security payment, or billed quarterly if you have not yet started taking Social Security. Traditional Medicare basically pays 80% of the Medicare fee after the deductible is met. There is no limit to the 20% patient responsibility.

Medicare Advantage: The government pays a private insurance company to provide your Medicare coverage. Plans often include extra benefits such as dental, gym benefits, and eye care not available from Traditional Medicare, and often for no additional premium beyond the $174.70 already being deducted. There is a limit on out of pocket costs. The plan can require you to have a PCP, referrals, and require you to stay in their network. They can also limit you to a specific service area for non-urgent/emergent care. Medicare Part D is almost always wrapped in as a pharmacy benefit.

Medicare Supplemental (Medigap): This is insurance sold by private insurance companies that pairs with Traditional Medicare to insure the 20% coinsurance or some portion of the coinsurance. Part D coverage has to be bought separately. The benefits to this type of coverage is that it works all over the US with all doctors who accept Medicare and there are no referrals, networks, PCP's and pre-cert requirements beyond what Traditional Medicare requires. There are various plans to choose from, but the most comprehensive typically costs between $250-300 per month depending on Zip Code.

The Medicare Supplemental (Medigap) Open Enrollment time period is within the six months after you turn 65 and go on Medicare Part B. If you buy a plan during this time period, it's not subject to medical underwriting.

If you choose Medicare Supplemental (Medigap) at age 65 when you are first eligible, you can enroll with no medical underwriting. If you subsequently decide you want to switch to Medicare Advantage, you have one year to try it out and you can switch back to your old Medicare Supplemental plan if you don't like it.

If you are on Medicare Advantage, you can switch to traditional Medicare within 90 days of original enrollment. You can always switch back to traditional Medicare from Medicare Advantage during Open Enrollment periods.

I think the point that many folks are talking about here is that there is limited opportunity to buy Medicare Supplemental without medical underwriting if you don't choose it within the first six months of being eligible when you are 65. Unless you live in the four states (Connecticut, Maine, Massachusetts and New York) which don't require medical underwriting of Medicare Supplemental policies regardless of when you enroll.

[retiredguy123]

Originally Posted by GoRedSox!

There are some terms which have been used interchangeably throughout this thread which are not necessarily interchangeable.

Traditional Medicare: This is standard Medicare, around since the mid-60's when the program was created. There is a Medicare Part B premium of $174.70 in 2024 that is deducted from your Social Security payment, or billed quarterly if you have not yet started taking Social Security. Traditional Medicare basically pays 80% of the Medicare fee after the deductible is met. There is no limit to the 20% patient responsibility.

Medicare Advantage: The government pays a private insurance company to provide your Medicare coverage. Plans often include extra benefits such as dental, gym benefits, and eye care not available from Traditional Medicare, and often for no additional premium beyond the $174.70 already being deducted. There is a limit on out of pocket costs. The plan can require you to have a PCP, referrals, and require you to stay in their network. They can also limit you to a specific service area for non-urgent/emergent care. Medicare Part D is almost always wrapped in as a pharmacy benefit.

Medicare Supplemental (Medigap): This is insurance sold by private insurance companies that pairs with Traditional Medicare to insure the 20% coinsurance or some portion of the coinsurance. Part D coverage has to be bought separately. The benefits to this type of coverage is that it works all over the US with all doctors who accept Medicare and there are no referrals, networks, PCP's and pre-cert requirements beyond what Traditional Medicare requires. There are various plans to choose from, but the most comprehensive typically costs between $250-300 per month depending on Zip Code.

The Medicare Supplemental (Medigap) Open Enrollment time period is within the six months after you turn 65 and go on Medicare Part B. If you buy a plan during this time period, it's not subject to medical underwriting.

If you choose Medicare Supplemental (Medigap) at age 65 when you are first eligible, you can enroll with no medical underwriting. If you subsequently decide you want to switch to Medicare Advantage, you have one year to try it out and you can switch back to your old Medicare Supplemental plan if you don't like it.

If you are on Medicare Advantage, you can switch to traditional Medicare within 90 days of original enrollment. You can always switch back to traditional Medicare from Medicare Advantage during Open Enrollment periods.

I think the point that many folks are talking about here is that there is limited opportunity to buy Medicare Supplemental without medical underwriting if you don't choose it within the first six months of being eligible when you are 65. Unless you live in the four states (Connecticut, Maine, Massachusetts and New York) which don't require medical underwriting of Medicare Supplemental policies regardless of when you enroll.

To clarify, the Traditional Medicare premium is not $174.70 for all enrollees. Depending in your income, it can be more than 3 times that amount for the exact same coverage.

[Carla B]

Originally Posted by GoRedSox!

There are some terms which have been used interchangeably throughout this thread which are not necessarily interchangeable.

Traditional Medicare: This is standard Medicare, around since the mid-60's when the program was created. There is a Medicare Part B premium of $174.70 in 2024 that is deducted from your Social Security payment, or billed quarterly if you have not yet started taking Social Security. Traditional Medicare basically pays 80% of the Medicare fee after the deductible is met. There is no limit to the 20% patient responsibility.

Medicare Advantage: The government pays a private insurance company to provide your Medicare coverage. Plans often include extra benefits such as dental, gym benefits, and eye care not available from Traditional Medicare, and often for no additional premium beyond the $174.70 already being deducted. There is a limit on out of pocket costs. The plan can require you to have a PCP, referrals, and require you to stay in their network. They can also limit you to a specific service area for non-urgent/emergent care. Medicare Part D is almost always wrapped in as a pharmacy benefit.

Medicare Supplemental (Medigap): This is insurance sold by private insurance companies that pairs with Traditional Medicare to insure the 20% coinsurance or some portion of the coinsurance. Part D coverage has to be bought separately. The benefits to this type of coverage is that it works all over the US with all doctors who accept Medicare and there are no referrals, networks, PCP's and pre-cert requirements beyond what Traditional Medicare requires. There are various plans to choose from, but the most comprehensive typically costs between $250-300 per month depending on Zip Code.

The Medicare Supplemental (Medigap) Open Enrollment time period is within the six months after you turn 65 and go on Medicare Part B. If you buy a plan during this time period, it's not subject to medical underwriting.

If you choose Medicare Supplemental (Medigap) at age 65 when you are first eligible, you can enroll with no medical underwriting. If you subsequently decide you want to switch to Medicare Advantage, you have one year to try it out and you can switch back to your old Medicare Supplemental plan if you don't like it.

If you are on Medicare Advantage, you can switch to traditional Medicare within 90 days of original enrollment. You can always switch back to traditional Medicare from Medicare Advantage during Open Enrollment periods.

I think the point that many folks are talking about here is that there is limited opportunity to buy Medicare Supplemental without medical underwriting if you don't choose it within the first six months of being eligible when you are 65. Unless you live in the four states (Connecticut, Maine, Massachusetts and New York) which don't require medical underwriting of Medicare Supplemental policies regardless of when you enroll.

Good explanation. We gave up the IBEW program provided to my husband. In my case it was nine years after first becoming eligible for a Medicare supplement. Yes, we had to go underwriting, which consisted of six questions being answered satisfactorily.

[GoRedSox!]

Originally Posted by retiredguy123

To clarify, the Traditional Medicare premium is not $174.70 for all enrollees. Depending in your income, it can be more than 3 times that amount for the exact same coverage.

This is correct. If you have a higher income, the Income-Related Monthly Adjustment Amount (IRMAA) may kick in. This applies to both the Medicare Parts A&B premium, and the Part D Prescription premium.

To determine if a surcharge is applied, Medicare looks the last income tax return provided by the IRS. They look at the Modified Adjusted Gross Income (MAGI), which is AGI plus tax-exempt interest. The first MAGI threshold where a surcharge kicks in is at $206,000 for couples filing jointly. The surcharge is $69.90. However, at $258,000, the surcharge is equal to the premium, $174.70. For singles, the threshold is half, so the increased premium starts at $103,000. The top surcharge is an additional $419.30 for couples over $750,000 and singles over $500,000.

I think that if I consistently had an income of $750,000 a year, I am ok with paying $594 a month for Medicare....however, it seems most of the complaints around IRMAA come from people who have a capital gain from the sale of stock or a house and that one event is what causes their monthly premiums to go up. Also, $129,000 for an individual is not really that huge of an income to trigger a doubling of the premium.

[tophcfa]

Originally Posted by golfing eagles

Interesting, since my Florida Blue MA plan has a MAXIMUM $2,400 out of pocket expense. Not much of a gamble.

Fair point. Everyone’s situation is different and their choices reflect that. However, not all MA plans are equal, especially if you have more than one home and travel extensively. You obviously did your research and selected one of the better ones, most likely not one of the little to no cost plans that offer free stuff to suck you in. We would possibly consider a plan like that if we had a single home, spent almost all our time in that one location, all our doctors participated in that network, and we had the patience to deal with referrals. The reason we strongly prefer a supplemental plan is because we split our time between two far away locations and hope to travel extensively throughout the country. Plus, all Supplemental plans in each lettered category are required to offer identical benefits. MA plans benefits can change each renewal period, making the selection process an annual event. For us, the Supplemental part G plan is ideal. It has a national network, no referrals, an annual deductible/max out of pocket of about $250, and the benefits from year to year are consistent. And after being on Obamacare since its inception, both the cost and benefits of a Supplemental plan are a great relative value.

Here is hoping neither of us will ever need to use our selected plans for anything more than wellness checks : )

[MX rider]

Originally Posted by tophcfa

Fair point. Everyone’s situation is different and their choices reflect that. However, not all MA plans are equal, especially if you have more than one home and travel extensively. You obviously did your research and selected one of the better ones, most likely not one of the little to no cost plans that offer free stuff to suck you in. We would possibly consider a plan like that if we had a single home, spent almost all our time in that one location, all our doctors participated in that network, and we had the patience to deal with referrals. The reason we strongly prefer a supplemental plan is because we split our time between two far away locations and hope to travel extensively throughout the country. Plus, all Supplemental plans in each lettered category are required to offer identical benefits. MA plans benefits can change each renewal period, making the selection process an annual event. For us, the Supplemental part G plan is ideal. It has a national network, no referrals, an annual deductible/max out of pocket of about $250, and the benefits from year to year are consistent. And after being on Obamacare since its inception, both the cost and benefits of a Supplemental plan are a great relative value.

Here is hoping neither of us will ever need to use our selected plans for anything more than wellness checks : )

AARP UHC Advantage has a huge national network. No pre aprrovals needed and has an out of pocket max. We travel between 2 homes in Florida and Indiana. It works well for us and we use the wellness benifits.

[Blueblaze]

Is Medicare Advantage a failed experiment? No more than Medicare or "health" insurance in general.

The moment you expect insurance to pay for anything non-catastrophic, the wheels come off. Just like when people expect their home insurance to buy them a roof when the old one is still there, and then can't figure out why EVERYONE'S insurance quadrupled in three years. Medicare WILL go bankrupt -- and probably in our lifetime. There is simply not enough money in the Gooberment's magic money machine to pay all the crooks who got in line the moment the word got out about Uncle Sam's deep pockets.

My grandfather was insulin-dependent for the last half of his life. The only "health" insurance he ever had was original Medicare -- a pure catastrophic hospitalization policy that he couldn't have afforded on a Coleman lantern assembly line salary. It never paid a dime for his diabetes. Most of his life he had NO insurance. So he paid for his doctor out of pocket. And he bought his insulin out of pocket. And that was possible because everyone else was doing the same thing, so a doctor's visit was only about $5 in the 60's. And his insulin was pennies a day -- back when they had to slaughter pigs to get it, instead of merely growing it in a vat like they do today, using some eternally-patented process, that for some bogus reason costs 1,000 times more than extracting insulin from pig pancreases.

Even my own daughters' well-baby appointments were only $15, back in the '80's. That wasn't the insurance co-pay, because that farce hadn't been invented yet. $15 was the entire bill. My company only provided hospitalization, which only paid the catastrophic costs of a hospital stay, like for when they were born. It didn't pay for doctors, and therefore, doctors were affordable.

And then Blue Cross invented the "HMO", which paid for everything, so long as it was "in-network". And the wheels came off. By the time I retired, my copay was $35 per visit, and I was paying over $350/month for "health insurance", while my company picked up the rest of the tab -- $1200/month. Effectively, $18,000/year of my salary went to pay for health care BEFORE I EVER EVEN SAW A DOCTOR!

Then I retired, 3 years short of medicare, and was forced to go on Obamacare. Since I was considered "wealthy", I was stuck with the entire cost -- $12,000/year for a $10,000 deductible, which left me on the hook for $22,000, before "insurance" paid a dime for a catastrophe that never came. Well, except for the "free" $12,000 annual physical.

But glory be! I finally made it to 65 and government "Medicare Advantage" insurance, courtesy of some crooked insurance company that gets a big cut from the gooberment to tell me which doctors I can see and which drugs I can take. And it only costs us $500/month for the privilege -- at least until Medicare goes belly-up in 10 years.

Reagan was right. The most terrifying words in the English language are "I'm from the government and I'm here to help".

The 2nd most terrifying words are "I'm from the Insurance company..."

[GoRedSox!]

Originally Posted by Blueblaze

Is Medicare Advantage a failed experiment? No more than Medicare or "health" insurance in general.

The moment you expect insurance to pay for anything non-catastrophic, the wheels come off. Just like when people expect their home insurance to buy them a roof when the old one is still there, and then can't figure out why EVERYONE'S insurance quadrupled in three years. Medicare WILL go bankrupt -- and probably in our lifetime. There is simply not enough money in the Gooberment's magic money machine to pay all the crooks who got in line the moment the word got out about Uncle Sam's deep pockets.

My grandfather was insulin-dependent for the last half of his life. The only "health" insurance he ever had was original Medicare -- a pure catastrophic hospitalization policy that he couldn't have afforded on a Coleman lantern assembly line salary. It never paid a dime for his diabetes. Most of his life he had NO insurance. So he paid for his doctor out of pocket. And he bought his insulin out of pocket. And that was possible because everyone else was doing the same thing, so a doctor's visit was only about $5 in the 60's. And his insulin was pennies a day -- back when they had to slaughter pigs to get it, instead of merely growing it in a vat like they do today, using some eternally-patented process, that for some bogus reason costs 1,000 times more than extracting insulin from pig pancreases.

Even my own daughters' well-baby appointments were only $15, back in the '80's. That wasn't the insurance co-pay, because that farce hadn't been invented yet. $15 was the entire bill. My company only provided hospitalization, which only paid the catastrophic costs of a hospital stay, like for when they were born. It didn't pay for doctors, and therefore, doctors were affordable.

And then Blue Cross invented the "HMO", which paid for everything, so long as it was "in-network". And the wheels came off. By the time I retired, my copay was $35 per visit, and I was paying over $350/month for "health insurance", while my company picked up the rest of the tab -- $1200/month. Effectively, $18,000/year of my salary went to pay for health care BEFORE I EVER EVEN SAW A DOCTOR!

Then I retired, 3 years short of medicare, and was forced to go on Obamacare. Since I was considered "wealthy", I was stuck with the entire cost -- $12,000/year for a $10,000 deductible, which left me on the hook for $22,000, before "insurance" paid a dime for a catastrophe that never came. Well, except for the "free" $12,000 annual physical.

But glory be! I finally made it to 65 and government "Medicare Advantage" insurance, courtesy of some crooked insurance company that gets a big cut from the gooberment to tell me which doctors I can see and which drugs I can take. And it only costs us $500/month for the privilege -- at least until Medicare goes belly-up in 10 years.

Reagan was right. The most terrifying words in the English language are "I'm from the government and I'm here to help".

The 2nd most terrifying words are "I'm from the Insurance company..."

I can agree with many of your points here, but five things really are responsible for the explosion of health care costs, in my opinion.

1. There are so many profit centers all over the American healthcare delivery system. It accounts for 1/6 of our entire economy. Many of these profit centers, including the insurance companies, are publicly traded corporations. When you have a fiduciary responsibility to shareholders, I don’t know how patients can be the number 1 priority.
2. Prescription drug costs are extremely high. We are one of the few countries in the world which allows direct marketing to patients. All those ads cost a lot of money.
3. We have a litigious society and the lawyers want their slice of the healthcare pie.
4. A very legitimate reason is we have added so many new treatments and technologies and it’s all very expensive. We didn’t have a heart transplant until the late 60’s. We didn’t have CT’s and MRI’s and many modern technology. It all comes at a cost.
5. 50% of all healthcare costs go to treat folks in the final year of life. Believe it or not, historically, this was not the case.

There are many more than this, but I think these are the top 5.