Medicare vs. Medicare Advantage (open enrollment ends Dec. 7)

[Morgana]

For anyone still wondering about Medicare vs Medicare Advantage, here's a pretty readable explanation from the New York Times.
You may be able to view it from the main URL:
https://www.nytimes.com/explain/2022/11/20/health/medicare-open-enrollment
If you hit the paywall, here's a "gift" link.

 

[justanothermaroon]

The reason I stay with traditional Medicare: "Advantage plans can also be problematic if you are traveling or spending part of each year away from home. If you live in Philadelphia but get sick on vacation in Florida, all local providers may be out of network."

 

[scaredycat72]

These are the 3 reasons I have traditional Medicare -

1. The VA providers most of my medical care.

2. Medicare Advantage providers get a set amount of money for each person and any money they don't spend on that person, they get to keep. So the more they deny a person's requests for medical care, the richer they become. I can't trust a system set up like that. - "Medicare Advantage plans, like traditional Medicare, are funded by the federal government, but they are offered though private insurance companies, which receive a set payment for each enrollee. The idea is to help control costs by allowing these insurers, who must cover the same services as traditional Medicare, to keep some of the federal payment as profit if they can provide care less expensively."

3. I'm not guaranteed to be in my home state when I get sick or need medication services. - "Adantage plans can also be problematic if you are traveling or spending part of each year away from home. If you live in Philadelphia but get sick on vacation in Florida, all local providers may be out of network."

 

[Morgana]

I was a bit surprised by how evenhanded/positive this article was toward Medicare Advantage. I've read other articles that were much more negative. (But I still like this article b/c it seems like a good all-round summary/explainer.) I agree with all of the reservations expressed about M.A above and I'm also sticking with traditional Medicare.

 

[Spaceman Spiff]

Those of you that don't have an advantage plans:
What do you use for Part D prescription drug coverage?

 

[Morgana]

Shop the different options and pick one? The website pretty much walks you through it.

 

[Oldwolf]

I attended a webinar for the Advantage plan offered by my employer (I am a State employee).
I asked that specific question, what do I do if I am traveling?
They said if the provider takes Medicare, they will honor them.

 

[user 423]

^But is that true for all MA plans? There's probably a lot of variation.

Also, I wouldn't necessarily take their word for it but would check the 'fine print'....YMMV

 

[Oldwolf]

Yes, I think it is highly dependent on the plan you have. I agree, always check the fine print.

 

[Steve]

Isn't there some sort of financial penalty for switching from Advantage to Medicare based on how many years you participated in Advantage?

 

[savana1957]

Isn't there some sort of financial penalty for switching from Advantage to Medicare based on how many years you participated in Advantage?

Stay away from Medicare Advantage. (SO many reasons). If you want to switch and you have been on MA for say a year you will be subject to underwriting and flat out refusals.

 

[Morgana]

Isn't there some sort of financial penalty for switching from Advantage to Medicare based on how many years you participated in Advantage?

I don't know, but the help desk at Medicare is pretty good, you could probably ask them.

Both are "Medicare" -- I think the terms are "Medicare Advantage" and "traditional Medicare"

Are you maybe thinking of the drug plan? I think that there's some sort of penalty if you don't sign up for a drug plan right away and decide you want it later. I wonder if having Medicare Advantage, where the drug coverage is just included rather than a separate policy, would affect that if you switched later.

Again, the help desk at Medicare might be able to answer -- or those nonprofits that help answer Medicare questions (I can't think of the names now -- SHINE? SHIP? -- they've been discussed here before) could.

Deadline's comin' up fast, folks...

 

[Camper]

.Lots of negative talk here on the Medicare Advantage plan, but I have it and am more than pleased with my provider.

Don't believe everything you read on this forum.

 

[user 22017]

I was a bit surprised by how evenhanded/positive this article was toward Medicare Advantage. I've read other articles that were much more negative. (But I still like this article b/c it seems like a good all-round summary/explainer.) I agree with all of the reservations expressed about M.A above and I'm also sticking with traditional Medicare.

Great find. I didn't think the author pulled any punches with Medicare Advantage. He/she explained the many pitfalls of Medicare Advantage. What they didn't explain is that states sometimes cover the fees for prescription drug plans (Part D) through Medicaid. I am just learning that part.

Got my Medicare Card today, but won't turn 65 until May 1. I'm not having much luck accessing sections of the Medicare website. Same for Ship. Think I will be able to access more on the websites come April 1 (one month before my birthday).

I was able to chat with someone via the Medicare site today. She confirmed that I need to contact Medicaid in Illinois about covering my deductibles and Part D.

I wonder if some states cover much more than others. Illinois is pretty good about providing healthcare and some states are even better. But I think some states don't offer much to their residents. If so, might be worth relocating... especially if you have multiple chronic conditions and/or pricey prescriptions.

 

[user 22017]

For anyone still wondering about Medicare vs Medicare Advantage, here's a pretty readable explanation from the New York Times.
You may be able to view it from the main URL:
https://www.nytimes.com/explain/2022/11/20/health/medicare-open-enrollment
If you hit the paywall, here's a "gift" link.

Thanks for the guest link, Morgana!

 

[VanGrrl57]

I have Traditional (Original) Medicare. My Part D is Humana (Walmart) Insurance which comes out of my Social Security. I thought about a Part C plan but I can't afford it right now. I did my research about the two different types but decided Original Medicare was the right choice for me. To each their own, though.

 

[user 423]

.Lots of negative talk here on the Medicare Advantage plan, but I have it and am more than pleased with my provider.

Have you had experience using it when traveling? That's a big factor for nomads. It seems a health care provider would just be able to charge traditional MC, so no big deal but your 20% might be pretty high.

 

[SLB_SA]

I have a Medicare Advantage ("Part C") plan and it includes Part D. I just checked and, if I went on (original) Medicare, I could get a Part D plan for under $3 per month. I pay $0 per month (in addition to $170.10 for Medicare) for my Medicare Advantage plan. What has been my experience with my MA plan? I have to pay copays; I just got a bill for $193 for a esophagogastroduodenosc I had in March, 2022 and I will have a 20% copay for a CPAP machine I will get in a couple weeks. No medical procedure has been turned down by my MA plan and they went to bat for me when my medical provider overcharged me. The copays have seemed reasonable to me and my overall coats (including copays) are less than a medigap policy would cost me. My policy includes no dental coverage except for semiannual cleanings and annual x-rays; unfortunately I needed an implant to replace a broken tooth and I had to pay 100%.

 

[bullfrog]

^^^Just wondering what your yearly maximum out of pocket is?

 

[mkoontz]

I am on the cusp of my initial Medicare decision. I am leaning towards a national MA plan. I do intend to save ~$150/mo to cover co-pays and other charges (about the premium of plan G) so at least I can keep the left over (not the insurance company).
I saw a YouTube video that compared a real-life hip replacement costs & all the appointments. These "total" costs included the premiums. Have a look at the picture to see how they compare.