Should I switch from Medicare Advantage to regular Medicare?
 

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.

If you are healthy, I wouldn't switch. You will definitely need a drug plan and a Medicare supplement plan, which will cost more than $200 per month. Why switch? My opinion.

If you have been on an Advantage plan for more that 1 year, you can be subjected to underwriting when going back to traditional Medicare. IMHO, I would contact SHINE and have a discussion with them. So, to answer your question it depends on how long you have been in an Advantage plan. We were on for 5o weeks and were able to switch back without any penalty, but we just made it.
SHINE has 800 number and LOCAL meetings in TV, and we have found them to be very helpful. If you get the Daily Sun, the weekly advertisement for healthy living usually has their contact info.

To help the OP, in simple English, underwriting means that supplement plans will want you to have a physical exam by a doctor.
If you are not very healthy, they will reject you.

Pittman Law Offices in The Village JUST did a video on this two days ago. Pittman Law Office often contributes to videos by the Newcomers, Jerry and Linda.

It sounds like you are usually unable to switch after one year, if I heard it correctly. I recommend you invest the 11 minutes in what might be a very costly decision:

https://www.youtube.com/watch?v=HAP1liGSCo4

If you want to switch, do it now while you’re healthy. If you wait, and have the misfortune to come down with an expensive medical condition, it will be too late. For us, a supplemental plan is a no brainer since we own homes in two far away states and like to travel. We find the national network of traditional Medicare to be very appealing.

It will also involve a review of your complete medical history/records, so you can’t hide a pre-existing condition.

I watched the video. Are his numbers correct? He says medigap is about $175 a month plus about $25 a month for prescriptions or about $2400 a year. Add the $240 deductible and the most you would pay would be $2640. But that doesn’t include dental or vision.

It seems that the most you pay with Medicare supplement would be about $2700 a year. But you pay that every year-whether you go to your primary care doctor once a year or if you have open heart surgery and chemotherapy the same year.

At this point I am paying less than $500 a year. I assume that will go up as I get older. But until then I am saving about $2000 a year.

Supplemental costs vary by age, sex, smoking history, the company, where you live, the plan (F, G, N, etc.), and whether you switched to an Advantage Plan and then switched back in less than a year. Prescription drug plans vary and can be as low as $0 per month. The numbers you presented are ballpark.

Traditional Medicare vs Medicare advantage is a MAJOR decision when one turns 65. I’m still a few years away from 65, but doing my research now. I think the mistake many make is that they look at their current health at 65 and make a decision based on how healthy they are currently. It’s important to look into the future, and consider what your health costs could be, as well as access to specialists, under each program should you need extensive health care, hospitalization, surgeries, rehab, etc. There is no “one size fits all” here. But it’s important to remember it can be very difficult, if not impossible, to switch from advantage to traditional Medicare when you are in your 70s or 80s if you have been diagnosed with serious health issues.

As far as I can tell, the main objection to advantage is that you are limited to in-network doctors while Medicare allows you to see any doctor. But in reality, can you see the best doctor in the USA or the best doctor in Florida? You can probably see the best doctor in Sumter County. I don’t think a doctor can see more than 32 people a day and that is probably generous. So your doctor is limited even with Medicare.

However, you are probably saving a lot of money every year with advantage.

And does the doctor make a difference? I have seen very wealthy people that have the best medical care in the world die from cancer or other diseases. And I have seen middle class people go to a regular doctor make miraculous recoveries.

Does anyone have any facts on whether people live longer under Medicare as opposed to those who have advantage?

Study comparing Medicare to advantage plans.


A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures | KFF

In Medicare Advantage your provider must write/agree a referral for a specialist. If you see a specialist without this they will deny coverage. They use this to limit their costs.

A person who is enrolled in Original Medicare does not need a referral from a primary care doctor to see a specialist. However, you must check that the specialist is Medicare-approved and currently accepts Medicare assignments.

I don’t need a referral to see a specialist in my UHC advantage plan.

And when I was working and before I had Medicare, I had to get a referral to see a specialist. It wasn’t a problem. My primary care doctor would always refer me.

Supplement
 

When I signed up for Medicare my broker advised me to marry my supplement and date my drug plan. My $200 a month supplement pays for everything that Medicare doesn't. Ex. If a visit costs $100 and Medicare pays $10, my supplement pays the remaining $90 however if Medicare pays nothing neither does my supplement. As a plus, I can go to any hospital, doctor or specialist anywhere in the US without a referral!! I have Welcare for my drug plan. The monthly premium is $0 and generic drugs are $0 for a 90 day supply. I can change my drug plan once a year with no penalty.

All advantage plans are very bad. There is a reason why they throw everything under the sun in them to entice you.
You might be healthy now but tomorrow you might not be. If you have been on an advantage plan for over a year, all the supplement plans can refuse you.

Have you investigated any advantage plan? If you have, you would have never joined 1. All advantage plans can refuse medical service because the insurance company are the 1’s that approve medical service to you, not Medicare. Medicare does not refuse any medical service, if a dr thinks you need help, you always get it. Why are advantage plans been talked about in congress for years? Because of the 60% refusal rate of coverage by advantage plans.

Also, your supplement plan covers everything that Medicare covers, there is no right of refusal of medical service from the supplement company.

Also, have you been seeing in the news that more and more hospitals are not accepting advantage plans? Right now your local hospital might cover your advantage plans, but don’t count on it tomorrow. I have Humana prescription plan and the salesman last year tried to get me to get their advantage plan so I asked him a couple of questions: do you refuse medical service even if a dr prescribes it? He said yes they can. A year ago, I had a medical device installed in me and the 1 I picked was $20,000 more than the cheaper device, so I asked the salesman if they would allow me to get their advantage plan device I wanted and he told me they would have recommended the cheaper unit if it did the job. Remember, these are insurance companies that make money when they don’t have to pay out.

What I don’t get is hearing about people taking a cheaper advantage plan that has many deficiencies to save a couple hundred $$$ when getting a much better supplement plan g/n/?? When overall you are saving hundreds of dollars a month compared to what you were paying when you were working with possibly better coverage.

SHINE.....Serving Health Insurance Needs of Elders. These are Medicare people, NOT insurance people. The best option for information. They meet at Eisenhower Rec Center, Lake Miona Rec Center, Chula Vista Rec Center and Lady Lake library. All at different days/times. No appointment needed. SHINE - Home

Beware of limited choices in rehab/nursing facilities with Advantage plans
 

My mother had one of the upper end Advantage plans which was ok until she started needing rehab or worse skilled nursing after a hospital visit. We were limited to 2 facilities and both were nightmares. i have neighbors and friends who have recently discovered that their Advantage plans greatly limit their choices in rehab and skilled nursing. The facilities prioritize supplement plans in making intake decisions.

Good Point! May also want to consider quality of life vs longevity!

I always thought that if an office visit cost $100 and Medicare says the office visit is only worth $50, Medicare will pay 80% of the $50 or $40. Your supplemental plan only pays the balance of what Medicare didn’t pay on the $50 that Medicare said the office visit was worth or $10. The medical provider has to eat the unpaid portion of the original office visit cost.

Hmmmm didn't they make healthcare required to no pre-existing conditions?? A quick google search reveiled info on that. Seems "Medigap" and a handful of states have the pre-existing on Medigap and certain enrollment periods as well as open enrollment times.

Medigap purchasing details: enrollment periods, guaranteed issue, and more - Medicare Interactive

You are correct.

However, one rare exception is if the provider has totally opted out of Medicare. In that case, the provider can charge whatever they want.

When you become eligible for Medicare, you have an opportunity to enroll in a supplemental plan with no underwriting. They have to accept you regardless of your health situation. If you want to switch later on from an Advantage plan to a supplemental plan then you might be subject to underwriting. You can initially try out an Advantage plan for a year and then switch to a supplemental plan without underwriting.

Does anyone have any figures on what percentage of people are rejected by underwriting?

I am 79 and paying $173 for Medigap Plan N. My partner, with many medical issues, pays about $245 for plan G, no deductibles, copays, etc and can go anywhere they accept Medicare. Has been to Shands, inpatient rehab 3 times, etc. and hasn’t paid a dime. We pay $0 this year for our drug plan, but drug plans are changing for everyone next year.

Medigap is the way to go when you get older. My opinion.

Why is the government so tricky on health coverage?

Traditional Medicare versus advantage
 

We researched this extensively, and decided upon traditional Medicare with a supplement. A great resource is The Medicare School. Medicare advantage can refuse to approve care, and Medicare cannot if you go to a provider that accepts it. Here is a good video to start. I know people are very happy with their advantage plans but I also know people who have their care choices limited or denied. My husbands Medicare part D is free and he has yet to pay for any meds. https://youtu.be/5OmK94JRerc?si=d_AATncnyQvKmFNB

Not exactly. Medicare can refuse to cover some treatments or drugs.

Underwriting at Mutual of Omaha supplement meant answering health related questions when I had that supplement. No medical exam. However keep in mind it all depends on what you want concerning your health care. I have traditional medicare and a supplement and last year I broke my leg with surgery and rehab, had a macular hole in my eye w/treatment at Mayo Clinic in Rochester Mn. I had breast cancer with surgery and radiation. All paid 100%. I never ever considered an advantage plan no matter if it cost initially less.

We steer clear of advantage plans because we don’t want an insurance company making our healthcare choices for us.


If you switch from an advantage plan you will need medigap which is supplemental and plan D also which is the drug plan.

As far as what it will cost you it depends on what plans you pick. But you will likely pay more than what you are now.

Go to Medicare.gov and you can find all the plans along with details. One thing to watch out for are plans that increase in cost based on your age. USAA is the worst.

Happy hunting

Can you share your reasons for switching back? I'll be going on Medicare next year and want to understand reasons for and against an Advantage plan.

I know someone who died due to her advantage plan denying the specialty facility she needed to go to. Very sad

I would disagree with you saying "all plans are bad". Like anything, some are better than others.
We did our research and even talked to some people with serious medical issues on our plan, UHC Advantage HMO/POS. We can go anywhere in their large nationwide network, with no pre-approvals needed.

We even checked many specialists, hospitals and doctors and the majority were in the network. We also have used the dental, vision and wellness benefits. We're satisfied with our desision.
Btw, SHINE said it was a good option.

Painting with a broad brush on this is foolish.

Agreed, the OP will not get an unbiased opinion here. Best thing is to go talk to the people at SHINE and get the facts.

Regular Medicare
 

[QUOTE=Rainger99;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?

I have regular Medicare $174 a month taken out of my social security. My supplemental is with AARP United Healthcare $166
Per month . ( up from $146 a month in 2023) . My deductible is $240 for the whole year after that I pay $0 . No referrals needed I can go anywhere. My drug plan Medicare part d premium is $0 some drugs I regularly take our $0 others $15, prescriptions I don’t regularly take range from $15 to ? . I also have VA healthcare but due to my income I’m put in a tier where I pay a copay for primary care $15 specialist $50 but if I see 3 specialist in the same day it’s still one charge of $50!.
I’m on my dentists dental plan $375 a year . 2 cleaning, X-rays free . 20% off other procedures .
Never had Medicare advantage but my wife does . She’s healthy but pays copays .

You NEED professional information which you can get from SHINE. From experience I would tell anyone to buy the best insurance you can afford. Your healthcare needs are not the same at 65 as they will be at 85 .

If you travel within the US at all then regular Medicare has you covered everywhere. With Advantage programs, you could get hit with a big bill if you need care outside of their network. We currently travel outside of TV to visit family and don't have to worry about whether network services are available. Also, join AARP and price their regular Medicare plans (via United Health) and obtain Medigap coverage too. As for pricing, it just depends on what plan you chose and where you live.

Everyone says you don’t need referrals for Medicare.

How does that work? If I want an MRI of my knee, I just show up and it is covered?

Switch now while you still can.There is nothing greater than piece of mind. Spend the few extra bucks and be worry free. You can’t take it with you my friend. Did you ever see a hearse with a u- haul trailer behind it?

Radiology typically works by having a Dr. make a referral. I doubt you would find a provider who will entertain a patient calling directly for an MRI. The provider will verify your insurance before any procedure.