2018 State by State Available Medicare Advantage Plans
- Thread starter SeaBreeze
- Start date
OneEyedDiva
SF VIP
- Location
- New Jersey
Thank you for posting this SeaBreeze. I'm going to share it with my BFF who is now researching what plan to choose next year. I'm sure she'll look at more on her own but this is a great place to start.
mathjak107
Well-known Member
- Location
- bayside ,queens , ny
just be very careful with advantage plans . they can be penny wise and pound foolish compared to medicare and a supplement . i posted this in another thread but it is information hat can not be repeated to much .
i do like kaiser but even they have issues and traps . a for profit insurer is never my first choice compared to non profit medicare and a supplement . .
You need to evaluate these four criteria -
Generally, with a Medigap F/G, your Medicare-approved expenses will be paid 100%. For the most part, medical expenses are pretty much limited to Medigap premium (and Part D premium and copays if you take medication).
There are less expensive (premium) cost-sharing Medigap plans available, as well, but often these prove to be a false economy when managing chronic illness or worse. Copays and hospital deductibles can eat up any premium savings in short order.
If you are reasonably healthy and can afford some premium and the very low 20% not paid by Medicare the few times you doctor - then a high-deductible Medigap F, which, again, provides the most provider flexibility and caps your annual max out-of-pocket (your 20%) at $2,180, worst case scenario, all at one-half to one-third the cost of a regular Medigap F. Bills go to Medicare and your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2,180. Thereafter, the Medigap pays 100%.
If you're healthy, over a period of years, you'll probably be much further ahead financially with an hd-F. (If you haven't done so, as yet, strongly recommend you read this: Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?
If you are cost-conscious, then an Advantage (aka Medicare health plan) (if you're healthy - or, even if you're sick - depending on plan) can be an appropriate choice, as it bundles docs and drugs, for a low or zero premium. Pay close attention to:
If you travel a lot or snowbird, unless it is a PPO with out-of-network coverage, Advantage is not an appropriate choice.
If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.
Check with network providers and providers' billing people on ease of use, timely payment, preapprovals, insistence on use of generic drugs, verify with the provider that provider is, in fact, in that network - insurance reps and websites often are wrong - and talk to people you know who have the same plan.
Unless you are in a guaranteed issue state, know that once past the Initial Open Enrollment, you will not be able to switch to a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another Advantage plan during Annual Open Enrollment.
So, choose carefully, because there may not be a do-over if you decide later you prefer a Medigap.
i do like kaiser but even they have issues and traps . a for profit insurer is never my first choice compared to non profit medicare and a supplement . .
You need to evaluate these four criteria -
- your health
- your need/desire for doctor/provider flexibility
- your ability to pay Medigap (and Part D) premiums
- carrier reliability (especially true for Advantage and some Part D plans)
Generally, with a Medigap F/G, your Medicare-approved expenses will be paid 100%. For the most part, medical expenses are pretty much limited to Medigap premium (and Part D premium and copays if you take medication).
There are less expensive (premium) cost-sharing Medigap plans available, as well, but often these prove to be a false economy when managing chronic illness or worse. Copays and hospital deductibles can eat up any premium savings in short order.
If you are reasonably healthy and can afford some premium and the very low 20% not paid by Medicare the few times you doctor - then a high-deductible Medigap F, which, again, provides the most provider flexibility and caps your annual max out-of-pocket (your 20%) at $2,180, worst case scenario, all at one-half to one-third the cost of a regular Medigap F. Bills go to Medicare and your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2,180. Thereafter, the Medigap pays 100%.
If you're healthy, over a period of years, you'll probably be much further ahead financially with an hd-F. (If you haven't done so, as yet, strongly recommend you read this: Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?
If you are cost-conscious, then an Advantage (aka Medicare health plan) (if you're healthy - or, even if you're sick - depending on plan) can be an appropriate choice, as it bundles docs and drugs, for a low or zero premium. Pay close attention to:
- copays and max out-of-pockets, especially if you're sick or anticipate health issues.
- restricted networks - an issue if you need specialty care or if you travel a lot.
- drug formulary (tiers and copays).
If you travel a lot or snowbird, unless it is a PPO with out-of-network coverage, Advantage is not an appropriate choice.
If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.
Check with network providers and providers' billing people on ease of use, timely payment, preapprovals, insistence on use of generic drugs, verify with the provider that provider is, in fact, in that network - insurance reps and websites often are wrong - and talk to people you know who have the same plan.
Unless you are in a guaranteed issue state, know that once past the Initial Open Enrollment, you will not be able to switch to a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another Advantage plan during Annual Open Enrollment.
So, choose carefully, because there may not be a do-over if you decide later you prefer a Medigap.
mathjak107
Well-known Member
- Location
- bayside ,queens , ny
you can also pay more for advantage plans that have an an option that covers you when traveling , out of network however these can be very dangerous as far as exposure to very high un-covered bills .
as an example If you go to a preferred provider, BCBS pays 85% of the doctor's charges and if you go to a non-participating provider, BCBS pays 65%, but that's not the whole story. The preferred providers have already agreed to be reimbursed a certain price from BCBS, but the non-participating providers haven't, so they can charge you anything they want. BCBS will only pay 65% of the UCR (usual, customary, & reasonable) charges. For example, a surgeon or an anesthesiologist charges $2,000, but the contracted price with BCBS knocks it down to $1,000. BCBS pays $850 (85%) and your copayment is $150. However, if the surgeon or anesthesiologist is a non-participating provider and he charges the same $2,000, BCBS will only pay $650, which is 65% of the $1,000 UCR. You are then responsible for paying not only the $350 difference between BCBS's payment and the UCR, but also the other $1,000 that the anesthesiologist billed.
So the bottom line is that your copay with the "in-network" doctor is $150, but you're copay for the out-of-network doctor is $1,350. So you see, just because BCBS will reimburse you for any doctor you see, the amount you have to pay can be quite different.
THERE IS A CATCH 22 WITH ADVANTAGE PLANS WHERE THEY ARE NOT LIKE HAVING MEDICARE AND A SUPPLEMENT .
they are supposed to cover everything that medicare does by law . but the catch 22 is when it comes to approvals and course of treatment you have a for profit gate keeper .
when you need approval for a procedure that is not black and white you can't prove what medicare would have paid for since you don't have medicare and the insurers are well aware of the fact they got you and can deny things medicare would have approved and you can't prove otherwise without having medicare.
we have a friend who fell in to that gray area with a cancer procedure that was denied even though the surgeons argued this procedure is always paid for by medicare . without you specifically being approved by medicare in your specific case , the fact others were approved by medicare does not help the cause when your private insurer denies you . ..
millions use advantage plans with no problems , but they are the type of coverage where nothing is ever a problem until it is a problem . my buddy went years with no issues , then his wife got breast cancer . his out of pocket max was hit and was 4500.00 , but being it was the end of the year he had to pay it again a few months later so he got hit for 9k . but that did not include the 4500 out of pocket he had for his plan . so any savings he saw for years was gone in 1 year and cost him even more .
he was lucky , new york let him switch to medicare at enrollment . most states will not allow that and it requires the insurer to under write you and decide whether to take you or not .
as an example If you go to a preferred provider, BCBS pays 85% of the doctor's charges and if you go to a non-participating provider, BCBS pays 65%, but that's not the whole story. The preferred providers have already agreed to be reimbursed a certain price from BCBS, but the non-participating providers haven't, so they can charge you anything they want. BCBS will only pay 65% of the UCR (usual, customary, & reasonable) charges. For example, a surgeon or an anesthesiologist charges $2,000, but the contracted price with BCBS knocks it down to $1,000. BCBS pays $850 (85%) and your copayment is $150. However, if the surgeon or anesthesiologist is a non-participating provider and he charges the same $2,000, BCBS will only pay $650, which is 65% of the $1,000 UCR. You are then responsible for paying not only the $350 difference between BCBS's payment and the UCR, but also the other $1,000 that the anesthesiologist billed.
So the bottom line is that your copay with the "in-network" doctor is $150, but you're copay for the out-of-network doctor is $1,350. So you see, just because BCBS will reimburse you for any doctor you see, the amount you have to pay can be quite different.
THERE IS A CATCH 22 WITH ADVANTAGE PLANS WHERE THEY ARE NOT LIKE HAVING MEDICARE AND A SUPPLEMENT .
they are supposed to cover everything that medicare does by law . but the catch 22 is when it comes to approvals and course of treatment you have a for profit gate keeper .
when you need approval for a procedure that is not black and white you can't prove what medicare would have paid for since you don't have medicare and the insurers are well aware of the fact they got you and can deny things medicare would have approved and you can't prove otherwise without having medicare.
we have a friend who fell in to that gray area with a cancer procedure that was denied even though the surgeons argued this procedure is always paid for by medicare . without you specifically being approved by medicare in your specific case , the fact others were approved by medicare does not help the cause when your private insurer denies you . ..
millions use advantage plans with no problems , but they are the type of coverage where nothing is ever a problem until it is a problem . my buddy went years with no issues , then his wife got breast cancer . his out of pocket max was hit and was 4500.00 , but being it was the end of the year he had to pay it again a few months later so he got hit for 9k . but that did not include the 4500 out of pocket he had for his plan . so any savings he saw for years was gone in 1 year and cost him even more .
he was lucky , new york let him switch to medicare at enrollment . most states will not allow that and it requires the insurer to under write you and decide whether to take you or not .
Last edited:
Colleen
Senior Member
- Location
- Pennsylvania
