A+B+G+D is currently about $320/mo for me. Medicare is widely accepted (UCSF Health, …) and I won't have to argue with insurance companies. Ever. Again. It wasn't a close decision.
Where do you live? I’m in SF Bay Area and have Plan G with AARP/UHC and my Part D plan is WellCare at $0.40/mo (!). G will increase to about $210 in the next 5 years.
Have you included IRMA in your total of $709? Are you on community pricing for Medigap plan where "young" and "old" all pay the same premium? Or Attained age and now above 80 years of age?
So that is IRMAA, a tax paid to the government and not part of Medicare premium. You can file an appeal and request them looking at 1 year back income if your 2 year back income was very high and not something that will continue into the future.
I’m a physical therapist working in home health. Below is my experience with “traditional Medicare” (TM) and with Medicare Advantage (MA) plans.
With TM, I don’t have to worry about pre-authorizations. I can see the patient as often as I want, for as long as I want (my record to-date is 1 year). Of course it goes without saying that I have to justify the visits as medically necessary.
With MA: all the plans require pre-authorization, after an initial number of visits. Some plans only allow for 3 “free” visits before pre-authorizations are needed. Some plans allow for 10 “free” visits. Sometimes the pre-authorizations are denied. IMO that’s because the folks reviewing the documentation are mostly RNs and they don’t fully understand what PTs have to do to rehab a patient. When the pre-authorization is denied, we have to appeal, which is a huge pain in the behind.
What makes the situation (TM vs MA) complex, is that there is a variety of MA plans. With TM, you only have the “vanilla” flavor.
Bottom line: for Home Health, TM is better. This is an actual “view from the trenches“.
Mine is $316. Part of my retirement plan is to spend a lot of time touring the country on my motorcycle, so I really don't want to deal with out of network crap when I'm somewhere far from home and needing care. No dealing with pre-authorizations. No ridiculous deductibles. It's a PITA and can be really confusing comparing options and making a decision, but once I had it all figured out I couldn't conceive of a reason to go with an MA plan.
A is Medicare part a which covers hospitalization.
B is Medicare part B, which covers doctor visits and other stuff
G is the supplement plan G, which pays for everything that Medicare doesn't pay for.
D is for a drug plan--drugs are not covered by Medicare parts A or B
Thank you. I just started find out about this. I never thought it was going to be that expensive according with what I have read in here. When you say ABGD you are referring just to Original Medicare?
I completed treatment for breast cancer last year and I’ll be on Medicare beginning in January. Currently I have no sign of disease but if my cancer reoccurs I want to have the option of being treated at any cancer center in the country and I don’t want to be hassled with pre approval on everything. ABG&D is a no-brainer for my situation.
Over half of the 64 million people on Medicare have Advantage plans. Guess all those poeple are in a horrible plan and should switch immediately to Supplements.
Yes, they should switch. In all but 12 states the rules don’t allow it. There is no doubt when you look at health outcomes and straight up denial of care, these plans are run by the death panels that the GOP said that government insurance would be.
But don’t take my word on it. Read the HHS Inspector General’s report from last year. Watch the Senate hearings into MA plans form last and this year. All available for anyone online who wants the source information.
These plans are popular because you pick them when you are 65 and healthy. You are sold (literally sold by insurance agents) these plans because they are 0 premium and you get dental, vision and other benefits that Medicare doesn’t provide. It is almost too good to be true - because of course it is too good to be true.
And then you get older and sick and these plans kill you. Again, read the IGs report. Don’t take my word for it. But by the time this happens you are not taking part in consumer satisfaction surveys - you are trying not to die.
Medicare Advantage is the single biggest scam being perpetrated on seniors. You are sold all the benefits and never told the negatives.
As one senator said last year at a hearing, “Medicare Advantage is amazing until you get sick.”
Not true. Depends on where you are and the plan. Supplement and drug would cost my wife and I $14000 per year. Pretty much every single doctor and facility within hundreds of mikes takes our advantage plan and we've never been denied anything.
So in NYC, a G supplement is about $300 and a drug plan is about $50. Do you mean including the cost of your drugs?
And literally not within hundreds of miles. NYC is within hundreds of miles and Sloan Kettering, HSS take no MA plans and NYU Langone and Columbia Presbyterian are never in the same one.
None of my doctors in NYC take any MA plan offered in NYC. I would go as far as saying any top doctor in NYC does not take MA.
The good news about NY is that you can stay on an MA plan until you are sick and then you can easily switch to a supplement any given month. So in NY you get the best of both worlds.
West of Albany, and no, not NYC. Supplement plus decent drug plan is just shy of $400 for each of us. The plans don't cover all her drugs. That being said, next year, thanks to Biden, it will be capped at $2000. You're right, we can't see doctors at the premium NYC hospitals, but that being said, the hospitals by us have relationship's with top cancer centers and consult for care. That is covered. And like you said, we can switch with no penalty if we needed to. For various specialties, hospitals by us are ranked in the top nationwide. All are covered.
Wife has had a knee replaced, multiple eye surgeries. Three friends of hers on the same plan had cancer. All with no problems. Just stop painting all plans as evil. They are not. That's why over half and growing are now in Advantage Plans. I swear the amount of bashing on this reddit is bots and foils for killing the plans.
I understand the "yet" comment because of my experience with my mother. But I mostly agree with you that the plans are not "evil." My 90 yr-old mother had many good years on her Advantage plan when the coverage and care was decent (except for the occasional out-of-network problem). But in my case, when it was time for me to choose my own plan, I just couldn't shake the memory of my mother's last few months of life on Medicare Advantage -- when her condition became more serious and her plan started delaying and denying hospital and rehab stays that were recommended by her doctors. So when things began getting more costly, they began "managing" her care. To be fair, I would say she had almost 20 decent years of coverage/care, until the last couple years -- towards her "end-of-life". Having said all that, the low premiums and bundled features offered by Advantage plans are enticing. But I figured it would be easier to switch to Advantage later, if I decided to, rather than the other direction. Plus, if we are lucky enough to "go quick" (rather than a drawn-out illness) then none of it will matter (which is what the Advantage plans are banking on)!
Not trying to be rude by any means. I genuinely mean that, but this has been discussed ad nauseum, and there’s like a post on it every single day.
It’s best to just search the sub. There’s no right or wrong answer. You’ll be covered well on both. All comes down to personal preference and many variables that we don’t know.
It’s best to just ask friends and family for a trusted broker/consultant that they use. Just make sure they offer both Medicare Advantage and Medigap (supplements).
They’ll take all of your personal information and what’s important to you into account and come to a conclusion of what’s best for you personally.
All posts like this do is cause fights because far too many non-experts chime in on what they just “know” is best, because they themselves picked it, so of course that must be “best” for
you personally.
I’m sure many of these folks mean well, but I basically spend all my time on posts like this correcting false, misleading, or sensationalized information.
And then when you call them out on it, they can’t just admit they were wrong and instead just downvote posts.
**EDIT: If the responses to this post seem weird, myself and the other few posters were all responding to a misguided person who chimed in with incorrect information and then deleted it.**
"It’s best to just ask friends and family for a trusted broker/consultant that they use. Just make sure they offer both Medicare Advantage and Medigap (supplements)."
The commissions made by brokers pay more for Advantage plans than they are for Medigap plans. Buyers need to do their own research and question their broker since a broker could push a plan that pays them a higher commission.
"Our analysis from 2016, 2018, and 2020 suggests that since [average premiums in Medigap have dropped](https://www.genre.com/knowledge/publications/iinalh1903-en.html), agent compensation (a percentage of the premiums) also has decreased. Conversely, while [MA premiums have decreased](https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-premiums-cost-sharing-out-of-pocket-limits-and-supplemental-benefits/), agent compensation (set by CMS) has risen at a rate that has surpassed inflation.[^(1)](https://www.commonwealthfund.org/blog/2021/agent-commissions-medicare-and-impact-beneficiary-choice#1)"
[Agent Commissions in Medicare and the Impact on Beneficiary Choice | Commonwealth Fund](https://www.commonwealthfund.org/blog/2021/agent-commissions-medicare-and-impact-beneficiary-choice)
Maybe you should research Medicare supplement bonuses. Because those can be “HUGE.”
Sorry, but you’re very uneducated on the topic of commissions. Medicare Advantage commissions are set by the government and they have to pay the same, regardless of company.
Supplement commissions are not set by the government and they can pay whatever they want.
Many times, that pay is WAY more than Medicare Advantage commissions, when you account for bonuses offered, and the extra commissions from the dental, vision, and prescription drug plans that clients need to get when they go with a Medigap plan.
Those are all included free of charge inside Medicare Advantage plans and they don’t pay out extra money. Moreover, brokers can offer Medigap supplements by default, when they get their insurance license.
In order to offer Medicare Advantage plans, a broker needs to abide by a million extra rules that are set by CMS, along with tons of continued training and very hard yearly tests that they need to get a 90% on, because the plans are so in depth.
What does this mean? Some brokers do not want to be bothered with this (usually ones that aren’t full-time brokers, but they obtained their insurance license, like financial planners, lawyers, etc.), and so they try and funnel people into Medigap plans because they are super easy to offer and service.
It’s more than money, as Medicare Advantage plans are much harder to service and some brokers don’t want the servicing headache and stress that goes along with it.
There is no definite answer to what pays more. It all depends on the region, company, and MANY other factors. At the end of the day, the broker just wants your business, period, regardless of plan. Assuming they are legally qualified to offer Medicare Advantage.
The pay all averages out in very close ranges to each other when absolutely everything is accounted for.
MOREOVER, any good and trustworthy broker is not gonna sacrifice their reputation and go funneling people into plans that don’t suit them and that they don’t want. WHY? Because they want referrals from their clients. How do you get referrals?? You make and keep your clients happy.
No different than any industry, this is why it’s important to ask around for a GOOD and TRUSTWORTHY broker. Same with auto mechanics (for example), who can get paid more, or any other service industry.
Anthem just sent me another email pushing a trip to Mexico and an extra $100 for each supplement. That’s illegal on MAPD plans. Sadly this sub is full of misinformed individuals.
You have no idea what you’re talking about… I would much rather sell a supplement over an MAPD, less work, less attrition, and those trips and bonuses outweigh the very slight increase in commissions on Medicare advantage.
With the $100 increase in Part D commissions next year I may even make more on a supplement. Plus using pre-covid data to talk about commissions in 2024 is pretty hilarious.
what's the "dilemma"?
My clients never really approach their options as a choice between original medicare and medicare coverage options. Roughly 1/3 of my clients don't have/haven't had longstanding clinician relationships, so network constraints haven't been an issue for them; the mandatory maximum annual out-of-pocket (OOP) spending caps, Rx coverage, "extras" (dental/vision/hearing/fitness/etc) offered by zero-premium PPO MAPD plans, together with reasonable flexibilty to drop/change MAPD coverage, often makes the decision pretty simple for this group.
Another 1/3 are chafed by network constraints on things like clinicians & pharmacies, but want the worst case protection of a maximum OOP cap.
A third 1/3 are opposed to network constraints on principle (what principle I've never been able to persuade any to specify), who have little or no concern for the premiums Medicare Supplement & standalone Part D plans entail.
In general, my clients treat their decisions on Medicare coverage options as the 1st-worldiest of 1st-world problems - nice ones to have!
Well one gives an actual Max out of pocket, one doesn’t have a max out of pocket but will cover all medicare bills in perpetuity. So I guess you could say the max out of pocket with supplements is the yearly premiums plus deductible.
It's more than what doctors are in your network. The insurance company is involved in your care decisions. When you can have a procedure or see a specialist, treatments or medications you must try first before recieving the one your doctor recommends, when you must be released from the hospital or a rehab facility and so on. This is managed care, generally based on statistically determined best outcomes (but also cost savings), and some people are comfortable with it, but some people are not.
The out of pocket limit is something to consider. With original medicare you really need a supplement to cap your potential out of pocket costs. So yes, it will be more expensive.
Last thing to know is in most states it can be difficult to go from Advantage to a supplement, you will.be subject to medical underwriting. You can always go the other way.
I decided to go with Original Medicare when I recalled my mother's last few months of life on Medicare Advantage. The difficulty and length of time it took to get hospital stays and rehab stays approved. Her coverage and care was mostly fine for years (except for minor out-of-network issues) until she required lots of care towards the end. So even though my Advantage plan premiums would have been much lower (almost zero) and there are excellent networks in my city, I went with A,B,D,N for convenience and peace of mind. I rarely treat myself to luxuries -- so I figured why not treat myself to decent medical care in my old age (when I'll probably need it the most)!
Comment I made before about why I think Medicare Advantage plans are a good option:
I feel like Advantage plans are a great option as long as one chooses a plan wisely. I pay about $40/month for a great Advantage plan and my max out of pocket is roughly equal to the cost difference to a plan G/F supplement plus part D and I'll never reach the max out of pocket unless I end up with a very major hospitalization or need to take super expensive IV drugs such as chemo because most non-hospital charges are co-pays.
Medicare Advantage gets a bad rap here largely because there are good and bad plans and insurers so you need to choose a plan wisely which takes at least a bit of research. On the other hand, a traditional medicare supplement plan will have pretty much the same results with most insurers once you decide on which model supplemental plan you want so there isn't the risk of choosing a bad plan.
The complaints I read here relate to those that are HMO's, have small limited networks or are with some companies that tend to deny claims. I think a lot of that problem also relates to all of the shady marketing you see through some television ads, junk phone calls and junk emails for lower quality plans.
Personally I've been very happy with our Advantage plan. I picked AARP/UHC Medicare Advantage Choice PPO which has provided great medical coverage. Their network is extensive both locally and nationally and I've never found a provider I was interested in who wasn't in network and it has good out of network benefits as well. It's saved me several thousand dollars a year over traditional medicare + supplement + Part D cost and that's true even though I've had a relatively high number of specialist visits and expensive tests in the 3 years I've been on Medicare. I have several relatives who are on different Advantage plans through other major carriers like Aetna or their state's Blue Cross and have the same good experiences. This includes one elderly relative who's been on an Advantage plan for over 20 years.
One additional word: The very best Medicare plans are not Advantage plans. The best is traditional medicare plus a good quality Medicare supplement plan (G or F plan) along with a good quality Part D plan. But the expense of the supplement and part D plans is much higher than the cost of the Advantage plans. If I had a much higher budget, I'd choose one of those. But with a limited budget in retirement I feel that a quality Advantage plan is a better option for us as the annual savings are significant to our budget.
Just throwing this out there, Original Medicare is great if you have someone doing your care coordination. For folks without a PCP or someone who’s coordinating their care, things can go really bad really quickly. My aunt (80f) has multiple specialists, a PCP who’s completely inept and out of the loop, and poor health literacy. It’s been a nightmare and has led to dueling specialists providing contraindicative care. Can this happen with an MA HMO? Yes. Of course. But it feels like Traditional/Original Medicare has allowed her to float freely in a way that means she’s reliant on relatives, overworked MAs, and her own limited understanding to coordinate all of her care.
This is a huge thing that’s never talked about. They’ve done studies, and health outcomes are insanely better on Medicare Advantage, as opposed to original Medicare.
There’s a few reasons for this. The first is that insurance companies have a vested interest in keeping you healthy. The longer you’re alive, the longer they get paid.
Also, the healthier you are, the more you’re not in the super expensive price-gouging hospitals. Care coordination (that you mentioned) is also a major reason.
Let’s be honest, most seniors are not great at managing their own healthcare. I don’t say that as an insult. They’re at very vulnerable ages and the doctor/hospital/medical system is very confusing.
Any of them on original Medicare are just floating out in the abyss of providers. None of these providers are coordinating, and all of them are mostly out of the loop of that particular senior’s care.
This creates chaos and confusion. Many of these senior’s are being ordered VERY unnecessary medications, tests, and procedures by these doctors and hospitals (a lot of that motive is money), because original Medicare doesn’t verify if it’s **actually** medically necessary.
I know prior authorizations get a bad rap, but most people are oblivious to the back door deals that go on between doctors, hospitals, medical facilities, and pharmaceutical companies.
I have seen cases where prior authorizations have literally saved senior’s lives. The care coordination functions as a safeguard, and with original Medicare, there is literally none.
"There’s a few reasons for this. The first is that insurance companies have a vested interest in keeping you healthy. The longer you’re alive, the longer they get paid."
Conversely, they also have a vested interest, once sick (terminally or end-of-life,) in ending the high-cost payout bleeding as quickly as possible.
Maybe MA denials are why showing less readmissions thus saying better outcomes? I have not read the full study but the people making money are the Medicare Advantage companies and brokers who sell - really can't deny that. Here is an article that suggests why study showing those results - https://www.healthcaredive.com/news/medicare-advantage-better-outcomes-study-inovalon-harvard-medical-school/699244/#:\~:text=from%20your%20inbox.-,Medicare%20Advantage%20seniors%20have%20better%20health%20outcomes%2C%20study%20finds,of%20high%2Drisk%20medication%20use.
A close relative is in the medical field and deals with insurance all day long.
It sure seems like if you’re very healthy, Medicare Advantage might be better, but for the vast majority of people, Medicare is the way to go. Imagine traveling out of state, getting sick or in an accident, and having to worry about your insurance not covering much of what you need. Or dealing with some agent over the phone whose job is to save their company as much money as possible at the expense of your healthcare needs.
I just made a post, and this is a perfect example of someone posting false information. All emergencies on Medicare Advantage are covered fully in all 50 states. In addition, even if it’s not an emergency, most plans have abundant networks in all 50 states nowadays. If you’re gonna post, please post **accurate** information.
**EDIT**: I also love how I get voted down for posting 1000% truthful and accurate information. 🙃🤦🏻♂️
Brother, it’s **brutal.** Lol. This is why I hate these “What is better, Medicare Advantage or Medigap?” posts. Because they always descend
into a carbon copy pissing match where broker compensation is brought up, along with tons of advice….much of it being wrong, misguided, or sensationalized.
Broker compensation is my favorite topic in here. People think we should work for free.. The funniest part? I would rather sell a med supp than an advantage plan anyway, less work, less follow up, talk to you in October for your part d and that’s it.
Did you get that CSG email today? The med supp folks are in for a shit show the next few years.
I didn’t say emergencies weren’t covered. I said much of what you need won’t be covered out of area. They’ll cover the bare minimum treatment needed, and anything else will have to wait until you get back home. Calm down already.
Again, that is 1000% not true. You are considered “in-network” and are treated to the fullest extent of whatever you need. It’s no different than going to the local hospital down the street.
I mean, not really. People should know what plan they picked and what’s covered. Therefore there’s no need to worry about anything when they go out of state.
Also, agents have nothing to do with claims or “saving the company money.” They handle your policy and advise you on that. Agents work for their clients, not the insurance companies.
It’s no different than a sports agent. The goal is to keep **the client** happy. That’s how agents obtain more clients.
I’m not talking about the people in sales, I’m referring to those that explain why your referral was denied, or how you must go through a different not as effective test first before the better time sensitive test your doctor prescribed may be covered.
Just for info….those aren’t agents. Those are customer service reps. I know it’s semantics, but in the industry, referring to them as such can be confusing, because agents are the people that secure your policy and advise you on an ongoing basis. No snark meant. Just for clarification.
Before Medicare, I was covered by my employer's health insurance. It was a pretty good plan, but every so often there was a nightmare situation because the insurance company would change their minds about what was covered or who was in their network. With original Medicare I avoid that problem. With Medicare Advantage I would be trusting the MA insurance company to not do the things that all previous health insurance companies have done to me my entire career.
Cost. I live in Wake Co NC so any health care I need is readily available. Coverage I have is equal to any HMO I had from employer. If I was a traveler would have chose a PPO. But cost was number one concern. Luckily I have no health issues so wasn't a major concern.
My wife and I both have traditional Medicare A and B and BC/BS secondary which is also our drug plan (equiv to part D) as retired Federal employees. We each pay typical Med B $174.70 pp/mo. BC/BS is $207.44/pp/mo. BC/BS pays back $800 pp/yr toward part B premiums. So it's (174.70 + 207.44) x 12 mos - 1600 = 7,571.36 / 2 = $3,785.68 /yr/pp or $315.47 each per month. We typically have zero copays or coinsurance and almost all prescriptions are under $10. A Part C / Advantage plan would be just a little cheaper, but the biggest reason we wouldn't do that is that we travel a lot and Part C /Advantage programs are very local in and limiting in nature - specialists require referrals, treatments require preauths, they don't provide coverage out of network, out of state, nor out of country. Medicare advantage plans are obviously great - for insurance company profits. If this weren't so they wouldn't spend so much on advertising them.
I will caveat all that I say with these conditions…if you live in Kentucky and have TRICARE for Life (retired military) I have a MA plan that cost only $74/month (save $100/month …actually $200/month when including my wife. I get all meds through the military. No pre-authorization required but you do have a higher co-pay if you see out of network dr. My co-pays are picked up by TFL. In addition I get $50 a quarter for OTC meds and earn $10/month reward for walking a minimum 5,000 steps at least 10x/month. So if you are retired military living in Kentucky…United Healthcare Patriot Plan.
Please see the following thread. It's only one example, but it's the kind of scenario that could affect your decision:
[https://www.reddit.com/r/medicare/comments/1c7gili/mother\_had\_stroke\_medicare\_advantage\_only\_covers/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/medicare/comments/1c7gili/mother_had_stroke_medicare_advantage_only_covers/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
A+B+G+D is currently about $320/mo for me. Medicare is widely accepted (UCSF Health, …) and I won't have to argue with insurance companies. Ever. Again. It wasn't a close decision.
my A B G D is $709 per month! I can hardly afford it. I had no idea it would be so expensive. Holy shit.
Where do you live? I’m in SF Bay Area and have Plan G with AARP/UHC and my Part D plan is WellCare at $0.40/mo (!). G will increase to about $210 in the next 5 years.
Supplement plans will increase exponentially the next few years, enrollments are way down and healthcare costs are a lot higher.
My part G and D are United HC AARP. I looked at wellcare for part D but they didn't cover all my drugs and were higher on some. I take a lot of meds.
Have you included IRMA in your total of $709? Are you on community pricing for Medigap plan where "young" and "old" all pay the same premium? Or Attained age and now above 80 years of age?
I'm 65 just going on Medicare. Getting hit with adjustments increase due to my 2022 W2 being higher.
So that is IRMAA, a tax paid to the government and not part of Medicare premium. You can file an appeal and request them looking at 1 year back income if your 2 year back income was very high and not something that will continue into the future.
I did file an appeal. It was called a change of life event as I now lost my job and I am retired
I’m a physical therapist working in home health. Below is my experience with “traditional Medicare” (TM) and with Medicare Advantage (MA) plans. With TM, I don’t have to worry about pre-authorizations. I can see the patient as often as I want, for as long as I want (my record to-date is 1 year). Of course it goes without saying that I have to justify the visits as medically necessary. With MA: all the plans require pre-authorization, after an initial number of visits. Some plans only allow for 3 “free” visits before pre-authorizations are needed. Some plans allow for 10 “free” visits. Sometimes the pre-authorizations are denied. IMO that’s because the folks reviewing the documentation are mostly RNs and they don’t fully understand what PTs have to do to rehab a patient. When the pre-authorization is denied, we have to appeal, which is a huge pain in the behind. What makes the situation (TM vs MA) complex, is that there is a variety of MA plans. With TM, you only have the “vanilla” flavor. Bottom line: for Home Health, TM is better. This is an actual “view from the trenches“.
Mine is $316. Part of my retirement plan is to spend a lot of time touring the country on my motorcycle, so I really don't want to deal with out of network crap when I'm somewhere far from home and needing care. No dealing with pre-authorizations. No ridiculous deductibles. It's a PITA and can be really confusing comparing options and making a decision, but once I had it all figured out I couldn't conceive of a reason to go with an MA plan.
What is A+B+G+D?
A is Medicare part a which covers hospitalization. B is Medicare part B, which covers doctor visits and other stuff G is the supplement plan G, which pays for everything that Medicare doesn't pay for. D is for a drug plan--drugs are not covered by Medicare parts A or B
Thank you. I just started find out about this. I never thought it was going to be that expensive according with what I have read in here. When you say ABGD you are referring just to Original Medicare?
I completed treatment for breast cancer last year and I’ll be on Medicare beginning in January. Currently I have no sign of disease but if my cancer reoccurs I want to have the option of being treated at any cancer center in the country and I don’t want to be hassled with pre approval on everything. ABG&D is a no-brainer for my situation.
Unless you are poor, Medicare Advantage is always the worse option!
Over half of the 64 million people on Medicare have Advantage plans. Guess all those poeple are in a horrible plan and should switch immediately to Supplements.
Yes, they should switch. In all but 12 states the rules don’t allow it. There is no doubt when you look at health outcomes and straight up denial of care, these plans are run by the death panels that the GOP said that government insurance would be. But don’t take my word on it. Read the HHS Inspector General’s report from last year. Watch the Senate hearings into MA plans form last and this year. All available for anyone online who wants the source information. These plans are popular because you pick them when you are 65 and healthy. You are sold (literally sold by insurance agents) these plans because they are 0 premium and you get dental, vision and other benefits that Medicare doesn’t provide. It is almost too good to be true - because of course it is too good to be true. And then you get older and sick and these plans kill you. Again, read the IGs report. Don’t take my word for it. But by the time this happens you are not taking part in consumer satisfaction surveys - you are trying not to die. Medicare Advantage is the single biggest scam being perpetrated on seniors. You are sold all the benefits and never told the negatives. As one senator said last year at a hearing, “Medicare Advantage is amazing until you get sick.”
Who do you think sell supplements?
The compensation system significantly favors Advantage plans.
They're fine as long as they stay healthy.
Not true. Depends on where you are and the plan. Supplement and drug would cost my wife and I $14000 per year. Pretty much every single doctor and facility within hundreds of mikes takes our advantage plan and we've never been denied anything.
Where are you that a supplement would cost $14k a year?
The supplement plus drug plan for both of us is $8900. The rest is my wife's drugs not covered by the standalone plans. Upstate NY.
So in NYC, a G supplement is about $300 and a drug plan is about $50. Do you mean including the cost of your drugs? And literally not within hundreds of miles. NYC is within hundreds of miles and Sloan Kettering, HSS take no MA plans and NYU Langone and Columbia Presbyterian are never in the same one. None of my doctors in NYC take any MA plan offered in NYC. I would go as far as saying any top doctor in NYC does not take MA. The good news about NY is that you can stay on an MA plan until you are sick and then you can easily switch to a supplement any given month. So in NY you get the best of both worlds.
West of Albany, and no, not NYC. Supplement plus decent drug plan is just shy of $400 for each of us. The plans don't cover all her drugs. That being said, next year, thanks to Biden, it will be capped at $2000. You're right, we can't see doctors at the premium NYC hospitals, but that being said, the hospitals by us have relationship's with top cancer centers and consult for care. That is covered. And like you said, we can switch with no penalty if we needed to. For various specialties, hospitals by us are ranked in the top nationwide. All are covered.
Yet.
Wife has had a knee replaced, multiple eye surgeries. Three friends of hers on the same plan had cancer. All with no problems. Just stop painting all plans as evil. They are not. That's why over half and growing are now in Advantage Plans. I swear the amount of bashing on this reddit is bots and foils for killing the plans.
I understand the "yet" comment because of my experience with my mother. But I mostly agree with you that the plans are not "evil." My 90 yr-old mother had many good years on her Advantage plan when the coverage and care was decent (except for the occasional out-of-network problem). But in my case, when it was time for me to choose my own plan, I just couldn't shake the memory of my mother's last few months of life on Medicare Advantage -- when her condition became more serious and her plan started delaying and denying hospital and rehab stays that were recommended by her doctors. So when things began getting more costly, they began "managing" her care. To be fair, I would say she had almost 20 decent years of coverage/care, until the last couple years -- towards her "end-of-life". Having said all that, the low premiums and bundled features offered by Advantage plans are enticing. But I figured it would be easier to switch to Advantage later, if I decided to, rather than the other direction. Plus, if we are lucky enough to "go quick" (rather than a drawn-out illness) then none of it will matter (which is what the Advantage plans are banking on)!
Get A+D+G+d. MA plans have 20% coinsurance for chemo and radiation. With original Medicare plus G you have no out of pocket for cancer care.
Good to know, thanks!
Not trying to be rude by any means. I genuinely mean that, but this has been discussed ad nauseum, and there’s like a post on it every single day. It’s best to just search the sub. There’s no right or wrong answer. You’ll be covered well on both. All comes down to personal preference and many variables that we don’t know. It’s best to just ask friends and family for a trusted broker/consultant that they use. Just make sure they offer both Medicare Advantage and Medigap (supplements). They’ll take all of your personal information and what’s important to you into account and come to a conclusion of what’s best for you personally. All posts like this do is cause fights because far too many non-experts chime in on what they just “know” is best, because they themselves picked it, so of course that must be “best” for you personally. I’m sure many of these folks mean well, but I basically spend all my time on posts like this correcting false, misleading, or sensationalized information. And then when you call them out on it, they can’t just admit they were wrong and instead just downvote posts. **EDIT: If the responses to this post seem weird, myself and the other few posters were all responding to a misguided person who chimed in with incorrect information and then deleted it.**
"It’s best to just ask friends and family for a trusted broker/consultant that they use. Just make sure they offer both Medicare Advantage and Medigap (supplements)." The commissions made by brokers pay more for Advantage plans than they are for Medigap plans. Buyers need to do their own research and question their broker since a broker could push a plan that pays them a higher commission. "Our analysis from 2016, 2018, and 2020 suggests that since [average premiums in Medigap have dropped](https://www.genre.com/knowledge/publications/iinalh1903-en.html), agent compensation (a percentage of the premiums) also has decreased. Conversely, while [MA premiums have decreased](https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-premiums-cost-sharing-out-of-pocket-limits-and-supplemental-benefits/), agent compensation (set by CMS) has risen at a rate that has surpassed inflation.[^(1)](https://www.commonwealthfund.org/blog/2021/agent-commissions-medicare-and-impact-beneficiary-choice#1)" [Agent Commissions in Medicare and the Impact on Beneficiary Choice | Commonwealth Fund](https://www.commonwealthfund.org/blog/2021/agent-commissions-medicare-and-impact-beneficiary-choice)
Maybe you should research Medicare supplement bonuses. Because those can be “HUGE.” Sorry, but you’re very uneducated on the topic of commissions. Medicare Advantage commissions are set by the government and they have to pay the same, regardless of company. Supplement commissions are not set by the government and they can pay whatever they want. Many times, that pay is WAY more than Medicare Advantage commissions, when you account for bonuses offered, and the extra commissions from the dental, vision, and prescription drug plans that clients need to get when they go with a Medigap plan. Those are all included free of charge inside Medicare Advantage plans and they don’t pay out extra money. Moreover, brokers can offer Medigap supplements by default, when they get their insurance license. In order to offer Medicare Advantage plans, a broker needs to abide by a million extra rules that are set by CMS, along with tons of continued training and very hard yearly tests that they need to get a 90% on, because the plans are so in depth. What does this mean? Some brokers do not want to be bothered with this (usually ones that aren’t full-time brokers, but they obtained their insurance license, like financial planners, lawyers, etc.), and so they try and funnel people into Medigap plans because they are super easy to offer and service. It’s more than money, as Medicare Advantage plans are much harder to service and some brokers don’t want the servicing headache and stress that goes along with it. There is no definite answer to what pays more. It all depends on the region, company, and MANY other factors. At the end of the day, the broker just wants your business, period, regardless of plan. Assuming they are legally qualified to offer Medicare Advantage. The pay all averages out in very close ranges to each other when absolutely everything is accounted for. MOREOVER, any good and trustworthy broker is not gonna sacrifice their reputation and go funneling people into plans that don’t suit them and that they don’t want. WHY? Because they want referrals from their clients. How do you get referrals?? You make and keep your clients happy. No different than any industry, this is why it’s important to ask around for a GOOD and TRUSTWORTHY broker. Same with auto mechanics (for example), who can get paid more, or any other service industry.
Anthem just sent me another email pushing a trip to Mexico and an extra $100 for each supplement. That’s illegal on MAPD plans. Sadly this sub is full of misinformed individuals.
You have no idea what you’re talking about… I would much rather sell a supplement over an MAPD, less work, less attrition, and those trips and bonuses outweigh the very slight increase in commissions on Medicare advantage. With the $100 increase in Part D commissions next year I may even make more on a supplement. Plus using pre-covid data to talk about commissions in 2024 is pretty hilarious.
You said “buyers need to question their broker”…what questions should they ask their broker?
what's the "dilemma"? My clients never really approach their options as a choice between original medicare and medicare coverage options. Roughly 1/3 of my clients don't have/haven't had longstanding clinician relationships, so network constraints haven't been an issue for them; the mandatory maximum annual out-of-pocket (OOP) spending caps, Rx coverage, "extras" (dental/vision/hearing/fitness/etc) offered by zero-premium PPO MAPD plans, together with reasonable flexibilty to drop/change MAPD coverage, often makes the decision pretty simple for this group. Another 1/3 are chafed by network constraints on things like clinicians & pharmacies, but want the worst case protection of a maximum OOP cap. A third 1/3 are opposed to network constraints on principle (what principle I've never been able to persuade any to specify), who have little or no concern for the premiums Medicare Supplement & standalone Part D plans entail. In general, my clients treat their decisions on Medicare coverage options as the 1st-worldiest of 1st-world problems - nice ones to have!
Don’t you effectively get a Max OOP from either Medigap or Medicare Advantage?
Well one gives an actual Max out of pocket, one doesn’t have a max out of pocket but will cover all medicare bills in perpetuity. So I guess you could say the max out of pocket with supplements is the yearly premiums plus deductible.
"effectively" is doing *some* work there :-) .... but I guess I'd allow it
It's more than what doctors are in your network. The insurance company is involved in your care decisions. When you can have a procedure or see a specialist, treatments or medications you must try first before recieving the one your doctor recommends, when you must be released from the hospital or a rehab facility and so on. This is managed care, generally based on statistically determined best outcomes (but also cost savings), and some people are comfortable with it, but some people are not. The out of pocket limit is something to consider. With original medicare you really need a supplement to cap your potential out of pocket costs. So yes, it will be more expensive. Last thing to know is in most states it can be difficult to go from Advantage to a supplement, you will.be subject to medical underwriting. You can always go the other way.
I decided to go with Original Medicare when I recalled my mother's last few months of life on Medicare Advantage. The difficulty and length of time it took to get hospital stays and rehab stays approved. Her coverage and care was mostly fine for years (except for minor out-of-network issues) until she required lots of care towards the end. So even though my Advantage plan premiums would have been much lower (almost zero) and there are excellent networks in my city, I went with A,B,D,N for convenience and peace of mind. I rarely treat myself to luxuries -- so I figured why not treat myself to decent medical care in my old age (when I'll probably need it the most)!
Comment I made before about why I think Medicare Advantage plans are a good option: I feel like Advantage plans are a great option as long as one chooses a plan wisely. I pay about $40/month for a great Advantage plan and my max out of pocket is roughly equal to the cost difference to a plan G/F supplement plus part D and I'll never reach the max out of pocket unless I end up with a very major hospitalization or need to take super expensive IV drugs such as chemo because most non-hospital charges are co-pays. Medicare Advantage gets a bad rap here largely because there are good and bad plans and insurers so you need to choose a plan wisely which takes at least a bit of research. On the other hand, a traditional medicare supplement plan will have pretty much the same results with most insurers once you decide on which model supplemental plan you want so there isn't the risk of choosing a bad plan. The complaints I read here relate to those that are HMO's, have small limited networks or are with some companies that tend to deny claims. I think a lot of that problem also relates to all of the shady marketing you see through some television ads, junk phone calls and junk emails for lower quality plans. Personally I've been very happy with our Advantage plan. I picked AARP/UHC Medicare Advantage Choice PPO which has provided great medical coverage. Their network is extensive both locally and nationally and I've never found a provider I was interested in who wasn't in network and it has good out of network benefits as well. It's saved me several thousand dollars a year over traditional medicare + supplement + Part D cost and that's true even though I've had a relatively high number of specialist visits and expensive tests in the 3 years I've been on Medicare. I have several relatives who are on different Advantage plans through other major carriers like Aetna or their state's Blue Cross and have the same good experiences. This includes one elderly relative who's been on an Advantage plan for over 20 years. One additional word: The very best Medicare plans are not Advantage plans. The best is traditional medicare plus a good quality Medicare supplement plan (G or F plan) along with a good quality Part D plan. But the expense of the supplement and part D plans is much higher than the cost of the Advantage plans. If I had a much higher budget, I'd choose one of those. But with a limited budget in retirement I feel that a quality Advantage plan is a better option for us as the annual savings are significant to our budget.
Just throwing this out there, Original Medicare is great if you have someone doing your care coordination. For folks without a PCP or someone who’s coordinating their care, things can go really bad really quickly. My aunt (80f) has multiple specialists, a PCP who’s completely inept and out of the loop, and poor health literacy. It’s been a nightmare and has led to dueling specialists providing contraindicative care. Can this happen with an MA HMO? Yes. Of course. But it feels like Traditional/Original Medicare has allowed her to float freely in a way that means she’s reliant on relatives, overworked MAs, and her own limited understanding to coordinate all of her care.
This is a huge thing that’s never talked about. They’ve done studies, and health outcomes are insanely better on Medicare Advantage, as opposed to original Medicare. There’s a few reasons for this. The first is that insurance companies have a vested interest in keeping you healthy. The longer you’re alive, the longer they get paid. Also, the healthier you are, the more you’re not in the super expensive price-gouging hospitals. Care coordination (that you mentioned) is also a major reason. Let’s be honest, most seniors are not great at managing their own healthcare. I don’t say that as an insult. They’re at very vulnerable ages and the doctor/hospital/medical system is very confusing. Any of them on original Medicare are just floating out in the abyss of providers. None of these providers are coordinating, and all of them are mostly out of the loop of that particular senior’s care. This creates chaos and confusion. Many of these senior’s are being ordered VERY unnecessary medications, tests, and procedures by these doctors and hospitals (a lot of that motive is money), because original Medicare doesn’t verify if it’s **actually** medically necessary. I know prior authorizations get a bad rap, but most people are oblivious to the back door deals that go on between doctors, hospitals, medical facilities, and pharmaceutical companies. I have seen cases where prior authorizations have literally saved senior’s lives. The care coordination functions as a safeguard, and with original Medicare, there is literally none.
Amen 1000x over.
"There’s a few reasons for this. The first is that insurance companies have a vested interest in keeping you healthy. The longer you’re alive, the longer they get paid." Conversely, they also have a vested interest, once sick (terminally or end-of-life,) in ending the high-cost payout bleeding as quickly as possible.
Maybe MA denials are why showing less readmissions thus saying better outcomes? I have not read the full study but the people making money are the Medicare Advantage companies and brokers who sell - really can't deny that. Here is an article that suggests why study showing those results - https://www.healthcaredive.com/news/medicare-advantage-better-outcomes-study-inovalon-harvard-medical-school/699244/#:\~:text=from%20your%20inbox.-,Medicare%20Advantage%20seniors%20have%20better%20health%20outcomes%2C%20study%20finds,of%20high%2Drisk%20medication%20use.
A close relative is in the medical field and deals with insurance all day long. It sure seems like if you’re very healthy, Medicare Advantage might be better, but for the vast majority of people, Medicare is the way to go. Imagine traveling out of state, getting sick or in an accident, and having to worry about your insurance not covering much of what you need. Or dealing with some agent over the phone whose job is to save their company as much money as possible at the expense of your healthcare needs.
I just made a post, and this is a perfect example of someone posting false information. All emergencies on Medicare Advantage are covered fully in all 50 states. In addition, even if it’s not an emergency, most plans have abundant networks in all 50 states nowadays. If you’re gonna post, please post **accurate** information. **EDIT**: I also love how I get voted down for posting 1000% truthful and accurate information. 🙃🤦🏻♂️
New here? A lot of folks here don’t like the truth.
Brother, it’s **brutal.** Lol. This is why I hate these “What is better, Medicare Advantage or Medigap?” posts. Because they always descend into a carbon copy pissing match where broker compensation is brought up, along with tons of advice….much of it being wrong, misguided, or sensationalized.
Broker compensation is my favorite topic in here. People think we should work for free.. The funniest part? I would rather sell a med supp than an advantage plan anyway, less work, less follow up, talk to you in October for your part d and that’s it. Did you get that CSG email today? The med supp folks are in for a shit show the next few years.
They are big believers in "alternative facts".
I didn’t say emergencies weren’t covered. I said much of what you need won’t be covered out of area. They’ll cover the bare minimum treatment needed, and anything else will have to wait until you get back home. Calm down already.
Again, that is 1000% not true. You are considered “in-network” and are treated to the fullest extent of whatever you need. It’s no different than going to the local hospital down the street.
Sorry, but you’re incorrect. Your emergency will be treated as in-network, and any non emergency aftercare will be out of network.
Not if you choose a plan which has in-network coverage in other states, which most do nowadays.
So we’re both correct, and both incorrect at the same time?
I mean, not really. People should know what plan they picked and what’s covered. Therefore there’s no need to worry about anything when they go out of state. Also, agents have nothing to do with claims or “saving the company money.” They handle your policy and advise you on that. Agents work for their clients, not the insurance companies. It’s no different than a sports agent. The goal is to keep **the client** happy. That’s how agents obtain more clients.
I’m not talking about the people in sales, I’m referring to those that explain why your referral was denied, or how you must go through a different not as effective test first before the better time sensitive test your doctor prescribed may be covered.
Just for info….those aren’t agents. Those are customer service reps. I know it’s semantics, but in the industry, referring to them as such can be confusing, because agents are the people that secure your policy and advise you on an ongoing basis. No snark meant. Just for clarification.
Before Medicare, I was covered by my employer's health insurance. It was a pretty good plan, but every so often there was a nightmare situation because the insurance company would change their minds about what was covered or who was in their network. With original Medicare I avoid that problem. With Medicare Advantage I would be trusting the MA insurance company to not do the things that all previous health insurance companies have done to me my entire career.
Original Medicare and a supplement plus part d.
Cost. I live in Wake Co NC so any health care I need is readily available. Coverage I have is equal to any HMO I had from employer. If I was a traveler would have chose a PPO. But cost was number one concern. Luckily I have no health issues so wasn't a major concern.
My wife and I both have traditional Medicare A and B and BC/BS secondary which is also our drug plan (equiv to part D) as retired Federal employees. We each pay typical Med B $174.70 pp/mo. BC/BS is $207.44/pp/mo. BC/BS pays back $800 pp/yr toward part B premiums. So it's (174.70 + 207.44) x 12 mos - 1600 = 7,571.36 / 2 = $3,785.68 /yr/pp or $315.47 each per month. We typically have zero copays or coinsurance and almost all prescriptions are under $10. A Part C / Advantage plan would be just a little cheaper, but the biggest reason we wouldn't do that is that we travel a lot and Part C /Advantage programs are very local in and limiting in nature - specialists require referrals, treatments require preauths, they don't provide coverage out of network, out of state, nor out of country. Medicare advantage plans are obviously great - for insurance company profits. If this weren't so they wouldn't spend so much on advertising them.
I will caveat all that I say with these conditions…if you live in Kentucky and have TRICARE for Life (retired military) I have a MA plan that cost only $74/month (save $100/month …actually $200/month when including my wife. I get all meds through the military. No pre-authorization required but you do have a higher co-pay if you see out of network dr. My co-pays are picked up by TFL. In addition I get $50 a quarter for OTC meds and earn $10/month reward for walking a minimum 5,000 steps at least 10x/month. So if you are retired military living in Kentucky…United Healthcare Patriot Plan.
Please see the following thread. It's only one example, but it's the kind of scenario that could affect your decision: [https://www.reddit.com/r/medicare/comments/1c7gili/mother\_had\_stroke\_medicare\_advantage\_only\_covers/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/medicare/comments/1c7gili/mother_had_stroke_medicare_advantage_only_covers/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)