Medigap or Medicare Advantage Plan?

Dudewho said:
Two day stay last year $520.00.
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That was what you paid out of pocket? Because with Traditional Medicare part A and a medicare supplement.. there would be $0 out of pocket for any hospital stay... no matter how long. Plus.. you get to pick which hospital you want to be in.
 

Medicare seems confusing at first, but after you learn the lingo it's not difficult. Certainly, sit down and do the research.
What I consider on Medicare Advantage vs. Original Medicare + a Medigap Plan-- don't just look at monthly premium. Look at Maximum Out of Pocket risk. That is what gets people.
Do you travel? Advantage plans have a limited area / network. Original Medicare does not
For Medicare to cover something it must be deemd medically neccessary. With Original Medicare, your doctor determines that. With an Advantage plan the insurance company makes the determination.
Look up the Medicare Facebook page and read peoples comments. You get lots of input from there

my 2 cents
 
Here's another tidbit.. Medicare part A is for inpatient hospital stay only. Medicare part B is for outpatient services.. When you are hospitalized, you will be required to satisfy a Medicare deductible of $1,260. Your Medicare supplement will cover this deductible. You will not be required to pay one single penny out of pocket for an inpatient stay since Medicare pays hospitals by DRG (diagnostic related group).. In other words.. medicare assigns a payment amount for each diagnosis.. It will pay the hospital the same dollar amount whether you are hospitalized for 2 days or 22 days.. not one penny more. If a hospital chooses to be a medicare provider, they have agreed to treat that diagnosis for the amount given.. and not a penny more. You are not responsible for paying the hospital ANYTHING... If you stay out of the hospital 61 days and re readmitted, you will then be charged another deductible of $1,260. If you are rehospitalized under 60 days time.. you do not owe another deductible.

Part B covers 80% of you outpatient services... Your Medicare supplement will pick up the other 20%... however, it will NOT pay for anything that Medicare doesn't cover.
 

All it takes is one serious battle with cancer to make a person curse the day they chose Medicare Advantage.
Medicare pays 80% of most chemotherapy. A supplement will cover the rest. You pay $0
With most Medicare Advantage plans, they pay 80% of Chemo you pay the rest. This can run into many thousands.
The maximum out-of-pocket for most Med Advantage plans I have seen $6,700 / year + additional Max out-of-pocket for prescriptions.
 
QuickSilver said:
That was what you paid out of pocket? Because with Traditional Medicare part A and a medicare supplement.. there would be $0 out of pocket for any hospital stay... no matter how long. Plus.. you get to pick which hospital you want to be in.
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I don't pay monthly for my plan and it includes Rx coverage. I don't pay for that either.
 
MJC-56 said:
All it takes is one serious battle with cancer to make a person curse the day they chose Medicare Advantage.
Medicare pays 80% of most chemotherapy. A supplement will cover the rest. You pay $0
With most Medicare Advantage plans, they pay 80% of Chemo you pay the rest. This can run into many thousands.
The maximum out-of-pocket for most Med Advantage plans I have seen $6,700 / year + additional Max out-of-pocket for prescriptions.
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I know that I would never give up my traditional Medicare for an Advantage plan.. I have seen far too may horror stories to consider it.
 
MJC-56 said:
Medicare seems confusing at first, but after you learn the lingo it's not difficult. Certainly, sit down and do the research.
What I consider on Medicare Advantage vs. Original Medicare + a Medigap Plan-- don't just look at monthly premium. Look at Maximum Out of Pocket risk. That is what gets people.
Do you travel? Advantage plans have a limited area / network. Original Medicare does not
For Medicare to cover something it must be deemd medically neccessary. With Original Medicare, your doctor determines that. With an Advantage plan the insurance company makes the determination.
Look up the Medicare Facebook page and read peoples comments. You get lots of input from there

my 2 cents
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QuickSilver said:
Here's another tidbit.. Medicare part A is for inpatient hospital stay only. Medicare part B is for outpatient services.. When you are hospitalized, you will be required to satisfy a Medicare deductible of $1,260. Your Medicare supplement will cover this deductible. You will not be required to pay one single penny out of pocket for an inpatient stay since Medicare pays hospitals by DRG (diagnostic related group).. In other words.. medicare assigns a payment amount for each diagnosis.. It will pay the hospital the same dollar amount whether you are hospitalized for 2 days or 22 days.. not one penny more. If a hospital chooses to be a medicare provider, they have agreed to treat that diagnosis for the amount given.. and not a penny more. You are not responsible for paying the hospital ANYTHING... If you stay out of the hospital 61 days and re readmitted, you will then be charged another deductible of $1,260. If you are rehospitalized under 60 days time.. you do not owe another deductible.

Part B covers 80% of you outpatient services... Your Medicare supplement will pick up the other 20%... however, it will NOT pay for anything that Medicare doesn't cover.
Click to expand...

MJC-56 said:
All it takes is one serious battle with cancer to make a person curse the day they chose Medicare Advantage.
Medicare pays 80% of most chemotherapy. A supplement will cover the rest. You pay $0
With most Medicare Advantage plans, they pay 80% of Chemo you pay the rest. This can run into many thousands.
The maximum out-of-pocket for most Med Advantage plans I have seen $6,700 / year + additional Max out-of-pocket for prescriptions.
Click to expand...

QuickSilver said:
I know that I would never give up my traditional Medicare for an Advantage plan.. I have seen far too may horror stories to consider it.
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1 ditto.gif...
All top notch advise!!!!!

It is not how your medical condition is now, but what will happen down the road!!!
 
Grumpy Ol' Man said:
I'm really confused!!! (Wife says I have been for many years!) We both currently covered under each of our employer's medical group plans. It appears we will both be finally retiring at the end of 2015. So, we need to pick up our "Part B" and "Part F"... or at least that's what I thought. It appears the Part F covers all the deductibles from Part A and Part B, so has very little out of pocket. Part F is available in a Medicare Advantage plan and that is the direction we planned on heading.

Now, a couple posters said their Advantage plans cost them nothing. Huh??!!?? I've priced a number of the Advantage plans and they run from ~$130/month and up. Part B is a standard cost item which is around $115/month. So, I assumed we would be out the $115... the $130... and our Part D (Prescription Plan), $40 for a total of about $300/month for each of us.

Where have I erred in that analysis? How do I find Advantage plans that have zero cost??
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One thing I noticed in your comment that is probably the root of some of the confusion: "Part F is available in a Medicare Advantage plan and that is the direction we planned on heading." That is incorrect. You can have Medicare Part A + Part B and a Supplement plan like F or G . OR You can have a Medicare Advantage plan. You cannot have a Medicare Advantage plan + a Supplement. Medicare Advantage plans are roughly equivalent to Medicare Part A + Part B, but are not near the coverage of Medicare + a Supplement.

Some areas have great Medicare Advantage plans. Some do not. Some have Advantage Plans with no premium, but if you get sick you pay $6,700 / year to $10,000 (this is called a maximum out-of-pocket risk). Some Advantage plans have a premium, but the maximum out-of-pocket risk is much smaller.

If you choose Medicare A + B and a Supplement, you get to also choose your own Part D drug plan. Go to Medicare.gov and shop for the best one each year based on your prescriptions. This feature alone can save a lot of money because with a Medicare Advantage plan you take whatever prescription plan they offer..and they are not all the same.

Lastly - Compare Plan F and Plan G and Plan N if you choose a supplement.
 
MJC-56 said:
One thing I noticed in your comment that is probably the root of some of the confusion: "Part F is available in a Medicare Advantage plan and that is the direction we planned on heading." That is incorrect. You can have Medicare Part A + Part B and a Supplement plan like F or G . OR You can have a Medicare Advantage plan. You cannot have a Medicare Advantage plan + a Supplement. Medicare Advantage plans are roughly equivalent to Medicare Part A + Part B, but are not near the coverage of Medicare + a Supplement.

Some areas have great Medicare Advantage plans. Some do not. Some have Advantage Plans with no premium, but if you get sick you pay $6,700 / year to $10,000 (this is called a maximum out-of-pocket risk). Some Advantage plans have a premium, but the maximum out-of-pocket risk is much smaller.

If you choose Medicare A + B and a Supplement, you get to also choose your own Part D drug plan. Go to Medicare.gov and shop for the best one each year based on your prescriptions. This feature alone can save a lot of money because with a Medicare Advantage plan you take whatever prescription plan they offer..and they are not all the same.

Lastly - Compare Plan F and Plan G and Plan N if you choose a supplement.
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I've seen some complaints in here about Medicare Advantage plans that are HMOs. I plan on getting a PPO Medicare Advantage plan from Blue Cross. I don't like HMOs in any flavor, I'd rather just pay more to have the freedom. Does anyone in here have any experience with Medicare Advantage PPO plans?
 
Thorn said:
I've seen some complaints in here about Medicare Advantage plans that are HMOs. I plan on getting a PPO Medicare Advantage plan from Blue Cross. I don't like HMOs in any flavor, I'd rather just pay more to have the freedom. Does anyone in here have any experience with Medicare Advantage PPO plans?
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I was not aware that there were PPO Advantage plans... If they cost more... why not just keep Traditional Medicare and a supplement?
 
Thorn said:
I've seen some complaints in here about Medicare Advantage plans that are HMOs. I plan on getting a PPO Medicare Advantage plan from Blue Cross. I don't like HMOs in any flavor, I'd rather just pay more to have the freedom. Does anyone in here have any experience with Medicare Advantage PPO plans?
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According to Medicare & You handbook, Advantage plans come in lots of flavors including HMO. PPO, Regional PPO, PFFS, POS and so on.
What Advantage plan is available to you depends on where you live.
Original Medicare and all the Supplements are available to you wherever you live.
In my opinion, it's not the type of Advantage Plan that is the issue. It is the fact that when you decide to go the Medicare Advantage route instead of staying with Original Medicare you are giving up your rights to an insurance company. Original Medicare makes it very clear that YOUR doctor is the primary director of what is medically necessary. With an Advantage plan, the insurance company tells you what is Medically necessary. Medicare only covers what is Medically Necessary. So, guess what happens way too often…the service you and your doctor say you need is deemed not necessary and therefore the insurance company will not pay for it.

Ta Da! Instantly reduce medical costs and build profit.
 
MJC-56 said:
According to Medicare & You handbook, Advantage plans come in lots of flavors including HMO. PPO, Regional PPO, PFFS, POS and so on.
What Advantage plan is available to you depends on where you live.
Original Medicare and all the Supplements are available to you wherever you live.
In my opinion, it's not the type of Advantage Plan that is the issue. It is the fact that when you decide to go the Medicare Advantage route instead of staying with Original Medicare you are giving up your rights to an insurance company. Original Medicare makes it very clear that YOUR doctor is the primary director of what is medically necessary. With an Advantage plan, the insurance company tells you what is Medically necessary. Medicare only covers what is Medically Necessary. So, guess what happens way too often…the service you and your doctor say you need is deemed not necessary and therefore the insurance company will not pay for it.

Ta Da! Instantly reduce medical costs and build profit.
Click to expand...

That's is the main thing.. Who do you want making your medical decisions... Your Doctor... Or your insurance company..
 
QuickSilver said:
I was not aware that there were PPO Advantage plans... If they cost more... why not just keep Traditional Medicare and a supplement?
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Traditional Medicare and HMOs are the same thing, they both require you to have a primary doctor whose choices rule your healthcare. While I do trust my doctor, I want to have the freedom to see anyone I please about anything I feel needs attention. That's going to cost more, and I know that, but I'll pay for it. With a PPO I am only limited by the policy itself, it's coverage percentages, and my deductibles which are spelled out in my plan.
 
Thorn - Did you mean to say "Traditional Medicare and HMO's are NOT the same thing? that would be correct.
Traditional Medicare is Part A inpatient care and Part B outpatient care. You can go to any doctor or hospital in the U.S. that takes Medicare (99% of doctors and hospitals). You do not need a primary care doctor.

Add a Supplement like Plan F or Plan G and you can do all that with an annual out of pocket maximum risk of between $0 to $147.

With a PPO you are going to have a maximum out of pocket risk of between $6,700 and $10,000 depending on if you are in network or not. PPO's still have a network like an HMO.
Some PPO's also have a monthly premium approx equal to a Medicare Supplement and have a reduced maximum out of pocket risk to around $3,500 in network, more out of network.
Please see page 17 and pp 67-73 of this 2015 Medicare & You handbook https://www.medicare.gov/Pubs/pdf/10050.pdf See page 83 for general information on PPO's.

I too much prefer PPO's to an HMO. I truly dislike the idea of having to get permission / referral from a primary care doctor to see a specialist.
Some PPO's are called Regional PPO's and have a very large in-network area. Here in Florida there is even a PPO for snowbirds that has in-network care both locally and the state where they spend their summer months. I have no idea if other states offer that benefit.
 
MJC-56 - Actually, except for my Mom, I've never known anyone on Medicare. And as far as I can remember, she's had this Advantage plan that works like an HMO, which I just hate the idea of. I've never even looked at straight Medicare because I've seen to many little notices in office doors in medical buildings saying "No New Medicare" patients are being accepted. Medicare is giving doctors and hospitals a hard time right now. Whether it's justified or not, I don't know. In any case, I want no part of it. Blue Cross has a Medicare Advantage PPO for $50 a month, which looks pretty much like the PPO I have from them right now.
 
I am sure you'll like the PPO more than the HMO. FYI -when they say "No New Medicare Patients" they mean both Original Medicare and the PPO / Advantage Plans.
Whoever sells you a PPO policy should go over that with you.
 
MJC-56 said:
Thorn - Did you mean to say "Traditional Medicare and HMO's are NOT the same thing? that would be correct.
Traditional Medicare is Part A inpatient care and Part B outpatient care. You can go to any doctor or hospital in the U.S. that takes Medicare (99% of doctors and hospitals). You do not need a primary care doctor.

Add a Supplement like Plan F or Plan G and you can do all that with an annual out of pocket maximum risk of between $0 to $147.

With a PPO you are going to have a maximum out of pocket risk of between $6,700 and $10,000 depending on if you are in network or not. PPO's still have a network like an HMO.
Some PPO's also have a monthly premium approx equal to a Medicare Supplement and have a reduced maximum out of pocket risk to around $3,500 in network, more out of network.
Please see page 17 and pp 67-73 of this 2015 Medicare & You handbook https://www.medicare.gov/Pubs/pdf/10050.pdf See page 83 for general information on PPO's.

I too much prefer PPO's to an HMO. I truly dislike the idea of having to get permission / referral from a primary care doctor to see a specialist.
Some PPO's are called Regional PPO's and have a very large in-network area. Here in Florida there is even a PPO for snowbirds that has in-network care both locally and the state where they spend their summer months. I have no idea if other states offer that benefit.
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The Humana PPO is a National Network.
Some HMOs do not need referrals. But they vary by area.
 
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MJC-56 said:
I am sure you'll like the PPO more than the HMO. FYI -when they say "No New Medicare Patients" they mean both Original Medicare and the PPO / Advantage Plans.
Whoever sells you a PPO policy should go over that with you.
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If a doctor is contracted with a Hospital, chances are they accept the local Medicare Advantage plans.
 
The simple fact is that there is "not" a one size fits all plan out there. A husband may like original Medicare and his spouse may get a better deal from a Medicare Advantage plan. Everyone should do their due diligence and figure out what is available in that area for them. Sicker individuals may want to keep a Medicare supplement policy to keep the their medical cost down, Vs a healthier individual may want to keep their premium down because you don't need as much medical coverage. Either way you're only going to know what's best for you if you do your due diligence.

Medicare time frame:

October 1 to October 14-Medicare Pre annual enrollment.- you may start to look up 2016 plans to see what's right for you.

October 15th to December 7-Medicare annual enrollment.- this is when you make your choices for plans I will start January 1.
during this timeframe if you choose a plan and think you made a wrong decision you can choose a second plan and the last application and takes effect Jan.1st

January 1 of February 14-annual disenrollment period.- during this timeframe you can disenroll from a Medicare advantage prescription drug plan or a prescription drug plan and go back to original Medicare.

February 15 through January 31- this is the lock in period when you can not make any plan changes (in most cases).
In some scenarios you may be able to make changes in the locked in. Anybody who has a low income subsidy known as LiS gets help with your prescription drug cost can make plan changes to their drug program all your long. Those who are dual eligible which means they have both Medicare and Medicaid can also make changes to drug plans or Medicare Advantage plans all year long. Your area may also have SNP plans or "special needs plans" that have an open election all year long to help treat chronic conditions.

If you choose a Medicare advantage plan for the "first time" and throughout the year and do not like it you can return at any time to original Medicare. This can only be done by calling Medicare.
 
I see there is a lot of misinformation about what Traditional Medicare is and does... and what an insurance company managed Medicare substitute is and does.. People need to get the facts before making a decision.
 
QuickSilver said:
That's is the main thing.. Who do you want making your medical decisions... Your Doctor... Or your insurance company..
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With an HMO your primary care physician ascts as your health care Cordinator. Not the insurance company. That's why you pick them with an HMO
 

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