Medigap or Medicare Advantage that is the question.

[Little Star]

I am on SSDI and Medicare A&B. I am covered under my husband's insurance through his job for right now. I am trying to do the "math"(he has a very high premium)to see if maybe I should get off his and do my own Medicare thing. Needless to say I am clueless about this stuff.

My questions are:
What do you think is better Medigap or Medicare Advantage?
Will I still need Medicare part D?
What about secondary insurance, why would I need that? (I keep getting confused with supplemental/secondary insurance LOL)

Thanks in advance.

[MineralMan]

1. I'd avoid the Medicare Advantage

programs. They're HMOish and may well be eliminated under the current HCR proposals.

The typical Medicare supplements, which pay the 20%, generally cost about $100 a month, more or less, and seem to be a better solution.

[Little Star]

2. Thanks. With regular Medicare can I

choose my own doctors, that is if they will accept me?

[marybourg]

3. Yes. nt.

[Little Star]

4. Thanks marybourg!

[MineralMan]

6. You can. If you have a supplement, they're more likely to accept

Medicare patients. The Medicare Advantage programs are turning into denial of benefit agencies these days. Talk to your doctor's office about acceptance.

In some areas, where there's a shortage of doctors, acceptance of new Medicare patients can be a problem. In areas with lots of doctors, not so much. Here in the Twin Cities, the big clinic operations would go under without their Medicare patients, there's so much competition.

[Little Star]

8. If I go with Medigap will I need Part D for drugs?

[MineralMan]

9. That I can't answer. It will depend on what drugs you take.

If you can use generics, then one of the fixed-price deals at the discounters would probably work. I'm a veteran, so I'll be using the VA's prescription benefit instead, and I don't take hardly anything at this point.

If you rely on expensive prescriptions, then the Part D may be worthwhile. You'll have to do a comparison to see.

[Bitwit1234]

17. The Medicare Advantage are not accepted by a lot of clinics and

hospitals. They are considered to be as bad as the big insurance companies. They are what is draining Medicare. And the government is doing an audit to see what the problem. Besides my clinic told me they don't pay..they have some bills submitted to the Advantage Plan and have not been paid in over three or four years. The republicans thought this would give a lot of insurance companies a foothold in Medicare and it has been crashing Medicare ever since.

[quiller4]

23. I'd avoid them, too. This HMO approach can be a good deal for

a healthy senior looking for insurance that includes vision and dental but it does not do a good job for those with serious medical issues that require regular and expensive care.

[petersjo02]

5. Stick with Medigap coverage.

Medicare Advantage costs too much (including taxpayer money) and you're very restricted as to where you can get care, who will provide that care, etc. Much of the Medicare "reform" now being discussed/legislated is about cutting funds to Medicare Advantage plans that have never proved cost-effective.

[Cleita]

7. My experience with Medicare Advantage programs is from my husband's

experience. He signed up with one and in that moment lost all his Medicare rights. He was then subject to the HMO's rules. We found out the hard way that few doctors in our area accepted them so his choice of primary physicians was very narrow. Then we got stuck with ten thousand dollars in medical bills because when he had a stroke, we were out in the forest, and I called 9-11 directly after running a couple of miles to a pay phone instead of calling the HMO to get permission first. So they denied everything, the ambulance, the air ambulance, the hospital the MRIs, everything because we didn't follow that one rule. I switched him to traditional Medicare after that and got him a medi-gap policy, which worked out fine when he got end stage renal disease, which the HMO didn't cover either. I too, have traditional Medicare with a medi-gap. It costs extra, but if you have the money to do it, it's the best way to go. I have had few problems with it. I recently reluctantly signed with Medicare Part D, because my pills are getting too expensive. I'm not happy with the fact that you are forced to sign up with a private insurance company for it. There is no government option like there should be.

I would really like to see the Medicare Advantage and Part D programs phased out and replaced with a traditional Medicare that covers the 20% co-pays and prescription drug coverage. This would help the drain Medicare is feeling from the insurance companies feeding at the trough. This is why Medicare is going broke, the Medicare Advantage programs and Medicare Part D draining it. Get the insurance companies out and it will be solvent again. It can cover most basic care 100% with a little extra funding and it can be made solvent again.

[Little Star]

11. So sorry to hear what you had to go through when your

husband had that stroke. These Insurance Companies are out of control and I never cared for HMO's when we had them. Thanks for sharing your experience with Medicare Advantage. I think I'll stay with regular Medicare and get Medigap. I'll probably need Medicare Part D also, right?

[Cleita]

13. Eventually you will need Medicare Part D. depending on your drug

needs. I tried to hold out until this year because I was hoping a Democratic Congress would change the administration of Part D from traditional Medicare instead of handing it over to insurance companies. I hope eventually this is what will happen yet but I finally had to cave in or try to do without. However, I have to think of the burden on my family if I don't take certain drugs. I have osteoporosis and must take medicine to strengthen my bones or I could end up with a broken hip, which would be a big burden on them trying to get me around, so I had to do it.

[napi21]

10. It depends on what ailments you have.ie: I have severe back pain

and numbness in my legs and can't drive or walk very much for about 10 years, but I don't take any continuous meds. My husband takes BP & cholesterol meds all the time but nothing else. We both enrolled in an Advantage Plan which also includes Part D coverage. It's only $20.00 a month for each of us and the copays are $10-office visit, $30-specialist, $6-generic drugs, $20-preferred drugs, $35-name brand drugs, & a copay of 20%-drugs not in their formulary. A supplemental + a Part D policy would have cost us A LOT MORE!

My cousin however is a transplant patient and takes 28 different drugs every day & must have tests done every month. He's paying $395 for a supp. & Part D coverage but when he checked on an Advantage Plan, the copays on the tests etc. would have cost them more out of pocket.

I know Obama said he wanted to make the Advantage Plans play on an equal playing field, and they will likely change at some point, but the prices are locked in for 2010.

See if you can find a Medicare Insurance Specialist on the internet for the State where you live. The one I dealt with here in GA. was a hugh help in pointing out all the things about each plan that most people don't know & never think to ask about.

EDIT: Not all Advantage Plans are HMO's! Ours is NOT. Ours is a PPO & we can go to any Dr. that accepts Medicare.

[Little Star]

12. Well, those are some things to consider! I didn't know

they had Medicare Insurance specialists. Thanks

[napi21]

14. Yes. The guy I've been dealing with for 2 years sells nothing

but medicare supplementals, Advantage Plans & Par D coverage. They are licensed by State, so me giiving you his name wouldn't help you. BTW, I checked with buying the same policy directly from the Co. to make sure I wasn't paying a premium for buying it through a specialist, and the prices were the same.

[Cleita]

15. Do remember when you sign up with these private plans

that you give up your Medicare rights. You won't be able to change back to traditional Medicare until the enrollment period in December for the next year. So if things go sour in January or February, you are still stuck with them until the end of the year.

[DURHAM D]

16. "give up your Medicare rights."

Doesn't this refer to Medicare Advantage only? Actually I don't understand your advice.

With a Medicare Supplemental what rights do you give up for Medicare coverage?

[shraby]

18. We have a supplemental policy through our local

insurance agent. Haven't had to give up a thing, plus it pays any deductibles that Medicare has. It costs us around $145 or so per month for each of us...and haven't had to pay a dime to hospitals and doctors. Husband had a stroke, and had to go to the Froedert hospital in Milwaukee for further tests..none of it cost us anything.
We had Wisconsin SeniorCare ($30 per year) for meds because neither of us needed any until my husband had a stroke and suddenly had to go on part D. Wisconsin SeniorCare was acceptable as a drug policy so we didn't have to pay any penalty for not having part D. I'm still on Wisconsin SeniorCare because it's cheaper and if I ever need to go to part D, I won't have a penalty either.

[Cleita]

20. Yes, it refers to Medicare Advantage only. Where did you get the idea

that it also held true for Medicare supplementals? Medicare actually tells you when you sign up for a Medicare advantage program that you give up your Medicare rights. They are crystal clear about it but a lot of old people don't read the contract, like my husband didn't, so it doesn't hurt to remind them.

[Paper Roses]

19. I just recently signed up for a supplement to cover what Medicare

does not. I asked everyone I know over 65 and all had either Tufts or BCBS in my area. I also went to two presentations, one by each insurer. Both were meant to explain, they did not try and sell the policies at the meetings. BCBS told us they were eliminating some plans and there were some attendees who complained at the current rates and at the proposed 2010 rates.

At the Tufts presentation, all plans were reviewed and it was emphasized that we all sit back and study the info.Their plans were less expensive and I liked what they had to tell us. Everyone there left with a better understanding.

The whole thing is a crap game, what works today may not be the thing you need tomorrow.

My funds are very limited so I chose the least expensive Tufts plan. With $97.00 a month for Medicare, now $20.00 more for the least expensive, a chunk of my survival is gone.

My Doctors and almost all others I could look up in the area accept Tufts as the Primary payer as do the hospitals. The only thing I have to do is present my Tufts card first at the Doctors office. That way they will bill Tufts first and Medicare will then kick in. I have 3 months to review my policy and increase the coverage I have. You need referrals for specialists.

I find it comforting because now that I some extra have coverage, however meager, I will be more relaxed as I read about a possible upgrade. The policy I chose is only $20.00 a month. That really is the lowest offering. It does not include drugs. There are co-pays and deductibles. Less and fewer as the grade of policy increases. There are several options that include drugs. For now, at least,I am not picking up drug coverage. I can't give them another $40.00 a month.

I can only stretch the Social Security check so far. If you would like the name of the Tufts representative, PM me. He is very nice, describes well and will send you info.

It took me months to try and figure this out. No easy task. You have to find out just how much your husband pays for your insurance per paycheck. Estimate your medical and drug needs and see if a saving is offered worth the change. Investigate the various plan offerings, see if you will be better off. Usually company sponsored plans have good coverage. Some do not or will no longer offer the all-inclusive insurance like the old days.

All states differ, this was Massachusetts.

[Little Star]

21. PR, Thank you for the information. I also live in

Massachusetts. I was out on the web researching Mass Health (Mass's Medicare) on the MassGov site today. I might be eligible for it due to my disability and the fact that they put middle income families on a sliding scale and allow us to pay a premium to join.

After reading your comment I was wondering if you had applied for Mass Health as your supplemental. I thought that maybe you would meet the criteria. It may be worth looking into.

I also saw that we have something called a buy-in. If I'm reading it right, this program allows Mass Health to cover all of the Medicare Part B premium for Mass residents who are not getting any other Mass Health Benefits. So if you don't have Mass Health this might be available to you. It might help.

[napi21]

22. It is true that you give up your Medicare rights if you subscribe to

an Advantage Plan, but I think it's worth a look. The cheapest supplemental plan I could buy here was $115.00/mo. The Advantage Plan we have is $20.00/mo. Both have the same benefits and if I bought the supplemental, I would also have to buy a Part D policy at about $19.00. You have to look cloesly at what is covered and what ailments you have. Sometimes it doesn't poay if you have a condition that requires long term expenxive meds and testing, but it's sure worth looking at!