Medicare question, supplemental vs. advantage?

[Luv2play]

When I read accounts like this I thank God I am a Canadian and have the benefit of our system of Medicare. I know it gets bad press in the US but my experience with it over the many years I have been retired is excellent and the only cost I have to pay is for a portion of my dental expenses, which are low as my teeth are in excellent shape. I pay less than $100 for prescription drugs per year. Any my eye care is totally covered except for the cost of glasses where I have private insurance that covers a portion.

And the beauty vof our system is that it is extremely simple to navigate. Sure we pay higher taxes but in the long run we pay less because we don't face these high co-pays and other premiums Americans do.

[Guest]

11 hours ago, Luv2play said:

When I read accounts like this I thank God I am a Canadian and have the benefit of our system of Medicare....

I'd think that most people who've actually crunched in the numbers know the Canadian system is wiser overall. In the US, we're actually paying for the bloated salaries of multiple healthcare insurance companies' CEO's and boards of directors, etc. There is no system in the world which is less efficient than the US from a financial perspective.

That being said, waiting times for many procedures is much lower in the US, so that is one thing which we do better. 

 

[+ bashful]

17 hours ago, jrhoutex said:

Not a stupid question. Yes, a supplemental plan is also referred to as a Medigap plan.  The supplemental plan fills in the gaps that Medicare does not cover.  If you don’t have a group retiree supplemental medical plan, then you would need to consider a private supplemental plan or consider the managed care options of a Medicare Advantage Plan. 

I’m in a similar situation.  I retired from an employer with group retiree medical benefits on the same basis as active employees.  When I turned 65 (in 2021), the group retiree plan becomes a secondary supplemental plan to Medicare.  Medicare is the primary insurance and once Medicare pays its share; the group retiree medical plan pays secondary.  If you have a group retiree medical plan, you likely don’t need another supplemental plan, unless of course you want dental coverage or vision coverage.  I also have those policies through my group retiree plans.

Upon retiring, the company’s retirement counselors made it clear that if you did not sign up for Medicare when you turned 65, the group retiree plan would only pay after you paid what Medicare would have paid. 

I also recommend the book recommended my @Act25and @MikeBiDude.  It helped me understand the complexities of Medicare.

Thanks so much.  Sounds like it’ll be easier to make choices.  A, B, and Supplement.

Does part D depend on if supplement includes prescriptions, or is it like A, and B, in that  D is primary prescription plan so need it, or if I choose D, then it is my Rx plan and supplement pays nothing even if it has prescription coverage?  I have some research to do.

I'm glad supplement is Medigap plan, as I recall seeing something that if you forgo Medigap plan, in favor of an Advantage plan when first eligible for Medicare, (and also mentioned in this thread), more difficult to move to a Medigap plan later.

Edited December 1, 2021 by bashful

[Epigonos]

I'm willing to pay what I do for my medical for TWO MAJOR REASONS.  1.) I get to select the physicians I choose not depend on the roll of the dice in some system that assigns physicians to patients randomly, and 2.) I don't have extremely long waits to set-up procedures like knee replacements, which are deemed elective, simply because I'm old. 

[MikeBiDude]

15 hours ago, Luv2play said:

When I read accounts like this I thank God I am a Canadian and have the benefit of our system of Medicare.

I appreciate the Canadian system and believe me I get a lot of odd looks from fellow small business owners when I say we should have full medical care for all here in the US!

I’ve only been on Medicare about a year, with a supplemental/medigap insurance program added (United Healthcare). I can’t complain about Medicare, and although I know there are some that have issues with it, it’s been a very clean transition for me. Even a couple phone calls to the government helpline have gone smoothly, and their website is easy to navigate and runs well. 

I’m saving money over my previous insurance, which was self insured and had gotten very expensive in the last 4 to 6 years. For me it’s been A blessing… With the exception of poor coverage for my Truvada. Supposedly that’s changing in the next 60 days with a generic my out of pocket costs will go way, way down.

[+ jrhoutex]

3 hours ago, bashful said:

Thanks so much.  Sounds like it’ll be easier to make choices.  A, B, and Supplement.

Does part D depend on if supplement includes prescriptions, or is it like A, and B, in that  D is primary prescription plan so need it, or if I choose D, then it is my Rx plan and supplement pays nothing even if it has prescription coverage?  I have some research to do.

I'm glad supplement is Medigap plan, as I recall seeing something that if you forgo Medigap plan, in favor of an Advantage plan when first eligible for Medicare, (and also mentioned in this thread), more difficult to move to a Medigap plan later.

@bashful - Since you have a group retiree medical supplement plan, you should check to see if the group also offers a Part D drug coverage.  If a company offers its retirees a group medical plan once you qualify for Medicare, it likely also offers a group Part D plan as well.  My former employer offers a group Part D plan to retirees that has similar benefits as active employees.  I have not seen any differences once I moved to Medicare with respect to the drug coverage using my former employer’s retiree group Part D plan.

If you opt for traditional (original) Medicare (Part A & B), then you need a Part D plan as well.  If you are shopping for a private Part D plan, check the formulary to insure it covers your current medications.  You likely will find different formularies from plan to plan. 

If you opt for a Medicare Advantage Plan, which is referred to as Part C, then you should check to see if they have a drug coverage.  Medicare drug coverage (Part D) is included in most Medicare Advantage (Part C) plans.

You should also check if your former employer offers a group Medicare Advantage plan to its retirees.  Some do. Group plans are designed differently.  My former employer offered its retiree's a group Medicare Advantage plan that is a nationwide PPO with the option to see any non-network doctor who accepts Medicare if they are willing to treat you.  The catch is only network doctors are required to bill the insurance company.  The retiree can ask a non-network provider to bill the insurance company but if they decline, the retiree would have to pay out of pocket and seek reimbursements from the insurance company.  Additionally, as will all Medicare Advantage plans, certain covered items require prior authorization.  I did not like all of the hoops to jump through and conditions, so I opted to stay with traditional Medicare and use my former employer’s group retiree medical plan as a secondary supplemental plan.  Traditional (original) Medicare with a supplement likely is more costly up front but provides freedom of choice and allows the doctors to make the decisions not the insurance company.  Medicare Advantage plans offer incentives like additional benefits – gyms, dental, vision, home delivery of meals after hospitalization– but come at a cost with their prior-authorization rules and medical case management utilization reviews. 

Edited December 2, 2021 by jrhoutex

[Guest]

8 hours ago, MikeBiDude said:

… With the exception of poor coverage for my Truvada. ...

It's already generic. It looks as though it's easy to get it for under $50 a month even without insurance:
https://www.goodrx.com/truvada

[Beancounter]

2 hours ago, Qualindron said:

If you're picking up a Medicare Advantage plan this year, you might wonder which one is best for you. It will depend on your situation, medical needs, how much you can afford, and other factors. Each plan offers options to meet your medical needs. If you have a chronic illness, SNPs are designed to help reduce some long-term costs. On the other hand, a PFFS or MSA plan can be helpful if you travel and need to contact non-network service providers. If you can't decide which plane to choose, I advise you to contact http://www.thefinitygroup.com.

It is customary to initially spell out abbreviations before actually incorporating them in a written narrative.   I have no idea what SNP, PFFS or MSA stands for.  
 

[BeamerBikes]

My experience from 2005 to 2017 as the long term caregiver and financial power of attorney for my mom with multiple providers. 

2 years preMedicare - Absolutely HATED private employer provider group health care from BlueCross "good" benefits.  Pre-auth/in vs out of network/rules 

In Medicare, opted for traditional A/B with pension provided supplemental including Drug benefit. It became easier.  Less uncertainty and overhead what was covered and how much.  Dental and Vision were out of pocket and needed to be planned for.  

One enrollment cycle Pension Plan switched everyone to Medicare Advantage.  Promised nothing would change. Could continue to see old providers.  WRONG.  At home care went out of network.  Quickly and forcibly had them change us back to traditional Medicare.  Advised the nice lady in benefits transfer out of this department for this year.  She was about to hear a crap load more complaints from others.  

I subsequently decided in the later years to go with the Cadillac of Supplement Plans that took care of 100% of the 20% copay.  It was worth the additional premium to only worry about the initial deductible in the beginning of the year and never process another bill for $5.87 or whatever chump change billshit.  

Medicare Advantage may be great for low health care needs, but once you or your loved one needs more regular advanced care. Switch to Traditional Medicare and big ass supplement plan to simplify the administration.  With Traditional Medicare - All you need to ask. Do they take Medicare or not?  If yes, everyone knows the rules and what's covered. I only had one provider refuse Medicare. 

[+ augustus]

On 12/1/2021 at 3:31 AM, Luv2play said:

When I read accounts like this I thank God I am a Canadian and have the benefit of our system of Medicare.

No Thanks!  6 months average wait time for medical procedures and Canada has fewer MRI's per capita than Turkey or Chile. There's even a year's long waiting list to get a PCP.  

[Luv2play]

1 hour ago, augustus said:

No Thanks!  6 months average wait time for medical procedures and Canada has fewer MRI's per capita than Turkey or Chile. There's even a year's long waiting list to get a PCP.  

On the other hand, the American system which incentivizes insured people to get needless tests, some of which are deleterious to their health and leaves the uninsured to get sick and die prematurely. 

Statistics show Americans are less healthy than Canadians and have a shorter life span . In fact shorter than in  most developed countries.

Edited November 23, 2022 by Luv2play

[Rudynate]

7 hours ago, BeamerBikes said:

My experience from 2005 to 2017 as the long term caregiver and financial power of attorney for my mom with multiple providers. 

2 years preMedicare - Absolutely HATED private employer provider group health care from BlueCross "good" benefits.  Pre-auth/in vs out of network/rules 

In Medicare, opted for traditional A/B with pension provided supplemental including Drug benefit. It became easier.  Less uncertainty and overhead what was covered and how much.  Dental and Vision were out of pocket and needed to be planned for.  

One enrollment cycle Pension Plan switched everyone to Medicare Advantage.  Promised nothing would change. Could continue to see old providers.  WRONG.  At home care went out of network.  Quickly and forcibly had them change us back to traditional Medicare.  Advised the nice lady in benefits transfer out of this department for this year.  She was about to hear a crap load more complaints from others.  

I subsequently decided in the later years to go with the Cadillac of Supplement Plans that took care of 100% of the 20% copay.  It was worth the additional premium to only worry about the initial deductible in the beginning of the year and never process another bill for $5.87 or whatever chump change billshit.  

Medicare Advantage may be great for low health care needs, but once you or your loved one needs more regular advanced care. Switch to Traditional Medicare and big ass supplement plan to simplify the administration.  With Traditional Medicare - All you need to ask. Do they take Medicare or not?  If yes, everyone knows the rules and what's covered. I only had one provider refuse Medicare. 

I'm under Kaiser's Medicare Advantage plan which is rated as one of the best.  It could be better - but having been a Kaiser member for 20 years, I have gotten used to doing my research and being my own patient advocate.  You can get nearly anything you want from Kaiser if you know what to ask for and then ask.  

My co-pays for two of the prescription drugs I take are pretty steep, but that is as much the fault of Medicare Part D as Kaiser.   During the pandemic, for doctor visits, they started relying very heavily on video appointments and telephone appointments, which they didn't charge for (a good thing).  But now, I think they have become over-reliant on remote visits.

I actually tried the AARP F plan (United Health).  After getting my health care from a staff model HMO for so long, it seemed weird, but I liked being able to choose any provider and using any hospital.  The United Health plan didn't include part D coverage.  I had to pay more than 50.00 extra for a part D plan that didn't cover anything.  It was because the part D coverage was so lame that I went back to Kaiser during the open enrollment period. 

[+ augustus]

3 hours ago, Luv2play said:

Statistics show Americans are less healthy than Canadians and have a shorter life span .

That's not because of the medical system.  It's because of homicides, drug overdoses and high blood pressure among certain groups.  Waiting 6 months for a hip or knee replacement is just terrible.  You can be in a lot of pain you know.  And the hospitals in Canada are pretty bad, with people lying on gurneys for days waiting for a room to open up.  It has been on the news numerous times. 

[BeamerBikes]

2 hours ago, Rudynate said:

I'm under Kaiser's Medicare Advantage plan which is rated as one of the best.  It could be better - but having been a Kaiser member for 20 years, I have gotten used to doing my research and being my own patient advocate.  .....

 After getting my health care from a staff model HMO for so long, it seemed weird, but I liked being able to choose any provider and using any hospital.

I tried to carefully caveat it.  Specifically as long as you are able to take the time and have the capacity to be your own advocate. You can put in the work to make Medicare Advantage deliver as promised.  

My experience came from managing complex medical condition with skilled nursing care involved that didn't always coordinate well with private insurance. It yielded surprise bills and fights for not getting preauthorized when it was scheduled outside of my control. 

When I compared the even playing field of Medicare and all providers knowing what would get paid for versus what's private pay with certainty, it took a significant administrative burden off me.  Kaiser as I understand it has the Western US pretty universally covered.   In the Chicagoland market, there was variability at play with long standing traditional Medicare providers not being in the Advantage networks.  Plus dementia care meant on boarding new providers held risk for knocking the dementia demons loose.  All that adds up for me to be sour on continuing the private insurer "benefit" versus universal coverage under a single national plan as traditional Medicare is. 

Again, it's my experience for my situation. I found private insurance via Medicare Advantage to be way too much hassles versus everyone takes Medicare. The cost savings didnt make sense for me. Why change to save money I'll end up burning through that money spending time fighting and paying bills.  My situation had a lot more provider services week to week so administration was key. 

[Rudynate]

1 hour ago, BeamerBikes said:

I tried to carefully caveat it.  Specifically as long as you are able to take the time and have the capacity to be your own advocate. You can put in the work to make Medicare Advantage deliver as promised.  

My experience came from managing complex medical condition with skilled nursing care involved that didn't always coordinate well with private insurance. It yielded surprise bills and fights for not getting preauthorized when it was scheduled outside of my control. 

When I compared the even playing field of Medicare and all providers knowing what would get paid for versus what's private pay with certainty, it took a significant administrative burden off me.  Kaiser as I understand it has the Western US pretty universally covered.   In the Chicagoland market, there was variability at play with long standing traditional Medicare providers not being in the Advantage networks.  Plus dementia care meant on boarding new providers held risk for knocking the dementia demons loose.  All that adds up for me to be sour on continuing the private insurer "benefit" versus universal coverage under a single national plan as traditional Medicare is. 

Again, it's my experience for my situation. I found private insurance via Medicare Advantage to be way too much hassles versus everyone takes Medicare. The cost savings didnt make sense for me. Why change to save money I'll end up burning through that money spending time fighting and paying bills.  My situation had a lot more provider services week to week so administration was key. 

True - Kaiser meets my needs in that way.  I have pretty high prescription drug costs.

[Guest]

12 hours ago, BeamerBikes said:

... I only had one provider refuse Medicare. 

I didn't know most providers took Medicare these days... 😜

[BeamerBikes]

6 hours ago, Unicorn said:

I didn't know most providers took Medicare these days... 😜

This is Medicare fraud I can get behind...  literally! 

[Luv2play]

18 minutes ago, BeamerBikes said:

This is Medicare fraud I can get behind...  literally! 

There may be penal consequences to such a fraud.😜

[Guest]

4 hours ago, Luv2play said:

There may be penal consequences to such a fraud.😜

Yes, crime will often get you in the end...

[+ JEC]

On 12/5/2020 at 4:31 PM, MikeBiDude said:

Follow up, I pulled the trigger on an AARP/United Healthcare supplemental policy Plan G, and with same group a Part D prescription policy.

There are many benefits to a Medicare Supplemental policy.  Just know these are "managed care" policies which means the ins co will require a lot of prior authorizations (for specialists, and some procedures) which also means denials.  They will also have a lot of control over directing what hospitals and step-down facilities you can go to.   A friend of mine works in a rehab hospital, many rehab admissions are denied and patients are sent to skilled nursing or home instead and their outcomes/recovery are much worse.  If you are used to the freedom of traditional medicare, you are giving up some of that freedom....denying these services is how they are able to pay for the additional benefits (and make a profit) since it's still costing Medicare the same or less to take care of you as a patient.

[Rudynate]

11 hours ago, JEC said:

There are many benefits to a Medicare Supplemental policy.  Just know these are "managed care" policies which means the ins co will require a lot of prior authorizations (for specialists, and some procedures) which also means denials.  They will also have a lot of control over directing what hospitals and step-down facilities you can go to.   A friend of mine works in a rehab hospital, many rehab admissions are denied and patients are sent to skilled nursing or home instead and their outcomes/recovery are much worse.  If you are used to the freedom of traditional medicare, you are giving up some of that freedom....denying these services is how they are able to pay for the additional benefits (and make a profit) since it's still costing Medicare the same or less to take care of you as a patient.

You're talking about Medicare Advantage - you can't go out of network for care without prior authorization.  Medicare Supplemental policies let you get care wherever you want.   I had Medicare Supplemental coverage for awhile, the AARP F plan through United Health.   I was just amazed at the flexibility it gives you.  You just go in , show them your Medicare card and you're good to go.  One year, I had been putting off getting a flu shot.  My husband and I were having lunch one day, and right next to the restaurant there was a Sutter Health Walk-in facility.   I went in, asked them if they did flu shots, they gave me my flu shot and I was done in about 15 minutes with nothing out-of-pocket. 

I was disappointed that the part D coverage was so lame because I liked the flexibility of going anywhere I wanted whenever I felt like it. 

A Medicare supplemental plan ends up being more expensive than Medicare Advantage.   The monthly premium was about 50.00 higher and then I had to pay an additional 50.00 for a prescription drug plan that didn't cover any of the meds I take.   I pay Kaiser a monthly premium of around 90.00.  The co-pays change from year to year - they keep going down.  I don't have any co-pay for labs, radiology involves various co-pays depending on the procedure - I think I had to pay 100.00 for a MRI. OTOH, I had a hip replacement last year and my co-pay was $200.00.