I’ve been on Medicare, with an Aetna Advantage plan, for five years. I’ve been happy with it, and have had no serious problems with it. My wife turned 65 in September and on the advice of a broker we enrolled her in a Humana Advantage plan.
Then we watched John Oliver’s report on Medicare advantage plans, which make them look horrible. He suggests that Medigap plans are much better.
My wife has had cancer twice (she is clear now, five years out from last treatment) and has had more health issues than I have. We are still in the open enrollment period, and less than six months since she became eligible.
I’ve read @JohnT 's excellent opening posts in this thread, which seem to agree with Oliver that we should move her (at least) to a Medigap plan. (I have not yet read the entire thread.)
Is that the consensus here? If so, how do we go about switching from her current Humana plan to a Medigap plan?
Any contrary views favoring staying with her Advantage plan?
Also, should I look into switching to a Medigap plan, even though I’ve been happy with my Advantage plan for five years, and am generally in better shape, at least WRT chronic conditions, than my wife? Can I switch, and if so, how do I get started?
Med(icare) Advantage has way too many hoops to jump through at times and does greatly limit your network in most cases. It’s not really Medicare even though you pay Medicare premiums for it and I’m pretty sure that they are reimbursed by Medicare. It’s really just an insurance network that usually has a few extras thrown in to try and entice you over Medigap. It’s primary benefit as far as I know is simply price.
Medigap (sometimes called Medicare Supplement) is basically coverage for the 20% that Medicare doesn’t cover. It doesn’t typically have all of the add-ins and is usually more expensive than Med Advantage, but at the end of the day, it’s Medicare. So any doctor that takes Medicare will take you. It also doesn’t require preauthorization for every little thing. Note that while Medigap is issued by a traditional insurer, such as Blue Cross, your doctor does not need to be in the Blue Cross Network, they simply need to accept Medicare. Doctors seem to love Medigap patients as they aren’t having to fight to collect that 20%. Again, it is almost always more expensive than Med Advantage.
You should have one or the other to avoid going bankrupt paying that 20% if some crazy expensive medical situation arises, but I always tell people to get Medigap (aka Medicare Supplement) if you can afford it. If you ever switch to Med Advantage, it can be very difficult or impossible to switch back.
You’ll also want Medicare Part D for your prescriptions with Medigap.
The advantage of the Advantage plan is the other things it often covers: dental, hearing, eyes or perhaps lower out-of-pocket costs.
The disadvantage of the Advantage is the restricted network they often have and that they require pre-approval for a lot of things–and this pre-approval can be delayed or denied. For example my elderly neighbor was on an Advantage plan and needed a stent. If he was on the normal plan (like F or G) he could have gotten it immediately. But because he was on an Advantage plan he had to wait several days in the hospital before the insurance company gave its go-ahead.
Medicare Advantage (Part C formally) is lower quality budget oriented care suitable for folks who’ll never ever get very sick before dropping dead one day. But the big thing is its the budget plan for folks who can’t afford better. It’s the equivalent of an employer-provided rock bottom cheap PPO plan.
Medigap (all the Parts above D, with G being the most comprehensive, despite not being the highest Part letter) costs more, but gives you costs and benefits akin to typical big employer health insurance. The largest benefit being less gatekeeping and a much wider array of service providers who’ll take your insurance. Which gets hugely important if you ever develop any serious medical condition. e.g. Cancer, Kidney disease, etc.
Gap insurance plans don’t necessarily cover that 20% for everything that Medicare covers 80% for, so compare plans carefully. We’ve been on Humana gap insurance for 10 years, and in general we are satisfied with it. Their in-house pharmacy sends 90 days worth of prescriptions at a time, which is a good time saver. You don’t have to use their pharmacy, and I don’t know if other plans have their own pharmacy. We are on a plan called Type F, which is one of several variants that include some extra stuff and have higher premiums.
The biggest problem for me with any of these plans is that your plan will change and all the other plans will change, and if you want to do due diligence and get the best deal, you have to review them every single year during the enrollment period. We haven’t bothered, and as long as we can afford it I try not to think about whether we are paying more than we have to.
Regardless, as has been mentioned before this is a perfect time to take advantage of a free SHIP counselor. My parents found their session in CA pretty useful.
Yes, I did that when I was getting ready to retire, and it was a big help in general in understanding the whole system. The person I talked to did not want to make recommendations between providers or plans.
As I said in the other thread, I’ve been on a Plan F Medigap plan for 9 years now (AARP branded UHC plan) and have not had a single problem with it. When I turned 65 none of the Advantage plans in my area covered my doctors, so it was a no brainer, but I have no reason to change even when they have. It is nice to not have to worry about which network the doctor/hospital is in.
The advantage is that I can budget for the payments, and not have to worry about shock for the copay for a hospital stay. I’ve probably paid more than I’ve saved so far, but I think heart surgery is in my future so that can change rapidly.
BTW, I found Medicare for Dummies to be really useful in decoding all the options.
All of that advertising for Medicare Advantage plans makes me suspicious of how profitable they must be. I’m a few years from Medicare enrollment but am leaning towards not getting an Advantage plan.
My understanding is that it covers the 20% in its entirety for both doctor visits and hospital stays. You’ll need separate coverage for prescriptions (Plan D now) as I noted, and you’ll need to find another plan(s) that covers long term care, private nursing, hearing, dental, etc. if those are desired.
I’ll also add a +1 to getting some free help from a SHIP counselor or at least a Medicare Insurance Broker (not Agent).
Medicare Advantage is also fine for someone whose doctors are in the network and who would in any case go to specialists that their regular doctor referred them to.
The medical group takes on the cost risks for these patients (paid more based on risk stratification, as long as they have fully coded all risk items). They are strongly incentivized to proactively keep people healthy, and they get money for accomplishing various population metrics such as adequate blood pressure control, getting diabetics into their regular eye exams, etc. They may even nag to get you in as a result. Some groups still do a shitty job of that (and lose money) but others can make money by doing quality proactive preventative care. And it is really hard for doctor groups to not lose money with what regular Medicare pays (which is why many are now opting out of taking Medicare)
My horror story:
After we married, I wanted my wife to transfer from Kaiser to my wonderful concierge doctor. When I talked to my doctor’s medical group, they falsely told me that she needed to have an Advantage plan to transfer there. So I signed her up with an Advantage plan. When we got the paperwork, we found she had been assigned a different physician. I talked to the administration of the Advantage plan, which started a several MONTHS long process of almost daily phone calls and blatant misinformation, with them telling me that they could assign her to my doctor after a little paperwork was done, after some higher-up gave their approval, after they entered some data in their computer system, or after this and that bullshit. Eventually it became clear that there was NO WAY for any Advantage plan to cover my doctor, and I had been lied to by both the medical group and the plan administration.
I then tried to change her from Advantage to a Medigap plan, and was told that that was impossible. I don’t remember if it was permanently impossible, or if it was just because we were past the Open Enrollment period. I had to talk to Medicare directly, explain all the ways I had been deceived and file some forms, and eventually we got a waiver that allowed her to transfer to a Medigap plan.
Bottom line, Advantage plans have restrictions that Medigap plans don’t have. After my admittedly anecdotal experience, I would recommend Medigap over Advantage, but if you’re already in an Advantage plan, find out how and even whether it’s possible to change.
Per the KFF, only 1% of non-pediatric doctors have opted out of taking Medicare, and most of those are for what many (not me) consider semi-optional specialties, such as psychiatrists and plastic surgeons. Even within those specialties, more than 90% take Medicare. The acceptance rate is much lower than 99%, but that’s due to doctors who are not accepting new patients, which also exists in all other insurance networks.
Medigap usually works better for people who have a long list of specialists or ongoing conditions because you can see almost anyone and the bills stay predictable. Advantage plans work fine when your care is light, but they can get restrictive fast when you need frequent visits, imaging or second opinions. Your wife’s history makes the Medigap move reasonable while you are still inside the window where switching is simple.
You can call any insurer that sells Medigap in your state and ask for a quote, then enroll directly. They handle the cancellation of the old plan. You can switch your own plan the same way if you want the broader coverage.
While following to their cite (pages 98 and 99) show different numbers - 96% - it is indeed other than what my impression was - both higher than I had thought and comparable to private insurance new patient availability numbers. I stand corrected.
Are you talking about switching from Advantage to Medigap? Or first-time enrolling in Medigap? The latter is easy, as they must take new enrollees. The former is not, as you must do it during an open-enrollment period, and you may be subject to underwriting. The insurance company does not have to take you as a customer if you’re switching from Advantage.
