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.