bwmarkus

Hello fellow hoggers,

Need advice on a non-photography question. My wife is approaching 65 in a few months and must make a decision concerning Medicare insurance. She has been doing a lot of research and is (I think rightly) confused about all the options.

I turned 65 five years ago and went with an advantage plan from a major carrier. It is low cost (zero dollar premium), the coverage seems pretty good, and as a bonus it pays for my YMCA membership ($52 / month value). So far, I have had mostly routine care, and this plan has met my needs. However, recently my carrier failed to reach a contract with the major medical system where I live, and negotiations have broken down. The medical system posted a web page on their site to explain why they failed to sign a contract with my insurer. They cited several incidents where patients were admitted, received what appear to be "medically necessary" care, but the insurer refused to pay. This has made my wife - and me - suspicious about this insurer.

There are many old jokes about insurance being great, right up until it's actually needed. That could be the case with this insurer.

On the other hand, the Medicare supplement plans guarantee to pay any costs that Medicare and other insurers don't pay. This appears to eliminate the risk that advantage plans refuse to pay. But like any insurance, there's a separate monthly premium to pay every month (additional to the Medicare premium), whether its needed or not.

Any experience or opinions any of you could share to help inform this decision? I always enjoy the insights from the people who post to this site. Thanks in advance!

SaratogaMan

Choosing a Medicare Advantage plan limits your choices -- many providers do not participate. A more traditional or non_Advantage supplement may not provide those "goodies" like the gym or no fee, but you will probably have fewer hassles. You get what you pay for...

Michael1079 Loc: Indiana

I thought your comment "about insurance being great, right up until it's actually needed" was spot on!

Just my two cents: I went with a Supplemental plan when I turned 65. The Advantage Plans look great because of their low premiums. They are great, as long as all you need is routine services like Annual physicals and such. My fears were if I experienced the need for a significant medical procedure - be it knee replacement or whatever - then the higher deductible of that medical care would negate whatever value was 'saved' with the lower premium. As long as your health remains good, the Advantage Plan is a good deal. Plus, they offer/include vision and dental, which must be picked up separately if you have Supplemental.

However, with a Supplemental, I know exactly what my plan covers and what out of pocket expenses I am going to have if I need medical care. Basically, I'm paying a bit more for that 'Peace of Mind.' A guy named Marvin Musick host a number of really excellent Medicare seminars on Youtube. Here are two:

https://www.youtube.com/watch?v=scFsHPFqT_w Approx 1 hour long

https://www.youtube.com/watch?v=X0jOmWayPKg Approx 2 hours

These are both a bit long, but excellent to watch.

Bottom line with insurance is that the companies are in business to make a profit. If you don't pay with a premium, they will get you with a deductible

Best wishes

Mike

fosis Loc: Pittsburgh, PA

This all depends on where you live, and which plans are there for you, and how few Rx's you have. BUT --
If you are both healthy, I found the zero premium plans just fine, with even a few that rebate some of the premium from your social security medicare premium payment (Aetna has a "value" plan here).
If you have Rx's, that can be a major cost driver, so check all of them against the plans, especially if they're not Class 1 (cheapest). From year to year, the companies can reclassify the higher priced Rx's so be careful.
There are consultants around who seek your business (and get a little commission from the companies), who can be very helpful in describing the medicare advantage landscape. They come to restaurants and coffee shops and hold short "classes", then help you get signed up. Ask around or call a health plan for a name/phone.

Marg Loc: Canadian transplanted to NW Alabama

Having been in the medical profession I have to recommend that you avoid Medicare Advantage plans as they are too limiting and go instead with regular Medicare with a good supplementary insurance. For example I have Medicare, blue cross Cplus, blue cross prescription coverage and blue cross dental. As noted by others you get what you pay for.

Longshadow Loc: Audubon, PA, United States

Some advantage plans require one to use their medical service providers. Yuck. My dad had an advantage plan that for one instance required him to go to a hospital 12 miles away instead of the hospital that was 1.5 miles away from him.
We elected to go with supplement plans for each of us which were recommended by the "insurance dude" that services my wife's <prior> employer.

bwmarkus

Mike, excellent advice and recommendations.

Thanks!
Barry

cjc2 Loc: Hellertown PA

I am NOT a lawyer or Medicare expert, but I am involved as I am over 65. I use a person duly licensed to provide opinions and have been VERY happy. I don't know where you live, but I will provide contact information if you PM me. Best of luck.

Mustanger Loc: Grants Pass, Oregon USA

Very limited choices in my area...but I have Aetma Medicare Advantage & regular Medicare. My advantage plan is a special package through my employer & gives me more coverage plus very inexpensive dental & vision. I can go to ANY doctor or hospital in the USA in or out of network the cost is the same. My wife has heavy demands on Medical, sorry to say, but this works for us.

I'd recommend joining AMAC & talking to their advisers that specialioze in medical coverage! AMAC is like AARP but for Conservatives & is very very good with their dedicated free services.

lamiaceae Loc: San Luis Obispo County, CA

Actually I know a bit about Medicare as it pertains to myself and my wife who will be eligible in December. In short (from what I know), Medicare Advantage Plans (Part C) are great if you are healthy but possibly problematic if and once you get sick as you age. I am rather ill with many conditions. I personally have the no longer available plan F for Part B. I have supplemental insurance with that too. My wife has been advised to choose plan G or N. These are not the cheapest choices up front but you should consider the costs when you get chronic diseases. You should speak to an independent advisor and Medicare directly. Insurance companies are selling a product and lie! Your and yours wife's needs may be totally different. Good luck!

ken_stern Loc: Yorba Linda, Ca

I think you can sum it all up with a single phrase:
"IT ALL DEPENDS"
Your current state of health
What State do you live in
What part of that State do you reside
How much money did you earn during your lifetime?
The current state of your personal retirement program

GOOD LUCK

As for us -- We are both very happy with SOCAL Kaiser Permanente

PS: Should have added this -- "All that can change tomorrow"

SteveR Loc: Michigan

My wife was a nurse for a state owned hospital system. One of her perks was that upon retirement they paid for her supplement plan through the insurance carrier that had provided insurance for the hospital as long as she'd worked for it. I had been on her insurance plan as a dependent after I retired. After I went on Medicare, I kept that insurance as my supplemental at the same rate. It works well for me considering that I'm on insulin and some other medications. When I hit the Medicare "gap" my supplemental picks up the tab. When I went into the hospital for a few days in 2018 I didn't pay a penny.

You may consider yourself fairly healthy at this point, and a supplemental not worth the money, but when you DO get sick, you'll find out why it's worth it. If you ever need surgery, you'll really find out why it's worth paying for it now.

Ollieboy

Be mindful of the deductible amounts. Often these amounts are not advertised upfront. You must pay out of pocket until you reach that amount, then the Medicare Advantage plan kicks in. Not always good.

Grump's Photos Loc: Dunedin FL

You might also check the "Senior Center" in your location. Many have a "SHINE" (Serving Health Insurance Needs for Everyone-I believe) representative that will sit down with you, go over ALL of the meds you take, and come up with a report on what is available to you, and what the costs (deductables, co-pays, monthly premiums, etc) will be for each available program. My wife and I went with the regular Medicare, and Blue Cross-Blue Shield of Massachusetts, and are very happy with that decision. We've gotten service and coverage no matter where, in the US, we've been. Good luck with your decision making process..............it certainly can be daunting!
Andy

TriX Loc: Raleigh, NC

The downside of not using an advantage plan is that in my area, a large percentage of providers will not process Medicare or take Medicare patients. On the other hand, almost everyone takes Blue Cross Medicare advantage since it is by far, the largest insurer in the state. I have been more than satisfied. The premium is reduced every year and the benefits have increased. Hospitalizations with total bills in the tens of thousands of dollars result in a copay of ~ $100 (several experiences). Couldn’t be more pleased, and if you call to discuss a drug or procedure, you get a real, helpful person within seconds. No copay for regular office visits, no pre approval to visit specialists, and 25-50 co pay for specialists. Includes vision, dental and physical fitness memberships. There is hearing aid coverage, but limited. Drugs are a few $ unless name brand specialty, but still reasonable. Highly recommended (used them for 6 years).