I get to start Medicare in November. I am researching options - I’ve read Medicare for Dummies, and have been deep in the plan comparison site.
I have no initial bias to Medigap or Medicare advantage, and have found two Medicare Advantage plans which cover my medical center, which is a requirement. One however does not seem to cover one of the drugs I take, which makes it a nonstarter, though I may be able to get a generic.
For Plan D I have found a good plan which uses a drugstore near me as the preferred supplier, and which is fairly cheap. For Medigap I’ll probably go with Plan F since I can afford it. Plus, I am probably going to be doing a fair bit of international travel, and so it is good that this gets covered.
But my spider sense is tingling, so some questions for those who have been through this.
Medicare Advantage is a lot cheaper than Medigap F. The MA plan that makes sense is like $250 a day for hospital for the for the first seven days, which is acceptable. In Plan F I pay nothing, which may explain it. Have you seen a big price difference?
Medigap covers dental and vision, which with my teeth is a requirement. If you use Medigap, what do you do for dental? I don’t see it in the benefits list.
One of the Plan Fs is community pricing, which is one price for all, the rest have the price go up over time. Any thoughts? I expect that I’d save with the non-community plans now, but I haven’t gotten quotes yet.
The Medicare site has average costs per year, which are similar despite widely varying premiums. Has your experience been that these estimates are accurate?
Anything else?
TLDR: version
Price difference between MA and Medigap/Plan D?
Dental/vision for Medigap
Are the estimates for Medigap costs accurate?
Thoughts on community versus age-based pricing?
I use MediGap F (high deductible) and a separate plan D. I can predict my max out of pocket since I am not on the hook for 20% of all Medicare expenses.
In my analysis, Advantage plans are simply ‘outsourced healthcare’ where the govt pays an insurer to manage my healthcare. I also object to the fact that the insurer is paid more than it costs the government for non-Advantage clients.
I prefer to not have an insurance company making medical decisions for me. That is why I have a doctor.
I ignored vision and dental. The coverages are not really that good.
Your understanding of Medicare Advantage is a little off. First, the gov’t doesn’t handle any Medicare claims at all. All Medicare claims processing is “outsourced.” Private insurers in a particular area or region will bid on getting a Medicare contract to handle all claims while also getting an administrative fee from the gov’t - as in, the insurer “is paid more than it costs the government for non-Advantage clients.”
One benefit of MA is that there is no benefit coordination between 2 different companies. With “Medigap” or a medicare supplement plan, Medicare is primary and the supplement is a secondary, separate health plan. There’s a bit of a dance that has to take place between the two carriers. Each claim has to be processed twice. A bit of extra red tape that creates more opportunities for mistakes, plus all the extra paper statements you receive.
With MA, it’s one single carrier applying Medicare pricing and coordinating in one shot. And they still have to follow all of the same claims rules/procedures that a traditional Medicare “carrier” does including how medical necessity is reviewed, etc.
Either way, a private insurance company is getting that extra administration fee, whether their logo is on the letterhead or not.
I agree that Medicare always uses subcontractors to handle billing but my objections to Advantage plans are not about billing. They are :
They receive a ‘rebate’ above and beyond typical Medicare costs. (If private industry is so superior to the government, shouldn’t they be able to do things more cheaply?)
They usually have limited networks.
They can demand pre-approval for a physician ordered procedure or test.
At least according to my calculations, the OOP max can be higher than MediGap.
Thanks for the input. I know about the skimming from MA, but I’m fine with it, and one of the plans is run by the humongous insurer I use now, whom I’ve never had a problem with. The clinic I use has pretty much everything in house, so getting approvals for care is trivial. The MA plans which didn’t include them were eliminated.
Plan F has lower hospital costs, but I’ve been in a hospital exactly one night since I was born, so the higher OOP costs for the MA plans are okay. One costs about $350 a night for 4 nights, then free afterwards, while the other costs about $250 a night for 7 nights. The latter one has the better drug plan, but hospitals tend to kick you out early these days - my father, when 90, had heart surgery and only stayed two nights.
Anyone else?
As I mentioned, Medigap F is good for that. The MA plan with the bad drug coverage has somewhat better travel coverage than the other one - but I haven’t deep dived enough to know the details.
I work with Medicare Advantage plans on a daily and my advise is go with a Medicare Supplemental plan & stand-alone Part D plan instead. It’ll pay off in the long rung (yes you will have 3 separate ID cards to juggle). Medicare Supplemental plans don’t have provider networks (they work with any provider that accepts Medicare), don’t require Prior Authorization for anything Medicare doesn’t, and usually once you sign up for one you can keep it no matter were in the country you move to.
MAPD plans have limited provider networks (which are subject to change at any time, even in the middle of the year), have all the Prior Authorization requirements common to commercial managed care plans, and have defined geographic service areas (which may consist of an entire state, or only select counties within that state). If you go with an HMO you’ll have to pick a PCP (or be assigned one at random if you don’t pick one yourself), and may or may not need a referral from them for specialist care. Out-of-network care will not be covered at all unless it’s a medical emergency or the provider get’s special permission from the insurance company to treat you. PPO plans cost more and don’t require PCPs or referrals, but usually have higher cost sharing for out-of-network care (ie you’ll pay 40% of the cost for your office visit instead of the $20 in-network copay or the 20% you’d pay under Original Medicare).
The defined service area can really screw people over because they can move, (sometimes at little as to the next county over), notify their insurance they have a new address, they find out their insurance is automatically terminated as of the last day of the month. A supplement plan may cost more, but it’ll pay off in the long run. You may be in very good health at 65 and only ever spend 1 night in hospital, but by 75 you could be a frequent flyer with 8 different specialist you see on regular basis and a tray of prescription bottles.
My clinic is big enough that I’m not too worried about it being dropped - and as I said my insurance from work (and now COBRA) has all those restrictions but has worked fine for me.
However I plan to move across the country in three years or so, so that might be an issue with MA. And Plan Ds seem to be far better than drug coverage from the MA plans.
So, how do people handle dental insurance? Is that easily available outside of MA plans? Vision too, but that is not that big an issue.
When I retired, I was a ways from Medicare and bought private insurance. I looked at Dental coverage, but it cost $60/month and had a maximum benefit of $750/year.
8 years later, I doubt it is better (especially since a dentist once looked in my mouth and said “If you were a horse, you’d have to be shot.”)