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This is a decision I had to make several years ago when I turned 65. I started out with a no premium five star local Advantage plan to take “advantage” of the free perks for the first year, then switched to traditional Medicare with a plan G supplement, the most expensive plan. To most this would seem quite contradictory, but let me explain my reasoning. Medicare allows first time enrollees to trial an Advantage plan for up to a year, and the switch to a traditional plan with supplement with guaranteed issue and premiums as if you had signed up for the supplement initially.
I chose the Advantage plan first so I could utilize the free eye exam, and the full value of the dental benefits, as well as an amount for exercise equipment. I am healthy so I rolled the dice regarding deductibles, copays, etc. Unfortunately an ER visit made my bet a loser (but my wife who initiated the same plan won the bet).
Towards the end of the year on the Advantage plan I signed up for traditional Medicare and a plan G supplement. This was not a result of losing the bet, but was the plan all along. Even though a plan G was the most expensive plan it comes with no deductible other than the Federal part B deductible, and no prior authorizations required. My wife worked in the medical field in nursing homes and saw the constant battle to have Advantage plans keep their insureds in rehabilitation until they were ready for discharge. Also I am very frugal so I have a tendency to look at the cost of everything to determine if it is a good value. If I were not having full coverage without a deductible I would most likely, to my detriment, delay seeking treatment for a perceived medical issue.
So both my wife and I have the more expensive plan. This year’s cost for medical issue just under 6K for all premiums and the Federal part B deductible. We have zero premium Rx plan with no copays, deductibles, for our few medications. We like the cost certainty in the future and have planned for the annual increases in our financial plan.
So my question is, how did you decide whether to sign up for an Advantage plan versus traditional Medicare with a supplement?
I start Medicare July 1 and also am retiring on July 1. My husband retired from a California state agency in 2016 and was fully vested in retiree health care, which we’ve both used until now. Now that we’re Medicare-eligible, we get the same plan, but it’s Medicare + supplement. So I’m thinking it’s the equivalent of Part G? We also get Part D coverage through this supplement and some Part B/IRMAA reimbursement added to our pension checks.
We were on the PERS Platinum PPO before Medicare, and now we’re on the Medicare version of that. It’s very generous in terms of allowing you to pick your own doctors and specialists.
If you and spouse have long term care insurance, you may consider MA plan as an option. An example was my friend who needed several months of rehab in hospital. His company insurance will not pay for more than 2 weeks. His LTC kicked in and they had no issues paying for it.His copay costs were paid by his company insurance once he exceeded maximum out of pocket. He has premium free MA now and saves on Plan G premium and that money will be invested for future health care needs.
LTC is not covered by private health insurance, Medicare, Medigap or MA. There is a distinction between rehabilitative care inpatient or not and custodial care which is what LTC is designed to cover. Medicare covers up 100 days in a skilled nursing facility for rehab purposes.
An MA plan may be fine while you are reasonably healthy, and if you avoid unusual diseases. Not so much if you need treatment they don’t want to cover, or that is not available where you live. I have a rare eye disease. The latest surgical techniques are measurably better than the previous versions. I was fortunate that I was able to have the latest surgery performed by a local doctor. However, if I had had the surgery a couple of years earlier, I would have had to travel out of state or settle for the older version. Reports posted to the online support group I still follow indicate that plans will not cover out of network treatment for this disease. I imagine a similar problem would arise for unusual cancers.