Talk of The Villages Florida

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-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Medicare Advantage or Medigap/Supplemental (https://www.talkofthevillages.com/forums/medical-health-discussion-94/medicare-advantage-medigap-supplemental-296320/)

RalphM 08-06-2019 11:56 AM

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!

billethkid 08-06-2019 01:44 PM

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.

retiredguy123 08-06-2019 02:18 PM

Quote:

Originally Posted by RalphM (Post 1670821)
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!

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.

gatorbill1 08-06-2019 04:48 PM

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.

biker1 08-06-2019 05:21 PM

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

Quote:

Originally Posted by gatorbill1 (Post 1670931)
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.


bob47 08-06-2019 07:49 PM

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.

villagetinker 08-06-2019 08:48 PM

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.

champion6 08-06-2019 09:48 PM

Quote:

Originally Posted by RalphM (Post 1670821)
<snip> We are leaning toward a BC/BS supplemental plan. This decision is based on our experience with our current employer BC/BS plan. <snip>

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?

Quote:

Originally Posted by RalphM (Post 1670821)
<snip>We've also been told by SHINE that Village Healthcare and the Village Hospital accept the advantage plans but not supplemental. <snip>

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.

rustyp 08-07-2019 05:59 AM

Quote:

Originally Posted by villagetinker (Post 1670988)
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.

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.

collie1228 08-07-2019 07:24 AM

Quote:

Originally Posted by bob47 (Post 1670980)
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.

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.

rexxfan 08-08-2019 03:49 PM

Quote:

Originally Posted by rustyp (Post 1671054)
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.

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.
--
bc

rustyp 08-08-2019 05:02 PM

Quote:

Originally Posted by rexxfan (Post 1671532)
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.
--
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.

Tom52 08-08-2019 07:25 PM

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.

valuemkt 08-08-2019 08:51 PM

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

rustyp 08-09-2019 06:25 AM

Quote:

Originally Posted by valuemkt (Post 1671595)
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.


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