You can see a specialist, like a dermatologist or a surgeon, "IF" they will see you. But, even some specialists will not see a patient without the patient first seeing a primary care provider. But, Medicare will not require a referral, when some Advantage plans will. For an Xray, like an MRI, you would definitely need an order from a medical doctor or other authorized provider.

So if I twist my knee playing pickleball, and I go the ER and ask for an MRI, the doctor has to order it? And he makes the decision to order an x-ray rather than an MRI?

Drs will typically follow a protocol appropriate for the injury. This may involve an x-ray and physical therapy and a subsequent MRI if the problem persists. It depends.

As a patient, you cannot demand an MRI if the doctor disagrees. But, personally, I think the medical profession is pretty stingy when it comes to ordering an MRI. Just my opinion.

You may not need a referral but you will definitely need an approval which may or may not happen. You need to get approval for a rehab stay if you need one. (dis)Advantage plans are fine if you're healthy not so much when you get older and need more care.

Medicare Advantage is great if you are healthy like you are, We personally went with an advantage plan G as we have a cancer history in the family and for example, the Mayo Clinic, one of the top 5 cancer hospitals in the country does not accept Advantage. Wife is a pancreatic cancer survivor because of the Mayo Clinic. It wasn’t just the treatments (chemo, radiation, surgery) but the order that they did it in. We have different opinions on her treatment and the Mayo was very different and they gave statistics on why they do what they do it the way the do. Plus places like Mayo have all the services under one roof. The docs just picked up the phone and called a different building to talk to other docs. My SIL is extremely healthy and on an advantage plan and had breast cancer just pop up out of nowhere and she had to go to various places for various opinions and that took weeks where we went to the Mayo on a Monday and by the following Thursday 10 days later, we started chemo…

You can switch now as underwriting will see you as healthy, once you are not healthy, you cannot switch…. IMO, never skimp on your healthcare

I would look at YouTube videos on advantage vs supplemental to do your homework… .

Just another uninformed poster painting with a broad brush. Medicare is not a one size fits all, as some of you are saying. Everyone should do their own research and do what's best for them. SHINE is a good resource

As I said in a previous post, not all MA plans are the same. As a matter of fact, some are much better than others. We know, we did the research.

You can go to the Medicare website and check ratings for all the MA plans, it's just another tool you can use to make an informed decision.

Advantage plan
 

I have an advantage plan and I am very pleased. I was recently diagnosed with breast cancer, I have had the best care at MOFFITT. My recent hospital bill was $30,000 and I only had to pay $150. I also had thousands of $$ in bills for tests and procedures prior to surgery and only paid $120.
I have great dental and vision coverage. Florida Blue worked with me to get into doctors ASAP. I have a $20 copay for specialist, but didn’t have to pay a copay at MOFFITT. Just wanted to share a positive view on Advantage plans.

I switched from std Medicare and supplements. Along with drug coverage to Florida Blue. Saving $1000 per month. That's $12,000 saved per year over std Medicare. 2 years ago I had over $500,000 in surgery and hospital bills all covered by Florida Blue Advantage plan. I would never go back to Std Medicare

I strongly urge you to go and speak with a SHINE representative.

They are not salespeople and only provide unbiased information. They are exceedingly helpful. In my case, they really helped me analyze which plans were available and what they cost. If they could not give me that info, they directed me to a place that had such information. As a result, I saved hundreds of dollars a year while getting the best original Medicare and Medigap policy for my health conditions. They schedule routine meetings at various locations throughout the Villages.

Please be aware, if you are currently on a Medicare Advantage plan and you wish to switch to original Medicare, the plan may or may not (most likely, will) underwrite you to see if you qualify for their plan. If you have any significant pre-existing health conditions, it is unlikely you will be able to switch easily. SHINE can help provide you with more information as to that.

The important thing to remember is that insurability for pre-existing health conditions is not a right as a matter of course. Unlike the ACA which provided for this very necessary arrangement, Medicare does not. So, please keep this in mind. You can not just change for the sake of change or for a matter of economics. Your health serves as the basis for change.

As for me, I am grateful to SHINE. I went with Original Medicare with a (now unavailable) Plan F. It is the best health insurance I have ever had. But, it does cost. But, the savings compared to my pre-Medicare is very substantial. I love Medicare!

I would avoid YouTube as a source of reliable information about MA plans. Most of that content is put out by people whose business is selling Medigap policies.

The first year on Medicare I had an advantage plan in NJ as did my husband. This was 7 yrs ago. After the first year I switched to a supplement plan. My husband had Prostate cancer that required 45 radiation treatments and various visits to specialist, Urology and Radiology. All at $50 a treatment/visit. That adds up quickly. That’s when I made my decision to switch my plan. If you really get sick, it can be costly in copays.

There are hospitals that do not except advantage plans. I understand Moffit is one of them.

Yes, you should switch.

Your understanding is wrong. Moffit does accept MA plans. Also, an MA plan will have a maximum out of pocket coverage depending on the plan. Some are more than others that’s why it pays to read the details or get professional non biased assistance.

OMG!! You're coming here with real world factual information about MA plans. Don't you know they're a scam?

You can't do that. You need to have a post that starts with " I heard" or "all ma plans are bad" or "someone told me" or "I read an article" or "never sign up for ma".

LOL!!

We too are happy with our MA plan. It's great to have options, that's a good thing for everyone.

SHINE is a good place to start for the OP.

You can switch if you are getting younger.

As far as I can tell, you can switch if you are in reasonably good health.

I called a company that sells medigap. He said plan G and plan N are the two most popular medigap policies. N is quite a bit cheaper than G. As far as I can tell, the main difference is that G does not have a copay when you visit the doctor but N does have a copay.

He said I could get G for about $205 a month and N for about $152. Drugs are about $75 a month.

I also asked him about the difficulty in switching from advantage to Medicare. He said it is pretty easy unless you have significant pre-existing conditions such as dialysis, severe heart problems, diabetes, or advanced cancer. He estimated 95% are approved.

For those interested in a Medigap plan, its also expensive. My mom is 97, only has medicare, never has had a supplement, and she just had her first major surgery, hip replacement, and the total uncovered medicare bill was $2,000.

am thinking that all those years of savings, and she cancelled her dental eye plan as a seldom used plan, but very high premium. If you have plenty of savings, i would skip the medigap and have a good chunk of cash, $10,000 for out of pocket emergency surgery.

Any other major surgeries uncovered by medicare expenses for comparison?

It’s all relative and situation dependent. A Medigap plan can be very expensive relative to both an advantage plan and just basic Medicare without a Medigap plan, under the huge assumption that the insured remains healthy and doesn’t require expensive medical care for a long time. On the other hand, after being on Obamacare for the last several years, a Medigap plan looks like an absolutely incredible bargain in comparison.

Please contact Shine for details on Medicare plans. As one post stated there are counselors available now in The Villages. Search for Florida Shine in you browser for locations and times in Sumter and Lake counties

Medicare
 

We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.

Aren’t Medigap companies a for profit business?

Medicare
 

We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.

Yes, they are. But, they operate significantly different from advantage plans. Medigap plans are designed by the Government to pay the 20 percent copay that original Medicare doesn't pay. They have very little flexibility when paying claims. Basically, if Medicare covers it, they must pay for it. They cannot deny coverage of a claim approved by Medicare. The only flexibility they have is in how much they charge in premiums. So, they are basically a piggyback plan to Medicare, and they are heavily controlled by the Government.

We currently have a supplement which costs us about $250 a month (for both of us) but are considering switching to an advantage to potentially save some dollars. My biggest concern is being able to get necessary services through an advantage plan. For instance, my sister in law has been ha i get back problems for about 6 months. She finally got in with a surgeon who ordered an MRI to try to determine exactly what was happening. It was denied. That would not happen with a supplement.

Obviusly, all MA plans are not the same. Mine doesn't require approvals. This person likes their plan as well. But don't let her facts get in the way of your story.

"I have an advantage plan and I am very pleased. I was recently diagnosed with breast cancer, I have had the best care at MOFFITT. My recent hospital bill was $30,000 and I only had to pay $150. I also had thousands of $$ in bills for tests and procedures prior to surgery and only paid $120.
I have great dental and vision coverage. Florida Blue worked with me to get into doctors ASAP. I have a $20 copay for specialist, but didn’t have to pay a copay at MOFFITT. Just wanted to share a positive view on Advantage plans."

Many of us would be interested to know the MA plan your sister has. Some MA's seem to be notorious for denials. I have UHC and have had many similar tests with no denials. I do know a person with UHC that had a knee denial, but it turns out it was a problem with the procedure coding. I am 100% pleased with UHC. I believe most Fl Blue folks have the same positive experience.

Which plan do you have (insurance company and plan letter)?

Sounds to me like you have a great advantage plan. I've had an advantage plan since I started Medicare, 3 years... I'm healthy so it works great for me. Why pay $200/mo for a supplement plan? To me it's a no brainer to keep what you have.

Rarely....

That is because most mainstream Medicare providers know in advance what Medicare will and will not cover. But, there are thousands of medical treatments and drugs that Medicare does not cover. For example, many people travel overseas and pay a lot of money for stem cell treatments.

Medicare Prescription costs
 

I'm on just a few prescriptions. One is NP thyroid which has been around since before FDA approval so it is never covered by any insurance. It's rediculous. So I found a mail order pharmacy to minimize my cost to $60 for a 90 day supply.

I'm also on a new generic. It is on a high tier on my part D plan. They want $177/mo through Part D. I got an exception through and it still costs the same and after I meet my deductible then I pay 50% because of the tier. I was able to get it filled at CVS and used a GoodRx coupon which brought the cost down around $70/mo from the start. CVS found me even a better discount than GoodRx. And my doctor did not think they would fill a 90 day supply, but CVS did and that was even less expensive.

I pay $0 for my plan D and what I pay on these two prescriptions do not count toward my $545 deductible. But I probably won't reach that anyway. I looked at all the available part D plans and spending more would make no difference whatsoever due to my particular prescriptions.

Everything depends on your own individual case. Also things can change.

Think about it. If Medicare covered everything, quacks and snake oil salespeople would be coming out of the woodwork to sell treatments and collect money from Medicare.

Unless money is a serious problem and the "free" teeth-cleaning and eyeglasses are extremely important to you, switch to regular Medicare as soon as you can and purchase a Supplemental plan from one of the private insurance companies (AARP gets you United Health).

Should you have a serious medical condition, your choice of doctors will be limited to those in the Advantage plan. They may, or may not, be the best available. Getting permission to use a doctor outside the Advantage plan will be as hard as pulling your own teeth.

With regular Medicare, you can be treated by any doctor you choose, provided the doctor accepts Medicare and accepts as payment in full what Medicare and your supplemental insurer pays.

If you don't care who cuts into your chest to place several bypasses on your heart or cuts into your brain to remove a tumor, stay with your Advantage plan.

Some Advantage plans being dropped!
 

According to the Wall Street Journal, about 7.1% of Advantage enrollees will have to find another plan next year because theirs is being terminated, up from 0.4% to 1.5% during the past four years.

Look at this site SHINE - Home
In my area we can also set up one on one appointments with a Shine person. I think this is what you need to do.

Reading through the comments here, I have not seen any comments about doctor choice. We choose Medicare Supplement over Advantage because we are not locked into just a pool of doctors. We can go to any doctor, anywhere in the country. Love that freedom.

I always hear that as an argument for Medicare. Can everyone on Medicare (about 30 million people) really go to the top heart doctor in the country? I would think it would be very hard to get an appointment.

You missed the point. Advantage has a much smaller pool of "heart doctors" to choose from.

I agree that it is smaller. However, UHC has over 1.3 million physicians and care professionals nationwide. I am not limited to Sumter County or even Florida.