My Advantage plan is no longer operating in my county (because reasons), but we were told to keep the separation letter. It serves as documentation for a Gap policy to accept us as “new” to Medicare, so they have to accept us without need for a medical exam.
I’m turning 65 this month. SIgning up for Medicare - tho working 2 more years. So I’ve been thinking/looking into this for a while. What I find extremely amusing is that of the people I have discussed this with, approximately 1/2 vehemently advocate Medigap - and say you are nuts to go with Advantage, and approximately 1/2 feel the exact opposite just as vehemently. These are all relatively intelligent folk. Some have more significant ongoing medical issues than others.
Personally, I’m going with Medigap because I’ll be able to continue my current insurance as the supplement, at rates that are as good if not better than other alternatives. A couple other thoughts. If I did not have that option, I seriously do not know which I would choose. But I appreciate essentially having the decision made for me. I repeat, tho, how amused I have been at the strong dichotomy between folk who favor the different options. So please do not expect any group to agree that one or the other option is preferable.
As best I can see, the main reason for choosing Advantage is to save $. If you think you are reasonably healthy, and if you are fine with going through some gatekeeper should you need any different care, AND if saving a few hundred/thousand bucks a year is worth any uncertainty that gatekeeping might involve, go with Advantage. No need to share with us - but what is your financial situation? If you are relatively well off, I’d suggest that especially with your wife’s health history it might impress me as kinda foolish to try to save a few bucks by going with Advantage. But IMO a lot of wealthy folk are cheap in ways I personally consider foolish.
Run your personal care needs through the various programs. Are your meds on their formularies - which can change every year, of course. What are the copays for the types of care you receive regularly. One reason to go with Medigap is if you are really tied to your current caregivers. Your caregivers may not participate in a particular Advantage plan.
What do you expect in terms of healthcare? Do you want absolutely top-of-the-line treatment from your hand-picked provider? Or are you OK with - pretty good but not special treatment? (I tend to think “pretty good” is most often good enough. But my personal views differ from many/most.)
I’m really pretty healthy. I anticipate that I will need 1 or both hips replaced in the sorta near future. When that come, I want to just go with the ortho I already have a relationship with, rather than jumping through hoops, and trying to pick among orthos in some Advantage group.
You have the opportunity to change between Medigap and Advantage every year. Not sure what plans might say/charge in light of pre-existing conditions. If you get sick in October, can you hold off on care and simply enrol in the plan you wish come November? I don’t know, but since I have the $, I don’t care to take that chance.
As far as researching and switching plans, personally, I’m relatively comfortable financially. I’m not sure how many thousand $ you’d have to pay me to give up an afternoon of my time trying to anticipate my health care needs and compare plans.
I have heard more than a couple of anecdotes where people say, “My Advantage is great! It gives me free health club membership, etc. But they won’t approve my spouse’s surgery.” Personally, I prefer to not ave to deal with such potentiality.
Good luck. The one thing I know for sure is that it shouldn’t be so damned complicated. So much for American exceptionalism! 
If I’m employed, and cover myself and my husband through my employer, and then go onto Medicare, i wonder if i can continue to buy employer insurance for my husband? Can i delay taking Medicare?
This must be a moderately common issue.
Everybody needs to sign up for the no cost Part A promptly when they turn 65. Failing to do that is a disastrously expensive mistake.
All the other parts of Medicare (that cost you something) are 100% optional if you have coverage through your employer or your spouse’s employer. And that’s true regardless of the age of the spouse. If you do choose some additional Medicare coverage, by law it pays only after all your other insurance(s) do.
So as a strong rule of thumb, if you have decent employer-related medical insurance, there’s zero incentive to sign up for any Medicare beyond Part A until that employer insurance is no longer available to you. Or until you choose to drop it for some reason. Perhaps that it’s getting real expensive faster than Medicare is.
Here’s something else that’s a bit hard to get used to after years of health insurance from your / your spouse’s employer that apply to your whole family: Medicare is 100% individual. Even if you and spouse turn 65 the very same day, you each effectively have totally different plans and coverages. Even if you made the same exact selections. There is no such thing as “family coverage”, “family deductibles”, etc., under Medicare. It’s tough to really grok that until a couple years after you’re into it; all your lifelong intuition works the other way.
No, not if you’re still covered under a creditable plan through work and don’t intend to go on Medicare yet. I have confirmed this with Medicare, agents, and brokers, repeatedly, over the last 5 years.
If your work policy is deemed creditable coverage, you don’t need to start on Medicare at age 65. Or even sign up for it. Our CEO has delayed it, but his wife, who’s a bit older, has signed up for Medicare. I can’t recall off the top of my head whether her primary is the company policy or Medicare - haven’t pulled out all the paperwork yet.
This is my understanding as well. Tho I am signing up now. That intelligent folk like LSL are positive about something different only attests to how stupid and complicated our system is.
You’re not kidding. Even the Medicare website dances around this instead of just explicitly stating it.
Here’s a gift link to a three-year-old article from the New York Times about how the companies that provide Medicare Advantage plans exploit it to make as much money as possible.
The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
The trouble with viewing oneself as being “reasonably healthy” is that life (and bad health) can come at you pretty fast, so getting stuck in an Advantage plan with care delays/denials is not something I’d want. My internist, besides being good people, is a croaker who writes scrip**, so I’d hate to find he was out-of network in an Advantage plan.
*noting that Dinsdale isn’t too keen on Advantage plans either.
**old junkie term for a physician who’ll readily write prescriptions. 
Of course there is a natural systems consequence to the perception that MA plans are best chosen if you are basically healthy - selection bias of a healthier population to them which helps the insurance company make more money off them, while charging less, and convincing congresscritters that deliver more value for less because their population needs less care.
NOT a fan of our insurance industry but the NYT article is IMHO a steaming pile of shit. YES any group that takes MA is going to work very hard to make sure they have captured every precise diagnosis each patient has that might impact the risk stratification. YES the system is designed to grant more money to the system based on the risk of their specific population. As a group you want to get full credit for the risks of your population. Medicare patients not in MA? Paid the same whether you do the work to fully accurately code or not so you are not going to spend the extra effort on making sure you have every diagnosis fully and precisely entered.
Doing that work to find and enter every accurate code and get credit for the work you are doing is not cheating. Motivating providers to do that work is not unethical. It is not fraud. But that’s the charge made. Saying as they said: “diagnoses of serious diseases that might have never existed.” is weasle worded. If they did not exist it would be fraud. “Might not” is not that. NO question that there are going to be examples of falsified claims, and others with honestly insufficient documentation to support the claim made, and both of those need appropriate corrective actions taken. But the article implies that efforts to make sure fully accurate coding is entered in pursuit of getting paid better is itself fraud. It ain’t.
Going against the flow here, I like my Advantage plan — and yeah, mostly because it saves me money. But the details of healthcare are complex, and my beliefs could be nonsense.
Compared to Medicare with added gap plans, I think I save, annually:
$2,000 on gap payments, $1,000 on dental, $300 on glasses/eye exams, and about $180 on OTC meds. To me that’s meaningful money.
I’ve kept my primary care doctor, and never had an issue getting drugs, emergency care, or specialist care. But, I haven’t had any major long-term health issues since going on Medicare or Medicare advantage. YMMV.
To be fair I don’t think the majority of people choose MA because of a carefully thought-out position on their relative health. For most it is just going to be dollars and cents. For others it might just be convenience/easier. An increasing number of MA plans are part of employment-sponsored retirement packages (for example like those offered by my former employer), rather than the commercially purchased MA plans advertised on TV. If you have a job, union or otherwise, where you can transition straight to an employer-sponsored retirement MA plan in the same HMO/PPO system you’ve been used to using for many years, it will likely becomes the default path of least resistance for many.
Especially in plans like my ex-employer’s where it is a roach motel model. You can check-in, but never check-out . Well, not and then get back in again if things don’t work out. Once you turn-down the employer plan (entirely out of them that is, there are usually high and low-deductible HMO and PPO selections you can move around in during open enrollment once a year) and go independent at any point, you’re locked out forever. Which can generate trepidation in the risk-averse.
The belief that there is a favorable selection bias to MA is certainly pushed back upon by the industry. But I take their cited analysis with enough grains of salt to exceed blood pressure control guidelines …
A question or two: Do gap plans require info on preexisting conditions, and factor them into payment costs?
My situation: My wife is turning 65, and has asked me to research her Medicare options. I’ve had an Advantage plan from United Healthcare for 5 years, and been satisfied, but our closest social couple (my BIL & wife, who we love) advocate for Medicare/Medigap). I’m trying my best to ignore the propaganda from both sides — which I think @DSeid has referenced honestly in this thread. If Medigap plans base charges on pre-existing conditions I’d view that as a particularly ugly wart.
Thanks for the correction. Oops on me.
Thanks for the implicit defense, but I screwed that one up pure and simple.
It’s now 5 years since we signed my late wife up for Medicare Part A and only Part A when she turned 65 despite her being covered by my employer-based insurance. Back then I had the latest books and was about as informed as an amateur could be.
But I really need to stop posting about things I remember without re-researching them now. The details of stuff like that get much fuzzier much faster than they used to. My thinking and posting habits have not caught up with my fading powers of memory.
Sorry to have confidently misled folks; that’s real unhelpful to all.
From the Medicare website:
Under federal law, you get a 6 month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can:
Enroll in any Medigap policy. An insurance company can’t refuse to sell you any medical policy it offers. They also can’t use medical underwriting to decide whether to accept your application or deny you coverage due to pre-existing health problems.
That should answer your question.
I think the NYT likes to be alarmist.
Not to suggest you personally aren’t a fuckup, , but it took my wife and me a few go-rounds on that one. My wife was certain I needed to sign up when I turned 65. I was certain I could wait until I stopped working. Yeah, we eventually resolved that. (Importantly, we figured out how to RECORD what we had learned so that a week/month later we didn’t find ourselves asking, “What did we decide about…?”
But then, you have to go the extra step to try to figure out whether there is any benefit/cost to signing up at 65 vs later retirement. Not an obvious answer.
For me, one hurdle was trying to figure out if my FSA was an HSA. (You can participate in an FSA while enrolled in Medicare, but not an HSA.) Turns out my FSA is NOT an HSA - tho I don’t really understand the difference.
And anyone thinking about Medicare gets slapped with the alphabet soup. Most recipients will rattle off, “Everyone enrolls in A, at no cost, but then you have to decide B, D, or FU…” And the newbie’s brain locks up.
And my wife and I aren’t the smartest folk on earth, but we aren’t dummies. We are both lawyers, so we are familiar with reading legal bullshit. If it is so challenging for us, we really wonder how confusing and challenging it must be for - say folk who were in the bottom half of their high school classes.
What a stupid system.
Thanks for the link Railer! If I understand it correctly…
You can switch to any Medicare Advantage plan any year without concern for preexisting conditions. Or you can switch to Medicare A & B any year without concern for preexisting conditions.
But after your initial enrollment (normally at age 65) you can’t add gap coverage without concern for preexisting conditions. Each gap provider is allowed to set their own policy rules after your initial enrollment period.
Does that align with everyone’s understanding and experience?