Skip to comments.Traditional Medicare vs Advantage Plans
Posted on 11/22/2018 7:12:14 AM PST by TNoldman
Happy Thanksgiving I hope you are having good weather and a relaxing time.
I have a Question on Medicare Plans. My Wife and I are thinking about Advantage Plans to replace Traditional Medicare. We are 81/83 now and active. We currently have Traditional Medicare with a Gap Policy.
The latest offerings from United Healthcare Advantage Plans seem to have taken care of out-of-network services with their Passport which create instantaneous in-network charges in most States that we visit. Emergency care is Covered in any State. Our current Doctors accept this Advantage Plan.
Our Saving would be about $5000./year (both of us) or a 50% reduction in our Total Healthcare Costs.
What do you think?
Anyone with the Industry experience and/or personal or Family member experience please let us hear from you.
Decision time on or before Dec. 7th!
Thank you for your post. I too am thinking of changing plans, but it all so very confusing to this old guy.
Th issue is that you are restricted to the network, and if you have specialists or ongoing health issues they may not be covered under the Advantage plans. I have regular Medicare and can go to any hospital, use any doctor that accepts Medicare. You will have people at the Advantage program second guessing the treatment protocols far worse than basic Medicare.
In my case with my health issues, the Advantage plan would not be an advantage for me.
That sounds like a very substantial savings!!
Maybe check with an independent agency that is less likely to steer you toward a certain policy group.
My wife and I have been on a MA plan for 5 years. Couldn’t be happier and the cost is very reasonable.
We do Medicare in concert with United Healthcare. It’s a plan offered thru the state (wife is retired state worker). United has been absolutely great to work with...on top of medical situations, helpful when called, great coverage, and reasonably priced. We’re even covered of we need medical care out of country. We only have to present the United membership card (not the Medicare card). Note: this is a state-supported plan so the state retiree system pays part, plus the state has probably negotiated a reasonable plan for retirees.
But United has been great.
I switched to Advantage through BCBS a couple of years ago for the very fact that I have four specialists for my current health problems, and Advantage lets me go to any doctor, not limiting me to just those who accept regular Medicare.
I like that flexibility.
Advantage is for healthy people, not sick people.husband sick chronic problems surgery paid only deductible so why would he ask if he should do advAntage to save money. They nit pic you.its a problem if you want to go back to Medicare costs more and underwriting.i told him he was nuts.
“Were even covered of we need medical care out of country. We only have to present the United membership card (not the Medicare card). “
That’s confusing the way I wrote that. What I meant to say... In general, we only present the UHC card at our doctor’s offices here on the states...not the Medicare card.
The plan also covers us out of country, but I’m not familiar with how that works as we’ve not used it in that situation.
66 also healthy take no meds. I also take supplemental N. Family history live into 90s. Had cobra 1300 mo family so this is a bargain to me. I dont want to need referrals. I want to go to best hospital if I get sick. Co payments can be very high with advantage if you get sick.
Plans vary from state to state and within states.
I have had MA for years and have changed plans [forced and voluntary] several times.
Two years ago AARP/United Healthcare shafted us. They dropped nearly 3/4 of the doctors from my plan in the summer. They did assign another doctor, however, but I did not want to have to get new prescriptions, etc. They were fighting with the area medical groups to get more $$$.
They finally settled in the late autum and retro’ed payments to doctors. They did not tell us, of course, that they would retro.
I dropped them.
My current plan is through Aetna. My PCP copay is $5; some companies are now charging $0. My 90-day generic prescriptions are $0. [Competition has heated up in the MA market.]
You have to consider your circumstances and pick the plan that best suits you. You can compare plans on the Medicare.gov website. If you get a mail copy of Medicare and You 2019, it may list plans available in your area.
I’m going to be checking this throughout the day to see what others have to say. I’m also considering changing plans - but reverse of what the person who posted this thread..
I have spent considerable time going through our drug costs this week and have almost decided to DROP Medicare Advantage, go with Original Medicare and buy a drug plan..
With our prescriptions for COPD (inhalers), we will both end up in the “donut hole” by summer time 2019...(expensive heart meds add it up for me also). So far, I haven’t found a great deal of difference in the cost just going with a drug plan but I’m hoping I’ll run into something that makes sense.
My husband has had several 4-5 day hospitalizations for COPD complications and with Medicare Advantage, the most we have paid for our share was roughly $1,800. 20% on Original Medicare would be more but I have to weigh everything...pro/con. We’ve had Medicare Advantage for years and have not had any complaints but the drug costs warrant another look...
I’m thinking about cutting out the heart meds as I’ve had the condition for 40+ years without any trouble but went along this year with the doctor when he told me I was risking a stroke...put me on blood thinner (Xarelto-no generic) and another drug before eating and before bed to slow down the heart.
Will watch for others experience and advice as the day wears on.
Happy Thanksgiving to everyone...
One of the best decisions I made was to join the National Guard after I left after duty. I have a total of 22 years of military service which qualifies me for Tricare For Life.
I began to receive all sorts of advertising for Medicare Supplement Plans when I qualified for Medicare at age 65. I contacted Humana which provided Tricare services. Humana said they would sell me a policy but that I already had the best supplemental policy there was, Tricare for Life.
Essentially, Tricare for Life pay very thing Medicare doesn’t. I had surgery to reconnect four tendons in my hand that had been separated. I saw one bill for $20K. My cost was $7 for some pain killers. My cataract surgery was paid for completely.
Most of this stuff is very individual, but there are a few things worth noting that are general.
1) Advantage is changing, and for the better. Advantage is presently less than 1/3 of seniors. That number is projected to be 1/2 in about 3 yrs. They are improving and they are outcompeting Medigap. They had problems in the past. They are erasing them one by one.
2) The standard description has always been “Medigap premiums are much higher, but once you pay them you pay nothing else. Advantage has lower premiums, but the copays and deductibles can exceed the lower premium differential” It is this which is also changing. Advantage is apparently getting their total costs equal to Medigap’s. This is huge. It means if you don’t get sick in some year, your premiums being much lower for Advantage puts money in your pocket.
3) If you try to enter Medigap after the initial age 65 decision timeframe, you have to go through what is called underwriting. This is a process of evaluting you for pre-existing conditions. At age 65, Medigap isn’t allowed to boost your premium for any pre-ex situation. If you try to enter Medigap after that timeframe, they can price your pre-ex conditions higher. Medicare Advantage must cover pre-ex conditions that Medicare covers. There are just a couple of rare exceptions (end stage renal disease).
4) This item 3) above is a big deal for people who lived outside the US. Many do. The Lake Chapala folks may be age 70+ and want to return to the US, but have pre-ex conditions. Medigap will refuse them. Medicare Advantage cannot.
“”United Healthcare Advantage Plans””
What would keep me from United Healthcare is their relationship to AARP which I want nothing to do with but if it’s saving $$$, I guess it’s time to stop being so prejudiced against AARP. I did find some lower drug costs when I checked some of prices there this week...Still cogitating and December 7 will be coming up fast.
Good luck to everyone with open enrollment...
advantage plans are fine as long as you are healthy ... not good at all if/when you or your wife develop multiple, severe and/or unusual health problems ... of course you can always switch each year in November ... in my opinion, if you can afford top of the line health insurance, it’s the only way to go ... trying to save money on your health is foolish IF you can afford it ... remember, the main purpose of advantage plans is to provide the cheapest and most limited options possible so the company can make a profit ... also, your care will be 100% restricted by a gatekeeper doc assigned to you, and you might not be able to get one you get along with ...
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