Medicare Part C

https://www.medicare.gov/sign-up-ch.../things-to-know-medicare-advantage-plans.html

In some parts of the country, Medicare Advantage (MA) plans can be a better deal than what's available MA wise in other states. Networks have a big impact. They can work better in urban areas, not so much in rural areas. Also with MA plans; your benefits, deductibles, copays, premiums, max out of pocket, etc can change each year. Your doctors can opt out of the network.

I still stand by what I said originally. I am a big fan of medicare supplements over medicare advantage plans. The link above goes over some of those details.

I feel my job as a broker is to show clients the pros and cons of each plan and let them decide. I give them my opinion and my experience, but in the end, it's their decision. I just hate it when I get a call a few years later when they have serious health issues and desperate to get off the MA plan. Often, there is little I can do for them then.

In my opinion, MA plans leave too much risk on the client. The only issue my medicare supplement clients have to worry about is the premium increase each year, which we can shop for them when they get a rate increase.
 

Well, I'll stick with my local advantage plan. I don't pay a premium for it, which saves me a lot of money right there. It has a HUGE pool of physicians to draw from. It does not require a referral to see most specialists (though without a referral you will wait longer for an appointment than if you have one). When I had my hips replaced, I just decided who I wanted to see and then asked my PCP for a referral to him. Piece of cake. I paid out of pocket WAY less than $1000 to get BOTH hips replaced. If I had had a supplement instead, I would have paid way more than that in a year for the premiums.

Before I signed on to this plan, I did extensive research on what was available, and this plan was and IS a much better deal than any supplement plans available here.
 
Different strokes for different folks. I'm a Part A/B and zero deductible Plan F guy myself. I had a quad bypass in 2013. I saw the hospital bill. $145k. My out of pocket was zero. 8 weeks after that, my wife was diagnosed with lung cancer. Started chemo at that time, and underwent chemo and radiation on and off (mostly on) until she passed away this past Easter. Didn't see any of the bills until after that, and then only for the last 4 months. $56k. $14k per month. If that rate was good for the two years and 9 months she was being treated then the total would be $462k. Her out of pocket was zero. She was treated in Florida and continued treatment when we moved to Hawaii. An advantage plan would have not travelled with us the way the Plan F did. The flip side is that my plan F premium is a little over $220 per month plus the Part B plus my drug plan.

When it comes to insurance, you pay for certainty and for choice. I know exactly what my medical costs are going to be. No variation, since all I pay is the premium. With an Advantage plan, my costs could be much lower when I'm healthy but much higher if I have a major issue. (The Florida Blue Advantage plan had a max out of pocket of something like $5k per year.) I also have greater choice. I can go to any doctor or hospital that takes medicare and my Plan F covers me. In Advantage plans, you are required to stay within their network of Doctors and hospitals unless it meet their definition of emergency. Limited choice.

In the interest of full disclosure, both my late wife and I were licensed to sell health and life insurance in Florida for a couple of years, including the Supplements and Advantage plans. We had a good friend that owned the local BC/BS office and needed help during the "senior season" when we're allowed to change plans.
 

Hoot N Annie said:
In the interest of full disclosure, both my late wife and I were licensed to sell health and life insurance in Florida for a couple of years, including the Supplements and Advantage plans. We had a good friend that owned the local BC/BS office and needed help during the "senior season" when we're allowed to change plans.
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I will be needing a new drug plan this year!! Suggestions ???
 
mathjak107 said:
the problem is with advantage plans it is hit and miss . like i said , kaiser has some excellent plans but we have none available to us . with supplements you know your exposure . with advantage plans they are a lot more complex and as many like my friend found out have exposure's you are not aware of until you hit them .

the old saying , nothing is a problem until it is a problem can be very true with many advantage plans
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Advantage plans all by will have to have a maximum out-of-pocket by law, so you do know exactly what your worst case scenario could be.
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Ken N Tx said:
I will be needing a new drug plan this year!! Suggestions ???
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At Medicare.gov you can and input your specific drugs and your ZIP Code and compare all part D plans available to you in your area.
Referrals won't help you in this area because nobody's taking the specific drugs that you are.
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mathjak107 said:
that is the other draw back , we travel and most advantage plans can give you grief outside your area except for what they consider the extreme emergency's . supplements are very tightly controlled unlike advantage plans .

advantage plans are no different than regular hmo's . they can decide what they will pay for ,what they will argue and limit .

supplements can not . as long as medicare covers the expense they are bound by law to cover and pay what medicare does not .

don't forget with an advantage plan ,what gets counted towards an out of pocket is based on what they will pay . you can spend money for something and they can feel they won't cover it and the dollars don't count .

after our agreed deductible we have zero holes . if we took the full f-plan instead of high deductible than that is it . we know there will be not another penny for anything paid out by us .
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By law Medicare advantage plans have to cover everything Medicare covers. All medicare advantage plans have been deemed by Medicare equal to or greater than the original Medicare coverage or they cannot be sold by law.

HMO networks are a tighter network and you usually cannot go out of network unless under an emergency situations.

PPOs Will give you the flexibility of network coverage and out of network coverage. Usually have to pay more out of network with a PPO.

With a PFFS plan you usually do not have a network and can see any doctor who will accept the plan. With a private fee-for-service plan that does not include prescription drugs in some cases you may add a part D plan with it.

If you have a PPO without prescription drug coverage it is illegal to add prescription drug coverage with it.
 
QuickSilver said:
Having worked in Case Management in a Hospital.. I have personally had to go to a patient's family and tell them that their 80 year old mother could not have her broken hip fixed at our hospital because her HMO wanted her transferred to another one many miles away. They were shocked and said.. "But she has Medicare!!" No... not really.. She has a Medicare Advantage plan and she signed away her traditional Medicare.. So Mom had to be loaded into an ambulance with a broken hip and moved. OR pay for her surgery herself.
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By law, in emergency situations you will be covered for out of network care. You just need to call the insurance company within 48 hours let them know what happened .
 
With MA plans, I have seen the benefits change every year. In most cases, the changes do not favor the client.

Again, my experience is people love MA plans until they get sick. That's when they want off of them...I know is some states, the networks are better. If you are in Florida, networks and benefits can be stronger, but over time those will erode too.

If the sickness is ongoing, you do know your limits are capped, but those limits change each year too. I have seen caps change from $3500 a year max out of pocket to $6500+ in just a few years. Still a lot of exposure.

MAs can be better than Original Medicare, but I still prefer clients on medicare supplement plans.
 
RustyatMMC said:
Turning 65 and Medicare - disclosure..this does promote my agency. If you want our help great, if not, please use the information to help you understand what your options are and find someone to compare all the plans and companies for you. I am very passionate about this subject....

I usually send this to my clients who are starting Medicare. I have several hundred clients on Medicare and I can tell you I recommend Original Medicare (Part A and Part B) with a supplement plan (Plan G) and a Part D plan from medicines.

Here is a chart I send to clients who ask about MA plans:


"SilverSneaker is a benefit on some Medicare Advantage (MA) plans. MA plans seem great until you use them. They have VERY high out of pocket exposure as compared to a medicare supplement plan G. With a medicare supplement plan G, you have a $166 deductible for medical expenses. That’s the most you will pay for doctor visits or hospital stays. With a MA plan, you have a max out of pocket (MOOP) from $5,000 (typical for HMO plans) to $10,000 (typical for PPO plans) per year depending on the plan type. That’s a LOT of risk to take on for a free gym membership!

Medicare SupplementsMedicare Advantage Plans
A 6+ day stay at hospitalYou pay $0You pay $1,500-2,200
ChemotherapyYou pay $0You pay 20% up to max out of pocket (MOOP)
Lab workYou pay the first $166 (part B deductible) per year, then $0 afterwards.You pay 20%
Doctor visitsYou pay the first $166 (part B deductible) per year, then $0 afterwards. You pay a copay every time you see your doctor and more for specialists.
NetworksYou can choose your doctor or hospital anywhere in the countryYou have to stay in a HMO network or pay more to be outside a PPO network.
Max out of pocket (MOOP) for Doctors and Hospitals per year$166 (part B deductible)$5,000+ with HMO networks
Up to $10,000 with PPO networks
Dental/VisionNoneYou get a checkup once a year
Gym membershipNoneYou get a Free gym membership
What clients wantPeople want to be on these plans when they get sick.
People want off of these plans when they get sick.

MA plans are great when people don’t have claims. When they get sick, MA plans are no fun! Lots of bills. I get calls all year long from people on MA plans desperate to get off them. Every one of them are sick and the out of pocket exposure is killing them. Problem is once you have major claims (like what these people who call me are having), it’s very difficult to impossible to move them to a medicare supplement. Medicare supplement are going to ask health questions and since they are on claim, they will not get approved.

Like what was described above, get sick in November or December and have treatment roll over to the next year...guess what...new year and your out of pocket exposure resets.

I try to show all my clients that Medicare supplements are a better choice. Most understand why, but some want the lower cost initially. I have had several comeback desperate to get off after getting sick, but there was little we could do then. Those conversations are never fun. I have had enough of them and that’s why I try to convince my clients that medicare supplement plans are the best for them long term.

On the other hand, I have had clients who get diagnosed with cancer and love how well their medicare supplement plan takes care of the doctors and hospital bills. They can focus on getting better and not have to deal with the stress of paying these big bills that would happen if they were on a MA plan. I have NEVER had a phone call from a client upset with me on what their medicare supplement did not pay…never."

I hope that helps people understand the difference. People often forget about how much exposure they have on an MA plan until it's too late.
Thanks
Rusty
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Your info on coverage on Medicare Advantage plans is very misleading. Although plans very from area to area, the plan I have has zero co-pays for labs, 250-300 a day for hospital visits, included eyeware along with check-ups and tooth cleanings. My plan has less than $5000 moop. I can go to any doctor with my HMO. It includes diabetic supplies for free. No underwriting. Not to mention it included prescription drug coverage built into it. Generic coverage mail to me for free.
My mother had nurses checking in on her at home and had meals sent to her. All for a couple of $$ a month.
I originally looked at Medicare supplements and even had one, but they kept raising the price. I just take the money they're was paying every month and save it in a separate account. I have my own Health $ account. Copy's are no problem.
We think we could use the premium $$ in our pockets more than the insurance company.
Different strokes for different folks I guess.
 
with an advantage plan if they are not in network look out . you could be responsible for quite a bit in bills . what they consider an emergency and what you do can be two different things . many advantage plan networks are local only . getting sick over seas can be a real nightmare
 
mathjak107 said:
with an advantage plan if they are not in network look out . you could be responsible for quite a bit in bills . what they consider an emergency and what you do can be two different things . many advantage plan networks are local only . getting sick over seas can be a real nightmare
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Your coverage is clearly stated in the summary of benefits and the explanation of benefits for out of in and out of network services. No surprises if you do your homework. During annual a enrollment period we checked our coverage options.
As I stated my HMO has out of network benefits, it is a POS or Point of service.
 
In 2015 31% of those on Medicare used Medicare advantage plans. Since then those numbers have been growing.
Starting in mid October annual enrollment period is used to check the summary of benefits for evidence of coverage for plans in your area. It clearly states what in network and out of network costs will be. No surprises if you do your homework.
What they cover under emergency situations is clearly stated in the evidence of coverage. Remember Medicare advantage plans by cover everything Medicare covers or they cannot be sold. That's the law. As far as getting sick overseas I kind of think you're off the reservation. Original Medicare and Medicare supplements are US government insurance and cannot be used off US soil other than very specific reasons. If the closest hospital in an emergency is over the border in Canada or Mexico or something happens traveling across Canada in route to Alaska. That's about the only time you're going to get coverage with Medicare supplement on foreign soil. Medicare advantage plans do you have worldwide coverage.
 
mathjak107 said:
your hmo has out of network benefits . in our area none do . they are strictly authorized if traveling on an emergency basis and case by case
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Yes its a Point of service .

All plans are specific to areas. That's why you got to be careful as to if a MA plan is a good fit or not.
 

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