Medicare Advantage Plan...Yes or No?

Stephanie

New Member
The process for picking a health insurance plan can be overwhelming. How do you know if you’re picking the correct plan? Will the ‘cheaper’ monthly premium cause issues when you’re trying to seek care? What if you need physical therapy, will it cover that? When people are selecting their insurance plans, they need to balance out the monthly premium compared to what their potential out of pocket costs could be.

I have first hand experienced this working in aging services. I work in a facility where we primarily serve seniors who fall in the low-income bracket. Many of these seniors have opted for a Medicare Advantage plan because of their limited financial resources each month. A Medicare Advantage plan are sometimes called “Part C” or “MA Plans,” and are offered by private companies approved by Medicare. Medicare pays these companies to cover Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage (Medicare, 2015).

Medicare Advantage plans have several positives that draw the consumer in. Some of them are: convenient coverage plans (all your coverage is through one plan), personalized plan structure (many different plans are offered that you can tailor to your individual situation), cost saving opportunities & coordinated medical care (Lockett, 2019). Some disadvantages are: limited service providers, overwhelming number of plans offered (making a decision could be difficult), additional costs for coverage & state-specific coverage (Lockett, 2019).

I personally don’t believe that Medicare Advantage plans really serve individuals better; especially the elderly clients. The residents that I have known to select an advantage plan is because they don’t pay a monthly premium. Which is very attractive, especially to a senior that has low income. Where I have seen a gap widen is when this resident needed outpatient physical therapy services. The resident had to pay a $35 co-pay for each therapy visit. This amount alone in one month is more costly than if they would have decided to keep their traditional Medicare plan. So while it may seem like an advantage plan is a good choice in the short term it does provide significant financial challenges when the person does seek care.
 

Geezerette

Senior Member
I have had a Medicare Advantage plan since I was eligible, quite a few years, very satisfied. I don’t want to mention it’s name but it was operated by a large non profit hospital system. I thought the copays were very reasonable and actually lowered over the years. Just this past January I switched to the BCBS MAP because the hands on care in the old plan had gotten poorer in quality as many providers moved away or retired and in the last 2 years prior had some unpleasant experiences and felt like I was being “processed “ rather than cared for. Putting more $ into bricks and mortar than they knew how to staff.

My BCBS plan actually costs less, no monthly premium, zero copays for many meds and primary care visits, and so far very satisfied with providers, especially the way they are managing care during the pandemic. I feel I’m a good judge of quality for my situation because I’ve worked in health admin in both inpatient and outpatient settings in areas of standards compliance. Have had quite a bit of PT with the old plan, (joint replacements) & never more than $20 an hour. Same now with the BCBS PLAN.

One disadvantage to just being on traditional Medicare here & some places is that providers may have a quota on how many traditional Medicare patients they will accept, partly due to lags in reimbursement. Many MAPs also offer free side benefits like the Silver Sneakers gym membership program. Spent many free hours swimming laps etc in a nice health club.
 

terry123

Well-known Member
Location
Houston, Tx.
I have a Humana PPO advantage plan that has worked well for me. This week I will have in home PT and OT and will not have a co-pay. I have not been here in awhile. I had gall bladder surgery and a problem with BP meds. Trying to get better now at home.
 

Aunt Bea

SF VIP
Location
Near Mount Pilot
I have a BCBS PPO with zero premium and it's as good as the underlying Medicare program.

BCBS is coordinating my care with Medicare for a fee paid to them by the government and working to control costs by negotiating with various healthcare providers.

BCBS isn't really insuring much of anything in the traditional sense.
 

Knight

Senior Member
I think health has a lot to do with choice. For my wife & me medicare advantage works. We both need cholesterol meds due to hereditary cause. That's the extent of meds so the $6.00 X 2 cost every 3 months means nothing. Blood work every 6 months & scheduled Doc visit following the blood work zero cost. I understand we are exceptional as a couple but no magic pills, diet & exercise was & still is our priority once I retired.
 

terry123

Well-known Member
Location
Houston, Tx.
I also would add that my plan covers all the meds I take and thy are free with a 90 day supply. For short term meds I can use cvs or walgreens and they are free also after using the plan benefits. The only thing I have paid a copay for was a small order of xanax (sic) to help me sleep. I had to cut the smallest dose in half as a whole one was too much for me. The doctor said okay. I only had to use them for a couple of nights as I started sleeping better. He only prescribed 10 and cutting them in half gave me 20 so I have some if I have the problem again.
 

Liberty

Senior Member
Location
Texas
The process for picking a health insurance plan can be overwhelming. How do you know if you’re picking the correct plan? Will the ‘cheaper’ monthly premium cause issues when you’re trying to seek care? What if you need physical therapy, will it cover that? When people are selecting their insurance plans, they need to balance out the monthly premium compared to what their potential out of pocket costs could be.

I have first hand experienced this working in aging services. I work in a facility where we primarily serve seniors who fall in the low-income bracket. Many of these seniors have opted for a Medicare Advantage plan because of their limited financial resources each month. A Medicare Advantage plan are sometimes called “Part C” or “MA Plans,” and are offered by private companies approved by Medicare. Medicare pays these companies to cover Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage (Medicare, 2015).

Medicare Advantage plans have several positives that draw the consumer in. Some of them are: convenient coverage plans (all your coverage is through one plan), personalized plan structure (many different plans are offered that you can tailor to your individual situation), cost saving opportunities & coordinated medical care (Lockett, 2019). Some disadvantages are: limited service providers, overwhelming number of plans offered (making a decision could be difficult), additional costs for coverage & state-specific coverage (Lockett, 2019).

I personally don’t believe that Medicare Advantage plans really serve individuals better; especially the elderly clients. The residents that I have known to select an advantage plan is because they don’t pay a monthly premium. Which is very attractive, especially to a senior that has low income. Where I have seen a gap widen is when this resident needed outpatient physical therapy services. The resident had to pay a $35 co-pay for each therapy visit. This amount alone in one month is more costly than if they would have decided to keep their traditional Medicare plan. So while it may seem like an advantage plan is a good choice in the short term it does provide significant financial challenges when the person does seek care.
We have a normal Medicare supplement plan G. Have had it for years - no complaints, can see any doc we choose /specialists without referrals or restrictions. Due understand that finances are probably the main reason for the Advantage Plans, but we wouldn't choose one unless we had to. We are both healthy - a cardiologist is what we use as our primary physican. Good luck!
 

Pauline1954

Member
I read the advantage plan wont let you pick go to another doctor if you want to. So I got plan N. Its a little cost than less than. Plan G ive had peace of mind because my primary care doctor does not listen to me about thyroid meds. So I went to anothet doctor. No questions asked no permission or anything. I felt from everything I learned about advantage was restrictive. But if I ever needed to change to it since its the most less expensive I could without any health examine. But, once I get on it I cannot change back unless I pass a health examine.
 

Ken N Tx

Older than Dirt !
Location
Texas
Remember this,all plans (G,H F etc) are the same, the only difference is the premiums that Insurance Companies charge!! I found out the hard way....Find the cheapest premiums you can!!
 

mathjak107

Senior Member
The difference
My wife was paying $320 a month with one company and we switched to another company same plan same deductible $107!!
that does not sound right at all ...i can see advantage plan but not medicare supplements. that sounts like you had an F PLAN AND dropped to a different letter . in these parts an F PLAN is in the 340 range .. but you can get other letters which have higher deductibles and lower prices . .. i can't believe it is the same letter plan
 

mathjak107

Senior Member
keep in mind that while they tell you advantage plans cover what medicare does , that is only in a broad sense .

when it gets down to specific course of action your doctors want to take , an advantage plan can deny certain things . these can be things medicare who is not for profit would have said fine to .

but the insurers know you don't have medicare and so you can not prove what medicare would have approved in your case .

they are well aware of this fact when you have an advantage plan and as gate keepers they get to decide your fate and treatment .

we saw this happen first hand
 

911

Senior Member
Location
USA
I pay $225 for my plan ‘F’. My wife pays for $120 for plan ‘G’. I took the higher plan because I wanted peace of mind. My state police retirement insurance expired this past year, so I had to get a supplemental or go with an Advantage plan. All very confusing.

If you go on Medicare and then switch to an Advantage plan, are you able to switch back to Medicare?
 

mathjak107

Senior Member
I pay $225 for my plan ‘F’. My wife pays for $120 for plan ‘G’. I took the higher plan because I wanted peace of mind. My state police retirement insurance expired this past year, so I had to get a supplemental or go with an Advantage plan. All very confusing.

If you go on Medicare and then switch to an Advantage plan, are you able to switch back to Medicare?
depends on the state ...many states require medical under writing if they do allow it and can reject you . you also can only do it at specific times of the year
 
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Happyflowerlady

Vagabond Flowerchild
Location
Northern Alabama
the op is an insurance professional, it appears.
She only joined, made the one post and never came back, or responded to anyone else’s posts, so it does seem like she was probably a professional.

I have a Medicare Advantage plan with Humana, and I am very pleased with it. I have the Silver Sneakers, and enjoy swimming at the fitness center, I get points for exercising that can be cashed in for gift cards at walmart or amazon, and I get an OTC allowance each month, which I use to buy my vitamins from Humana.
 

mathjak107

Senior Member
She only joined, made the one post and never came back, or responded to anyone else’s posts, so it does seem like she was probably a professional.

I have a Medicare Advantage plan with Humana, and I am very pleased with it. I have the Silver Sneakers, and enjoy swimming at the fitness center, I get points for exercising that can be cashed in for gift cards at walmart or amazon, and I get an OTC allowance each month, which I use to buy my vitamins from Humana.
We have a Humana high deductibl F plan and get silver sneakers
 

OneEyedDiva

Senior Member
Location
Nrw Jersey
The choice was easy for me. I started with the employee health plan Healthways which morphed into something else and eventually Aetna HMO. Just before I turned 65 the State Health Benefits plan seamlessly sled me into Aetna Medicare HMO. Funny....I never payed premiums for my plan until I got on Medicare.
 

FastTrax

Member
The process for picking a health insurance plan can be overwhelming. How do you know if you’re picking the correct plan? Will the ‘cheaper’ monthly premium cause issues when you’re trying to seek care? What if you need physical therapy, will it cover that? When people are selecting their insurance plans, they need to balance out the monthly premium compared to what their potential out of pocket costs could be.

I have first hand experienced this working in aging services. I work in a facility where we primarily serve seniors who fall in the low-income bracket. Many of these seniors have opted for a Medicare Advantage plan because of their limited financial resources each month. A Medicare Advantage plan are sometimes called “Part C” or “MA Plans,” and are offered by private companies approved by Medicare. Medicare pays these companies to cover Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage (Medicare, 2015).

Medicare Advantage plans have several positives that draw the consumer in. Some of them are: convenient coverage plans (all your coverage is through one plan), personalized plan structure (many different plans are offered that you can tailor to your individual situation), cost saving opportunities & coordinated medical care (Lockett, 2019). Some disadvantages are: limited service providers, overwhelming number of plans offered (making a decision could be difficult), additional costs for coverage & state-specific coverage (Lockett, 2019).

I personally don’t believe that Medicare Advantage plans really serve individuals better; especially the elderly clients. The residents that I have known to select an advantage plan is because they don’t pay a monthly premium. Which is very attractive, especially to a senior that has low income. Where I have seen a gap widen is when this resident needed outpatient physical therapy services. The resident had to pay a $35 co-pay for each therapy visit. This amount alone in one month is more costly than if they would have decided to keep their traditional Medicare plan. So while it may seem like an advantage plan is a good choice in the short term it does provide significant financial challenges when the person does seek care.
Just curious, Is that the same Medicare Advantage Plan that Joe Namath has been hawking lately?

 

Pauline1954

Member
I believe you revert back to basic medicare when you stop paying on the advantage plan. With the letter gap plans I understand you can go to an advantage plan but cannot go back to a letter plan, g, f, n etc.

An introductory plan when first going on medicare is a one year price. Then it will go up and could ve higher than others. I tried to look at what plans and companies increased their rates more. If you can find it it gives a bit of insight and help in selecting a plan. But, the deductible is the big indicator of how much you are willing to pay and afford to pay. So far ive had good luck with my N plan. Ive met both deductible about mid year since i started in 2019.

I could pribably save more if i had gotten the g plan but im still satified with my plan. You just need to make sure your doctors are covered. Medicare.gov is where you find out.
 

Luv2Cycle

New Member
Location
California
If you can stay away from an advantage plan, i would. You get what you pay for. From my research, they are good for the healthy and poorer people due to providing things like drugs and dental but if you get anything serious, often you are out of luck. Advantage Plans scare me. However if you need the dental, chiro, drugs, eyecare, what-ever and cannot financially afford it otherwise, it may be your only choice. I'd try to get creative before going that route, even if it means joining a healthcare sharing ministry, medical tourism, dental schools, etc. Learn your states Medicare Laws, California allows people to switch once a year on their birthday. There are a few other perks to living in California with regards to Medicare but my memory is weak now.

I've barely gotten by in life so my healthcare needs will not likely be truly covered. And that's ok.
My physical & mental problems are mostly kept in "remission" due to our active lifestyle & church.
Even our few close friends do not know.
DH is off his water pill & cut his BP meds by 50% due to cycling. I lost a few pants sizes so am down to a size 9

Very few cars on the road in our area and the weather remains fairly cool all yr (July is hot though)

Winters are fierce. Snow is as high as our windows, constant snow storms for about 30% of the yr.

I work 20 hrs a wk for min wage. Never made much $ my whole life.
I commute 3 hrs a day.
After reaching tenure to qualify for the retirement healthcare plan,
the stress was much less. It's basically the same plan I have now as a part timer.

My employers healthcare plan for p/t employees & retirement plan is below
Premium $10 a month

$5 generic/$15 brand name medications
$2000 year dental care/
Eye plan- One exam, one pair of glasses each yr
$15 unlimited doctor/chiropractic/ & specialists, visits
$15 x rays, blood tests, most tests
$50- ER Visits & advanced tests such as, MRI, EKG's, Cat Scans.
$100 admission to Hospital or Nursing home
Telehealth with Nurse

Our closest Doctor is old. He doesn't want to see patients but is available 2 days a wk for half of a day. Usually the few poorer folks we have will visit or any COVID tests. Since my SS will only be about $1200 a month our location matters. Being somewhere where there is no ambulance to wrack up charges, instead being flown by a medi-copter (memberships) at no cost. An area which provides seasonal jobs, etc. to supplement SS. recreational opportunities keeping fit. Food is medicine so to be your own doctor heading off any possible issues before they arise is prudent. Diet is so important, moreso when you are poor. Sometimes I think poor is a gift seeing so many who do not exercise and do not eat right. Yet talking about their health plans all the time. i wonder who is worse off, me or them. I guess we'l see.
 

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