Medicare Advantage or Medigap/Supplemental
 

We are about to retire, thus we will no longer have our Highmark BC/BS employer coverages. We have spoken to consultants about both the Medicare Advantage and Supplemental plans. We are leaning toward a BC/BS supplemental plan. This decision is based on our experience with our current employer BC/BS plan.

We've also been told by SHINE that Village Healthcare and the Village Hospital accept the advantage plans but not supplemental. They also informed us that there are very good medical services surrounding the Villages who do accept supplemental plans.

We would appreciate thoughts and recommendations for general practitioners. Thank you!

Traditional medicare plus supplemental.

Most importantly no restrictions on what doctors/specialists to use, locally or when traveling.

We have not had to reach into our pocket for anything these past 15 years....including some very major events like breast cancer, significant cardio vascular repair/replacement treatment and follow up care.

Can you keep your employer plan after you retire? If so, you may not need to sign up for Medicare at all. I retired from the Federal Government, and I still maintain my Federal Blue Cross insurance as my only health insurance. It has a $5,000 annual catastrophic limit which I can easily afford, if necessary. I just cannot justify a $265 per month Medicare Part B premium plus another $200 or so per month supplemental premium plus $85 per month for drug coverage.

You pay $$$ for supplemental - you do not pay for most advantage plans, some give you money back from your monthly medicare charge.
Most people go with advantage plan - I think about 70% of people with Medicare. Most doctors take advantage plans. I have never found one that did not.

No, about 1/3 go with Advantage Plans. The number might be different in The Villages.

We were advised that as a rule of thumb, if you have or expect significant medical issues, you are better off with a Medicare supplemental plan. If you have few medical issues, you may save money with an advantage plan. I believe this to be true.

Be sure to check for coverage if you travel, when we looked at this a few years ago, the entire state of Colorado WAS NOT COVERED by any of the advantage plans that were offered at the time, that was a deal breaker. Then we found out that several of the specialists my wife was already using would not accept the advantage plans, the was a deal killer, we stayed with Medicare and supplemental.
Also, if you go with an advantage plan, there is a very limited time where you can go back to medicare and NOT be subjected to underwriting, be sure you understand this.

If you a leaning this way, then shop around. Everyone's Plan F is the same, for example. Why pay a higher premium for the same coverage?

I don't think this is exactly true. Here's my take:
1. Village Healthcare (The Villages Health) accepts specific advantage plans (not all advantages plans), but not Original Medicare with a supplement.
2. The Villages Regional Hospital accepts most all insurances.

The Villages Medicare Complete 2 advantage plan has a passport system. This allows one to go to areas outside of their local coverage and find an in network doctor or facility and be charged the same as in network.The $80 / month covers (amongst other items) an In Network Out Of Pocket max of $1900 and an Out of network Out Of Pocket max of $7500. True not all areas of the U.S. are covered under the passport plan but a large percentage is. Example all counties in New York State are covered. FYI I recently needed a short trip to emergency in New York the bill was $2500(highway robbery) and my total part was the $90 deductible. For those areas not covered like Colorado (I assume - did not look it up) you are still covered but at out of network rates with a max out of pocket of $7500. This would probably work for most people if traveling to Colorado is a vacation short term but probably not the right plan for you if you are a Colorado snowbird.

In my experience this is true. My doctor and I discussed the relative advantages of Medicare Advantage vs. Medicare with a supplement, and he convinced me that since I am very healthy, an Advantage plan is best for me, as it costs me nothing (other than the basic Medicare premium paid by everyone on Medicare), and it includes many benefits not provided by standard Medicare (some dental, some vision, pays full cost of my gym membership, etc.) However, Medicare Advantage is restrictive, and to get full benefits you must stay within the program network, which means you can't go to any provider you want. If you think you might need specialty care outside the network, you should probably avoid Medicare Advantage.

Actually, the passport feature is available with both Villages 1 and Villages 2 and if you travel to an area that has coverage, you are able to use the UHC doctors and hospitals there just as if they were in network (e.g. anywhere in NY state, but as VT has reported, not in Colorado).

The Villages 2 plan adds coverage for areas where there are no in-network providers, albeit at a reduced rate (e.g. instead of insurance paying, say, 80% for an in-network provider, it might only pay 45%). The $80/month also buys you some reduced copays versus the Villages 1 plan.
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bc

Yes I agree the passport is available with both 1 and 2. However it is my understanding the $1900 and $7500 OOP is part of the 2 plan only ($80/mo). I've been wrong before.

I never understood the idea that if you are healthy an advantage plan might be better because you save some money. Your health can change very quickly for the worse. Maybe their crystal ball works better than mine. Just based on both my parents experience, they had significant hospital bills, well in excess of $500,000 each in perhaps the last five years of life. They had BCBS F medigap plans and they paid absolutely zero beyond their monthly premium.

Even though it is more difficult to find a Dr in TV who accepts medicare plus suppliment, We would never consider an advantage plan. Outside the bubble I would believe most doctors accept medigap. That makes it much less of a concern when traveling. Concerning The Villages hospital I have spent 5 days there plus emergency room visits and my medicare plus BCBS medigap supplement covered all costs 100%.

Of course if the budget is tight going with an advantage plan is understandable. I justify the monthly premium as protection against catastrophic expenses. As an added benefit I don't have get a referral to see a specialist.

I started off with a supp plan when i retired and still lived in georgia. For whatever reason, the county i lived in did not have the passport / advantage plan. Moving to the villages has allowed me to drop down to the advantage w passport with a relatively low out of pocket max at $80 / month. I did quite a bit of research and found most of the places out side the villages that i might go w serious issues were covered as in network. I'll be giving the villages health system a try. If you switch from supp to advantage you can switch back within a year w no problems.. Also, since wife has decided to continue working, I might suspend medicare and go under her corporate plan, saving $$$ from IRMAA

Just to be clear - you can switch back at reup time always. You are not locked in forever. There are extenuating circumstances that you can switch in mid year. I do remember seeing something about the first year switch but can't remember what it was. I am long past the first year. There is something about you may pay a higher supplemental with medicare and supplemental because they can charge the supplemental based upon your age Vs if you had been in from day 1.

I think what you are talking about is what medicare "Guaranteed Issue Right". Switching from Advantage to regular Medicare is not a problem.

What might be a problem is picking up a Medigap, i.e. supplemental, policy. If you have the Guaranteed Issue Right then any insurance company that offers a Medigap policy must accept you without any conditions.

Here is the Medicare page that explains when you have a Guaranteed Issue Right:

https://www.medicare.gov/find-a-plan...otections.aspx

Even if you don't have a Guaranteed Issue Right an insurance company may accept you anyhow, but they don't have to and may charge you extra over their regular rates.

I just read online that if you have had an advantage program for over a year you will be subject to medical underwriting if you wish to change to a more comprehensive medigap policy. There are a few exceptions but this can be risky. I would link to this information but I don't know how to do it.

OK now I am confused. What is the difference between Medicare with a supplemental and medigap?

Medigap is the supplemental insurance policy which picks up some or all of the costs that medicare does not cover. It does not cover prescription drugs. That requires a separate part D drug plan.

Talk to SHINE, we were almost in this position, found out you have to change back to Medicare after 50 weeks or less (if my memory is correct) and are guaranteed supplemental coverage WITHOUT medical questions, etc., after that you can get back to medicare, BUT you may be subjected to medical questions, and possible additional charges for supplemental due to preexisting medical conditions. SHINE was very helpful in this area.

FYI - Plan F is probably going away for new Medicare recipients in 2020. Suggest you Google for exact details.

It is true plan F is going away but plan G is nearly identical. Only difference is plan G had a $185 yearly deductible. After the deductible is paid everything else is covered the same as plan F. On the plus side the monthly premium for a current plan G is lower than the current comparable plan F.

The supplement plans are sometimes called medigap plans, i.e. they cover the "gap" not covered by Medicare - the deductible and copays for hospital and doctor charges. As has been stated, prescription drugs are covered by a separate Prescription Drug Plan, aka Medicare Part D.

That's my understanding as well. The $80/month gets you the out of network coverage plus a few other perks as compared to Villages 1.
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bc

Are you saying that if someone has an Advantage plan and their health changes for the worse that the Advantage plan won't pay for it? I thought the big difference between Medicare+Supplement and Advantage was that the latter restricts you to in-network providers, but other than that, both provide similar coverage. No?
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bc

I've read the same.
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bc

I suspect all this is going to change anyway, especially if Medicare For All becomes a reality. If that happens, I wouldn't be surprised if Advantage plans went away altogether (and if so, I can't imagine that everyone on an Advantage plan being forced back onto MFA would be penalized in any way, it'd be chaos).
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bc

Yes, by law an Advantage Plan must provide all the services that regular Medicare does.

Medicare Advantage Plans cover all Medicare services | Medicare

We have had Florida Blue Advantage PPO for 7 years. My wife has had stomach cancer surgery, and her knee and hip replaced. Our choice of specialists though limited to preferred providers, has been excellent. Her choice of Moffitt Cancer Center in Tampa is in the Network, while not in the UHC Advantage Network. Her knee surgeon choice and hip choice we also in Network. Monthly premiums have varied a bit each year, but currently are $42. I investigated The Villages UHC Plans and system but found them to be ever changing and seeming to have a difficult time finding a satisfactory identity. Now I understand TV Healthcare Plan will be accepting Florida Blue Advantage. Not sure why now and not earlier. I have a Primary GP and have had him since before going on Medicare. Most of my friends that have had TV UHC Plans have had issues. Originally they accepted supplemental plans, then they didn’t. Primary Physicians have left frequently leaving them to change and change hoping to find one they like. My experience is to date TV Healthcare has not been able to solidly find it’s identity, at least for me. It certainly is a great concept and I wish them future success.

My Wife had Federal Bluecross/Blueshield for years but turning 65 this year made her eligible for Medicare. With her on Medicare we decided to drop her Federal Bluecross/Blueshield because of the cost. We met with an independent Health Insurance Representative outside of The Villages and discussed different supplemental plans. We chose Unitedhealthcare, they have two options, one is no cost and the other is $80.00 a month. With that said at the moment the Villages Health Clinics are only accepting Unitedhealthcare to be seen at there clinics. There are doctors and specialist outside the clinic that are preferred providers. Because she turned 65 this year we are eligible to change again during this open season and I am looking at other options.

did you fully consider the coordination of benefits? or a cheaper plan? or the rebate a couple of plans give to medicare customers? or not taking medicare and using FEHB by itself?

I have the Federal Blue Cross standard plan, and that is the only insurance that I have. No Medicare Part B, but Part A is free. There are plenty of preferred providers in the area. The only disadvantage to not having the United Health Advantage plan is that you cannot use The Villages primary care doctors, but you can use their specialists. If I were to buy Medicare Part B, the supplement, and Part A, my premiums alone would exceed my annual Blue Cross catastrophic limit of $5,000. I would suggest that you reconsider dropping the FEHB, especially if your Medicare premium is higher than the basic $135 per month. Mine would be over $260 per month. If you can budget for the possibility of an out of pocket expense of $5,000, everything after that will be covered at 100 percent, including drugs.

We opted for the Unitedhealthcare option 2, we pay the extra $80.00 a month for the coverage. By dropping her from Fed Bluecross/Blueshield my insurance dropped $219.29 a month after paying the $80.00 a month for Unitedhealthcare. My out of pocket for this plan is $1900. For the her prescriptions, I have paid zero dollars since switching plans, where as Fed Bluecross/Blueshield always had a small cost. I will be checking in to other plans for this open season for comparison.

Medicare Advantage vs Medicare W/ Supplement
 

Wife & I have been on both plans over the last 16 years now. Though Traditional Medicare with a supplement is more costly, it is hands down the way to go. We feel you can’t put a price on your healthcare. No copays, paperwork, or referrals which at times cause lengthy delays in getting your healthcare taken care of ASAP. I waited 3 months one time while in extreme pain for a referral to be approved for back surgery, & my daily calls fell on deaf ears. It’s your decision, but for us we would never go back to a Medicare Advantage plan.

Thanks for your input. Would apprecaite if you would share the names of the supplemental company your currently with? My consultant here in Colorado is recommending BC/BS supplemental as it has a traveling component. BTW...BC/BS is our current health insurance provider through my wife's employer.

By law all Medigap (or supplemental) plans have to offer the same coverages. Plan G is Plan G no matter which insurance company you choose. Choose the Medigap policy that has the coverage you want, and shop around for the best price. Prices with each carrier change with your location. I lived in Ohio and purchased Plan G from Americo for $108 per month. I just moved to TV last week, and my premium will increase because of my move. There are independent agents who sell for multiple companies. If you can't find one locally, there is a company in Ft. Lauderdale called National Plan Advisors who represent 28 insurance companies that offer Medigap coverage.