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Medicare Advantage or the Original Medicare?


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4 hours ago, Kirk W said:

My medicare advantage plan pays well. I just had major surgery that cost me only $400 out of the thousands billed. For dental I can have two fillings and an extraction per year. They also pay for a pair of glasses every year. But I don't need all of that every year.

I take a medicine that is $245 a month but I certainly don't pay that, either.

I have Humana Choice.

Linda

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I have long been amazed by the deluge of advertising for these policies by a wide range of insurance companies. I learned many years ago that for profit companies do not spend vast amounts of money on advertising unless there is a big profit generated by that advertising. Since our primary care physician does not do Advantage plan patients, I went looking to try and find the reason. Such plans do seem to work well for at least some people, but that doesn't change the question of why the advertising. Here are some examples of what I have found. 

Misleading Ads Driving People To Sign Up For Medicare Advantage Plans (Kaiser Health News), NOV. 7, 2022

Finally, Some Accountability for Medicare Advantage Ads  The National Committee to Preserve Social Security and Medicare

The Truth About Those Medicare Advantage TV Commercials   (Forbes) Nov 12, 2021

You can also get some very interesting reading if you use Google and search on "are medicare advantage plans good or bad".

Edited by Kirk W
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1 hour ago, Mark and Dale Bruss said:

Remember Medicare Advantage is a form of a HMO and not the best kind of plan for an RVer because of travel outside your medical area.

There are multiple Medicare Advantage PPO plans that work across the country. Many of us have and use them. Very happy with our Medicare Advantage PPO plans that we've been on since we've been eligible. Our out of pocket costs are negligible. Jay

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52 minutes ago, Jaydrvr said:

Our out of pocket costs are negligible.

I must admit that one of the reasons we have not considered an "advantage" plan is the fact that my previous employer supplies us each with an HRA to cover the costs of our Medigap premiums, part D, premiums and nearly all of our other out of pocket expenses. Even so, companies do not advertise to sell a product that makes little or no profits. 

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The primary reason we don't use a Medicare Advantage plan is because we don't like having an insurance company dictate to us which doctors we can go to.  My wife just had retinal surgery and we researched and found a doctor who we believe to be the most qualified retina surgeon in south TX.  We didn't have to worry about whether or not he was "in network."  Not all doctors have the same backgrounds or skill levels; that's just a fact of life.

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1 minute ago, docj said:

The primary reason we don't use a Medicare Advantage plan is because we don't like having an insurance company dictate to us which doctors we can go to.  My wife just had retinal surgery and we researched and found a doctor who we believe to be the most qualified retina surgeon in south TX.  We didn't have to worry about whether or not he was "in network."  Not all doctors have the same backgrounds or skill levels; that's just a fact of life.

Our zero additional premium UHC Medicare Advantage plan lets us see in-network providers anywhere in the country, but we can also see any out of network provider we choose at a higher co-pay. An network specialist for instance has a $40 co-pay (drops to $35 next year), and an out of network specialist co-pay is $75. Urgent care and ER services are covered at the same co-pay regardless of in or out of network. So far, we've never had to pay an out of network co-pay.

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There are different Medicare Advantage plans!  The zero cost plans can be rather basic but there are plans that pay for nearly everything.  Ours is an employer provided plan that doesn't have a deductible and a maximum out of pocket of $150.  The prescription benefits have also treated us well.  We can go anywhere that accepts Medicare in network or out of network.  There aren't additional costs for out of network.

Edited by Randyretired
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1 hour ago, Randyretired said:

There are different Medicare Advantage plans!  The zero cost plans can be rather basic but there are plans that pay for nearly everything.  Ours is an employer provided plan that doesn't have a deductible and a maximum out of pocket of $150.  The prescription benefits have also treated us well.  We can go anywhere that accepts Medicare in network or out of network.  There aren't additional costs for out of network.

That's a good deal for you of course, but not one that's available to many others. I wouldn't call our UHC PPO plan "basic". They've paid thousands for my wife's cancer and COPD treatments, with our out of pocket costs less per year than most supplement plan premiums. We pay $16/mo for our prescription coverage, and our highest co-pay is $20 for a 90 day supply. All of my meds are $0 tier 1 prescriptions.

Edited by Dutch_12078
clarity
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15 minutes ago, Dutch_12078 said:

That's a good deal for you of course, but not one that's available to many others. I wouldn't call our UHC PPO plan "basic". They've paid thousands for my wife's cancer and COPD treatments, with our out of pocket costs less per year than most supplement plan premiums. We pay $16/mo for our prescription coverage, and our highest co-pay is $20 for a 90 day supply. All of my meds are $0 tier 1 prescriptions.

Basic was probably a poor choice of words.  What I was trying to point out is that many want to put all Medicare Advantage plans together.  They are as different as the supplement plans.  Just because it is an advantage plan doesn't mean it is good or bad.  

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4 minutes ago, Randyretired said:

Basic was probably a poor choice of words.  What I was trying to point out is that many want to put all Medicare Advantage plans together.  They are as different as the supplement plans.  Just because it is an advantage plan doesn't mean it is good or bad.  

I can agree with that. Due diligence pays off.

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3 hours ago, mike5511 said:

My daughter works in the medical field. She advised us that nobody she knows in her career field likes  Medicare Advantage. She told us NOT to switch to it. FWIW

Does she say they also don't like Medicare itself? Advantage plans cover everything Medicare does plus more...

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Medicos will often consider reimbursement/income when talking about insurance, versus coverage and costs. Just had the same discussion with my med student son who, like most of his classmates, is on government insurance because of no income. Irony defined. Med students are poor, and often remain poor for a significant time after getting their MD/DO while they serve their training hospital for a relative pittance per hour. 

As for me, second generation Kaiser lifer. Will swap to their advantage plan when the time comes. Not a perfect system, but we know it well and how to get what we need. 

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7 hours ago, 2gypsies said:

And right there continuously at the bottom of the screen is their 800 number so they can sell you a new and expensive plan. The article doesn't exactly seem unbiased or accurate to me. The fine print says "powered by Elite Insurance Partners". Jay

Edited by Jaydrvr
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7 hours ago, 2gypsies said:

This may shed some light on your questions:

Here are some comparisons from sources not part of the insurance industry.

Compare Original Medicare & Medicare Advantage   from Medicare.Gov

The Pros and Cons of Medicare Advantage     from Consumer Reports November 3, 2022

"Advantage plans (also called Part C), on the other hand, provide the benefits of Parts A, B, and often D, usually for about the same amount, with lower copays, so there’s no need for Medigap. Some also offer benefits not in Original Medicare, such as fitness classes or some vision and dental care. Sounds good—but be wary. Choosing between the two requires careful consideration of your finances and health needs. And Advantage plans can carry hidden risks, especially for people with major health issues."

Top Advantages & Disadvantages of Medicare Advantage   from ValuePenguin.com

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9 hours ago, 2gypsies said:

As Jay said, that article is quite biased obviously. I did get a good laugh from their list of "disadvantages" though, since our zero additional premium Advantage Plans have none of the ones listed. Our annual out of pocket costs for instance, have consistently been less than most supplemental plan premiums for the 12 years we've had them. Our coverage is nationwide, requires no referralls, and the only annual changes have been to the better, such as additional coverage and lower co-pays. Our PCP co-pays for instance have gone from $15 to $10 to $0 over the years, and our specialist co-pays from $45 to $40 and next year to $35. Our Part D coverage includes $0 co-pay for Tier 1 drugs. The bottom line is doing your homework before choosing a plan that fits your medical needs at the lowest cost from a reputable company pays off.

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2 hours ago, Kirk W said:

Here are some comparisons from sources not part of the insurance industry.

Compare Original Medicare & Medicare Advantage   from Medicare.Gov

The Pros and Cons of Medicare Advantage     from Consumer Reports November 3, 2022

"Advantage plans (also called Part C), on the other hand, provide the benefits of Parts A, B, and often D, usually for about the same amount, with lower copays, so there’s no need for Medigap. Some also offer benefits not in Original Medicare, such as fitness classes or some vision and dental care. Sounds good—but be wary. Choosing between the two requires careful consideration of your finances and health needs. And Advantage plans can carry hidden risks, especially for people with major health issues."

Top Advantages & Disadvantages of Medicare Advantage   from ValuePenguin.com

Thanks, Kirk, those are much more balanced articles. As I've said before, do your due diligence to find the best fit for your circumstances. Our UHC Medicare Advantage Plan has worked quite well for my wife and I for the past 12 years, and we've found no reason to switch so far.

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5 hours ago, Dutch_12078 said:

Thanks, Kirk, those are much more balanced articles. As I've said before, do your due diligence to find the best fit for your circumstances. Our UHC Medicare Advantage Plan has worked quite well for my wife and I for the past 12 years, and we've found no reason to switch so far.

Don't shoot the messenger!  I was trying to find a reason why the poster's daughter said doctors don't like Advantage programs since he hasn't returned to reply.  BTW.... Kirk's link from 'Value Penguin' also states they may received some compensation.

The site I referenced sells all kinds of insurance... Supplement and Advantage.  

Again, here is a 'possible' reason that the poster's daughter made her statement.

 

"If you ask your doctor how they feel about Medicare Advantage plans, the answer may surprise you. The average physician is not a fan of Medicare Advantage because these plans put the patients’ financial risk in the hands of the doctor.

The Medicare Advantage plan carrier will pay the doctor a set amount of money upfront based on the patient’s diagnosis. So, the only way the physician will make a profit is if they stay under budget. If they don’t say under budget, they end up losing money. Meaning, you may not receive the full extent of care.

Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services."

Again.... this is from the link that sells Advantage plans.

Not all the plans are a one size fits all.  I agree with you that everyone needs to investigate which one is best for them.

 

Edited by 2gypsies
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Nearly half of the people on Medicare use Medicare Advantage plans and that number is expected to be more than half soon.  The plans are all different and it takes considerable research to see if one is right.  The ability to change back to regular Medicare after a year could be in jeopardy. 

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1 hour ago, sandsys said:

Pretty much everything in life "can".

You are quoting the author, Penelope Wang as if I had made the statement. Go read the article before you criticize the messenger who posted the link. 

Edited by Kirk W
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2 hours ago, Kirk W said:

You are quoting the author, Penelope Wang as if I had made the statement. Go read the article before you criticize the messenger who posted the link. 

Sorry, I didn't mean to be criticizing you. I knew I was quoting the article but the quote system on this forum didn't.

Linda

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