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.