Medicare vs. Medicare Advantage.

[RicROC]

The way I hear the argument between Medicare vs. Medicare Advantage is that with Medicare , one must pay 20% of the health care costs, whereas there's a $ cap for charges for those on Medicare Advantage. At least, that's the way it was presented to me by my insurance broker, who pushed the Advantage option.

He gave me the impression that there is no cap with Medicare so who knows what a patient will pay?
Could it be 20% of $1million?

But seems to me, that's not exactly right. If anything, a patient would have to pay 20% of the ALLOWANCE that Medicare permits a claim to be paid. That's a big difference. Yes, it's still may seem to be an unknown #, but Medicare has its allowances printed for what they will pay each and any procedure.

My thinking is that Medicare might not be as scary as my broker explained it. Although by switching back from Advantage to Medicare, they may not cover pre-existing conditions. Compare that to Advantage, which in your final days may just decide not to allow procedures to prolong life or comfort.

Does anyone here have more knowledge or expertise in explaining the difference between these two medicare plans?

[SWBTATTReg]

1. There are YouTube videos that help explain all of this. I don't have any particular links.

Good luck.

[SheltieLover]

2. I personally would not havd Advantage

It is private insurance, charging the govt very high fees.

Those on DU who have Advantage & have had hospitalizations were not happy with what they had to pay.

Get Medicare & a gap policy & everything is covered!

[Demsrule86]

38. There is good and bad in both...Advantage plans cover medications that Original doesn't.

Since my bout with Covid I take four meds daily...two were not approved by Medicare and I couldn't get them on the original Medicare plan. But, I do get them on the Advantage plan. Eliquis is one of the drugs which cost more than $500. per month...there are cheaper drugs but the risk of hospitalization and bleeding is higher. I took Advantage because I needed to save money. It was my first time.

My husband had two spinal surgeries and has one more to go. Mine was a giveback plan where I got $100.00 back from Medicare B and there were no premiums. I didn't have to pay extra for pharma, vision, and dental. When I got Covid and ended up in the hospital, I was worried. I had been completely healthy before and had no idea what to expect. But everything was paid for and I have received great care with my plan. I do have a $2000 out-of-pocket but if I paid a premium there were still be out-of-pocket costs and I would have paid full price for Part B.

[William769]

70. +1

[boston bean]

3. Maybe get Medicare with a supplement and drug plan supplement.

[SCantiGOP]

4. That's what I do

My HR Director at my office advised me before I retired. She said her Rule #1 would be to avoid Medicare Advantage plans.

[ProfessorGAC]

21. Exactly What We Have

Both of us have Medicare and a BCBS supplemental, plus a PDP.
The supplemental carries the annual & lifetime caps, which protects against a potentially crushing Medicare copay.
It's very affordable, but my frame of reference is based on paying for private health care coverage for 3 years before I turned 65.
My wife's been on it longer due to the disability. Has worked very well for her for years

[kskiska]

61. I have the same.

[Skittles]

5. steer clear of Medicare Advantage, it is a scam

and anyone on it is helping with the repuke goal to get rid of Medicare

https://prospect.org/health/medicare-advantage-is-a-massive-scam/

[PortTack]

13. Yes it is! You cannot chose your drs for starters. It's the gqp way of privatizing medicare

And it bankrupts medicare.

When something seems too good to be true..it probably is. No where is this more true than with these advantage plans.

[JCMach1]

53. My parents were able to choose Dr. The same way anyone else with insurance does...

I really don't see your point here.

However, I will tell you what I did see moving my parents. Quality varies from state to state. Florida sucked and Texas is actually pretty good.

We were able to get my dad (who had dementia and other issues) on hospice which was actually super good. He had the nurses and care he needed to make him comfortable his last months.

1. Expect variance state to state and between companies who offer advantage.
2. Which program works best will likely depend on your health and individual circumstances.

My father passed away last Thursday.

[PortTack]

64. Here's just one of my points.

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, says his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.

More at the link

https://www.npr.org/sections/health-shots/2021/11/11/1054281885/medicare-advantage-overcharges-exploding

[JCMach1]

65. Transparently I am prosinglepayer for everyone

Having said that, my only point is Med. Advantage plans vary widely. It's a mixed bag and highly dependent on situation. Because my parents moved into a metroplex which has world class healthcare, the choices were extensive. They were able to take my Dr. For PCP which made things very smooth and easy. When they lived in their rural environment, Drs were limited and scattered over several counties.

I would also note $ is not always $. With just the personal example. If someone is getting very good homecare with Med+ it is quite a bit more efficient than a memory care facility, or little aid at all which leaves an elderly, or family on the verge of serious illness themselves.


My biggest point is once you are in that position, it is going to be hard for you to measure what is best for you. As a number of people have noted, it's way too complicated to navigate for most people.

There are people on here posting people do this, or that. I will not say that at all and just leave it at heavily research and work through the options before you choose. DO WHAT WORKS BEST for YOUR situation.

As good as my father's care ended up, I am sure there are horrific Med+ providers out there. There is another huge divide between urban and rural settings as well.

[PortTack]

66. The other really big disadvantage with these plans, should you decide to go back to medicare

With a supplemental and you’ve had some major health issues, the supplemental is going to cost a LOT.

[JCMach1]

67. Just like the take, or leave aspect of ACA these are things that need

To be fixed...

Or just simply going to single-payer

[montanacowboy]

6. I have Medicare

with a backup supplemental BCBS and never have to pay a penny for anything. My BCBS pays for all my prescriptions.
Medicare Advantage is PRIVATE INSURANCE and the insurance industry's wet dream to take over. It should be outlawed by the government. I don't even know how they are allowed to drag people in, it's all so the taxpayers pay more and the insurance industry makes billions.

[MOMFUDSKI]

15. What is your premium dollar amount per month and

how much is being withheld from your SS check each month? That total is what you are paying each month. I have Advantage Plan and I pay $9/mo premium after they return the rest of the roughly $135 they take off the top of my SS check to me. If I were to bank that 'savings' each month and pay a low co-pay for seeing a specialist on occasion (my primary doc is a free office call) I would be way money ahead at the end of each calendar year. My scripts are usually $0 co-pay. Diabetic supplies are free as Medicare directs that to be the case. My Insurance Broker said the only time one would want a Medicare Supp is if one is really quite ill. With my Advantage Plan, being that I am diabetic, I can switch to another Plan any time I might want. It is certainly a personal choice for each of us. I also learned that the government will help the Advantage Plans if they get stuck with a really sickly/costly batch of folks. Thanks for starting this thread. Good to be as educated as we can in our old age! G'Nite cowboy.

[Ms. Toad]

28. You are comparing apples to oranges.

The comparison to Medicare plus a supplement needs to include your actual out-of-pocket expenses.

My total out-of-pocket expenses for the year are $233. So, while I pay around $1200 in premiums for a Medicare supplement plan over a year's time, compared to your $108/year, I have no copays at all when I visit a doctor, go to the hospital, or have very costly tests.

While you can change plans - you have no guarantee that you will be able to go back to a supplement plan if you end up with tens or hundreds of thousands of out-of-pocket expenses. This year, plans can require you to pay as much as $11,500 before they pick up 100% of the costs. If disaster strikes - can you afford to pay that each and every year on top of $9/month?

[Demsrule86]

45. I have Advantage plan also, the only reason my eliquis is covered is because it is advantage.

It was not addee to Medicare formulary. It isover 500 per month,

[LizBeth]

44. How much monthly out of pocket for your set up. Curious. I have a good five years

but it is so confusing I am starting to educate now, though hopefully things change and improve.

[Tree Lady]

7. I have Medicare with supplement

But boy does my area push Medicare advantage. A lot of doctors won't take new patients with regular medicare but will with the other.

Then I went for just a pab test and was told the office visit portion not the test is not covered by Medicare but by advantage. What a bunch of bull, it is because I dared to ask about one other thing i have besides the test. Of course they don't tell you that and i had to pay almost $200.

Now on waiting list for new doctor, that one retired.

I think there is law that if you go to doctor before medicare with other insurance they have to take Medicare but if your new they don't.

[WaterSong1951]

8. Get a MediGap plan

As others have replied, advantage plans take money from Medicare and then tout lower monthly premiums, dental coverage etc - try to find a dentist who accepts that coverage- personal experience: my husband and I have a Medigap plan and a separate drug coverage- once you meet the deductible we pay nothing and have never been denied coverage (knock on wood) and I am an insulin dependent diabetic

[c-rational]

9. Here is my read. I am two years into Medicare with a Supplemental Plan. This limits me to

an annual deductible of several hundred dollars, and max out of pocket of several thousand. As I understand the Advantage plans, they are steps towards privatization of medicare...my opinion. With the Advantage Plan you are limited to the Doctors in the Plan, and if you go out of network it costs. You could also have out of pocket costs of say 7-10K, with a several thousand dollar deductible.

So, my summary is go with Medicare and supplemental. Also remember the insurance broker gets a big commission from selling an Advantage Plan.

This all took me too many hours. The whole process should be much simpler. When they dazzle you with ads and these extra free services, that is all they are, imo, just dazzle.

[Demsrule86]

49. All of the doctors and hospitals in my area accept the Advantage plan I am on

I pay no premiums and have had no issues with my plan after Covid care...serious issues I might add. I have an out of pocket of under 2000 when you count the fact that the I have a Medicare B giveback.

[Big Blue Marble]

10. Traditional Medicare is the better choice for most over time.

The agent is mistaking the facts, as you have guessed. Traditional Medicare is organized into Part A
and Part B. A covers all hospital expenses include drug therapies with the exception of a deductible.

Part B is for doctors, outpatient therapies and treatments. It covers 80% of these expenses. There
are no deductibles or co-pays. You select your providers. To cover the other 20%, you purchase
a supplemental plan which is government designed from a private insurer. There are several plans
to choose from depending on your needs and your budget.

Part D is for drug coverage.

Medicare Advantage is a republican scheme to privatize insurance by heavily subsidizing corporate
HMO's to make your health care decisions. Your care is secondary to their profits. Plus depending
on the plan, there are co-payments and deductibles. They would not push these plans so much
if they were not very profitable. This agent is obviously rewarded for his dishonest efforts to
scare you. I have a rule never make a purchasing decision based on fear.

[Emile]

11. I was told the Advantage plans is a republican plot to do away

with government run Medicare.

[Vinca]

12. All I can tell you is I have straight Medicare and I just had hip replacement surgery that

costs tens of thousands of dollars. I paid about $2,500 out of pocket. My impression of Medicare Advantage is that it's just another form of private insurance that will tell you who you can see, not who you want to see and in the end you'll probably be on the hook for more than I just paid having plain, old Medicare. Just my impression from talking to others.

[Enter stage left]

14. We live full time in a motorhome and travel from coast to coast across the US & Canada...

The advantage plans INSIST you go to the provider in your area that you signed up in.

There was no way that was going to work for us.

We've been on Medicare for 12 years now, and while we still have copay's we have to make, it has made our lives so much better.

P.S. (I was told this info 12 years ago, you may want to verify it with an expert in your area)

[RicROC]

16. THANK YOU ALL for replying to my post. It is the information that I needed.

[scarletlib]

17. When I retired I chose an Advantage plan.

I was stupid and should have known better. After the first year, I wanted to go back to regular Medicare with supplemental for the 20% not covered.

Guess what. I have a particular pre-existing condition and because of that I could not get supplemental coverage. I was shocked. I thought denial of coverage for pre-existing conditions was disallowed after passage of ACA.

Evidently not for Medicare supplemental. So I stayed with the Advantage plan.

When I signed up for it, everything I read said you could switch with no problems. That was wrong.

[Ms. Toad]

29. You are not stupid. The information is incredibly confusing.

I retired along with two of my colleagues this year.

We are all three lawyers. The other two teach contract law and administrative law. All three of us had at least one criticial misunderstanding of how the plans work.

In particular, the law professor who teaches administrative law believed exactly the same thing you did - the worst that could happen was that he might have a 6 month waiting period before any pre-existing conditions were covered. I challenged him on that. We went back and forth. Ultimately, it took him hiring an independent Medicare consultant before he acknowledged I was right.

The other is on a Medicare Advantage plan that she believes is not a Medicare Advantage plan - she has decided to put off serious consideration until sometime during retirement. If she doen't wake up in the next 2 months, she will be in the same situation you are in.

If the government's documentation, SHIP consultations, SS/Medicare customer service reps are not descipherable by the three of us (with at least 4 graduate degrees between us, and directly relevant expertise) each get something significant wrong, the information available is not available in an accessible form to most people in this country.

Related - my parents live in a retirement community. They have someone on staff (whose job it is to counsel people entering Medicare) who was pushing people into Medicare Advantage plans based on the same misunderstanding you had. She has now stopped after my parents (and perhaps others) intervened to educate her.

So - I'm sorry you got caught in this. I'm doing what I can to educate folks - because although I wasn't really at risk for the mistake you made, it is only because I was lucky enough to be born when I was (and not 5 days later) or I would have been without insurance (during cancer) treatment for 2 months. Truly only luck (and an ability to decipher regulations and push my insurance broker friend to apply when she did not think I was eligible) saved me.

[Hermit-The-Prog]

59. Thank you very much.

[redstatebluegirl]

18. I did my homework and chose medicare with supplement.

It has been awesome very little out of pocket. My doctors take it and the customer service has been great.

[Ritabert]

19. I have Medicare and a supplemental

It costs more but they just covered 5 days in the hospital for my husband and cost us nothing but the Medicare deductible for the year.

[walkingman]

20. My former employer offers us a Medicare Advantage PPO plan that allows you

to go to anyone that takes Medicare. I have used this for the last 8 years including two bouts with cancer without issues.

Unless you can get that type of plan it is true that you have to go to an "In-Network Dr. and Facility" and you do run the risk not being able to later get a M. Supplement with pre-existing conditions. The one exception is if your employers stop offering the coverage then you are once again guaranteed underwriting and can then go to the supplemental.

[Ms. Toad]

32. Those are often as expensive as a supplement plan - but cover less.

I have access to the state teacher's retirement plan (a Medicare Advantage Plan). The premium for that would have been more than my Medicare Supplement Premium - and would have covered less. (My out-of-pocket cap is $233 (no copays, no coinsurance) - the out of pocket cap there was in the $3-$5,000 ballpark, with copahs and coinsurance until I met the cap.

(You are correct that those often offer the multi-state advangate that most Medicare Advantage plans lack.)

[JCMach1]

54. My parents have always paid 0... For either

But they both had retirement that covers that.

It's just the advantage was way better for covering home hospice for my father.

It's caveat emptor and will vary state to state and between providers

[Ms. Toad]

55. Medicare now (at least) covers home hospice care.

And they likely paid the Part B premium (just not a separate MA premium).

State pension plans keep paring back benefits - and the health care plans (the reason I left my $$ in the plan when I left teaching in '89) aren't guaranteed. When I left I was promised I'd always have access through the state teacher's retirement system. Then the number of years of teaching was bumped to 4 more than I had at the time. Then when it came time to make the decision, it was considerably more expensive than open market MA plans and the only advantage over an open market MA plan was that it would allow me to access care in other states.

[JCMach1]

56. Bringing us to it's way overly complicated and circles back again

To why everyone needs single payer

[Ms. Toad]

57. No argument here! n/t

[jojog]

22. Good post on KOS the other day

[https://www.dailykos.com/stories/2022/8/5/2114705/-Stop-the-Medicare-Advantage-Scam-Before-Medicare-is-Dead]

[snowybirdie]

23. We have always

had regular Medicare plus a supplement. More expensive, but we never have to fight with some person about a test or treatment our doctor feels is necessary. That's worth a lot to us. Advantage tries to cut costs by denying some treatments

[Ms. Toad]

34. I ended up in the hospital twice this year.

MRI & CT on the first admission - no one batted an eye.

CT, HIDA scan (nuclear medicine), ultrasound this time, and expensive bloodwork. No one batted an eye.

These kinds of tests frequently require advance approval and/or are denied by standard insurance (i.e. the way Medicare Advantage plans are run)

[Demsrule86]

47. I have had a an echocardIagram, countless EKG, CAT SCAN,MRI, Sleep study, Stress test and

likely need a hysterectomy (four ten pound babies)....All is APPROVED and paid for. At the moment, I am wearing a heart monitor for my A-Fib which cost nothing. Getting money back from Medicare B pretty much covered the deductible. Most of my prescriptions cost nothing. And I will pay 20 or 30 per month after a 400 deductible for a 500+ per month medicine (Eliquis) that is not covered by original Medicare. Iam also being sent to a heart Physiologist-all ready approved.

[Ms. Toad]

51. One clarification -

Medicare Advantage is Part C. So the plan comparison is original (Medigap/Supplment) to Part C. Part D is separate portion of Medicare. Some, but not all, Medicare Advantage plans include drug coverage (Part D), but Part C itself doesn't.

So it isn't that Eliquis is not covered by original Medicare - it also isn't covered by Part C. You just chose a Part C plan which linked your Part D coverage to it, rather than allowing you to purchase it separately. It's a way for the insurance company to save money - but it allows you less flexibility if your drugs aren't the ones covered well by the formulary the Part C plan chose for you. (AND even under a MA plan which includes drug coverage, you are still subject to the donut hole, and unlimited cap on drug care - having it bundled with Part C doesn't change that.)

If your MA plan chooses a different formulary for next year which requires you to pay most of the $500/month, because your two plans are bundled together, in order to get away from the changed formulary you would have to change your medical coverage (and potentially providers if they aren't covered under the new plan) in order to get better drug (Part D) coverage.

[Timewas]

24. When I tried

An advantage plan, I was paying 160+ more per month for the plan and all of my bills were higher than without the advantage plan...With straight medicare parts A and B my out of pocket is very manageable even with my wife and I both dealing with cancer. And ye sit is 20% of what medicare allows, and any physician or hospital that accepts medicare has to agree to accept what medicare will pay, they cannot bill you for more than that. Most will tell you an amount that s your part and a lot give a discount if you pay that amount up front.

[SharonClark]

25. Have you been to a pre-retirement class

offered thru SHIP in your state? After I took the class, I could schedule an appointment with a counselor who answers all your questions. The counselors are well-trained volunteers and the service is free. I found it helpful.

Then I scheduled an appointment with an independent insurance agent from the hundreds of postcards I received in the months leading up to retirement. Based on my research, I’d selected a company for the supplement but the agent recommended a different company that I ended up with. My part D is AARP-Walgreens.

[Ms. Toad]

35. On the Medicare Part D -

Also look at buying prescriptions off-plan.

My wife and I have different plans - based on which plan was best for the medications we were then taking.

Each of us buys the majority of our medications from Costco. As members, the uninsured cost for more than half of each of our meds is cheaper than we could buy them using our Part D plans.

Another good alternative is GoodRx (discount coupons).

I wish I'd learned that trick while I was still on regular insurance - I would have saved a lot of money.

[Ms. Toad]

26. Your broker is incorrect - Medicare is not scary at all.

Talk to your state's SHIP representative to get a less biased view than a broker (who is paid by the insurance companies).
Also make sure your broker represents several insurance companies, not just one, if you are seriously considering Medicare Advantage.

With original Medicare, most people buy a supplement which covers all or most of the 20%. Aside from premiums, my total out-of-pocket for medical care and hospitalization is $233. I've been hospitalized twice already this year, had two MRIs, one nuclear medicine test, and a bunch of other stuff.

Original Medicare:

Medicare A and B cover all but 20% of medical and hospitalization costs.

You have a one-time opportunity to purchase a supplememt plan which is not based on your health or age - either initial enrollment (the 7 months surrounding your 65th birthday OR later if you continue to have work-provided coverage).

In Ohio (where I have done the research), the plans start at about $90/month for the cadillac plan (and a lot cheaper for plans with less coverage). Mine is about $95/month. My father (age 90) is on almost the same plan - his premium is about $200/year. Each plan is lettered, and covers the exact same thing regardless of who you purchase it from - so buy the cheapest one. Most plans start low, then increase annually based on age either until you hit a certain age or forever. Plans may also have inflation related increases. But my father and I are 25 years apart - and the plan we're on stops age-based increases at around 80. So you see the aproximate range of prices.

Original Medicare covers all 50 states (so you can go anywhere - in case you get a rare disease and need to be seen out of state by the best expert in the country, since no one else has enough experience.

Original Medicare generally does not include vision, dental, or silver sneakers - but AARP plans have options which included vision, dental, and silver sneakers which cover approximately as much as Medicare Advantage plans.

Drug plans are always separate.

Here is what the supplements cover (I have plan F): https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

I have plan F, which covers all out-of-pocket expenses but the annual deductible, currently $233 (including coverage in all 50 states plus some out-of-country coverage).

Brokers don't want to sell these plans because they are not as lucrative for them.

Medicare Advantage

Medicare Advantage plans have very low premiums - BUT - significantly more out-of-pocket expenses. Currently, the maximum out-of-pocket expenses (which you may be required to pay each and every year) is $11,500. So if you acquire a chronic, costly illness count on exhorbitant expenses every year - AND - if you try to return to original Medicare you will be (1) denied entirely if you are too expensive or (2) charged a premium that is several times the premium you would have been paying had you started in original Medicare. (It is like trying to buy insurance with pre-existing conditions before the Affordable Care Act - no insurance company is required to sell you one and, if they choose to, they can set the price point where they want it.)

These work like insurance plans - underwriters review requests for the fancy scans I had (and frequently deny them, sometimes resulting in significant delays in treatment). You are generally limited to coverage in a single state (unless you move to a new one), so if you live in Ohio have PSC you can't go to Mayo (the best for treatment of PSC), or a sarcoma you can't go to MSK (New YorK) or MD Anderson (Texas) - two of the best places to go for doctors who have seen more than one like your case.

Brokers are paid by the insurance companies, aren't allowed to sell all plans, and are motivated to sell you Medicare Advantage rather than a Medicare Supplement plan - because their fees are higher when they sell Medicare Advantage. You may be forced to buy a more expensive/less comprehensive plan because your broker isn't allowed to sell you the best/most comprehensive since they dont' have a contract with that insurance company.

Most Medicare Advantage plans include discounted vision/dental care, many include drug coverage.

As to drug coverage - you can sometimes buy it separately (a better option if you have significant medication costs) - but usually you have no choice and will be stuck with the formulary chosen by the Medicare Advantage plan. If your drugs change - and you need a very differentl formulary the next year you will need to change health care plans in order to adjust medication coverage.

Bottom Line

At age 65 the costs are likely to be similar. You will pay:

Original Medicare: Part B Premium + Supplement Premium (around $100 @ age $65) + (in most instances) Vision, Dental, Part D drugs + out of pocket expenses which can be capped as low as $233.

My total out-of-pocket costs for my hospitalization and medical coverage for 2022: $170.10 x 12 + $95 x 12 + $233 = $3314. 20. (My supplement premium ($95) is an approximation, since my comparison chart is on another drive right now.

Medicare Advantage: Part B Premium + Medicare Advantage Premium (For some plans) + a portion of the cost of each encounter with the medical system. The plans will govern the share you play - the law allows them to set your annual expense cap as high as $11,500 this year.

As you age, as long as you started in Original Medicare, your costs will likely be lower over time. And you can't count on ever getting back into original Medicare unless you start there when you are first eligible.

I was forced to enroll in Medicare earlier than I anticipated, and without much notice. So I did a deep dive in a very short period of time. I assumed I would enroll in a Medicare Advantage plan - but very quickly learned that there is a one-time opportunity to enroll in original Medicare, and that if I skipped that opportunity I might pay for it forever if I developed an illness like my daughter has for which her bills are $400,000/year. My advice is to enroll in original Medicare, buy a supplemental plan. Try it for a year - you'll realize it isn't scary at all. If you decide it is scary, you can ALWAYS switch to Medicare Advantage. There is no guarantee you can go the other direction.

If it helps, I have the entire premium list for NE Ohio for original Medicare plans. Other states are likely to be similar

[LizBeth]

46. so you are paying about 276 a month and about all medical this year has been covered?

Lots to read and process in your post, and I am only starting to educate and be aware at 60, so I appreciate it. This is the kind of post I was looking for

[Ms. Toad]

52. That's roughly what I"m paying.

On top of that, I've paid $233 for medical/hospital care (the anual deductible).

I've been hospitalized twice, had follow-up care for 2 cancers, two or three MRIs, a couple of X-rays, a HIDA scan (nuclear medicine test), 2 CT scans, an ultrasound, an ambulance ride, 2 ER visits (both resulting in hospitlaizations), costly blood tests, and my routine care. The total cost for that has been the $233 deductible. My father's plan is the same, except he has to pay $20 per doctor's visit. My mother's plan is more expensive, but includes paying for the deductible - so her costs are just the monthly premiums (her plan is not availalbe unless you are ~68).

I chose not to purchase AARP's Wellness plans which include dental/vision/hearing/silver sneakers. Those plans cost a bit more per month ($5 - $30/month with a slightly different pricing structure.) When we looked at it, the lifetime costs were enough higher that we rejected that option. But if you are looking for the more comprehensive and flexible coverage of a supplement plan and still want some of the "freebies" which MA often throws in, I'd go that route rather than a MA plan.

I also have a Part D (drug) plan. That is a separate part of Medicare. Some MA plans include drug coverage, some don't. When drug coverage is included in a Medicare Advantage plan, the coverage is subject to the Medicare rules (so you still get the donut hole, and after you emerge from the donut hole, coverage is at 95% - with no cap on your expenses for the rest of the year).

If I had decided to go with a MA plan, I probably would have chosen one without Part D bundled in. The formularies in Part D plans vary tremendously from year to year. Your costs for a particular medicine one year might be $108 the year you choose the plan, and jump to $1407 the next year (the actual difference we found for a single drug when shopping plans). Insurance companies count on you not shopping plans. If you buy drug coverage separately you can keep the MA plan you like (they tend to be more stable) and just switch your drug insurance plan for the best drug pricing. (Not recommending a MA plan - they keep the worst of how insurance plans operate, and are so heavily marketed people don't recognize until too late what they are giving up.)

Here's info on the donut hole, if you haven't encountered it before:

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap

My drug plan costs $12.90/month; my spouse's costs $7.10, so you can get a Part D plan relatively cheaply. We shop drugs and buy less than half through our plans. The rest we buy through Costco mailorder - which is significantly cheaper for many drugs. My anticipated total out-of-pocket drug costs for this year (including premiums) is $342.46, plus any new medications my doctor adds (which I couldn't predict at the time I priced things out)

Great job starting early! I hadn't planned on retiring until I hit 72 - so I hadn't even started exploring Medicare when I was unexpectedly retired in October, and had 2 months to research and make a lifetime decision. (Once you choose original Medicare, you are generally stuck with the carrier and Plan you choose for the rest of your life. The rules on switching plans (they don't have to issue you a plan; they can charge what they feel like) apply to changing companies, and sometimes to changing plans. on the AARP Wellness plans, you can switch to less comprehensive coverage but not to more comprehensive coverage for example. If you want more coverage, they price it based on your health at the time of the switch.

That was quite a crash course - I spent about 200 hours researching to sort all of this out and then choose a plan.

[kairos12]

27. I would never select Medicare Advantage. Too many snake clauses and hidden

traps regarding who you can see.

[moose65]

30. Medicare Advantage is not a "Medicare Plan"

Medicare is a government-run system. You can select any doctor you want. Medicare Advantage plans are private insurance plans, and the government pays a set amount each year per patient, even if the patient has very low health care expenses.

For example, let's say that you are in an Advantage plan and you are healthy and you have a good year in which your medical expenses are $5,000 (or pick any amount). Instead of the government paying that $5,000, they pay a private insurer a set amount (let's say $11,000). That extra $6,000 is pure profit for the insurance company.

Medicare Advantage providers have been grossly overpaid for years. The ACA tried to rein that in by reducing the per patient amount. Remember in 2012 when Romney and other Republicans said that Obama wanted to cut 700 billion from Medicare to pay for Obamacare? That was a lie. The ACA didn't cut a penny from Medicare. It cut payments to Medicare Advantage.

Medicare Advantage does have lower premiums, but there are high out-of-pocket costs if you have a serious medical condition. To me, it's a scam and a way to weaken and privatize Medicare. Brought to you by George W. Bush.

[keithbvadu2]

31. Previous discussions...

https://www.democraticunderground.com/100216622964

Katie Porter leads letter urging Biden not to dump more money into Medicare Advantage

After reading up on it, MA is more of a HMO and it was less risky to pay the Part B for better coverage.

https://www.democraticunderground.com/10142909182

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
---------
https://www.democraticunderground.com/1017732643
Get Medicare! No to Medicare Advantage. It's perfume-covered doo-doo that'll bankrupt or kill you.

https://egbertowillies.com/2022/04/30/get-medicare-no-to-medicare-advantage-its-perfume-covered-doo-doo-thatll-bankrupt-or-kill-you/
--------------------
https://www.democraticunderground.com/1261935
advice

[Emile]

39. +1

[LiberalFighter]

33. Medicare decides what is covered and the limit. Cap on what doctors and hospitals can charge.

I have a Medicare Advantage plan not available to the general public with over 500,000 members enrolled.

Medicare pays 80% of covered cost and either you or your insurance pays the other 20%. The key is covered cost.

I don't pay any premium. I researched to see what was available to the general public. Especially those claiming no premiums. My co-pays, deductibles, max out-of-pocket far better than for the general public. In addition, I have hearing, vision, dental, and Rx coverage at no additional premium. The available services and costs for them far lower.

Yes, out-of-network doctors and hospitals are higher but in most cases doctors are in-network.

[moose65]

36. What's the catch, then?

You have "no premium"? None at all? Isn't there an amount deducted from your Social Security?

Who is paying for your vision, dental, etc?

Why isn't your plan available to the general public? Do you mean that it's not available to everyone on Medicare?

[LiberalFighter]

50. It is part of my retirement benefit that was union negotiated.

I do have to pay for the Part B.

[Horse with no Name]

37. As someone who works with it from the provider side

The Advantage plans suck and not everyone takes them.
When I am scheduling surgical procedures for patients, those with traditional Medicare don’t have to wait weeks for authorization and the possibility of being denied.
They can have their surgery almost immediately.

[RicROC]

40. If the US gov't wanted to save Medicare,

it would not allow the insurance companies to piggy-back on the Medicare brand.

Medicare should sue to force them Advantage companies to drop the Medicare name.

[GoneOffShore]

41. I no longer have any skin in the Medicare game - But, it would seem that there are two disadvantages

to Medicare 'Advantage': It's a way to destroy Medicare. And it puts you at the mercy of the insurance company.

[JoanofArgh]

42. My mom is on Medicare and pays nothing if she's

hospitalized or for tests and procedures. Her coverage is awesome.

[Hotler]

43. HI, IT'S ME AGAIN......

[Skittles]

60. call NOOOOOOOOOOOOOOOOOOWWWWWWWWWWWWWWWW

OMFG.....JUST KILL ME

[Hotler]

62. Skittles you didn't finish. It could be what ?????

[Skittles]

63. (clapping my hands)

[Nanjeanne]

58. Get a Medigap Plan to supplement Medicare. My advice is Do Not get an Advantage Plan which

is a private insurance plan (subsidized by taxpayers -- but don't get me started on that stupidity). The Advantage plans are typically cheaper than what your Medicare plus Gap plan might be but are usually much more restrictive which might not be an issue when you aren't ill - but can become extremely troublesome when you are. And honestly, the Medicare plus Gap isn't a huge amount of money out of our pocket although more than the Advantage policies seem to be.

Anecdotal but here's an example. We spoke to advisor when we turned 65 and (luckily it turned out) when we said we wanted the freedom to go to any doctor, not have to deal with what state we might be in as we travel, wanted freedom to seek out specialists, etc. steered us to regular Medicare plus a Medigap Policy N. Medigap Policies cover the same things no matter where you are - so all N policies are the same, as are all C plans, etc. Private insurance companies that handle these plans compete by price and customer satisfaction. Some plans may not be available in all states - but the Medicare website (not the "fake insurance agent sites) can show you easily what is covered in each Plan A-N.

A few years into Medicare - my husband got diagnosed with multiple myeloma which is a blood cancer disease - termed incurable but "manageable". This was in 2014. Since that time he has had countless chemo treatments, undergone a stem cell transplant and most recently just did a new FDA approved treatment called Car-T. I cannot tell you how much money these treatments cost - it would be blow your mind. We traveled to Dana Farber to have his treatment overseen by a myeloma specialist - did his sct there as well. His regular oncologist is at Yale and he did his CarT treatment there. We have never had an issue with any doctor we wanted to see, or been turned down or had to jump through hoops for any regime he has been on in all these years.

My dear friend and husband wanted to save a few dollars and "loved" their Advantage plan . . . until she was diagnosed with a glioblastoma. Then they found out that even though they lived in New York City - they were only able to see doctors at one hospital in NY. Second opinions were very hard to get. They couldn't choose the surgeon they wanted and weren't able to travel to another state to seek medical advice. Glioblastomas are deadly - and unfortunately when it came time for hospice care - her husband was shocked to find that there was only one facility in Manhattan that he could access and it was not one he wanted to place her in. He found out that he could put her in hospice where he wanted it would have to be covered by Medicare. That meant 80% would be covered but the Advantage plan wouldn't pay anything and he didn't have a supplemental to cover the additional 20. So he went into debt to keep her at the hospice he wanted.

Research on the Medicare.gov website - and try to understand what you ultimately want from your healthcare and what you can afford to do. It's hard to know far in advance what treatments or care you may need but try to look at what is important to you. Switching from Advantage to a Gap is possible with some restrictions - and once you have become ill - you may find you have to wait a certain number of months, etc. It's a shame we have to do so much research and wade through so much confusion to simply get care but our system of healthcare is so screwed up . . . do your homework and think about your future needs before committing. My 2 cents!

[appalachiablue]

68. K/R Medicare v Medicare Advantage

[William769]

69. Medicare Advantage is out for one thing only, making money!

Want to get snarled up in out of network? Join a Medicare Advantage! Want not to have the doctor of your choice? Join a Medicare Advantage!

[Ron Green]

71. One risk pool is a health care system. Multiple risk pools is an investment scheme.

We have enough investment schemes in this country; we need a health care system.

[hamsterjill]

72. Okay, I'm going to be toast!!!

Just reading this thread has given me a headache! It’s all SO confusing. I hate dealing with insurance.

We should all have universal and complete healthcare. Vision, dental, the whole nine yards.

[RicROC]

73. When any insurance agent comes to my house to explain his product,

my eyes glaze over in minutes.

[hamsterjill]

75. Yep.

And I automatically expect to get screwed over.

[mackdaddy]

74. Medicare 'Advantage' is a private insurance plan paid for with Medicare funds.

Advantage plans have all the same limitations you have in any private insurance plan. In/Out of network doctors and facilities, and the need for pre-approval for services, and many have area limitations, and you may not be covered if you are traveling out of state. They can decide also that they do not cover some work just like other private plans. You insurance agent does get a slice for selling you on these plans.

Medicare plus the medigap plan (plus a drug plan) pretty much covers you for everything with a small minimum one time charge, although there are some low cost medigap that have less coverage. But real Medicare covers you everywhere and it taken by almost every medical professional.

Advantage plans were started during the W. Bush admin as a first step to privatizing Medicare. And it is working because people do no know this.

[Emile]

76. +1 Spot On!