Talk of The Villages Florida

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-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Should I switch from Medicare Advantage to regular Medicare? (https://www.talkofthevillages.com/forums/medical-health-discussion-94/should-i-switch-medicare-advantage-regular-medicare-353203/)

Janie123 09-24-2024 08:07 AM

Quote:

Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.

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… .

MX rider 09-24-2024 08:13 AM

Quote:

Originally Posted by Joeint (Post 2373106)
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.

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.

frostola 09-24-2024 09:07 AM

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.

schrdr 09-24-2024 09:16 AM

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

dougjb 09-24-2024 09:39 AM

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!

Mrprez 09-24-2024 10:34 AM

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.

Rande 09-24-2024 10:42 AM

Quote:

Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.

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.

jimjamuser 09-24-2024 11:15 AM

Quote:

Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.

Yes, you should switch.

Mrprez 09-24-2024 11:39 AM

Quote:

Originally Posted by Rande (Post 2373173)
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.

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.

MX rider 09-24-2024 01:36 PM

Quote:

Originally Posted by frostola (Post 2373136)
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.

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.

bill4952 09-24-2024 02:00 PM

You can switch if you are getting younger.

Rainger99 09-24-2024 02:46 PM

Quote:

Originally Posted by bill4952 (Post 2373234)
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.

CoachKandSportsguy 09-24-2024 04:51 PM

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?

tophcfa 09-24-2024 09:37 PM

Quote:

Originally Posted by CoachKandSportsguy (Post 2373294)
For those interested in a Medigap plan, it’s also expensive.

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.

DAVIDW5084 09-25-2024 05:56 AM

Quote:

Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.

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


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