PSA - If you enroll in Medicare Advantage, you could be stuck for life

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75. More uninformed and mistaken information about Medicare Part C aka Medicare Advantage

(Although not a specialist in medicare I am a licensed insurance agent)

If the OP has any interest at all in providing accurate information as a PSA the OP will delete this OP.

Every statement I make will be backed up with a direct reference to a Medicare, .Gov source

To clear up some of the misunderstanding that is common here are the basics about A and B

Medicare A provides for hospital coverage for those eligible for Medicare @ 65 and there is no premium.

Medicare B provides for partial coverage of doctors and specialists fees. It has a monthly cost of $ 164.90 a month and you are automatically enrolled with A at 65



1) First of all Medicare advantage is Medicare Part C, not private insurance

https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf


Medicare Advantage (also known as“Part C”) is a type of Medicare health plan
offered by a private company that
contracts with Medicare. These plans include
Part A, Part B, and usually Part D. Plans may
offer some extra benefits that Original Medicare doesn’t cover.

Medicare Advantage is NOT privately funded insurance. Let me explain. The VAST VAST majority of Medicare Advantage clients choose a Medicare Advantage that has zero premium.

These plans are ADMINISTERED by private companies but the premium is PAID by Government.

Why was it set up this way? Medicare part C also known as Medicare Advantage has expanded benefits that involve more client management involvement than the simple reimbursement of A and B so it was decided to offer more Medicare benefit
but have it paid by the government.


Example: Medicare Advantage has a significant priority in incentivizing preventative health practices. For example they pay for basic gym membership (aka Silver Sneakers). My Medicare Advantage includes paid incentives if I do certain things:

Going to the gym $ 5 a month
Colonoscopy $ 40
Eye Exam $ 40
and so on

My wife gets additional incentive payments for

Breast exam
Bone Density

So not only does Medicare Advantage not cost me (and the vast majority) a dollar we actually get paid by the insurance company. Because of the detailed and individual nature of the benefits in Medicare Part C it was decided that it was better not to have a government agency administer it but to do it through private companies. All Medicare Advantage plans meet basic medicare requirements and are strictly controlled by medicare.

Some people choose to buy an Medicare Advantage Plan that has a monthly premium and offers additional coverage for prescriptions. For some people it is a big savings, for others it is an unnecessary expense.

The OP has it backwards, Medicare Part C are government paid plans (with some people paying for additional coverage).
Medigap helps pay for some office co pays but doesn't offer additional help on prescription drugs

https://www.medicare.gov/health-drug-plans/medigap/basics/how-medigap-works#:~:text=A%20Medigap%20policy%20is%20different,supplement%20to%20Original%20Medicare%20coverage.

A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage. When you’re getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can’t have both.

If you have a Medicare Advantage Plan, you can’t buy and don’t need a Medigap policy

To summarize:

Medicare Advantage is government paid insurance that is also known as Medicare C

Most people on Medicare C pay no premiums

You can actually get money back on most Medicare Advantage Plans

Medicare Advantage with no premium offers additional assistance on co pays and prescription drugs.

Medigap is paid by you, you pay the premium. The range for Medigap plans (aka Medicare part L, M and N)is between $ 59 and $ 310 a month. Again the average premium for Medicare Advantage is $ 0 for 70% of the recipients.



Seniors have 4 choices

1) Medicare A and B only

2) Number 1 plus a zero premium Medicare C

3) Number 1 plus a Medicare Advantage plan that has a premium and has additional prescription benefits

4) Number 1 plus a Medigap plan.


Which is best for you?

Even though I have been a licensed insurance agent for 20 years I could not answer that question and OPs like this one that prescribe one option is best for all are highly irresponsible. If I were an agent specializing in Medicare I would need a detailed list of prescriptions to input into the different plans to come to a conclusion.

What I can tell you is that there is no one who benefits most from option 1 (Medicare A and B only) because you can get (and most people do) a Medicare Advantage policy that has no premium but has additional benefits. Even though it is clearly preferable to get more benefits with no cost you will find DUers frequently post OPs discouraging people from getting Medicare Advantage even though it will cost them nothing.

What should you do to learn the actual facts and not be misled by someone who is completely uninformed about Medicare Advantage?

1) Read the links above which includes the official Medicare brochure that explains in detail what Medicare Advantage is.

2) Do not call the companies that advertise but find an independent medicare insurance agent that represents more than one company and ask for their recommendation. If they don't ask about your prescriptions, don't bother using them. If you are worried about finding the right one make an appointment with three different ones and pick the one that gives you the best plan.

3) Don't worry if you are not 100% happy with your Medicare Advantage. I am delighted with Humana but I know that they don't have many approved doctors in Yuma but have a ton in Tucson. If you are ever unhappy with your Medicare Advantage plan you can change in the next open season.

4) Don't get bummed out by all of the Medicare Advantage commercials. They advertise that way because the rules for client acquisition are very strict for Medicare part C. They can only respond to a query they cannot initiate the contact. I was in a Walmart once and stood next to an agent that had an approved table in the front. For three minutes I smiled at him and waited for him to say something. He smiled back but said nothing and I asked him if he could help me and invited me to sit down. He explained that he could not say anything to me until I made the first comment.



My experience with Medicare Advantage

I have Humana

My Medicare Advantage Premium is $ 0

My wife and I get about $ 200 every year back for participating in preventative incentive plans

I am an insulin dependent diabetic with diabetes, HBP and prostate meds and my total prescription cost is about $ 125 for three month refills.

Humana also provides very valuable guidance on health related issues. For example there is a severe doctor shortage in Tucson and after spending hours trying to find a doctor that would take an appointment before 2024 I called them up and had a doctor in 5 minutes. A call to get information about hearing aid options answered my questions in 15 minutes and it was better than the ENT doctors have been giving me for 20 years.


You wouldn't take medical or legal advice from a random poster on the internet so why would you take advice on Medicare insurance from a random poster with no links to government information on medicare. If you want to do it right find a Medicare agent that specializes in Medicare

I have been a licensed insurance agent for 20 years but don't specialize in Medicare and would not try to find the best solution without a licensed agent that specialized in it.