Without writing a dissertation (that’d probably have errors since my last HSA was about 10 years ago) …
FSA and HSA are very very different beasts with sorta the same goal: pay for medical care with pretax dollars. Kinda like IRA and 401k are both savings vehicles for pre-tax dollars, but the similarity between IRA & 401k ends right there.
Any given FSA or HSA account is one or the other; there’s no overlap between the two types. The very name of whatever you have tells you everything about which one it is.
This. I had the same reaction.
If every American is supposed to play this game, it needs to be simple enough that the dimmest 10% of the ordinary populace can play it well enough to not be screwed by their own ignorance and administrative ineptitude.
Policy rules as far as acceptance, but not for the plan benefits, just to be clear. A Plan G’s benefits will not be different across providers, which is one less complication for traditional Medicare versus Advantage.
A reminder that Medicare Advantage plans often have steep out-of-pocket costs for plan holders, even in-network.
That in-network limit has been raised to $8,550 for 2025.
About those “preventative care” visits that MA plans aggressively target people for: beyond giving insurance companies extra chances to pile on billing codes and charges, there’s added incentive to subject seniors to potentially unnecessary tests and invasive procedures which aren’t all that innocuous.
Thank you Raza. The coverage is uniform, but acceptance is optional.
I’m assuming the price is unregulated, and there will be questions about pre-existing conditions, life style, family history, etc, but you can pick the lowest price you can find with reasonable confidence in the coverage?
That is my understanding as well. We held off on enrolling my former wife under Medicare Part A because she was covered under my employer-provided plan, and I think having duplicate coverage can result in finger-pointing and both insurers insist the other one pay first, possibly resulting in nobody paying. (This actually happened to me in college.*)
When we later divorced, my ex-wife promptly signed up for Medicare Part A and an Advantage plan. There was no penalty because she had been covered by a creditable insurance plan (through my work).
(But on that note, it is my understanding that there is never a financial penalty for failing to sign up for Medicare Part A on time, because it is free. You won’t be covered, though. There is a penalty for failing to sign up for Part B, though, unless you have creditable coverage elsewhere.)
Anyway, reading the relevant threads here on the SDMB, and more recently following the John Oliver piece on Medicare Advantage plans linked above, we have discussed the pros and cons of Medicare Advantage vs. Medicare Supplement plans yet again. Also because the Medicare Advantage PPO plan she has been using dropped coverage here in Connecticut as of next year. I pointed out that this would allow her to switch to a Medicare Supplement plan with no underwriting. But she pointed out that this is always allowed here in Connecticut due to state-specific laws (though it might have to be during open-enrollment periods). So she is planning to stick with an Advantage plan for the time being, and will switch to a Medicare Supplement plan if the Advantage plan goes downhill or her health declines.
*Details below if you’re curious:
This happened to me in college when I had triplicate coverage: (1) BCBS insurance provided by my father, (2) the school’s required heath insurance, and (3) military TRICARE through my stepfather. Result: after a ER visit for an injury, nobody paid, and I ended up paying a collection agency for the whole bill a year later because I couldn’t spend any more of my life fighting with three different insurers.
So when my son went off to college decades later, I made sure he was still covered under my employer-provided plan, and then made a point of declining the school-provided health insurance.
Specifically for Medigap policies such as Plan G (very popular among the choices), there should be no differences in coverage or payment across providers; except that some (UHC/AARP) throw in some minor non-core benefits like gym membership. In my 2.4 years of being on the plan, I’ve had zero interaction with my Plan G provider, by design. They get the bill, they pay their portion.
That, thankfully, happened with my husband’s current “advantage” plan. We have enrolled him into a medigap plan. NO underwriting because of the circumstances. He has Parkinson’s, mild copd, several joint replacements, a couple of stents, sleep apnea, and the list goes on.
If he was subjected to underwriting no company would take him. He is in and out of the hospital freaquently. He falls a lot which accounts for about 3/4’s of his stays. He needs a revision of his hip replacement. Yes, “advantage” is cheaper afa premiums however, if you have serious health issues it is much more expensive**. Medicare and gap typically pay for all inpatient care. Advantage does not. Too many hidden costs and deductibles, preauthorizations etc. It is all complicated (intentionally so imo.)**
Often the optical is useless, the dental can be good if you don’t mind driving two hours one way, the hearing aids are OK, but it’s a discount. These details are not explained in any online source I’ve been able to find. So when it says, “covered” take it with a salt lick of salt.
Imho: DO NOT do “advantage” unless you have no other choice.
Truly not your fault. It’s really difficult to find that information on the Medicare website. Like I said, they dance around it. I have not been able to find a single place where they state this clearly, outright. There’s clearer information on alternative websites such as National Council on Aging.
COBRA coverage, for some arcane reason, does NOT count as creditable coverage as far as Medicare-signup-at-65 is concerned. Either does coverage from a retirement program.
In terms of which categories of care are covered, the law specifies that Part G plans must cover (made up example) X visits per year to a psychologist / psychiatrist.
What the law doesn’t specify is how hard Company A versus Company B can try to weasel out of paying your claim for those X visits. Leaving you to pay the bill when they don’t.
Ultimately the companies are competing with each other for profitability. The company charging less has to make it up somehow. Unless they truly are more internally efficient and are passing those savings on to you, rather than to their executives and shareholders.
A comment I make often regarding consumer purchase decisions:
You don’t always get what you pay for. But you almost never get what you don’t pay for.
Intentionally stupid and obtuse. Congress, insurance companies (mostly these guys), and their lobbieists, make it a labyrinth, to increase the money they can make off us. This is why we can’t have nice things like simple, straightforward, universal Healthcare.
True, but since you have to sign up for A to sign up for B and there is a financial hit for failing to sign up for B, you should never be late to sign up for A. Because you should always sign up for B. And man, what a couple of ugly sentences those are .
My mother ignored my advice (I even offered to pay the premium for her) and stubbornly refused to sign up for B since an advisor at the Red Cross convinced her that since she was poor she’d get treated anyway without having to pay the monthly premium. He must have assumed she would get Medicaid, but she never did. Because back then the max amount of cash you could have on hand and still qualify was draconian. You could own a $1 million house and qualify because homes were exempt, but more than $2000 in any combination of bank accounts and you were screwed. Since she was a renter in a pricier urban area, she needed more than that rotating through monthly to make ends meet. Without going into details that lack of Part B ended up biting her very painfully in the ass in multiple ways.
Unless you are eligible for Medicare but have creditable coverage elsewhere (like from an employer-provided plan.)
In that case, it makes no sense to also pay for Part B, even if you are eligible.
And if you are holding off on signing up for Part B, you may as well hold off on signing up for Part A.
When I verified all of this with an advisor (actually an insurance agent who brokers Medicare Supplement and Advantage plans), he pointed out that there was no penalty for failing to sign up for Part A on time, because it’s always free to those who are eligible.
Oh, absolutely . I was speaking to the general situation, rather than the specific. I had a couple of co-workers that went past 70. Though in their case unlike DSeid’s it was obsessive love of money (that extra from overtime and standby, mostly), not love of job.
I know we’re discussing generalities here, but I want to make loudly the point that you need to research your local conditions.
I live in New York and that is one of four states in which you can switch from MA to Medigap at the sign-up period every year with no issues, or so an advisor told us. And you can switch back and forth between them annually if you think one will be better for the next year. In the other states, I believe that once on Medigap it is difficult if not impossible to move back to MA.
My city is controlled by two hospitals and their systems cover virtually every hospital-related medical need (i.e, not vision and dental and such). All the reasonable MA plans cover both systems. They also have a somewhat more expensive option for out-of-network coverage. That could change. Major hospitals in San Diego - though not all - are dropping MA coverage in 2026.
Medigap does not cover Part D, prescriptions. A separate plan is needed for those. Prescriptions are getting more expensive every year and the more expensive, the less likely there are to be covered. I know many people who pay out of pocket for $1000/month prescriptions. Some of these get coverage as they get more popular with more demand. My wife is on two, and when we looked at next years’ plans’ formularies (the products they will cover) we found one that would cover the first but not the second and one that would cover the second but not the first.
We’re talking with local organizations to get advice about how to handle all these variables. We’re both in our 70s and have had to make these decisions for years, but the changes every year continue to throw twists we didn’t expect and our medical needs continue to grow and change. If you can, book an appointment with a local advisory group before making any decisions.
Actually, it’s the other way around. It’s easier to switch to MA from Medigap than vice versa. But once you’ve switched from Medigap to MA, it’s virtually impossible to go back to Medigap.
It’s my understanding — as always, subject to correction — that the decision whether or not to approve a Part B / Medicare Supplement claim is made by Medicare, not by the company issuing the supplement plan. I’ve never had my supplement provider reject paying their portion of a claim that Medicare had approved; come to think of it, I’ve never had a claim rejected by Medicare, other than one for service during a cock-up with my Part B enrollment.
ETA: The above applies to Part F/G; I’m not sufficiently familiar with the other supplement types to comment on them.
Ditto here after 9 years (today) on Plan F. It appears my doctor screwed up their claim on my cataract surgery. I got copied on some of the discussion, but no one came looking for money.
One more thing to think about for Medigap vs. MA. When I had prostate cancer I went with treatment from someone who was an expert in it. I have a hard time believing he was on many MA plans. With Medigap it was no problem.
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