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Finding a new doc that accepts Medicare or an advantage plan is difficult in many areas. I have found that many will accept new patients with regular insurance but not medicare. Medicare and the advantage plans do not pay as well. That said my DW has an enhanced advantage plan from her prior employer and she has had excellent care in multiple states. Most of the times we can search and find a facility that accepts it. If necessary we can turn in the bills our selves and pay the facility. I would not want to have just Medicare without a supplemental plan as the portion not covered could overwhelm my budget. In fact I know a person that ended up in banktuptcy relying on Medicare only. Illness can strike at anytime and the older we are the more likely it is to happen.

Randy

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No supplement may get you by for a few years. But when needed and you don't have it could get real expensive in a hurry.

 

I had never been in a hospital or had any major health problems in my first 65 years. But after 65 things changed. I did get a supplemental F at 65.

 

Cataracts and Cancer came after that. My 20% for the next 11 years varied a lot.

Had 5 years the average was $358.14 a year :)

The other 6 had a lowest of $1,133.47 to the highest of $11,314.06 or the average of $4,615.51 a year. :(

 

Paying the high monthly rate for my F plan. I am still way ahead $$$$ if I didn't have it.

And not even counting what I have saved by having a Part D plan.

 

And I always thought my health was good also. I don't know what some of my friends have had to pay out for cancer treatments, knee & hip replacements etc. for their 20%.

And almost all of them has needed something done. And the rest are not here any more.

 

Good Luck with your health staying good for a long time. Odds are probably as good as buying a lottery ticket. :(

It is not if but when you will need good health insurance.

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No supplement may get you by for a few years. But when needed and you don't have it could get real expensive in a hurry.

 

I had never been in a hospital or had any major health problems in my first 65 years. But after 65 things changed. I did get a supplemental F at 65.

 

Cataracts and Cancer came after that. My 20% for the next 11 years varied a lot.

Had 5 years the average was $358.14 a year :)

The other 6 had a lowest of $1,133.47 to the highest of $11,314.06 or the average of $4,615.51 a year. :(

 

Paying the high monthly rate for my F plan. I am still way ahead $$$$ if I didn't have it.

And not even counting what I have saved by having a Part D plan.

 

And I always thought my health was good also. I don't know what some of my friends have had to pay out for cancer treatments, knee & hip replacements etc. for their 20%.

And almost all of them has needed something done. And the rest are not here any more.

 

Good Luck with your health staying good for a long time. Odds are probably as good as buying a lottery ticket. :(

It is not if but when you will need good health insurance.

 

Ditto.

Everybody wanna hear the truth, but everybody tell a lie.  Everybody wanna go to Heaven, but nobody want to die.  Albert King

 

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Thanks JM, Kirk, Barbaraoak, Randy Retired and Biker56. I just have to start with Medicare and Part D and see what happens. That is the best I can do for now. But I have thoughtfully considered every response here and appreciate all points of view. I know I have a well-rounded view of all of this now, and I did not know all this before.

 

I have one final question, please.... if Supplements are good wherever Medicare is accepted, does this mean that if Medicare is not accepted at the offices, then your Supplement won't get you in, either?

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I don't believe they will since the supplemental is tied to the amounts Medicare doesn't cover?.

 

Here is a link that may provide more info for you. https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html

 

What's Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

 

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

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Finding a new doc that accepts Medicare or an advantage plan is difficult in many areas.

 

I don't think you can generalize and lump Medicare with supplementals into the same pot as Medicare Advantage plans. The Advantage plans are HMOs and they do not have to have the same fee structure as traditional Medicare. Many seniors are attracted to Advantage plans because they often don't cost any more than just the part B premium.

 

I hate to say that you get what you pay for, but it an Advantage plan promises to give you the benefits of a Medicare supplemental without any of the costs I figure something has to give somewhere. It's an HMO, need one say any more.

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The Advantage plans are only HMO's if that's what you choose. We've had Advantage PPO's since we became eligible. Of course, availability varies by location. The plans have worked quite well for us. YMMV.. Jay

 

What area are you in and how far a field can you travel? For people who stay in one area an Advantage plan might be a great deal. But if you are fulltiming, the ability to see anyone who takes Medicare is very important. We switched primary care physician two years ago to AZ where we spend the winter. No questions asked, Medicare paid their share, our supplemental paid the rest. We never see a bill.

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My DW Advantage Plan is a PPO that provides excellent coverage and we have not had any problems finding care. In fact she has the option of regular Medicare with a supplemental plan or this advantage plan and we chose the advantage plan. All of this is provided by her former employer at no charge. They said as long as the provider accepts Medicare they will cover her. If the provider doesn't accept the plan we can submit the claims from the providers bill. When she had Medicare and the supplemental plan we found we had to keep a close eye on the billing due to numerous errors. Now it is a simple copay of $5 to see her doc ($10 for specialists) and all of the rest is full coverage. We are thrilled with it. She also goes to the Mayo Clinic and the same copays apply.

 

On edit Not all advantage plans are the same. This one also has a good prescription benefit.

Randy

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When she had Medicare and the supplemental plan we found we had to keep a close eye on the billing due to numerous errors.

 

 

I don't know what carrier she had for her supplemental, but my wife and I have had Plan F supplementals under Humana for ~18 months and we've not paid one cent to any provider nor have we had any billing issues.

Sandie & Joel

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What area are you in and how far a field can you travel? For people who stay in one area an Advantage plan might be a great deal. But if you are fulltiming, the ability to see anyone who takes Medicare is very important. We switched primary care physician two years ago to AZ where we spend the winter. No questions asked, Medicare paid their share, our supplemental paid the rest. We never see a bill.

 

Our UHC Advantage Plans have a "Passport" feature where we can tell them where we're traveling if we need services, and they direct us to participating providers at our normal in-plan co-pays. The Part D coverage is good anywhere, as is urgent care and ER coverage. We can also use non-plan providers anywhere at a higher co-pay. And our budget really likes the $0 premium.

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docj, Sounds like you have a good plan. My DW has used her plan a lot unfortunately but there is no way we would consider going back to the supplemental plan. Both are written by United Health Care. I just wish I could get the same plan.

Randy

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What area are you in and how far a field can you travel? For people who stay in one area an Advantage plan might be a great deal. But if you are fulltiming, the ability to see anyone who takes Medicare is very important. We switched primary care physician two years ago to AZ where we spend the winter. No questions asked, Medicare paid their share, our supplemental paid the rest. We never see a bill.

Our residence and enrollment are in Ohio. Our situation is a little different, as we travel full-time for work. I choose Anthem Blue Cross specifically for their extensive nationwide provider network, and have been completely satisfied so far. Coming from high deductible, self employment coverage, it's an incredible value. Our primary care physician, etc. are in Florida, where we winter. We actually have never used the Advantage plan in our home state of Ohio.

 

 
 
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docj, Sounds like you have a good plan.

 

My wife and I both have Supplemental Plan F. All Plan F policies have exactly the same benefits regardless of who is the carrier. That's true for all Medigap supplements. We enjoy the ability to go to any health care facility in the US that accepts Medicare without having to clear it with anyone. We can consult specialists without needing referrals. And we get $50k of emergency care in Canada where we like to vacation.

 

Yes, we pay a premium for that and everyone has to do the risk/benefit calculation for themselves to determine which solution is best for them. We are fortunate in that my prior employer pays about half our Plan F premiums each year.

Sandie & Joel

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docj, My DW advantage has the same benifits as you have as does the supplemental plan her previous employer offers. The advantage plan simplifies everything for us. Had she had just Medicare last month our cost would have been thousands. With her advantage plan our cost was $10. My only point is there are a few advantage plans that rival some of the best supplemental plans. A few months ago my DW doc wrote her a prescription for a drug with a cost of over $13,000 a month and the prescription needed to be shipped overnight and required a signature upon delivery. Her cost was less than $50 a month for however long she needed to take it. This advantage plan works well for us and we intend to keep it as long as we can. We have never found a hospital that wouldn't take her plan. When my DW had a supplemental plan I found a number of errors by the provider and the supplemental plan and my guess is that there were more because of how difficult it is to to decifer medical billing. I know I saved Medicare hundreds from billing errors and I found billing payments that did not meet their obligations that saved us a sizeable amount. Now we just pay the small copay and the Insurance company and the provider can figure out the rest. We don't even see the bills. Mayo Clinic has some of the finest docs I have ever seen and they charge 15% more than Medicare approves hut thier billing leaves a lot to be desired. Now we just pay our copay and let the provider and insurace company figure it out.

Randy

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docj, My DW advantage has the same benifits as you have as does the supplemental plan her previous employer offers. The advantage plan simplifies everything for us. Had she had just Medicare last month our cost would have been thousands. With her advantage plan our cost was $10.

 

I'm not going to debate you on this; clearly your plan works for you and your wife and that's great.

 

But for the benefit of others who may not fully understand the complexities of Medicare and its supplements, there are Medicare supplements, specifically Plans F and G, which have no copays and which pay your entire hospital bill for any doctor and hospital that takes Medicare. If you've never priced them, these plans cost ~$150/mo for someone at age ~70. You do not have to have an Advantage plan in order to be free of residual hospital costs. My wife has an annual visit to MDAnderson that results in a ~$10k bill. I've yet to pay Anderson a dime for anything other than parking!

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Docj, et al. There are some very good and true points in all this dialogue but not everyone is feeling the same part of the elephant.

 

  1. Your address of residence, primarily state, determines just what choices you have. As a NC resident, I would have a choice of 9 plans not including Advantage plans. As a SD resident, that is trimmed down to just 3 so what works in Ishkuta may not even be on the radar in Des Moines.
  2. The cost of Rx meds keeps going up and in a very non-linear manner so no generalizations can be applied. Fentanyl patches, as an example, were only $1.50 per box. Now, even with a great supplemental PDP (Prescription Drug Plan), they still cost $30. They don't cost anymore to make and probably less. The more critical the drug the faster and higher the prices seem to escalate. Insulin is a great example of this. For a type II diabetic it might not be life dependent.... just yet but for a Type I diabetic, it is essential but it costs the same for both patients.
  3. The issues of picking coverage that DocJ mentioned a few pages back, can be "biggies" for some kinds of conditions as they age. An all encompassing plan that initially "overlooks" certain aspects typical to a medical condition during the original signup, may not be available later. It's like buying life insurance when you are 30 versus trying to buy the same policy when you are 70... your age will likely make things look different to the underwriter even if your BP, Heart condition and other baseline tests are exactly the same, and then, said life insurance cannot be bought at any price, To pay a little more (don't count nickels and dimes) when trying to buy a new car, buy what will work for you in the long term because things change and you might become stuck with it with no other choices.
  4. I choose my doctors based on how well we work together to solve my problems. If a Dr. is not working for me, I pick another one. This is not always an option in an HMO, thus PPOs often offer more flexibility. When traveling, most Advantage plans do offer a "way around" the non local nature of their format but in those cases it will cost you something more and some conditions may not be covered "out of area". The only way to really determine the right combination is to work with a brokering agent that does know all the plans, loop holes and pot holes in all the plans to help you pick what will fit you best. Often, what works best for one spouse is not what will work best for the other so they need to be sized to the individual and maybe resized each year the new enrollment period comes around. We use OneExchange and a few others have been mentioned but trust me, a broker is one place you don't want to just dismiss out of hand because you think you know it all well enough. These guys are the only place you can go to get a level playing field to start with. They can tell you if your cheaper choices may haunt your future options and changes.
  5. Prescription drug coverage is something that can change dramatically each year so look at the details very closely. A few things people don't usually know about them is that the enrollment period in the fall of one year, sets the coverage for the next 12 months starting in January but the pricing changes in June so only half of the new year's charges are based on what you are told in November. A common trick is changing the drug tier and not all drugs are included in the same tier by each supplemental policy.. Different carriers may tier the drugs differently and not match the medicare tiers, either. This can happen in June, too. If medicare changes the tier of your Rx to a higher one the plan you are locked into may suddenly not cover it or require a higher co-pay for it. This, of course, can happen mid year and be additive to your already higher Rx costs if you are in the GAP. Pay attention; this is a real pocket dumper!
  6. A biggie in this arena can be the "GAP" coverage. Since one falls into the GAP based on retail pricing and not on what you (or your insurance) have actually paid for them, it can appear long before you are expecting it. Some of the PDPs offer monthly costs breakdowns by month for your drugs so you can see when you will fall into the GAP based on your own list of Rx meds. USE these charts to get a feel for just when your Rx costs will go up and consider GAP coverage as a significant aspect of picking your PDP supplement. You don't have this option for an Advantage plan.
  7. Discount Drug plans and coupons: Pay attention to these, they are not all bogus hype. We have both gotten meds cheaper on a discount drug coupon than on our own PDP and in a few cases, saved half of our out of pocket costs for an essential drug. Most pharmacies have available discount plans but one usually has to ask. Some want to charge for their plan, some don't but most pharmacies will accept most of the discount plans. I have had Walmart cover my dog's Rx on their own discount plan when neither my own PDP nor any of my 5 discount drug plans would cover it. It pays to ask even if you weren't brought up that way. It is important to look a gift horse in the mouth to be sure that you will actually be better off with it.

I doubt anyone actually read all of that but it is all very important to understand and to work through in detail, especially if you are just turning that critical 65 and entering the medicare complexity. If one is fortunate enough to be well heeled and does not need any of this, I applaud your resourcefulness and ambition. I wish we could afford to avoid this whole white whale..but,for us, that is not an option. Whatever you choose just know that it will change so don't be surprised when they happen and it costs you more than anyone ever told you it would. It's like skeet shooting on a ship.

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It is my understanding that the Medicare Advantage Plans that Medicare pays for do cost

more then regular Medicare. But Medicare pays the extra cost and not you. I don't know what that extra cost

is but it is in addition to your Part B. You don't have to pay extra. I have been looking into an Advantage plan

and for my Part B cost I am to receive: Part A, Part B and a drug plan (Part D). Good Luck

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Docj, et al. There are some very good and true points in all this dialogue but not everyone is feeling the same part of the elephant.

 

  1. As a SD resident, that is trimmed down to just 3 so what works in Ishkuta may not even be on the radar in Des Moines.

 

I'm not going to go through all your points, but this one caught my attention. According to the health insurance brokerage we use, in SD there are four companies selling a broad range of Medigap supplement policies and three companies selling a number of varieties of Advantage plans. I didn't count all the varieties of policies in both categories but there were quite a few.

 

Your statement makes it sound as if there are only 3 choices available in SD and that simply isn't the case. If your broker isn't providing you all this information then I would suggest finding a different one.

Sandie & Joel

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Medicare Advantage Plans recieve a subsiday from the goverment. I believe it is about 350 a month.

c u on the road

 

That's not quite how it works. Medicare pays Advantage plan providers in accordance with "capitation" rates they propose. There is not a specific subsidy relative to traditional Medicare. Advantage plans exist because the health insurance industry lobbied Congress to include them claiming that they could provide the same coverage for less money. The data has consistently shown this not to be the case. I believe that as of 2009 it was calculated that Advantage plan participants were costing the government ~14% more for the same coverage compared to those in traditional Medicare.

 

Under the Affordable Care Act, payments to Advantage plans are being reduced to bring costs more in line with those of traditional Medicare. This is a hotly contentious topic and virtually any website you can find is heavily biased on one side or the other of it.

 

In comparing ti benefits of traditional Medicare to those offered under Advantage plans it is necessary to examine the full spectrum of benefits, not just the ones you are using today. Under the rules for Advantage plans there can be tradeoffs in the costs of different types of benefits. For example, plans that require higher out-of-pocket costs than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits so you might not notice the tradeoff unless you needed to use that benefit.

 

However, the fundamental difference between Advantage PPO's and HMO's and traditional Medicare is that the choice of doctor and medical facility is limited to those that are "in network" unless you're prepared to pay the cost for using out of network facilities. We're willing to pay a premium to have the ability to go anywhere we want for medical care. That's a personal decision and everyone has different circumstances to consider in deciding what is best for them.

Sandie & Joel

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"" As a SD resident, that is trimmed down to just 3 so what works in Ishkuta may not even be on the radar in Des Moines. ""

 

For SD and I assume most states, how many companies offer what supplement plans, varies by County and by which of the A-N supplement plan variations you want. In my SD county there are 4-5 providers offering F or G plans; in other SD counties there are 12-14 providers offering F or G plans. Also, not every company offers all plans in all Counties. I believe they are all required to offer at least Plan A and either C or F, the others are all optional. So some counties may have 30 companies offering Plan A, but only 3 offering M or N, etc

 

I would also add emphasis to your comment about how difficult it can be to change your supplement plan years later. Its important to put lots of thought into your initial choice, including considering what your health & financial circumstances may be in the future. When you first turn 65 you get a free pass on any pre-existing conditions and can't be denied your initial choice of supplement coverage. But years later if you develop some health issues, the "underwriters review" requirements can make it impossible to change companies or change plans within the same company.

Jim

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When you first turn 65 you get a free pass on any pre-existing conditions and can't be denied your initial choice of supplement coverage. But years later if you develop some health issues, the "underwriters review" requirements can make it impossible to change companies or change plans within the same company.

 

Changing Medicare supplement policies is complicated. The "new" company doesn't have to cover you, but if they do then they can't write pre-existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy. If you'd like to read more about changing your supplemental policy you can use this link: https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html

Sandie & Joel

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"" The "new" company doesn't have to cover you, ""

 

That's the only point I was trying to make, for those just getting into Medicare Supplements. Not only for a new company, but your current company does not have to allow you to change plans. I recently wanted to change from my F plan to a G plan, staying with the same provider, and was refused due to "underwriters review" of my medical records.. When I signed up at 65, the difference in premium between the F and G was minimal and it made sense to pay a few extra dollars a month to not have to deal with the Medicare deductible separately. Now over 3 yrs later there is a significant difference in the F & G premiums, since the F premium increases were significantly more than the G increases over the last several years. So it made sense now to pay the deductible myself, since the premium difference was almost twice the annual deductible (that's the only diff between F & G). same provider, same benefits, just a difference in who covers the deductible; sorry, no can do based on your health records. We will continue to cover you under your existing F plan (because they're required to), but we wont allow you to change plans, and presumably no other provider would sign me up on a new policy now that I'm not guaranteed coverage. So I'm going to be stuck with the choice I made at 65 forever. Not that it was a bad choice, but I thought I'd be able to change my choice down the road. Nope, only if you're in perfect health, plan ahead.

Jim

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