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WHEN MY FATHER DIED, my mother moved to be closer to me. I didn’t know anything about Medicare, but I knew she needed health-care coverage.
I would call up Medicare and ask questions, and the phone reps would read me a script. I’d ask another question and they’d read me the same script. Rephrase the question, and I’d get the same useless scripted responses.
I had no idea about the difference between traditional Medicare and Medicare Advantage. I chose Anthem Blue Cross Blue Shield, since it was a familiar name. I was steered toward a Medicare Advantage plan. It was touted as convenient and low cost, with additional benefits such as vision care, dental and reimbursement for gym fees. Who wouldn’t want a Medicare Advantage plan instead of some other costly, more confusing plan?
Initially, the Medicare Advantage plan worked well for my mother—that is, while she was relatively healthy. Then she moved into an assisted living facility in Stamford, Connecticut. None of the doctors, podiatrists and physical therapists who came to her facility would accept Medicare Advantage plans, because the plans paid them far less. I had to find doctors that would take her Advantage plan, and then drive her to her appointments.
My mother had quit smoking 20 years earlier. Still, prior to that, she had smoked for almost 50 years. She developed COPD, or chronic obstructive pulmonary disease. I had to get her an oxygen concentrator. Unfortunately, her Medicare Advantage plan would only pay for a huge oxygen concentrator, not a portable one. This meant that, if she wanted to breathe well, she had to stay in her room. She couldn’t go anywhere unless she wanted to go without oxygen.
The pulmonary specialist and I appealed and appealed this decision to her Medicare Advantage plan. I finally got the portable oxygen concentrator approved, but the only company that would accept Medicare Advantage was a poorly run medical supply company. After calling every executive at the company, I got her the portable unit. If she’d had traditional Medicare, the portable oxygen concentrator would have been authorized much faster and I could have dealt with better-run medical supply companies.
My mother developed pneumonia and the assisted living facility sent her to Stamford Hospital. Medicare Advantage did a good job of covering her hospital expenses. Since she was in bed for more than a week, she needed to go to a rehabilitation facility to avoid being wheelchair-bound for the rest of her life. She was transferred to a rehab facility that took Medicare Advantage. The rehab facility and I had to keep calling Anthem Blue Cross Blue Shield to get her stay extended.
Eventually, her time ran out and she was transferred back to assisted living. Unfortunately, the physical therapist who worked at my mother’s facility wouldn’t take Medicare Advantage because of the low payments.
My son Jake had recently graduated college and wasn’t starting his job for a few months. Every day, he went to visit his grandmother to get her walking. He was the only one who could get her out of her wheelchair.
The final straw: I was notified by Anthem that my mother’s Medicare Advantage plan would no longer pay for her COPD inhaler that she needed daily to breathe. Then came a pleasant surprise. By pure dumb luck, my mother was living in one of the four states—New York, Connecticut, Massachusetts and Maine—that required Medigap plan providers to accept seniors without regard to preexisting conditions.
Why is that important? If you’re in a Medicare Advantage plan, it’s often effectively impossible to switch to traditional Medicare because you can’t qualify for an accompanying Medigap policy. Indeed, in any state other than the four states mentioned above, it’s highly unlikely that an insurance company would sell a Medigap plan to a woman in her 90s with COPD.
We had to wait a number of months for the annual enrollment period. I then switched her to traditional Medicare, plus a Medigap plan from Blue Cross, plus a drug plan. Big difference. Any doctor who came to my mother’s facility was thrilled to take traditional Medicare.
Instead of driving her to the nail salon to get her toe nails trimmed, the podiatrist who came to her assisted living facility every week took care of this. Similarly, the doctor who came to the facility now saw my mother, so I didn’t have to drive her to appointments.
What Medicare plan am I going to choose when I turn 65? I know the plan I select during the initial enrollment period is likely to be the plan I’ll have for the rest of my life. It’s an easy choice: traditional Medicare.
I’m willing to forgo Medicare Advantage extras such as vision care, dental and gym fees. I’m also willing to pay higher premiums to ensure that I have the best medical and drug coverage. My priority is a plan that’ll allow me to choose the best facilities and doctors. I’ll also pick the most comprehensive Medigap plan available, which is currently Plan G.
Lucretia Ryan is the founder of FinancialFreedomforWomen.org. A graduate of Cornell University, she spent her career at IBM.
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the other problem with Medicare Advantage is the way the insurance companies overcharge the taxpayer.. it’s much more expensive for government (which means you and me paying taxes) than traditional.
See,
https://www.npr.org/sections/health-shots/2021/11/11/1054281885/medicare-advantage-overcharges-exploding
Hi I am wondering if someone who lives in one of the four states that allow you to choose a Medigap plan after the initial sign up period can tell me if insurance companies in those states can, if the person has pre-existing conditions, can they charge them a higher premium going forward than if they had started with the company initially. My husband and I are returning to the States after 30 years abroad and have been paying for Medicare part B since turning 65 but of course not a supplemental policy because we have been covered here in Australia for all our medical needs.
In NY State the insurance companies cannot charge you a higher rate or deny you coverage for preexisting conditions. https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/supplemental-insurance-for-original-medicare-medigaps/medigaps-in-new-york-state#:~:text=In%20New%20York%20State%2C%20all,because%20of%20your%20health%20status.
If you’d like to find out the rate you will be charged you can look up your rates at medicare.gov
Thanks Lucretia for your reply and the information to help me get started.
A few things:
If you travel frequently, say in an RV around America, and you have an acute illness, wouldn’t it be a comfort to have traditional Medicare and not need to worry about all the in or out of network business?
Second, how are insurance agents compensated for enrolling their clients in MA plans? When I wanted to move my father to traditional Medicare, the insurance agent who had handled his MA plan (an old church friend) became rather obnoxious…
The reason I wanted to change is that when my dad needed a specialist in the Dallas Fort Worth area, the only in-network specialist was 40 miles away.
As dad was in assisted living, it fell to me to travel from the East coast to take him to the specialist.
Last and separately, a number of years ago when I had UHC insurance through work, I was in an accident requiring many tests in an emergency facility. It took countless hours of calls, changing requirements, lost records by UHC, etc. to get any of the providers paid. Eventually, some just wrote off their losses and I paid much more than I should have. As you might imagine, especially having now had better experiences with BC/BS, I’ll never touch UHC for anything again under any circumstances.
DEATH BY PAPERWORK: Watch NY Times Opinion video on health insurers’ “prior authorization” practices < https://tinyurl.com/3fpb8ddm >
In Maine, switching to supplemental insurance from an Advantage plan without underwriting is possible only under limited circumstances: https://www.maine.gov/pfr/insurance/consumers/medicare-supplement-insurance/buy-switch-outside-open-enrollment I do not know about the other three states you have mentioned.
A great podcast about Medicare
https://podcasts.apple.com/us/podcast/an-arm-and-a-leg/id1438778444?i=1000647517455
After spending 54 years in finance and Insurance, and teaching financial planning and retirement planning at the collegiate level for the past 15 years, until I retired this past January, I can assure you that Medicare Advantage plans are only advantageous for the Insurance Carrier.
I think it is criminal to allow Medicare Advantage Plans to be so blatantly misrepresented to the public. While I am a small government person, this is one area where regulation needs to be stepped up.
I am sorry you had to go through all the turmoil and pain carrying for your mother.
Thank you for all of your comments. I also teach a course and wrote an article about all the things no one tells you about Medicare and Medicare Advantage. https://www.financialfreedomforwomen.org/healthcare/blog-post-title-four-n67z6-jkjdl Since I do not accept any fees, donations, advertising or sell any financial products I can write about the the real issues with Medicare Advantage. I wrote a series on Medicare and Medicare Advantage that you can read at my non profit https://www.financialfreedomforwomen.org/
In the same vein as this article, the University of Washington reported the results from a large study comparing traditional Medicare to Medicare Advantage and found the latter to systematically provide less health services than the traditional Medicare.
Analysis: Medicare Advantage limits home health care | UW Medicine
https://youtu.be/GTeDAIrIiZs?si=PgMs6N9l2UJkmInn
Sorry to hear about the struggle you had to deal with. I just turned 65 last year and consulted an insurance agent who helped me understand the nuances of Medicare advantage vs. traditional Medicare. The biggest one of all is that I could go see anyone who accepts Medicare. This was the prime reason I went with traditional. In addition, the fact that it is much harder to get back into Medicare if you don’t enroll when you become first eligible was the reason I went with traditional. The nice thing was that when I reached out to Medicare requesting to remove my IRMAA (Income-Related Monthly Adjustment Amount) because I retired, they removed it and that brought my premiums down to standard premium.
I’m surprised you were taken in, Advantage plans have a terrible reputation to the point that I have heard them called Medicare for poor people. But the whole scene is quite confusing. In a small town like mine I just asked around and got the same advice from every source.
Ever wonder how they (MA) can offer little or no fee?
“The government pays Medicare Advantage plans a set rate per person, per year (around $12,000 in 2019, not including Part D–related expenses) under what’s known as a risk-based contract. That means that each plan agrees to assume the full risk of providing all care for that inclusive amount.”
However, we see that MA’s do not pay for everything. They are purely profit based.
Even though we are very healthy, my wife and I have original Medicare and UHC/AARP part B (gap) insurance. This coverage also provides free gym coverages at the YMCA and a few other places, which was not a factor in choosing them.
I suggest original Medicare for many reasons, and the government should stop paying them.
To anyone contemplating retirement, I strongly recommend they spend time reading “Medicare For Dummies” by Patricia Barry, a long time AARP retirement specialist. The choice between traditional Medicare and a Medicare Advantage plan is critical and should not be made without some understanding of the pros and cons. In the year before I retired, I spent considerable time reading this book, which not only helped me understand how to enroll for Medicare, but which version (traditional + a gap policy) would work best for me. In the 10 years since I retired, I have loaned my copy of this book to numerous friends who have also benefited from its advice. While Medicare Advantage plans typically appear cheaper and can offer more benefits, their limitations in service can become critical when illness or disability strikes.
For me it was Journalist Philip Moeller’s (who formerly wrote for PBS’s Making Sen$e ) book “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” that came out in 2016. I loaned out my copy of the book and then the person who borrowed would say something like – I have a friend who could really benefit from reading this Medicare book, can I loan it to my friend? I have given up trying to get the book back, I think it served its purpose. After reading this book most readers seem to choose the traditional Medicare part B paired with a quality supplemental Medigap plan and Part D drug plan.
I just checked on line and the Kindle version lists for less than $5. The key point of this article and the comments is the need to inform yourself so you can make an informed insurance decision that you may only get one opportunity to make.
I will read every single comment here to learn more about this issue.
I revisit the issue of Medicare vs Medicare Advantage for me every year, and am never sure which one is best. I chose a PPO Medicare Advantage plan (with a small premium on top of Medicare) when I moved to Maryland, because even though my health is mostly good, I have a couple of dangerous issues and I wanted to be able to choose my new doctors myself. That worked out great. It was a MA plan without an HMO-type limitation.
Those details in the trenches you describe are critical – hospital stay coverage, approvals for specific procedures, approvals for specialized equipment, even limits on the number of procedures covered.
I really began to question my current plan when it wasn’t clear if the plan covered the most recent COVID booster, and I sent an email asking that simple question (“Is it covered or not?”) that was never answered, and then called and talked to two people who couldn’t tell me, either. (I got a long complicated narrative about whether the provider was registered in a certain way and had agreed to file the requisite paperwork.) It made me think that every time my plan people gave that answer, they were trying to transfer the $100-odd charge for that booster from them to the insured, and so save thousands of dollars – which would be put in the owner’s pocket. It didn’t give me the warm-and-fuzzies about them.
So I will again revisit the plan come fall, and a lot more carefully.
I believe that all Medicare policies are required to cover all recommended vaccinations.
I also had as my first year trial of an Advantage plan with a PPO which is the same policy that other retired that we know have. I took advantage of the PPO benefit when I had a knee issue and wanted to go to an out of network orthopedist whom I used to work for. Only had to pay a slightly larger copay. Was very satisfied with this nonprofit plan but still switched to traditional with G plan for maximum flexibility and cost (though more expensive) certainly.
Lucretia, great article and welcome to HD as a writer.
This is among the best things I’ve ever read in succinctly laying out the actual nightmares faced by someone with a MA plan.
As is often said, “Medicare Advantage is great till you get sick….”
Thank you. The saying I’ve heard is “Healthy people swear by Medicare Advantage. Sick people swear at Medicare Advantage”.
Extremely helpful article and comments here. What I thought was a forthcoming slam dunk decision may not be so!
Curious, for those that had or have MA plans, were you enrolled in it via eligibility in having worked for a state government entity with a union? My wife worked in our public school system and having had to retire early due to health issues, receives SSD and a BCBS MA plan from her retirement plan. She’ll soon convert to regular SS and my BCBS healthcare coverage from her public school benefits will be converted to the same MA program when I hit 65 early next year. I’m retired and collecting SS. We can opt out of MA but then we’re on our own going forward in selecting our coverage each year.
Boiling it down, is there a “one and only” MA plan or can additional or better cost coverages be attained via union contracts, etc? My wife’s coverage seems to be decent even through a multitude of severe health issues over the years. Her school retiree friends also have had no complaints and they are 5-10+ years older.
Best to all.
Many unions (Conn Teacher’s Retirement Board) and corporations(IBM) have negotiated “super” Medicare Advantage plans for their members . This MA plan allows members to see doctors or Hospitals that are not in network. This is a big plus because they can go to the best cancer hospitals (like Moffit) if the hospital will take the payment that the MA is paying them. However you still have the requirements of “prior approval” which means the MA has to authorize care for in network or out of network for many procedures and hospital stays. So if the MA denies the care then the MA won’t pay for the care whether it’s in or out of network. Like I did for my mother, you can appeal but very few people do appeal. United Healthcare is being sued for using AI to deny care to many members.
My father-in-law was with Verizon for many years and belonged to the union. After being retired for many years they switched his retiree healthcare to a MA through United Healthcare. Honestly, it was the best. He was a union member, and they took good care of their people. Individuals are not able to get plans like his. My retiree healthcare, which I am so grateful for, just provides a small supplement to spend as I wish as long as I get insurance through their marketplace. So far, so good.
Very insightful. Thank you.
I researched Medicare as others here did — Medicare for Dummies — but I also used the excellent AARP resources, and when I moved to Seattle I did the best thing of all. I solicited recommendations from a finance counselor at the University of Washington, whose oncology (Fred Hutch) and diabetes clinics would be providing my care. Then I lined up a new PCP I really liked and sat down with that billing person as well.
And with all that information, I came to the opposite conclusion of Lucretia and others. Medicare Advantage was the right choice for me, specifically the United Healthcare plan that AARP recommends and UW works most closely with. We’ll see how it works out in the long run, but right now I’m delighted with it.
Yes as the other people mentioned. AARP receives money from United Healthcare for allowing United Healthcare to use their name on the AARP United Healthcare Medicare Advantage Plan. AARP gets significantly less money from United Healthcare for allowing United Healthcare to use their name on the AARP United Healthcare Medicare Supplement.
Unfortunately AARP isn’t as squeaky clean as they appear. UHC pays them, so beware and do your homework.
Thanks, Boomer. As mentioned above, I did a tremendous amount of homework by meeting with the finance people of my providers at UW, Fred Hutch and Virginia Mason Franciscan. I certainly didn’t take AARP’s UHC connection at face value. I’m a little bewildered by everybody’s exclusive focus on the AARP thing.
I was an AARP member when I first became age eligible and canceled in the first year. I saw no real benefit to me. The organization just seems like a clearing house for companies advertising their wares to seniors.
Wow, couldn’t disagree with you more strongly on that one. I have found AARP’s resources and publications tremendously informative. And I admire their political advocacy on behalf of seniors. But different strokes I guess.
Mike – I worked at UHC. There is a large financial arrangement between UHC and AARP. There is no independence. Hopefully your plan is great for you but I wanted to clarify.
Thanks, Doug, appreciate that. I was fully aware of the relationship, which is why I sat down with the finance people for my providers as well. It’s a step I highly recommend to anyone who asks because these are the folks who are the daily conduit between patients and insurers, and they see ALL the problems.
Looks like Medicare Advantage is turning
Into a public policy fiasco.Current article
in Barron’s indicates that Federal spending
on Medicare in 88 billion per year higher
as a result of MA.
where is this money going –
insurance companies
lower income Americans who want
to avoid Medigap premiums but dont
recognize they could be on the hook
for large out of pocket costs under
some circumstances – not to mention
all of the other negatives mentioned
in this very useful post.
if 25 million people are in MA, we would
be better off giving low income seniors
a subsidy on medigap of 1000-1500
per year.
of course, stockholders in many
insurers would not be happy.
MA joins things like student loans
And multi employer pensions as
ideas that sounded useful but brought
many unexpected, deleterious
consequences.
Thank you for sharing your, unfortunately, sad story. We have friends and family who chose Medicare Advantage, and they really like it – but they haven’t run into the problems (yet) such as you’ve described.
I wish they taught a class in all the schools that warned students that if it’s advertised as “cheaper and better” they really need to ask a lot of questions. Maybe call it “Simple Logic 101.”
The government needs to require a warning on Medicare Advantage plans similar to the one on cigarettes. “This product may be hazardous to your health.”
Well, I have different MA company for my plan than her mom and I did have a major health crisis. The bill was closer to $200,000 than one but my payment was less than $200. But, I do use the gym memberships and take health seriously in many ways.
There’s so many things we are responsible for in regard to health, or are supposed to be.
I have a friend who once told me one of her other friends told he “Don’t drive after dark, you’ll get in an accident.” My friends reply, “I have insurance!”
I feel, having an insurance policy shouldn’t be a license to be reckless.
I’m so sorry you and your mother had to cope with this. Thanks for the article – the more people who hear about this kind of experience with Medicare Advantage the better.
I have always viewed Medicare Advantage with deep suspicion. Unfortunately, last year my former employer discontinued the annual stipend it had been paying (some) retirees towards medical coverage and replaced it with a Medicare Advantage plan. It is actually a good plan – at present. Having no faith it would remain as good, I used it last year as my premiums were zero, but transitioned back to Original Medicare plus Medigap before the end of the year. I would fail medical underwriting, so took advantage of the one year’s grace period available when you first go on a Medicare Advantage plan.
I am another fan of “Medicare for Dummies” which I consulted when I first had to decide how to handle Medicare. However, my last encounter with a SHIIP counselor was not as positive as the first. I had to explain the grace period to her.
Since I live in Connecticut I am able to have Medicare Advantage now while my medical needs are few and original Medicare later with a supplement plan when I need it. I am saving $3K – 4K a year now with Medicare Advantage and it is worth it to me.
Susanne – I’m in NY which is also one of the 4 states allowing to move later to Traditional Medicare w/o underwriting. Nonetheless, I just signed up for Traditional Medicare (turn 65 soon). I probably should have done as you as I’m quite healthy…right now. I did choose Medigap G high deductible to hopefully save $. Wish you luck.
We were fortunate to have a knowledgeable and unbiased broker assist us with the selection process when my husband first became eligible for Medicare. People are easily swayed by celebrity ads and enticements of freebies, but they aren’t told about the downsides of an Advantage plan or the inability to switch to traditional Medicare later without medical underwriting (in most states anyway). This is yet one more way our healthcare system is a complete mess.
You are very fortunate to have found a Medicare Consultant who will help you select a Medicare Supplement. Medicare Consultants are paid 3 to 4 times as much to sell a Medicare Advantage Plan instead of a Medicare Supplement. And every time they get you to switch to a different Medicare Advantage Plan they are paid again. People rarely switch Medicare Supplements. So most Medicare Consultants will sell you a Medicare Advantage plan.
I have heard some (many?) Medicare insurance brokers are not able to sell insurance plans from all companies so you may not have access to the best, least expensive plans.
One of my wife’s many cousins is a CPA. And so is her husband, who ended up working in the Tax Department of an insurance company.
Before we took medicare we asked them about which plan we should use.
They chuckled and gave us the name of the Insurance broker they used for Medicare.
Interesting how an insurance company CPA used a broker when it came to Medicare. It is very, very complex because of all the possible factors that need to be addressed in selecting a supplement.
A couple does NOT have to use the same company or plan.
… And then, perhaps, there is the Medication plan to choose …
I agree with you that MA may initially be less expensive while your health care needs are lower, but as your health declines and needs increase, you will regret not having traditional coverage with medigap and part D. Imagine needing oxygen, a pulmonologist verifying it, yet having to file appeals to get the provider to agree to provide it!
I should have said, “…appeals to get the insurance company to agree with the need, and to pay the provider to provide it”.
Everyone enrolling in Medicare should first find the SHIIP program in their state. The program is designed to proved assistance in choosing Medicare choices. Using volunteers, the state department of insurance operates the program so there is no sales pitch. Contact your state department of insurance to find the contacts in your county.
I just did this. I had a good idea what I wanted to do and wanted to bounce it off them. They were nice but not very helpful. I knew some details they didn’t. I’m sure some offices are more helpful than others.
I was perplexed when my late husband chose Medicare Advantage for both of us when we became eligible just six months apart. A thrifty and analytical guy, I can only guess it was because of some expensive meds he was already on, with anticipation of more in the future. Since then, I’ve switched MA plans a couple times, thanks to an agent who has saved me money and gotten me into plans that have worked pretty well so far (though it annoys me when I get unsolicited boxes of unnecessary supplies like thermometers and cough drops because they’ve built up too large a surplus of revenues). After reading several articles here, especially this one, I may seek to switch to traditional while I’m still healthy.
Thank you for this article. This is extremely helpful!
I learnt about the pitfalls of MA coverage while researching Medicare as I approached 65 and for many of the same reasons outlined in this piece, chose original Medicare. I found this book helpful in navigating the landscape-one of the better 10-buck investments I have made. 10 Costly Medicare Mistakes You Can’t Afford to Make: Roberts, Danielle Kunkle: 9781735378619: Amazon.com: Books
Hi Lucretia, this is Chris. I can corroborate with what you write. Have been through similar with my mother, who has a MA plan. It is a real pain, and she can’t change b/c she wouldn’t pass underwriting. I am glad your mom was able to switch.
Thanks Chris. It was poor dumb luck that my mother was in Connecticut. I had no idea that you couldn’t switch to a supplement plan without underwriting in most states.
Essential reading especially for peeps approaching age 65. I shared this on on Facebook. Thanks LR.
Medicare for Dummies by Patricia Barry is an excellent resource. Her writing is clear, concise, and well written. I have commented multiple times how Federal law allows one to sign up for an Advantage plan, and one is guaranteed to be able to switch to traditional plan within the first year as your initial signup is a trial. If you become seriously ill the first year and are facing large medical expenses you can switch at any time in the first year.
We signed up for the Advantage plan, utilized the extra vision, and dental benefits which includes in network pricing for dental work, then transferred to traditional plans just before the trial year expired.
My concern is I have been reading on Phil Moeller’s Get What’s Yours blog (an excellent resource for keeping up to date on Medicare changes) that the government is planning change traditional Medicare fee for service plans into an ACO plans in the not to distant future.
I am afraid of a government bait and switch where we will be forced to continue paying top dollar in Plan G and get stuck in a fancy name program for which is just another HMO.
Don’t underestimate the power of the insurance lobby. That is why we have the current complicated mess of senior health insurance.
My husband and I are on traditional MC, me G, him N. So far (KOW), so good, including 15 nights in the hospital this January for open heart surgery. The hospital was absolutely fantastic. Surprisingly, we just got letters telling us our hospital was part of ACO. Maybe this is not something to be scared about, If Medicare costs are not controlled, none of us will have it. The devil is in the details but KFF has some interesting research on the subject and some change is going to happen. ACA was change and that turned out to be pretty good.
Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many “closed block of business / closed risk pool” (deadpool) policies the company has.
I am sorry you and your mother had to go through this. This is a great testimony to why Advantage (a misnomer) is inferior to traditional Medicare.
All your issues are well known, except many times by seniors looking for the lowest price and promise of higher benefits. That just doesn’t exist without tradeoffs which are limited networks of providers and more managing of patient care..
MA is effectively the old HMO model. They operate the way many younger people find objectionable in employer plans. All in an effort to manage costs by managing care. Most people object to that even while still wanting lower costs. You can’t have both.
For most people looking for a balance between cost and flexibility Medigap Plan G is the best choice leaving the patient with only the Part B deductible each year.
MA Is a political nod to insurance companies and recent studies indicate many are over subsidized by Medicare. They can work well if all in network services can be used, if no disagreements on required care arise, but can also work as you describe.
The chances of Medicare paying doctors much more, if anything, above MA are slim.
I don’t know about other states Dick, but in NH Plan G is by far the most expensive, so really there is no “balance” between cost and flexibility. It is however the best plan for people of higher financial means which describes my wife and me. We chose it to have annual cost certainty.
So far, two years into Medicare and quite healthy, I’m a big fan of Plan G – High Deductible. Yes, deductibles are high, but the premiums where I live are only about a sixth of those of a regular Plan G.
That’s what I just chose!
Interesting. I looked at it from the other side: For *no* deductible beyond the base annual amount (under $300, which my CCRC pays), my OH Plan G is currently $138 per month. I’m happy to pay that for the financial simplicity and security of knowing there will be no out-of-pocket expenses (hip replacement and cataract surgeries, so far).
Yes, it will tend to be more expensive, but most people are more afraid of possible out of pocket cost-unnecessarily in most cases. Plan G is the most popular choice and before it was eliminated the most costly F was.
Your reasoning is why we chose G, along with no prior authorization, and greater choice of MDs
If there was a ‘Truth in Naming’ law, they’d have to call it Medicare Disadvantage…glad things worked out for your mother eventually. Living in NY has some ‘advantages’.
If you read Moffit hospitals website they have a good name for Medicare Advantage – they call it “Medicare Replacement”. Obviously the hospitals hate Medicare Advantage because it pays them less than Original Medicare and they have to get many approvals before procedures.
https://pnhp.org/news/medicare-advantage-is-under-fire-what-it-means-for-your-health-and-wallet/
I am so sorry about the issues dealing with your mom’s health care. Ugh.
Based on our own experiences and the experiences of others, I think the choice of Medicare vs. Medicare Advantage depends on the plans in YOUR state. Both my husband and I had cancer. My husband also required brain surgery for a subdural hematoma. The ungodly retail cost for all of this care was well over $150K. Our out-of-pocket through Kaiser Permanente Medicare Advantage in Calfornia and now in Washington State was under $10K. Our premiums are 0. And we feel we have received top notch care for 10 and 5 years respectively.
A dear friend was on Kaiser Advantage in Georgia. His heart stopped and then restarted. It was “heart block.” Kaiser said they wouldn’t authorize a cardiologist appointment for 3 months. One month later it stopped again and he died.
I’m still furious.
I’m so sorry for your loss.
I have heard good things about Kaiser, however, it can be subject to the usual issues with a closed network. I have an unusual eye disease, and have seen reports from people with the disease who have Kaiser Permanente insurance saying that none of the doctors available to them perform the latest surgeries.
Kaiser is a long standing exception to any form of managed care. It has been around since the 1940s with a good reputation. And as long as you get the care you need within their large system it probably is a good choice.
Great article. I wish more people understood the unnecessary complexity of Medicare.
The real complexity is in part d drug plans. If you don’t take any meds, or just cheap generic ones, it’s easy, pick the cheapest plan. When your medication needs become more complex, it can be very confusing.
And then there is goodRX that costs less than the insurance price. Totally insane.
All the insurance company marketing creates confusion. There is no real complexity aside from that. There should be no choices. A person should be auto enrolled in Parts A and B of Medicare. Part D and Medigap Plan G remain options. No other choices are needed.