General Discussion
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someone in this house needs to make some decisions (not me, I am YOUNG, dammit!)
do you have supplemental insurance or did you go with an advantage plan?
I know things differ by states but please tell me what you did and think about it.
thank you for helping!
18 votes, 0 passes | Time left: Unlimited | |
medicare a and b, that is all | |
1 (6%) |
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medicare and some other (please elaborate, if you would) | |
12 (67%) |
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an advantage plan (please elaborate, if you would) | |
3 (17%) |
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other (feel free to elaborate) | |
2 (11%) |
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Robb is a dingbat (guess I am not that young) | |
0 (0%) |
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0 DU members did not wish to select any of the options provided. | |
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medicare and a supplemental. The supplemental is paid by my former employer and they reimburse me what I pay for my medicare. Translation, my insurance is free, lucky me!
Kali
(55,019 posts)we are both self-employed (well, he is pretty damn retired LOL)
only offer supplemental. I retired from Calif Dept of Corrections Unit 4 Office and Allied workers.
rampartc
(5,432 posts)my former employer provides blue cross which handles, deductibles, copays, and drugs (except the copay on drugs. )
my wife has a pretty good advantage plan (peoples' health). she gets a few extra benefits i suppose.
too shabby either. I only have to pay prescription copay, I have one prescription, I order by mail, 3 months $10.
rampartc
(5,432 posts)for the expensive stuff bcbs likes their mail order plan (max of $40 per 3 month per prescription).
if i were paying copays on radiation and chemotherapy i would be quite bankrupt by now.
Kahuna
(27,311 posts)Popcorn 51
(84 posts)eventually got surprised with a bill that they did not understand because they did not understand their coverage to begin with. I have listened to married couples fight over the issue of who made the decision to go with Advantage instead of regular Medicare. Lots of anxiety as they get older and need more medical attention.
I have regular Medicare, plus a Medigap (Plan F) and Part D (prescriptions) for past 10 years. No surprises ever.
murielm99
(30,754 posts)It is wonderful.
A helpful insurance agent, who got nothing out of the deal, helped my husband sign up for Plan F. I went to the senior center and they helped me find the best Part D plans for both of us.
I think a lot of people need help wading through the Medicare thickets. We were lucky that someone made the right suggestions to us.
Kali
(55,019 posts)and earlier had pretty much decided he needed to go with supplementals but this morning it was coming across as being easier and the ones offered had vision and dental (though I didn't look into them yet and I am sure they are limited)
so I went from fairly certain to confused again.
notinkansas
(1,096 posts)We retained vision and dental coverage through my husband's employer.
I believe that the Advantage plans can limit coverage if you become seriously ill.
redstatebluegirl
(12,265 posts)NewHendoLib
(60,018 posts)A few months in, extremely happy. Ask anything!
A costs nothing, B is standard cost (148 monthly or so) - my supplemental (G plan) is about 100 monthly, D, which is parma (13 monthly) - so 260 monthly for me.
Friends encouraged me to not go Advantage - less flexibility with future changes
Kali
(55,019 posts)and have been fairly happy with them. I think I was looking at a k plan before but now i don't remember...so afraid to make a mistake here!
SMC22307
(8,090 posts)I'm about six years away but starting to pay attention. Although who know what it will be like when If finally get there!
ananda
(28,873 posts)Through Teacher Retirement System of Texas.
Kali
(55,019 posts)are you happy with it?
ananda
(28,873 posts)TRS-Care Medicare Advantage was offered as soon as I retired.
It's $75 a month and works fine. Part D is especially good.
The provider has changed between Humana and United, but
I can't really tell the difference.
My Medicare Part B, however, has gone up to $145 now since
I don't get SS. That part I don't like much, but at least I have
health insurance.
dflprincess
(28,082 posts)I'm in the rare postion that my current insurance is cheaper and covers more than Medicare. It also has lower out of pockets.
If you go with traditional Medicare you'll pay about $140 a month for B. You may also want to buy a supplement plan, plus a drug plan, plus a dental plan. (I currenty pay $135 for medical & dental, No deductible and a max out of pocket of $2500.. You see my dilema)
Medicare Advantage can be cheaper but it can also have big deductibles and narrow networks.
It shouldn't be this hard or cost so much.
Kali
(55,019 posts)and making the wrong choice has serious consequences.
yellowdogintexas
(22,270 posts)very much. Traditional Medicare has no networks
We went with A & B and I have a plan F. We also both have D. I had to change my D plan this year because I could only find one that would cover all 3 of my medications. However the premium is significantly lower so I am saving some $$
Takket
(21,609 posts)and we pay out the nose for it. it was only $122 a month in michigan when we signed up because the state fixed the price. when rethugs took over the state government they let the regulation lapse and now it is over $400 a month. but we really have to pay it because even though she doesn't run up that many medical bills in a month, if she were ever hospitalized it could bankrupt us.
medicare only covers 80% so even a $100,000 bill (which you can run up REAL fast) would leave us holding a $20,000 hospital bill we could never afford to pay. It is truly disgusting that this burden is placed on the disabled. her monthly benefit after medicare deductions, her prescription plan deduction, is a little over $600, then we pay the $400 gap, and that basically leaves us with $200 a month that goes into our bank account.
Fortunately I make enough money that we can get by with this cost, but most of the disabled are forced to pay Russian roulette. Get by with little, or get by with more but risk financial ruin for a major medical event.
Kali
(55,019 posts)do people on disability have the option for an advantage type plan?
Takket
(21,609 posts)if they do i would love for someone to correct me!
Big Blue Marble
(5,124 posts)You are only responsible for 20% of your Part B expenses if you do not have Supplemental
coverage. Part B coverage is for doctors and outpatients procedures. Part B is what
you are paying for. There multiple medigap plans you can choose that may reduce
your premium. Check the Medicare website or check with a knowledgable insurance
agent.
jpak
(41,758 posts)Supplemental is $19 a month with a HUGH amount of benefits.
dflprincess
(28,082 posts)Who is your supplement with? Thats the cheapest I've heard of. When I was looking t didn't see anything under $100.
jpak
(41,758 posts)Martin's Point
Big Blue Marble
(5,124 posts)Advantage care is less upfront, but essentially is a corporate HMO who will control and sometimes limit
your access to health care. Advantage Care was designed by the Republicans to privatize Medicare
and turn it into a profit center for insurance companies.
You will pay less monthly (there are co-pays not so with Traditional) with Advantage Care. Note
the clever name. If you are healthy, you may save money, but you will have less control if you
need care when it counts most.
Kali
(55,019 posts)not to say public-private partnerships are all bad, but there is the original background as you mention.
Jake2413
(226 posts)My wife and I have Medicare and a supplemental plan (F). Most expensive, I dont think it is available anymore, but in the 9 years we have had the plan we have never paid for any medical treatment, office visits to hip replacements. We do not need referrals to see specialists as long as they accept Medicare, we havent found any that dont. But you need to review supplemental plans not all cover 100%, see what works for you. Supplemental plans are offered by many companies but what each plan covers is regulated by Medicare and they are all the same just different pricing.
If I remember right the Advantage plans the like an HMO, where you get a primary care physician, pay a deductible, need approval for some procedures and to see specialists. Some do cover drugs and glasses etc. need to review what is covered. But I do like the freedom of my supplemental plan. It all comes down to what you feel comfortable with and what you can afford.
Take a look at Medicare.gov they will help explain.
Politicub
(12,165 posts)And I have a plan through the ACA.
Based on his ongoing needs for DME, the Advantage plan is a better value. It clearly lays out the costs for various procedures, so we havent been surprised after him being on the same plan for the past four years. It includes Part D coverage, too.
He is disabled, so he doesnt have access to all of the Medigap plans. Unlike Advantage plans, Medigap plans are not required to cover anyone who wants them if the person applying is not of retirement age.
Both of our plans cover doctors we have been seeing for over the past 15 years or so.
My plan is expensive, but it allows me the flexibility to avoid job-lock. We both need to get prior authorization for a lot of procedures. But that has been fine because the hospital group we go to has staff whose only job is referrals and prior authorizations.
Hoyt
(54,770 posts)You usually have choice of more doctors and hospitals, etc. You may also need a drug plan.
If money is tight, you might save a bit going to an Advantage Plan, especially if the insured is in relatively good health. But, there is a gamble with that.
You are not stuck in a plan forever if you want to change. But depending on what you do, there may be penalties. Plus, you need to change at certain times of the year. You really need to research the instances where you can change Advantage Plans and consequences of leaving an Advantage Plan and enrolling in traditional Medicare (and getting a supplement). It can be complicated, and you don't want to make a mistake.
If it person gets down to the time to go on Medicare and you still haven't decided what to do, I'd go traditional Medicare, supplement and drug plan. Good luck.
ProfessorGAC
(65,134 posts)Not me, but my wife. But, in 6 more months I hit Medicare, so I'll be going Advantage, too.
We're very pleased with my wife's plan, so we'll cover me the same way.
Depending on insurer & networks, I've hear supplementals are better. But, we found this Advantage plan to be the best coverage per cost.
Admittedly, we have the resources that we're not looking for the cheapest option. Just the best deal for what we get.
grantcart
(53,061 posts)I found mine at a Wal-Mart info booth.
You can Google for an agent in your area.
He/she will represent all of the plans in your zip code and can advise which is best for your situation.
When you have problems you call them instead of a computerised answering service.
Hamlette
(15,412 posts)I knew I'd be having knee replacement surgery right after retirement so I "bulked up" on insurance. I had 4 months of physical therapy after the surgery (my decision) and my total out of pocket for everything, physical therapy, surgery, prescriptions filled at the hospital, doctors, overnight at hospital, etc.etc. was $105.
I also have a prescription policy through Humana but I don't really know how much I save. The bills have gone up some in the 4 years since I retired. Currently the prescription bill is $53 per month and the supplemental is $162.
My employer (State of Utah) converted my unused sick leave to a Health Savings Account when I retired which we use for dental and prescriptions.
csziggy
(34,136 posts)J and K plans. I'm not which of us is on which one - my husband has a yearly deductible (about $180) and my plan has no deductible. We both also have drug plans (Part D), this year with a new company that has much cheaper plans than we paid for last year. Right now neither of us are on very many medications, or expensive ones. Previous years I got socked with meds costs.
A friend of ours worked for an insurance company and guided us through the options. I did some shopping around, but found his advice good. The plans he recommended were slightly more expensive but also more comprehensive, so we went with him.
One caution he gave me with the particular plans - there has been talk of phasing those out. If we went with a group plan such as AARP or other organizations offer, you really can't be grandfathered in when the plan is closed out. Since we are buying direct, we will be grandfathered in unless we cancel our plans or the company goes out of business.
The year I went on Medicare and began my supplemental I had aortic valve replacement. The only thing I had to pay out of pocket was the co-pay for drugs, nothing else. I'd only been on Medicare for two weeks when they did the MRI I'd been trying to get for six months. About three months after the MRI I was getting a new valve. MY ACA plan through Blue Cross had delayed - I suspect so I would be on Medicare before BC had to pay for it.
northoftheborder
(7,572 posts)VickiSmith
(32 posts)HUMANA Advantage plan which has $300 Vision and $1,000 Dental per year.
Just signed on at $109 per month.
IBEWVET
(217 posts)As our favorite do's do not take advantage plans. If I was less fortunate with money I would go with advantage plan.
peggysue2
(10,836 posts)Works for us!
yellowdogintexas
(22,270 posts)1. Part B Medicare is essentially non profit. It is allowed a small % of override per year to accomodate raises, rent, supplies, etc. Last time I read anything about it that over ride was 3 % increase from the prior year's budget.
2. Advantage plans are sold by commercial insurance plans and are designed to make money for them. Remember the CEOs and other senior officers of these companies are paid obscene amounts of money.
3. Advantage networks are tight. You may have to change doctors depending on the plan you choose. Ask your primary MD which plans seem to work best for their practice. Their office staff with be very familiar with the good, the bad and the ugly.
4. Part B has no networks.
5. You do not need a PCP visit before you see a specialist. The specialist has to document the consult.
6. Hospital based lab, radiology, anesthesiology and ER are usually billed under Part A although there are exceptions.
7. Medicare B does not pre X.
8. Traditional Part B has one deductible regardless of where you are when you need care. There is a national databank which every claim hits before the claim is finished to check how much deductible you already have. That has been working like a charm since 1976.
If traditional Medicare is tweaked a bit it would be a godsend for so many people.
If I were in charge there would be an annual cap on out of pocket costs, carryover deductible (meaning that if you did not start building your deductible until the 4th quarter of the year that amount would roll to the following year) So if I accrued $75 of my deductible in 2020 it would roll over to 2021. Medicare had this when I was a claims examiner; the system we were using way back in 1976 handled that just fine.
Children could be included, with coverage for well child care.
It should start out a public option on every employee benefit plan, and be available to anyone who does not have access to employee insurance.
It would need to be phased in because adding that size of a member base to a plan is a logistical nightmare. There are many ways to do this.
..
Greybnk48
(10,170 posts)We just were switched from Aetna to United Health, and so far so good.
Backseat Driver
(4,394 posts)Haven't had a doctor since I fired mine when the office told me my ACA plan was accepted; true, but all out-of-network! It's all we can do to make bills on the reduced SS we "earned" under serial unemployment since the '80s, so DH is now an "essential: convenience store clerk.
As seniors, it became quite clear that he had aged out of usefulness in IT after age 40; and pretty much contracted foreign and automated software made my work obsolete (voice to text). Used to have a supplemental Anthem policy, but the company screwed up an e-mail used to send the bills and when DH discovered that fact, it was evidently not possible to re-instate it. I had a dental policy once too; I used it twice to begin care, but dentist said my BP was off, so no further scheduled services in the care plan could be accomplished, and it was weird but this insurance company also failed to send premium notices (didn't go to Spam either) so the policy evidently lapsed or business closed(?). The feds capture any refunds of taxes to apply on student loans for the kids. Who knew he was so unemployable when the loans were doable and a good downsizing retirement plan was in place. SS never adjusted DH's payments in his 66th year as required. When finally noted, they wanted $16K back in overpayments. DH is an only child who attended the needs of his dad's costly final illnesses. We lost our Countrytime-mortgaged home in a bait-and-switch to 2nd tier lending and our savings trying to save it. Did we make errors in judgment - yes probably; but it's difficult not to explain our problems as being "targeted" by greedy GOP policies. It's also difficult to not feel abused and disenfranchised by my country.
After DH retired, it's been clear we can't afford healthcare other as noted above. I've used Medicare a total of 3 times for flu and 1st CoVid shot provided by a pharmacy, fully covered. DH has used it once for an Urgent Care visit to get a script for antibiotic for a sinus infection - result: $105 bill plus an out-of-pocket prescription. If it's not covered, we don't use it because the 20% would even be problematic.
As we head toward really old age, sooner or later the SGTHTF healthwise; it's terrifying!
panader0
(25,816 posts)So about two months after I turned 65, I got a call informing me that I qualified for AHCCCS,
or access as it's called here. They are better than insurance. They covered my hernia surgery
100%, and will cover my cataract surgery later this year. Jeannie and I both take eliquis for DVT.
and my prescription for a month is about a dollar. Jeannie's is $497. Unreal.
Sometimes being poor has advantages.
AHCCCS doesn't cover everything, but what it doesn't cover I don't want.
in2herbs
(2,947 posts)with a medi-gap policy. I don't think a lot of people understand that anything and everything that Medicare offers must be offered in an Advantage plan at the same price that could be obtained through straight Medicare. If you find that your Advantage plan cannot meet this Medicare care requirement you can change plans. For instance, just this week I changed my H's insurance plan because his Medicare Advantage provider did not have any in-home physician care in our area. The new provider begins on March 1, but until then he's still covered under his old provider. I can tell you that the govt comes down hard on Advantage providers who can't/won't meet Medicare requirements. His old insurance provider kept giving me names for in-home physician care referrals but each one I contacted said they didn't service our area even though they claimed to service our zip code. A few years ago, H's soon to be old insurance provider was on a one year suspension for violating their Medicare requirement. They could not write any Medicare policies during that year and before they could get off suspension they had to prove that they could meet Medicare care requirements.
So now the question is did his soon to be old insurance provider know that the parties they were subcontracting with could not meet Medicare requirements, or did the subcontractors dupe the insurance company? When I spoke to the Customer Service Center at H's current insurance company she asked if I wanted to file a complaint about this. I said yes and while on the phone she typed out the complaint, read it to me for my approval, and forwarded it to the insurance company legal department. I have a feeling they are all going to be blaming each other. I have already started getting calls from insurance administration officials.
In summary all Advantage Medicare plans must provide the same price and coverage as does Medicare. This does not change state by state. The only difference in the two are the frills such as dental, eye glasses, etc., and what they charge for these frills (RX optional).
dflprincess
(28,082 posts)(Minnesota Senior Health Options). It's Medicare and Medicaid combined. My mom was on it and it was incredible coverage, even covered hearing aids. No premium or deductible, just some small copays on prescriptions (like $2 when Mom was on it). The problem with it was/is your income has to be so low to qualify.
Bur, whenever I hear "Medicare for all" I think MSHO for all is what we really need.
Tree Lady
(11,482 posts)Was part of a states PERS for retirement and benefits. He was a train driver for BART in SF.
When he retired early we stayed on Blue Cross because he paid extra all the years he worked, then at 65 got A & B and a supplement through them.
I am still on Blue Cross but will join him when I turn 65 this summer.
I know we have choices but whatever choice this one is and I don't know it works great we hardly pay anything for him.
Greybnk48
(10,170 posts)We just were switched from Aetna to United Health, and so far so good.
rgbecker
(4,834 posts)sign up to add a supplemental policy at any sign up period (Nov.) so you can put off deciding without penalty. I think there are a couple of states that do the same.
Wife and I are healthy with no meds. We put off getting a Supplemental plan until just this year, when we each turned 73. We saved $2400/yr for 7 years by doing this. Now, if something comes up, the supplemental at about $100/mo. each, will cover the 20% Medicare doesn't. Hopefully we won't need it, but chances are higher now as we age. Also our savings have grown because of the recent market run up and so funds were available that weren't 7 years ago.
We started the Med D drug coverage with the cheapest plan offered ($20/mo each just to avoid the 10% premium penalty if we waited. We heard from many that even basic drugs were very costly and didn't want to be hammered. Neither or us has benefitted from those polices so far.
I believe the Advantage plans are not available to people in Mass now unless you were on one when you started Medicare. Those plans seem to require use of "In network" service providers and if you are not in an area that has them, trouble. This should be considered if you think a move in retirement is in the cards. Many people do change their address as they want to move to be near kids or to get into better climate or to an income tax free state.
Big consideration seems to be smoking and over weight problems. These issues affect people the most and we have not had problems because of that. The Doctors pretty much can tell if you have smoked or not just by seeing what problems you have. So this would be consideration in deciding if you need more or less coverage. That is no way saying we are not all subject to accidents and a list of hundreds of medical issues, but Medicare will most likely keep you out of bankruptcy court and so protecting your assets would be what you are looking at. If you don't have any assets to lose, all the more reason to not bother with the extra coverage and plan on moving to Medicaid when you finally are broke.
ironflange
(7,781 posts)I live in Canada.
Liberal In Texas
(13,567 posts)Have regular Medicare A & B and a supplemental from my employer when I retired. Covers Rx.
Medicare is easy to understand and never denies coverage. Just wished it covered 100% so we wouldn't need the supplemental.
myccrider
(484 posts)I have Medicare A, B, D and a medigap (plan G) through United Healthcare. My copays are minimal but it does cost a few hundred dollars more a month than an advantage plan. I havent had to be hospitalized, but the costs are supposed to be specified/controlled by the plan you pick. Hopefully, itll be a looong time before I have to find out if it really works.
My husband has his Advantage plan through Kaiser and its been wonderful for him. He had a stroke 7 years ago and Kaiser was fabulous. No surprise billing or costs and minimal copays, they took care of all his care including rehab hospital. We did have to foot a larger part of the bill for some brief at home care, though. Thankfully, he recovered to 95% of pre-stroke function and hasnt needed any further medical treatments, except a blood thinner.
I have a mild form of a rare genetic condition that now causes me chronic pain, among other complications. I was in Kaiser at first, too, but their pain management team in our area was run by a crusading idiot of a doctor who objected vociferously to my using medical marijuana to reduce my opioid use (Im in California and this was between the time medical marijuana was instituted and just before it was completely legalized) while simultaneously insisting that I reduce my opioid use without offering any other reasonable alternatives. He always treated me like a drug abuser, too, although I had letters from all my previous doctors declaring that I never exhibited abusive behaviors wrt my meds. I had been taking opioids for over a decade before I became his patient.
My, admittedly very cautious, attempts to go around him were rebuffed by Kaiser. He declared that Id never find a "real doctor" who would give me the prescriptions while I used MJ. It took me 2 weeks to find one who was better qualified than he was and listens to me and gives me the benefit of the doubt about what I tell him! It was about 9 months before I could change insurance, so we paid out-of-pocket for me to see the new pain specialist.
One of the happy consequences was that the new guy is an expert in a procedure that he has since used on me that has, in fact, reduced my pain! The Kaiser doctor had told me he didnt recommend this procedure for me because he didnt think I was a "good candidate" so Kaiser wouldnt give it to me!
So, Kaiser is a mixed bag. My husband and other friends love it. The problem is that if you dont have one of the "cut-and-dried" health conditions they are very good at treating and/or you get one of the lesser doctors, you have more limited options for getting the specialized care you may need.
KentuckyWoman
(6,690 posts)Just remember, you only have to live with it a year.
I had an advantage plan my first 12 years on Medicare. It covered most drugs also. Only what they took a month out of my social security check. No copays for primary care and a lot of routine tests. No co-insurance, deductables. It was easy. The downside was a limited group of docs and facilities, but in my area that worked out fine.
Until it didn't.
I needed surgery and my husband was in hospice already. I went into it too tired from full time caregiving. I assumed the hospital got all the needed approvals. Turns out the anesthesiologist was not in network. The bill was $12000 to me.
I switched to straight medicare with the AARP United Healthcare supplemental. It's costing me an extra $219 a month for the supplemental. I have never seen a bill, and EOB, nothing. If medicare covers it, United Healthcare pay every penny of the rest. I have NO other costs. I also pay for a drug plan. That's where the real pain the butt is. However, I've been on the insurance plan for a few years with several medical surprises, but everything was covered. Both years, what I paid in premiums to the supplemental more than paid for itself in savings. It has been the "easy" button for me.
I know people who are only on medicare and don't carry a supplemental. They have been lucky so far with no big health issues. The small amount they have to pay that medicare doesn't, isn't adding up to the extra expense of a supplemental. For them, advantage plans with limited networks are not appealing for whatever reason.
My advice, once you decide keep a spreadsheet if you can of all expenses, what was paid for you and what you had to pay. The next year for enrollment you will have a better guide to help you decide.
Kali
(55,019 posts)I could tell that you could switch advantage plans during enrollments, but I could not figure if you could actually switch from supplemental to advantage or viceversa. that really takes a load off!
oasis
(49,398 posts)Keep those responses coming. Thanks