Trying to choose between Medigap and Advantage

T

Trex395

New Member
Hello,

Sorry for the length of this post but I think that adding specifics helps to make this a meaningful question.

I’m retiring soon and am trying to decide between Medigap AARP United Health Plan N and Advantage AARP United Health Patriot PPO. My wife (already retired and on my work BCBS) and I live in Oregon and are both in pretty good shape. I am on a statin for slightly high cholesterol and my wife takes no medication.

From what I read and understand, the comparable highpoints of each plan are:
Medigap AARP United Health Plan N:
  • Premium yearly total for wife and I: 3144 (excludes vision/dental)
  • Bullet proof approval of medical costs.
  • Any Medicare doctors.
  • Separate cost guestimate for both of us for vision:26/m, dental: 60/m
Advantage AARP United Health Patriot PPO (Can use any Medicare doctor or UHC network)
  • Premium yearly total for wife and I: 0 dollars
  • Not bullet-proof approval of medical costs.
  • Can go to in network or any Medicare doctor (extra fees)
  • Primary copay: In:0 / Out 25
  • Specialist copay: In:45 / Out 65
  • No specialist referral
  • Includes dentist (comprehensive), vision, hearing
  • Max out of pocket: In: 5600/Out+In:10000 (OOP)
  • Chemo 20% copay/Radiation 60 dollars per. (all in network)

Not taking into account cost increases, etc., if we project living to the ripe old age of 90 (24 years on Medicare) then we will have paid out to Medicare and dental/vision approximately 99K.

For comparison of Advantage: Between the two of us if we had spent 2000 per year for 24 years = 48,000. If we had hit the max OOP limit 10 times we would be approximately even

I’m inclined towards Medigap, but it really doesn't seem like a slam dunk win.

I’d appreciate any comments on whether I am missing something and on how much money medical costs can be.


Thanks,
 

Medicare advantage plans must differ. Our situation is probably different.

We are healthy with only cholesterol as a med. 90 day supply of generic $6.00 copay.
I had complete rebuild of my cervical spine due to disc collapse. Diagnosis was $60.00 copay. Surgery, recovery & rehab $0.00 out of pocket. Company I worked for stopped paying for health insurance when I went on Medicare. But put the amount they would have paid for insurance into a HSA. That has been accumulating for 15 years.

This year our advantage plan has a feature of $75.00 each, every quarter to get a variety of med supplies.

So as you might guess were happy with our advantage plan.

I forgot to add total cost for meds , surgeries & general office yearly wellness office visits I haven't kept track but estimate less than $1000.00 out of pocket for the past 15 years
 
Last edited:
Since retiring the wife and I have had an Advantage plan that has worked for us, so we plan to stick with it for the foreseeable future. Don...
 

I have a couple of minor health issues, and one biggie. When I was retiring a few years ago,
my HR department put me in touch with this group:
The MediGap Advisor | Medicare Coverage Options Consulting

What I remember is that they either sent me a form (or asked a lot of questions and they filled out the form) and then gave recommendations based on where I lived, what medications I took, and what health issues I had.

In my case it was fairly easy, as I knew I did not want a Medicare Advantage coverage.
Using that piece, they suggested one or three (?) Medigap options that were available in NY.
They did the same with the Part D prescription plan. (some plans are only offered in some states)

I am not sure how they get paid, since it did not cost me anything. Nor did it cost several friends I referred. Maybe it is like the old Travel Agencies, that received something from the airlines & hotels.

I deal with Dan Katzoff. But everyone I spoke with there at different times are very nice and no hard sell. It might be another opinion for you.
Oh, and they also send me an email yearly during open enrollment to ask if I wanted a review of my coverage.
 
I have a zero-premium plan through Excellus BCBS that is fine for me.

Consider a similar plan and discipline yourself to bank the premiums each month while you are relatively young and healthy.

Every year you get the opportunity to rethink your coverage and choose a different plan as your circumstances change.

Good luck.
 
More that I just thought of:
I opted for the AARP Medicare Supplement (Medigap)
My sister in New Jersey went with the AARP Medicare Advantage.
My friends were divided among Medigap & Advantage. Everyone's situation is different, and the coverage varies dependent upon which plan and also which state you are in.
 
Knight said:
Medicare advantage plans must differ. Our situation is probably different.

We are healthy with only cholesterol as a med. 90 day supply of generic $6.00 copay.
I had complete rebuild of my cervical spine due to disc collapse. Diagnosis was $60.00 copay. Surgery, recovery & rehab $0.00 out of pocket. Company I worked for stopped paying for health insurance when I went on Medicare. But put the amount they would have paid for insurance into a HSA. That has been accumulating for 15 years.

This year our advantage plan has a feature of $75.00 each, every quarter to get a variety of med supplies.

So as you might guess were happy with our advantage plan.

I forgot to add total cost for meds , surgeries & general office yearly wellness office visits I haven't kept track but estimate less than $1000.00 out of pocket for the past 15 years
Click to expand...
Thank you for sharing your experience. I think that your plan covered your spine issue really well.
 
Kika said:
More that I just thought of:
I opted for the AARP Medicare Supplement (Medigap)
My sister in New Jersey went with the AARP Medicare Advantage.
My friends were divided among Medigap & Advantage. Everyone's situation is different, and the coverage varies dependent upon which plan and also which state you are in.
Click to expand...
Thanks for sharing your experience and I will check out the Medigap Advisor.
 
Aunt Bea said:
I have a zero-premium plan through Excellus BCBS that is fine for me.

Consider a similar plan and discipline yourself to bank the premiums each month while you are relatively young and healthy.

Every year you get the opportunity to rethink your coverage and choose a different plan as your circumstances change.

Good luck.
Click to expand...
Thanks and good advice on banking the premiums.
 


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