[retiredguy123]

Originally Posted by Pat2015

You have to go through your primary care doctor and they get referrals sent out for you for specialists and tests that are required.

Traditional Medicare does not require a referral, but some specialists may. If you have an advantage plan, the plan may require a referral before going to a specialist. That is the difference.

Also, with traditional Medicare, you may be able to get 2 or 3 second opinions without a referral, but your advantage plan may not allow a second opinion at all.

[BrianL99]

Originally Posted by kingofbeer

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten.

There's nary a person in the United States of Medicare age, that isn't overweight, has high blood pressure, heart issues or all 3.

There's hardly a 65 year old in America, who's not taking medication of some sort, on a regular basis.

There's one and only one reason for have a Medicare Advantage Plan and that's COST.

Everyone is entitled to get whatever kind of Medicare or Insurance plan they want, but the folks who come on here and promote Advantage Plans because they're a "better plan", are simply disingenuous.

People are entitled to make a value decision, based on a cost/benefit analysis ... that's their right. Anyone who argues Medicare Advantage Plans offer better healthcare, are simply rationalizing their cost saving decision.

[CoachKandSportsguy]

Originally Posted by kingofbeer

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium

LOL! that belief will work until it doesn't! anyone can develop a chronic illness between 65 and whenever, after they chose a plan, through no fault of their own Anyone can get into an accident requiring lots of medical care, though no fault of their own. .

Thinking if you are healthy today and will stay that way forever is hopium. . so do healthy people who believe that then know how they will die?
will it be a golf cart accident? someone else's fault? a tree falling? a lightning bolt? dementia/Alzheimers, which can result in a long life needing assisted living or in home care?
but never needing any thing else but an annual physical and a gymn membership?

[tophcfa]

Originally Posted by retiredguy123

As I understand it, if you don't have a supplement plan, you are responsible for 20 percent of all health care costs under Medicare Part B, with no limit, and about $1,500(?) copay per hospital stay under Medicare Part A. If you have a supplement, the supplement will pay the 20 percent Part B cost and the Part A hospital copays.

That is my understanding as well.

[Snowbirdtobe]

Originally Posted by LuvtheVillages

Yes, within the Medicare guidelines.
Yes for cardiologist.
Yes for neurologist.
I think the colonoscopy guideline is every 5 years.
I think the skin check guideline is once per year.
For lab work you need an order from a doctor. Go to the appropriate doc first.

I have a Plan F sup. I go to an ER they take me, no bill.
My wife had 3 ER visits and 2 admissions, 3 cardiac procedures and a pacemaker. No bills.
My plan has 50,000 in out of country coverage.
We were lucky when we ran away from TVH 10 years ago because we passed the screening to change to BCBS TM sup Plan F.
Now they would have rejected us for medical reasons.
If you have a MA plan you might not be able to switch if you are ill.

[HappyTraveler]

Originally Posted by BrianL99

There's nary a person in the United States of Medicare age, that isn't overweight, has high blood pressure, heart issues or all 3.

There's hardly a 65 year old in America, who's not taking medication of some sort, on a regular basis.

There's one and only one reason for have a Medicare Advantage Plan and that's COST.

That post didn't end where I first thought it was headed (I guess I was hopeful). I thought you were going to say what I'll go ahead and add.

THE BEST health insurance costs very little. It is simply this:
-- Eat primarily high-quality and healthy food (Mediterranean diet is still the best)
-- Get regular exercise with stretching and keep your weight in check
-- Quality sleep and enough of it is important
-- Have people in your life who routinely cause you stress? Ditch them. Not kidding, you want to be healthy or not? Eliminate stress.

Brian, there are many people of young Medicare ages that are healthy and who very intentionally take care of themselves. I'm one of them and know others. They don't have need to see Doctors because they live like the above. So, some of them choose Advantage plans because why wouldn't they? Over a decade it's quite a lot of money saved (for a couple probably $40,000+). Plus they can switch plans every year in the 4th quarter.

Of course, those healthy people could be in a bad car accident or get a serious disease -- guess what will happen then? They will get medical care.

I hear and read a lot of justification from people about the premiums they pay for traditional Medicare - which I find interesting. If it's worth it to them, that's all that matters. But, I think some are convincing themselves that they're getting more than they actually are and they seem to need to convince others too.

[collie1228]

I’ve been on Medicare Advantage for over ten years (Careplus each year) and do you know how much I’ve saved over regular Medicare? Over that ten years I’ve paid a total of less than $3,000 out of pocket for my health care. I’ve had one major surgery, a sleep study with a CPAP machine prescription, the usual prescriptions for fairly routine issues, and great doctors, nurses and support. I really love my Medicare Advantage. Maybe I’ve been lucky, but I don’t see where traditional Medicare with a supplement plan could have been any better for me.

[Dexterconfetti]

All my gym memberships, through the local YMCA’s and Lifetime, are free with my Medicare Supplement Plan. Mine is Renew Active. There is also Silver Sneakers.

[Rainger99]

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

[Mrprez]

Originally Posted by Rainger99

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

Never denied anything in 5 years.

[CoachKandSportsguy]

Originally Posted by Rainger99

The main objection to MA seems to be that MA denies necessary medical coverage while TM provides it with almost no questions asked.

Has anyone with MA been denied treatment? If so, what were the circumstances? If MA denied treatment, did they provide alternative treatment?

Did the patient suffer adverse medical consequences as a result of the denial?

Did you appeal? Bring a lawsuit?

Mass has had to propose new / change laws to bring MA into reasonable behavior due to their delaying / denial behavior. The hospitals were complaining because it was costing them money and backing up beds, resulting in delayed healthcare due to lack of beds

[Michael 61]

Originally Posted by CrazyTiki

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TM vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they choose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TM + Medigap. Even though I’m healthy and prescription-drug free at this time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

[CoachKandSportsguy]

Originally Posted by Michael 61

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TA vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they chose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TA+Medigap. Even though I’m healthy and prescription-drug free at his time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

Had dinner with high school / college friends/couple where one is a doctor. She would never take MA, too many rejections from a doctor's point of view. The point to remember, which I would wager that most don't realize, that MA private insurers,don't make procedure decisions on medical need/basis, they make their decisions based on corporate policies.

good luck with that . .

[tophcfa]

Originally Posted by Michael 61

My exact sentiments- I’m 63, so two more years from Medicare age, but have done extensive research and homework in preparation of making the very important decision TA vs MA. I have also met with the folks at Shine - great resource.

I’m amazed how many my age haven’t done any research on the topic, and have an almost “cavalier” approach as to what to do when they turn 65. Many, unfortunately, appear that cost and freebies will be the deciding factor as to what they chose.

I feel it’s so important not to just to assess your current health conditions/situations, but look down the line 20-30 years from now, and determine what type of coverage would suit you best if diagnosed with a serious or terminal illness or if in need of rehab.

Everyone’s situation is different - and one plan may work better for some than others. For me, I’m going with TA+Medigap. Even though I’m healthy and prescription-drug free at his time in my life, it will help me sleep better knowing I have the best coverage available if needed. It’s the same as house or auto insurance, I don’t go with the cheapest premium necessarily, but for what is the best actual coverage in the event I need to make a claim. (I’m a retired insurance claims manager).

Smart. Wait until you get about 5 months before turning 65 and have two files handy, one very large file labeled “Medicare Advantage” and another much smaller one labeled “Medicare Supplement”. You will begin to get a steady avalanche of mail right up until your 65th birthday. You will be absolutely amazed at how much marketing stuff you get for Medicare Advantage plans, relative to information brochures related to Supplemental Plans. The amount of MA marketing materials you will get from AARP in conjunction with United Healthcare alone will practically fill up your large file. Take all that for what it’s worth, but it was easy for me to interpret it.

[kingofbeer]

Originally Posted by CoachKandSportsguy

Had dinner with high school / college friends/couple where one is a doctor. She would never take MA, too many rejections from a doctor's point of view. The point to remember, which I would wager that most don't realize, that MA private insurers,don't make procedure decisions on medical need/basis, they make their decisions based on corporate policies.

good luck with that . .

of course, the doctor makes a big salary and can afford the supplement. The average person chooses MA.