[Rainger99]

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

[LuvtheVillages]

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

[tophcfa]

Originally Posted by Rainger99

For those with TM, what additional benefits would you need to switch to MA?

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

[retiredguy123]

Originally Posted by tophcfa

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

It sounds like you want to abolish advantage plans altogether.

To me, the biggest difference between an advantage plan and traditional Medicare is that advantage plans are managed by a private company with a profit incentive. If they deny claims or prevent you from using a doctor or other provider who charges too much or performs unnecessary procedures, they can increase their profit. By contrast, traditional Medicare claims are managed by Federal employees who have no profit incentive. I don't trust the Government's accounting costs for these programs, but it seems that advantage plans should cost less than traditional Medicare. But for the patient, it appears as though traditional Medicare would be a better choice.

[Bemabound]

TM does not cover out of country needs. TM consistently reduces what they cover, especially for quality rehabilitation - which is a high need in elderly populations. TM does not meet criteria to retain certain retiree federal health care benefits, but MA does. MA have some plans which reduce TM premium costs. MA - PPO plans let you see docs in other areas of the country (TM does but the clinic may cap their new pts, unlikely for MA to be capped). Many reasons to go with MA depending on your specific health needs.

[tacostello]

Good points made above. Here are some other thoughts:
TM subscribers often get a supplemental which will increase in price with age. Supplementals don't include Part D - which must be purchased separately. The better the supplemental and Part D, the higher the price. Both supplemental and Part D providers are private for profit companies. TM doc's and facilities don't have a common integrated health info network, so each time you change either, get ready to provide your health history all over again.
Apart from the above issues, TM would seem to provide the most health flexibility independent of cost.
MA (aka Part C) comes in many forms including HMO, in network only, out of network optional and PPO. All include Part D. I currently have HMO and am satisfied with it with two exceptions - speed of service for anything other than ordinary care and the potential for disagreeing with a doc and having little recourse. The integrated health info system is very good - no time wasted in providing health history or dealing with billing.
I'm glad we have choices. And I would be interested in hearing from anyone who is very pleased with their health care choices - and what those choices are.

[CrazyTiki]

Originally Posted by Rainger99

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

[tophcfa]

Originally Posted by retiredguy123

It sounds like you want to abolish advantage plans altogether.

No, that’s not necessarily true. MA plans don’t suit my wife and my needs, but that doesn’t mean they don’t work for others. I was simply answering the OP’s question regarding what it would take to get us to switch from Traditional Medicare, with a supplemental plan, to MA.

That being said, I would be in favor of abolishing them if the powers that be can’t get their act together and revise MA plans so the cost to the Medicare Fund is the same or less than traditional Medicare. By costing Medicare 22% more per subscriber than Traditional Medicare, MA plans are bleeding the rapidly dwindling Medicare Fund dry even faster, which is not a good thing for anyone involved. Plus, their excessive costs are causing everyone’s Part B premiums to increase more rapidly.

I would add that I get the appeal of MA plans for healthy subscribers, since they are much less expensive (to them, not the government) and come with benefits that Traditional Medicare subscribers don’t get. But I also worry for those people as they get older and develop potentially very expensive medical conditions. At that point, they will have a pre-existing condition and very well might not be able to switch to Traditional Medicare with a supplemental plan, since they won’t pass medical underwriting.

[tophcfa]

Originally Posted by CrazyTiki

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

Recently went through all that as well, and came up with the exact same conclusion.

[Rainger99]

Before I went on Medicare a few years ago, I thought that Medicare was free. People were always saying that the answer to the health problems in this country was “Medicare for All.” So after paying into Medicare for about 55 years, I expected that I would not have to worry about ever paying for medical coverage again.
To my surprise, I found out that even though I had retired and was not making much money, I still had to pay for Medicare.

I was also surprised to learn that the amount you pay for Medicare depends on how much money you make. The more you make the more you pay.

Married Filing Jointly:
$212,000 or less: Standard premium ($185 in 2025)
Above $212,000 to $266,000: $74.00 surcharge
Above $266,000 to $334,000: $185.00 surcharge
Above $334,000 to $400,000: $295.90 surcharge
Above $400,000 to $750,000: $406.90 surcharge
Above $750,000: $443.90 surcharge

I have learned a lot about Medicare since I retired.

[mtdjed]

Originally Posted by tacostello

Good points made above. Here are some other thoughts:
TM subscribers often get a supplemental which will increase in price with age. Supplementals don't include Part D - which must be purchased separately. The better the supplemental and Part D, the higher the price. Both supplemental and Part D providers are private for profit companies. TM doc's and facilities don't have a common integrated health info network, so each time you change either, get ready to provide your health history all over again.
Apart from the above issues, TM would seem to provide the most health flexibility independent of cost.
MA (aka Part C) comes in many forms including HMO, in network only, out of network optional and PPO. All include Part D. I currently have HMO and am satisfied with it with two exceptions - speed of service for anything other than ordinary care and the potential for disagreeing with a doc and having little recourse. The integrated health info system is very good - no time wasted in providing health history or dealing with billing.
I'm glad we have choices. And I would be interested in hearing from anyone who is very pleased with their health care choices - and what those choices are.

Take part D out of the equation. There are zero cost options by Well Care.

[HappyTraveler]

Originally Posted by tophcfa

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

You forgot to mention what your monthly premiums are for the TM plan and the Medigap plan? Costs vs benefits are one of the most relevant equations.

[HappyTraveler]

My original comment here was not accurate therefore is no longer needed. Cheers....

[Rainger99]

Originally Posted by HappyTraveler

You left out a few relevant details. What you're referring to above is Part A - hospital coverage. Yes? And the costs noted above are monthly.

Having Medicare medical insurance is different and, depending on the plan, may have its own monthly premiums in addition to the above.

I think Part A is free and the monthly premium is for Part B (TM) or Part C (MA).

[tophcfa]

Originally Posted by HappyTraveler

You forgot to mention what your monthly premiums are for the TM plan and the Medigap plan? Costs vs benefits are one of the most relevant equations.

I’m paying $185 for part B, $189 for the absolute best Blue Cross Blue Shield Medigap plan available (which includes a year 1,2,3 discount of 15, 10, and 5% respectively, and also includes an annual vision and hearing exam and $150/year for corrective eyeglasses or contacts), and $12 for a WellCare part D prescription plan that covers both of my scripts for no cost via mail order. That’s a grand total of $386 for outstanding insurance with about a $250 annual deductible/max out of pocket plan. How sweet is that after having to pay over a grand per month through Obamacare for a high deductible and max out of pocket plan with a limited network and having to get a referral for everything. Although I hate getting older, becoming eligible for Medicare has helped mute the pain : ) I am well aware I could have saved a couple hundred bucks per month with a MA plan, but the piece of mind of a national network with no referrals, and more importantly, knowing if I ever need major medical care I’m totally covered after a $250 annual deductible, is priceless. Also, knowing both a hip and another knee replacement are in my future, that $200 per month MA savings would more than disappear very quickly.