Medicare Advantage vs Medicare plus supplement
 

Since this is open enrollment and since it seems we are being pressured to obtain UHC Medicare Advantage, I'd like to hear personal experiences with the UHC Medicare Advantage Plan in the Villages. We have had Medicare plus a UHC supplement for 6 years and have been very pleased. When we looked into changing to a UHC Advantage Plan a couple of years ago I was disappointed to find that my cardiologist had just been dropped from participating in the plan and that doctors could be dropped or withdraw at any time. I also thought it strange that none of the UHC agents I talked to could tell me if I might be able to switch back to regular Medicare (without penalty for pre-existing conditions) should I not be pleased with the Advantage plan. Thanks for sharing!

Cost is the major factor for us using Medicare Advantage. However, Medicare Advantage is under assault, and most of the small players have gone out of business, leaving just the major insurance companies. For the past four years we have had to get a new plan each year, due to plan terminations, or cost increases we were not willing to pay. This year our Florida Blue plan had co-pay increases that doubled or tripled. It is not a pretty system. But it works for us and the price savings are still worth it.

I may heave read it wrong, so correct me if that is the case.

My wife has UHC supplemental plan F for $178/month and part D for $32/month, so a yearly cost of about $2500. For that, just about everything is 100% covered except prescription co-pays.
The UHC advantage plan has a whole bunch of co-pays. Their maximum out of pocket expense is about $4500/year, and you still have to pay exactly the same prescription co-pays as plan F. So if you anticipate less than $2500 in advantage co-pays, go for it and save some $$$. If it goes over $2500, you pay up to $ 2000 extra. Double the numbers for a couple

This is a good post and good discussion. Thanks.

A few years ago we had a Medicare Supplement and had to pay another monthly fee for our RX insurance. We then changed the the Villages advantage plan. We've been quite pleased. This is what we did: Each month we put away the money we would have paid for the supplement and RX insurance. Then, as the need came up for co-pays, the money is taken from this fund. This has worked out quite well. We now have a fair amount of money in our "fund"

So you are saying go for the ADVANTAGE plan, if you think you'll be under $2500 in copays, however if you go over you'll be liable for a total of $4500. if you have a lot of copays. But go for the Supplemental if you think you'll be over 2500 in copays because the Supplementals are a max of 2500 out of pocket, except for some small copays. Thanks Bill

Which means you had less than about $2500 each in copays, so you essentially self insured for about $2000 each and were winners. Good for you. At the same time, any couple that had $4400 each in co-pays has a negative balance of $3800/ year in their "fund". It all comes down to what works best for an individual

I have Humana Choice PPO just as reference last year I had my right hip replaced and it cost me 300.00 thought that was pretty good. I have optical and prescriptions also. All I pay is the medicare cost of 104.90 and that is effective for 2016 . You do have copays but you will anyway to a point.

All depends on how much health care you are likely to "consume". The significant advantage plan co-pays appear to be:
$275 each day 1-6 in the hospital
$160 each day 21 - 49
$250 for an ambulance
$ 275 for outpatient surgery
and the scariest---20% of all diagnostic studies---radiologic and non-radiologic
The rest are all like $30

So for me, personally, if I were over 65 and on this plan:
I had 2 days in the hospital for surgery
3 MRIs
1 EMG
1 plain x ray
all in the last 7 weeks

Whether the out of pocket cost for this exceeded the $2500 a traditional supplemental plan costs depends entirely on whether the 20% copay for diagnostic test is based on the full (cash) price or the negotiated UHC price, which I do not know.
For someone else, they might have far less out of pocket cost
The only other concern would be the availability of specialists who participate in the plan

The "availability of specialists" is what scares me the most about any Advantage plan and especially if doctors come and go from the plan. Whereas, with Medigap supplement plans, any physician who accepts Medicare is available to you, the patient.

What I don't understand is: what is the incentive to the provider, if any, for agreeing to participate in an Advantage plan, like The Villages Health is doing? I always thought a provider would have to accept a lesser fee in an Advantage plan than they do for traditional Medicare but I don't know.

In answer to an earlier question, I don't think it would be easy to go back to original Medicare from an Advantage plan. A call to AARP might clarify that. We joined AARP/UHC late and I think were penalized in the monthly premium for not joining within six months of being 65. We did have to answer six health questions satisfactorily before joining.

Providers receive payment from the government to have the insurer supply the individual with the ADVANTAGE PLAN. Essentially you are out of Medicare and the insurer provides you with all the Medicare benifits plus whatever "perks" the insurer adds on to the plan. The payment (Govt. to insurence provider) used to average $10000 + or - per individual. This amount is being eaten away because of Obamacare, thus the Advantage plan costs are rising as are traditional plans.

By the way...for anyone over 65 and on Medicare and who wishes to join the Villages Health System as a NEW patient they will only accept UnitedHealthcare Medicare Advantage plans. No more stand alone Medicare/supplemental or other Medicare Advantage plans for new patients. For existing patients like myself Villages Health will still accept me with my traditional plan but it probably will only be a matter of time before I will be excluded. I would not switch to UnitedHealthcare since I fortunately have a much better plan from my former corporation than they can ever offer me.

I'd have to check with my billing manager, but I believe the advantage plans pay exactly the same as traditional medicare--subject to change in the future, I'm sure

There is an opt out window for Medicare Advantage in Jan/Feb if you change your mind.

MA is real insurance. Medicare pays the insurance company a monthly premium, and they have to cover all your medical expenses, less co-pays. They can't go back to Medicare for more money.

With a MA plan you assume some additional risk up to your out-of-pocket limit. Drugs, under all Medicare plans have separate out-of-pocket risk.

MA works for us because we don't consume much in the way of medical care, and can afford the out-of-pocket risk if something happened.

For my insurance, I'd take either one right now. I'm under 65 and my BC/BS policy is going up to $657/month with a $6300 deductible.. Thank you, 111th congress and prez # 44.

It depends
 

It could depend on "which side of the fence your on"----if you were uninsurable because of a pre-condition or whatever ----I would thank the Congress and Prez that I could get insurance at almost any price. I know some that we're in that situation.

For sure, somebody (including me) is going to pay because it's not going to be free. Just saying..........

We have United Health Care Medicare Advantage PPO because we have no other choice. I'm not happy but when my former employer quit paying my supplement as a retirement benefit it really left us few choices. The good thing about our Plan we can go to any doctor anywhere. That is important to us.

No exclusion for pre-existing conditions was probably the one and only good point in 2700 pages. But it does come with a price tag for everybody, at the same time it was the right thing to do. There were probably better ways to accomplish this as well---after all, name one thing that government has interjected itself in that did end up costing way more than it should

I think that's the clincher! If you don't have chronic health problems MA is a good option. Not so sure if you have some health problems like heart disease or diabetes or if you are on some "heavy duty" drugs with high price tags.

Since there are doctors outside TV the do accept other health plans and would most likely provide the same coverage you had before, why is TV health care so important? They are just another health care provider right?

I am personally very disappointed in the Villages Health Care. I moved here four years ago and found it difficult to find a doctor who provided the same trustworthy relationship I had with my doctors back home.

The Villages announced their plans to meet a need they recognized in the Villages which was, the lack of quality medical care. Marcus Welby medicine would be reborn through their Health Care Centers. I watched with excitement as they built beautiful buildings nesseled within central locations throughout the Villages. I drank the koolaide and signed up as a new patient. Due to growing pains, Physician realignments and my own personal needs, I am now on my third doctor in the Villages System.

I was just informed by the staff my new doctor is very over burdened at this time and seeing a medical assistant and Nurse Practioner will be protacal for semi-annual check-ups.

This system is not what I expected. It reminds me of a Kaiser Permanente model.

I do not have their Medicare Advantage Plan and will make a change. It's just a shame these medical buildings were built to provide this kind of group model medical care.

We also moved here four years ago and after having bad experiences with TWO outside doctors we were hoping to find satisfaction with The Villages Health System. We have been completely satisfied with our care there, however I have switched from my initial choice to a new female doctor whom I have seen only once but was very impressed with her care and concern. I like being able to see my medical records via the patient portal. After having bad experiences with the two outside doctors I'm really hoping The Villages Health system will be successful so I do not have to try to find another doctor. I am really not a picky, needy person. I just need someone that will work with me and not against me in trying to stay healthy.

What were the 6 questions or type of questions?

TVH was supposed to be designed to make sure the doctors were not overburdened and you would receive personalized care from your doctor. Maybe it has more to do with you not being under the "preferred med adv plan". They are not kicking you out; just making it inconvenient enough that you will either convert or leave.

Knowing some of the doctors there and the overall philosophy of TV Health I doubt it. On the other hand, the doctors are employees and don't have the final word on overall policy. I would think, physician recruitment issues aside, that they would be very happy to fulfill their original plan of 8 primary care centers with 6 docs each and sign up as many residents as possible. This in turn would attract more specialists and ancillary services and make for a more vibrant healthcare system in TV

The advertised policy is only 1250 patients per doctor. TVH has already stated no new patients w/o UHC Med Adv plan. I and many others have received the email stating when you reach 65 we need to have an insurance "review". In my opinion, that is legalese for "convert or leave". The writing is pretty much on the wall. So why do you say "sign up as many residents as possible"? That is contrary to what is actually happening.

My post contained an implied conditional. Should have said IF they completed the original plan........

It is my understanding that you can be turned down by a supplemental insurance company if you don't meet their underwriting standards, but not a Medicare Advantage company. There are separate MA plans if you have certain chronic medical issues.

there is a great deal of misinformation here. I was accepted into a supplemental plan with a heart transplant, an amputation and a blood clotting disorder. Affordable care also forced the acceptance of pre existing conditions...no questions. If you go to the hospital on an advantage plan good luck with the bills.

Your understanding is not true. If an insurance broker told you that, find another broker.

I was told that that since a lot of people don't like the advantage plans that they allow you to switch one time at renewal time without health questions. I'm not sure if that's federal and if it is the same for everyone.

I stand corrected. You are right. If for some reason you must make a change because your insurer is no longer offering an advantage plan or if you move and your advantage plain is not available, you can switch to regular Medicare and apply for supplemental without underwriting requirements.

When I tried to think of the AARP/UHC questions we had to answer satisfactorily to be accepted for supplemental insurance I didn't remember all of them so had to do some research. It turns out there were more than six. They all required a "NO" answer. Apart from the usual tobacco use question, I think there may have been weight qualifications also. Any "Yes" answer to the following meant automatic denial:

End Stage Renal disease?
Dialysis is required?
Admitted to a hospital within the past 90 days?
Within the past two years has a medical professional recommended or discussed as a treatment option any of the following that has not been completed:
Hospital admittance as an inpatient
Organ transplant
Back or spine surgery
Joint replacement
Surgery for cancer
Heart surgery
Vascular surgery.

These were AARP/UHC questions. In trying to find these online I came across Gerber Co.s' questions and they seem to be much more stringent. Apparently, each insurer can set their own underwriting guidelines within each state's regulations. I was curious about Gerber & asked for a quote. It was more expensive than the AARP plan.

Some years after turning 65 we voluntarily gave up my husband's employer insurance (in another state) to get AARP Supplemental, as few of our providers here were in network. We always ended up with a balance to pay. If our insurance had terminated us or gone insolvent, we would have been guaranteed enrollment without medical underwriting but we voluntarily left (and cannot return) so it required much thought.

A person enrolling in a Medigap plan within 6 months of turning 65 is guaranteed acceptance, no matter what their health. Same if their Advantage plan becomes insolvent or terminates them. There are complicated rules to follow in other situations, such as moving from Advantage to Supplemental plans.

Of course, the negative thing is the cost of the premium, especially if you join late and the added cost of getting Medicare Rx. On the other hand, we've had absolutely 0 copays since enrolling. We can choose any provider in the U.S. who accepts Medicare. As long as we can afford it, we plan to keep Medigap.

Medigap subscribers and the government have been forced to subsidize Advantage plans for years. The government is trying to wean Advantage plans off the dole and bring the costs more in line with Original Medicare + supplement; that is why copays are getting larger for Advantage plans. IMHO it's the right thing to do.

So I wonder if the government does away with Advantage Plans if people will go on supplemnts without the penalty?

Do I understand you correctly that you can go to any of those 9,000 Primary Care doctors and 24,000 specialists in the state of Florida with an UHC Medicare Advantage HMO plan? You don't have to stay in your network?

any dr. that accepts medicare is the network!

The other thing is, as I understand it, you only have a small window when you first set these things up to get a Medicare Supplement. It is not necessarily available to you again if you don't get it to start with, and if you drop a Supplement, you won't get it back. I found a nice one if you are looking to have a Supplement and don't want to pay for Plan F, take a look at Plan L, it has a ceiling of 2600 a year, and although it says it covers 75%, it covers 75% of the 20% left after Medicare pays, so if you had a $100 bill, medicare pays 80 and the supplemental insurance pays $15 and you pay $5. I see both a cardiologist (which does not take Advantage Plan members any more), and a neurologist, and an endocrinologist (diabetes). I pay my Cardiologist $11 a visit. It's worked out well for me. I don't like changing my doctors. This plan costs me $108 a month, much more cost effective than Plan F.

I switched from a UHC supplement plan to Advantage 2 years ago. I regretted it right away when I found I had to give my own doctor a copay. Also worried that if I became ill away from home I wouldn't be able to find a doctor that accepted Advantage.
Switching back to UHC sipplemrentv wasn't easy and it was several months beforebthevswitch was completed

I would encourage anyone with questions to visit one of the SHINE counseling sessions at various rec centers.

I stopped by Eisenhower Friday afternoon. The volunteer counsellors are well trained and have resources to answer questions at their fingertips. My questions were answered.

Well meaning folks on TOTV can give incorrect info and/or communication may be misinterpreted.

Consult the SHINE experts for help in making what is a very important decision. This service is free.

We visited the United Medicare store last week. Have had the Villages Advantage plan, but wanted to review it and see what changes were available for 2016.
Continues to be no copayment for pcp. $30 co pay for specialists. And very happy to hear zero co pay for medications that areTier 1 and Tier 2.

Using their passport services I could have planned surgery near my daughter in NC If I wanted to.(would use docs who accept United). Not planning to do this, but asked a theoretical question.

We are glad we set up an appointment to ask questions. So much false info around.

I have had Humana Plan F since I hit Medicare age. No co-pays, no deductible and a Silver Sneakers plan. They will pay the entire difference that Medicare doesn't pay. They will pay for any doctor that accepts Medicare. No preexisting conditions restrictions.