Medicare Advantage plans are not the first alternative Congress has given us. It died as the insurance companies were not able to be profitable within the constraints of the program. I believe history will repeat itself.
I am a retired physician who will be take traditional Medicare and the best possible MediGap plan (currently Plan G) when I become eligible next year. In 46 states (exceptions include NY, MA, CT, ME), once you pick Advantage Plan, you cannot go back to traditional Medicare.
Well, you may be able to go back. You will face medical underwriting, which you may fail. However, occasionally a company will waive underwriting (Humana did so a few years back for Plan G), and in my area UnitedHealth offers more expensive versions of its Medigap plans, presumably for those who fail.
With all due respect, I refer to Advantage plans as “Dis-Advantage Plans.” Advantage plans are exceptional right up to the point when you need medical coverage. Many are blinded by the bells and whistles of gym membership etc. The true medical coverage comes with many restrictions that one will not encounter with traditional Medicare. The best bullet proof plan: Traditional Medicare with a Medicare Gap plan G. Just my 2 cents
I have two homes in two different states, and roughly split my time between them. I’ve read that in my case Medicare is the better option, primarily because I will have different medical providers in each state. Does anyone have a similar situation, and if so, would this approach (i.e. basic Medicare) be advisable?
I have the option of a Medicare Advantage plan that is a bit unique and am wondering if anyone has perspectives about it. I’m a retiree from Illinois State government and they provide free health insurance to retirees. However, when you become eligible for Medicare, you have the option of enrolling in the State of Illinois’ Medicare Advantage Plan. The Plan covers all the ancillary things that a Medicare Advantage Plan does, including the Donut hole, vision, dental, etc. It has a low maximum out of pocket for a family of $3,000 per year. It costs about $30 per month, but you have to make your normal monthly payments directly to Medicare based on your financial situation just like you were still enrolled directly in Medicare. However, it doesn’t have a network of providers you have to adhere to. The third-party administrator is Aetna and you can see any doctor or hospital as long as they accept Medicare AND they can process payments through Aetna. It looks to me almost every doctor independent doctor and hospital network as far as I can see has the ability to interact with Aetna. Of course, I could still keep Medicare and purchase a Medigap policy, but the Illinois plan seems to have no real downside.
We have been covered by my wife’s City of NY Aetna Medicare ESA PPO plan since she retired 5 years ago and have had no problems with coverage or physicians who don’t take our insurance. We initially had no deductible or copay but now have a modest $300 deductible and $15 specialist copay. We also get Plan B premium and IRMAA reimbursement. We are very fortunate.
After many years in a Medical Advantage plan in SoCal, my wife and I elected to go back to Medicare last January when I was 79, she 76. We were both accepted due to our good health. We were approved for a Medigap policy too. What a mistake. We found our new Medicare doctor to be only interested in prescribing drugs and rushing us through our visit. Real waste of time. Long story short, we were able to go back to MA with doctors that are vetted in their system and an organization we could call if we had problems. We view Medicare as a big vacuum where you guess who the good doctors are and have little recourse if you encounter problems. And, MA is much less expensive too! Maybe I’m missing something and enlighten me if I am.
Tom Matera, it is very unusual — almost unheard of — for a physician to accept an Advantage plan but not accept traditional Medicare, especially when supplemented by a Medigap policy as you describe. So maybe your former physicians, who you really liked in part because they were “vetted in their [MA] system,” were employed by and worked exclusively for your specific SoCal Advantage plan? If so, that is not a typical arrangement for most physician practices or most Advantage plans — with the exception of ChenMed, but they don’t operate in California.
Did you try to use your preferred “MA physicians” when you transferred over to traditional Medicare for one month?
Further explanation of the details of your situation and your Advantage plan may help others understand what appears to be a fairly unique situation for you.
I volunteer as a Medicare counselor for Minnesota’s Senior Assistance. We provide information only, without bias to any particular plans. I cant tell you how many people think MA is so great because of the lower premium costs and the full service (Part A,B,D plus extras) it includes. I advise them to maintain an account for the ‘surprise costs’ they can see when using services. Another issue is friendly comparisons, so many come in and say “my friend only pays X (small premium) for their plan”. It is super important not to drop that Medigap before they know the real facts as has been noted, as it is unlikely to get it back. I agree with most comments regarding the benefit of the Medigap, but I also have folks that simply cannot afford these supplement premiums either.
Do you remember the old car repair commercials that said “you can pay me now or you can pay me later?” I feel that way about traditional Medicare vs. Medicare Advantage. Do I pay higher amounts for traditional Medicare and a supplement, or buy the MA plan and limit my choices?
My choice is traditional Medicare with a high deductible G supplement. That way I have the wider choice of providers traditional Medicare offers and the lower premium found in Medicare Advantage. Since I had an HSA while working, I have saved enough there to not worry about the deductible. Is this for everyone – no. But I don’t about what will be paid or if i can find coverage.
Anyone interested in Medicare vs an Advantage Plan should find the article link below helpful. It focuses on the challenges if not total inability to switch back to Medicare if your health has significantly deteriorated as far as diagnosed conditions.
We may begin retirement years in relatively good health and a MA plan makes sense but health has a way of changing without warning and the insurance plan that once made sense may no longer be a fit. Chosing a MA plan may then feel penny wise but pound foolish retrospectively.
A bit off topic, but switching among the different Medicare supplemental lettered plans may also trigger an underwriting review. I’m a fan of traditional Medicare + supplemental insurance, but people need to choose wisely when first given the choice (in my mind, that would be supplemental plan G).
Agree 100%! The best part of a traditional Medicare with a supplemental insurance is: you don’t need the prior authorization from insurance company when you need medical care such as surgeries, testing, rehab etc. and you have nationwide access to the providers who accepting Medicare. Your health care needs are not dictated by the insurance company.
Medicare is hands down better than Medicare Advantage. MA tries to seduce people with added services like eyeglasses or hearing aids. But it can have serious limitations with access to doctors and critical services you may need for cancer and other illnesses. There is a reason it can save you money and provide ancillary services. It cuts cost in the most important areas.
Mr Rogers has had a great experience with MA, but probably because he lives in a large city with several large medical centers. I know San Antonio a bit, but I would be interested to hear if the University Hospital is always on the MA plans and if the mitral valve surgery was done there.
There are two disadvantages to MA, stemming from their ability to limit the physicians and hospitals available to their members.
In CT where I practiced Yale was frequently not available to MA plans because of its higher costs.
Most of the outlying community hospitals were generally competent for simple problems, but I would not have wanted to be told my mitral valve surgery had to done at a community hospital, where the open heart program had just started and they had done 5 procedures. I saw this happen several times, and more patients were also forced to drive 30 miles or so for a CT scan although a ( non participating) place was available ( with better radiologists) next door.
The other major disadvantage is that once you elect MA the supplemental plans you need with traditional Medicare do not need to accept you if you want to change so you may be stuck.
The feds have finally caught on they are overpaying MA companies and are cutting the reimbursement rates ( causing dramatic declines in insurance companies stock prices). There will likely be further cuts and limits to care in MA plans. Remember , almost all MA advantage plans are owned by corporations whose first ( and only priority) is to make a profit, as large as possible.
Traditional Medicare is usually universally accepted although I know in some states ( ie Texas) a lot of some specialists are refusing to participate. I dont know if they also refuse MA.
Full disclosure here, ten years as a Medicare beneficiary, now in my sixth year in rewirement/refirement as an independent agent working in the Medicare space in the San Antonio area. Wife and I have had Medicare Advantage plans since reaching eligibility, and have had surgeries for hip, heart, rotator cuff, knee replacement, wrist, most requiring hospitalization, and oh, yes, a blood infection,too. Over that decade we’ve had no MAPD plan premiums, since all local plans for all of carriers are $0 monthly premium plans. The most expensive out-of pocket cost of these procedures was a $2,500 bill for open heart surgery to repair a faulty mitral valve prolapse. I’d say a pretty good deal frankly for five day hospital stay, including all inherent expenses of such surgery. All other calamities have been less expensive than that. Over those years we’ve avoided thousands of dollars of monthly premiums and annual monthly premium increases brought on by increased utilizations through COVID, and general medical care inflation. We could not have made better choices and with money saved and invested, have come out far to the good financially, with excellent healthcare outcomes, from doctors we have chosen. Nationally, last year 53% of Medicare beneficiaries chose Medicare Advantage, up from 25% over the last two decades. Something’s going right with Medicare Advantage, and privatizing healthcare. Over 90% of my clients have chosen Medicare Advantage, I think primarily because they are familiar with group plans, where now, government(Original Medicare) pays part of their expenses, and patients pay remainder. When you share maximum out-of-pocket costs of a hospital stay in a MAPD, with total expenses for premiums for a Medigap/Supplement Plan, in worst-case scenarios, it’s been a comfortable decision for most. Oh, and Just One More Thing….my clients make their plan decisions, not me, except in our personal case.
Insurance should first cover catastrophic health issues. Medicare will do a much better job of that than most MA plans. If I have a very serious health issue, I want to pick the best medical resource I can for that. I can do that with Medicare, but I am limited to the medical resources in my MA plan, so I am rolling the dice. I think seniors are at greater risk of catastrophic health issues, so its seems a no brainer to me that Medicare is best.
I was a primary care internist and geriatrician for 40 years and saw many patients whose Advantage plans forced them to go to substandard hospitals and specialists.
If you use Advantage, you are making a bet that all of your future medical problems will be treatable at the hospitals and specialists your plan currently has available.
If you live in Boston, where almost all of the hospitals are excellent, this is probably OK. But what about San Antonio, or Phoenix? Many hospitals in San Antonio are poor. Mayo Clinic in Florida has been cut out of Advantage plans, and the University Hospital in San Antonio may be unavailable also.
( Another advantage to MA is the legislature eliminated the A to F supplements and allows only 2 or 3.)
If you need a bone marrow transplant, or complicated chemotherapy for melanoma, or complicated heart surgery with the surgeon with the lowest mortality rate, you may be out of luck.
The real answer is: nobody knows. Medicare is DESIGNED to be a confusopoly – it’s so complicated and confusing no one understands it, or can determine what is best for them.
Scott Martin is right on target. I have had extensive Hospital stays due to Myeloma Cancer. I was able to choose all my doctors, and never had any doctor refuse Medicare although, I know there are some, but very few. All bills paid promptly and easily by Medicare, but always be careful as Hospitals make errors, so if you get a bill, it is most likely an error, call to make sure, never just pay any bill. The accounting people at the Hospital told us Medicare is golden compared to Medicare Advantage. Here is the bottom line, if you never need any care Medicare Advantage will be OK, but most of us in our senior years will eventually need special care of some sort, and then you will be most happy to have Regular Medicare and save $’s at the same time. I am happy my wife and I chose Regular Medicare.
I agree with Martin totally. I had a complex hernia operation, pacemaker and two prostate procedures, a total well over $100,000. Plan F paid 100%, with only statements showing how much was paid. As for Arizona, Mayo Clinic in Phoenix told me last year they don’t accept Medicare, only private insurance.
I can’t explain what you were told, but I’m a Mayo Clinic Phoenix patient and they accept my medicare insurance. Plus Medicare is listed on their website as an accepted insurance. Insurance types accepted at Mayo Clinic – Mayo Clinic
I have a Medicare Advantage plan that lets me go to any doctor. I pay a modest MA premium on top of the regular Medicare premium that is deducted from Social Security. I saw a host of different MA and Supplement plans, so anyone who is thinking about this should really dig into each plan’s coverage and costs – they are not all the same. (Because of the low MA premiums, I never really considered traditional Medicare alone. At the same time, I ignored the MA plans that promise to “give back” or cover meals and the like. (Dyno-Mite!)) I am in very good health, but have had some unusual procedures since I’ve retired – lots of Mohs surgeries and some prostate stuff, all at no cost beyond the smallish co-pays I have for every doctor visit. I passed on Supplements initially because the Supplement premiums were quite high and I couldn’t see where the benefit could ever offset the cost for me. I am happy with my MA plan (which is offered by a Johns Hopkins-related unit.) However, the comments here about Supplements and Medi-Gap will keep me attentive to my other options each year. Thanks for everyone’s inputs.
Retiring as a single female at 70 to a life plan community (a.k.a. CCRC: continuing-care retirement community), I aimed to simplify and avoid unexpected costs. I chose Medicare plus Medigap for the reasons Rick Moberg and Andrew Forsythe listed. For my Medigap Plan G (at Mutual of Omaha), the premium is the same every month (about $150/mo in 2022). I set it to autopay from my bank account. My Plan G has an annual deductible set by Medicare (which my CCRC pays), and beyond that I incur $0 out-of-pocket costs. For example, in 2022 I had a total hip replacement and knew all the associated costs would be completely covered. The bills up to the Plan G deductible went to my CCRC, and all bills after that went directly to Medicare and Medigap — simplicity and security.
Edits: (1) The Plan G premium is about $130/mo in 2022. (2) And of course there’s the Part B monthly premium set by Medicare, taken out of my Social Security benefit.
The goal I have above all in retirement is flexibility and resilience. We should have a strong enough balance sheet when I stop working to afford traditional Medicare + medigap with a high-deductible gap plan. For many of the reasons Rick Moberg mentioned, this should be optimal for us.
Traditional Medicare covers 80% and you are responsible for the other 20% with no limit. However, if you get medigap plan G-HD, this plan does add a max OOP limit on the remaining 20% that Medicare did not pay..
I think the lower upfront premium costs and expanded benefits of Medicare Advantage plans are great as long as you never get seriously sick or injured. Inasmuch as that’s unlikely as we age, I like traditional Medicare with a Medicare Supplement plan for the following reasons:
First, your out-of-pocket expenses with an Advantage plan could be significant if you get sick or injured. Your exposure to out-of-pocket expenses is much lower with a Supplement plan.
Second, there are no networks or referrals with a Supplement plan. You can go to any hospital or doctor that accepts Medicare. You are covered if you wish to seek treatment in other states that have hospitals and specialists you might need.
Third, Medicare Supplement claims are processed by the Centers for Medicare Services and not your insurance company. Once CMS covers a claim, your supplement insurance company must pay the unpaid balance regardless of whether they would have approved the claim for their Advantage plan holders.
Fourth, Medicare Advantage plans expose you to underwriting risk. If you start with an Advantage plan and then get very sick and want to switch to a Medicare Supplement plan, your insurance company may require medical underwriting. If so, the insurer will look at your medical history and current health status. If it determines the risk of covering you is too great, it can refuse to sell you a plan or it may charge you much higher premiums. In fairness, this is less of a problem if you live in MA, CT, NY or ME.
Lastly, Medicare Supplement plans are portable. You can take them to another state if you move and like your plan.
I’m learning about Medicare complexities in prep for when I reach 65. You say MA is great as long as you never have a serious condition. Is it true that MA sets an out-of-pocket maximum but traditional Medicare and Medigap does not? If so, wouldn’t MA be better to cover catastrophic?
I’ve been happy with my Medicare Supplement: no referrals, choice of any Dr. who accepts Medicare rather than being locked into a network, no pre-approvals, etc. The hassles are really minimal. I just signed up my wife for a similar plan. And if we have more medical problems down the road, I think we’ll be even more glad we went with the Supplements.
We felt that choosing Senior Care Coverage was such a difficult and daunting task we paid an expert advisor to help us choose.
Obviously, others have different perspectives and opinions.
File this under FWIW
https://www.kiplinger.com/retirement/medicare/medicare-advantage-customers-face-shrinking-pool-of-insurers
“Medicare Advantage Customers Face Shrinking Options – Medicare Advantage plan insurers are reducing their enrollments as profit margins shrink.”
Medicare Advantage plans are not the first alternative Congress has given us. It died as the insurance companies were not able to be profitable within the constraints of the program. I believe history will repeat itself.
I am a retired physician who will be take traditional Medicare and the best possible MediGap plan (currently Plan G) when I become eligible next year. In 46 states (exceptions include NY, MA, CT, ME), once you pick Advantage Plan, you cannot go back to traditional Medicare.
Well, you may be able to go back. You will face medical underwriting, which you may fail. However, occasionally a company will waive underwriting (Humana did so a few years back for Plan G), and in my area UnitedHealth offers more expensive versions of its Medigap plans, presumably for those who fail.
With all due respect, I refer to Advantage plans as “Dis-Advantage Plans.”
Advantage plans are exceptional right up to the point when you need medical coverage. Many are blinded by the bells and whistles of gym membership etc. The true medical coverage comes with many restrictions that one will not encounter with traditional Medicare. The best bullet proof plan: Traditional Medicare with a Medicare Gap plan G. Just my 2 cents
I have two homes in two different states, and roughly split my time between them. I’ve read that in my case Medicare is the better option, primarily because I will have different medical providers in each state. Does anyone have a similar situation, and if so, would this approach (i.e. basic Medicare) be advisable?
I have the option of a Medicare Advantage plan that is a bit unique and am wondering if anyone has perspectives about it. I’m a retiree from Illinois State government and they provide free health insurance to retirees. However, when you become eligible for Medicare, you have the option of enrolling in the State of Illinois’ Medicare Advantage Plan. The Plan covers all the ancillary things that a Medicare Advantage Plan does, including the Donut hole, vision, dental, etc. It has a low maximum out of pocket for a family of $3,000 per year. It costs about $30 per month, but you have to make your normal monthly payments directly to Medicare based on your financial situation just like you were still enrolled directly in Medicare. However, it doesn’t have a network of providers you have to adhere to. The third-party administrator is Aetna and you can see any doctor or hospital as long as they accept Medicare AND they can process payments through Aetna. It looks to me almost every doctor independent doctor and hospital network as far as I can see has the ability to interact with Aetna. Of course, I could still keep Medicare and purchase a Medigap policy, but the Illinois plan seems to have no real downside.
We have been covered by my wife’s City of NY Aetna Medicare ESA PPO plan since she retired 5 years ago and have had no problems with coverage or physicians who don’t take our insurance. We initially had no deductible or copay but now have a modest $300 deductible and $15 specialist copay. We also get Plan B premium and IRMAA reimbursement. We are very fortunate.
After many years in a Medical Advantage plan in SoCal, my wife and I elected to go back to Medicare last January when I was 79, she 76. We were both accepted due to our good health. We were approved for a Medigap policy too. What a mistake. We found our new Medicare doctor to be only interested in prescribing drugs and rushing us through our visit. Real waste of time. Long story short, we were able to go back to MA with doctors that are vetted in their system and an organization we could call if we had problems. We view Medicare as a big vacuum where you guess who the good doctors are and have little recourse if you encounter problems. And, MA is much less expensive too! Maybe I’m missing something and enlighten me if I am.
Let me guess, your MA plan is through Kaiser?
Tom Matera, it is very unusual — almost unheard of — for a physician to accept an Advantage plan but not accept traditional Medicare, especially when supplemented by a Medigap policy as you describe. So maybe your former physicians, who you really liked in part because they were “vetted in their [MA] system,” were employed by and worked exclusively for your specific SoCal Advantage plan? If so, that is not a typical arrangement for most physician practices or most Advantage plans — with the exception of ChenMed, but they don’t operate in California.
Did you try to use your preferred “MA physicians” when you transferred over to traditional Medicare for one month?
Further explanation of the details of your situation and your Advantage plan may help others understand what appears to be a fairly unique situation for you.
I volunteer as a Medicare counselor for Minnesota’s Senior Assistance. We provide information only, without bias to any particular plans. I cant tell you how many people think MA is so great because of the lower premium costs and the full service (Part A,B,D plus extras) it includes. I advise them to maintain an account for the ‘surprise costs’ they can see when using services. Another issue is friendly comparisons, so many come in and say “my friend only pays X (small premium) for their plan”. It is super important not to drop that Medigap before they know the real facts as has been noted, as it is unlikely to get it back. I agree with most comments regarding the benefit of the Medigap, but I also have folks that simply cannot afford these supplement premiums either.
Do you remember the old car repair commercials that said “you can pay me now or you can pay me later?” I feel that way about traditional Medicare vs. Medicare Advantage. Do I pay higher amounts for traditional Medicare and a supplement, or buy the MA plan and limit my choices?
My choice is traditional Medicare with a high deductible G supplement. That way I have the wider choice of providers traditional Medicare offers and the lower premium found in Medicare Advantage. Since I had an HSA while working, I have saved enough there to not worry about the deductible. Is this for everyone – no. But I don’t about what will be paid or if i can find coverage.
I am in health care field over 30 years. Traditional Medicare with a supplemental plan are the BEST!
Anyone interested in Medicare vs an Advantage Plan should find the article link below helpful. It focuses on the challenges if not total inability to switch back to Medicare if your health has significantly deteriorated as far as diagnosed conditions.
We may begin retirement years in relatively good health and a MA plan makes sense but health has a way of changing without warning and the insurance plan that once made sense may no longer be a fit. Chosing a MA plan may then feel penny wise but pound foolish retrospectively.
https://prospect.org/health/2023-11-29-medicare-advantage-trap/?utm_source=substack&utm_medium=email
A bit off topic, but switching among the different Medicare supplemental lettered plans may also trigger an underwriting review. I’m a fan of traditional Medicare + supplemental insurance, but people need to choose wisely when first given the choice (in my mind, that would be supplemental plan G).
Agree 100%! The best part of a traditional Medicare with a supplemental insurance is: you don’t need the prior authorization from insurance company when you need medical care such as surgeries, testing, rehab etc. and you have nationwide access to the providers who accepting Medicare. Your health care needs are not dictated by the insurance company.
Medicare is hands down better than Medicare Advantage. MA tries to seduce people with added services like eyeglasses or hearing aids. But it can have serious limitations with access to doctors and critical services you may need for cancer and other illnesses. There is a reason it can save you money and provide ancillary services. It cuts cost in the most important areas.
Mr Rogers has had a great experience with MA, but probably because he lives in a large city with several large medical centers. I know San Antonio a bit, but I would be interested to hear if the University Hospital is always on the MA plans and if the mitral valve surgery was done there.
There are two disadvantages to MA, stemming from their ability to limit the physicians and hospitals available to their members.
In CT where I practiced Yale was frequently not available to MA plans because of its higher costs.
Most of the outlying community hospitals were generally competent for simple problems, but I would not have wanted to be told my mitral valve surgery had to done at a community hospital, where the open heart program had just started and they had done 5 procedures. I saw this happen several times, and more patients were also forced to drive 30 miles or so for a CT scan although a ( non participating) place was available ( with better radiologists) next door.
The other major disadvantage is that once you elect MA the supplemental plans you need with traditional Medicare do not need to accept you if you want to change so you may be stuck.
The feds have finally caught on they are overpaying MA companies and are cutting the reimbursement rates ( causing dramatic declines in insurance companies stock prices). There will likely be further cuts and limits to care in MA plans. Remember , almost all MA advantage plans are owned by corporations whose first ( and only priority) is to make a profit, as large as possible.
Traditional Medicare is usually universally accepted although I know in some states ( ie Texas) a lot of some specialists are refusing to participate. I dont know if they also refuse MA.
Full disclosure here, ten years as a Medicare beneficiary, now in my sixth year in rewirement/refirement as an independent agent working in the Medicare space in the San Antonio area. Wife and I have had Medicare Advantage plans since reaching eligibility, and have had surgeries for hip, heart, rotator cuff, knee replacement, wrist, most requiring hospitalization, and oh, yes, a blood infection,too. Over that decade we’ve had no MAPD plan premiums, since all local plans for all of carriers are $0 monthly premium plans. The most expensive out-of pocket cost of these procedures was a $2,500 bill for open heart surgery to repair a faulty mitral valve prolapse. I’d say a pretty good deal frankly for five day hospital stay, including all inherent expenses of such surgery. All other calamities have been less expensive than that. Over those years we’ve avoided thousands of dollars of monthly premiums and annual monthly premium increases brought on by increased utilizations through COVID, and general medical care inflation. We could not have made better choices and with money saved and invested, have come out far to the good financially, with excellent healthcare outcomes, from doctors we have chosen. Nationally, last year 53% of Medicare beneficiaries chose Medicare Advantage, up from 25% over the last two decades. Something’s going right with Medicare Advantage, and privatizing healthcare. Over 90% of my clients have chosen Medicare Advantage, I think primarily because they are familiar with group plans, where now, government(Original Medicare) pays part of their expenses, and patients pay remainder. When you share maximum out-of-pocket costs of a hospital stay in a MAPD, with total expenses for premiums for a Medigap/Supplement Plan, in worst-case scenarios, it’s been a comfortable decision for most. Oh, and Just One More Thing….my clients make their plan decisions, not me, except in our personal case.
The reason 53% chose MA is because they advertise and make it sound great. It is not
Another reason is large employers forcing the issue by providing MA plans rather than subsidies for Medigap.
Insurance should first cover catastrophic health issues. Medicare will do a much better job of that than most MA plans. If I have a very serious health issue, I want to pick the best medical resource I can for that. I can do that with Medicare, but I am limited to the medical resources in my MA plan, so I am rolling the dice. I think seniors are at greater risk of catastrophic health issues, so its seems a no brainer to me that Medicare is best.
I was a primary care internist and geriatrician for 40 years and saw many patients whose Advantage plans forced them to go to substandard hospitals and specialists.
If you use Advantage, you are making a bet that all of your future medical problems will be treatable at the hospitals and specialists your plan currently has available.
If you live in Boston, where almost all of the hospitals are excellent, this is probably OK. But what about San Antonio, or Phoenix? Many hospitals in San Antonio are poor. Mayo Clinic in Florida has been cut out of Advantage plans, and the University Hospital in San Antonio may be unavailable also.
( Another advantage to MA is the legislature eliminated the A to F supplements and allows only 2 or 3.)
If you need a bone marrow transplant, or complicated chemotherapy for melanoma, or complicated heart surgery with the surgeon with the lowest mortality rate, you may be out of luck.
The real answer is: nobody knows.
Medicare is DESIGNED to be a confusopoly – it’s so complicated and confusing no one understands it, or can determine what is best for them.
That is not accurate. People make it more complicated than necessary.
Scott Martin is right on target. I have had extensive Hospital stays due to Myeloma Cancer. I was able to choose all my doctors, and never had any doctor refuse Medicare although, I know there are some, but very few. All bills paid promptly and easily by Medicare, but always be careful as Hospitals make errors, so if you get a bill, it is most likely an error, call to make sure, never just pay any bill. The accounting people at the Hospital told us Medicare is golden compared to Medicare Advantage. Here is the bottom line, if you never need any care Medicare Advantage will be OK, but most of us in our senior years will eventually need special care of some sort, and then you will be most happy to have Regular Medicare and save $’s at the same time. I am happy my wife and I chose Regular Medicare.
I agree with Martin totally. I had a complex hernia operation, pacemaker and two prostate procedures, a total well over $100,000. Plan F paid 100%, with only statements showing how much was paid. As for Arizona, Mayo Clinic in Phoenix told me last year they don’t accept Medicare, only private insurance.
I can’t explain what you were told, but I’m a Mayo Clinic Phoenix patient and they accept my medicare insurance. Plus Medicare is listed on their website as an accepted insurance. Insurance types accepted at Mayo Clinic – Mayo Clinic
Here’s a link to Martin’s article:
https://humbledollar.com/2023/05/time-to-decide/
I have a Medicare Advantage plan that lets me go to any doctor. I pay a modest MA premium on top of the regular Medicare premium that is deducted from Social Security. I saw a host of different MA and Supplement plans, so anyone who is thinking about this should really dig into each plan’s coverage and costs – they are not all the same. (Because of the low MA premiums, I never really considered traditional Medicare alone. At the same time, I ignored the MA plans that promise to “give back” or cover meals and the like. (Dyno-Mite!)) I am in very good health, but have had some unusual procedures since I’ve retired – lots of Mohs surgeries and some prostate stuff, all at no cost beyond the smallish co-pays I have for every doctor visit. I passed on Supplements initially because the Supplement premiums were quite high and I couldn’t see where the benefit could ever offset the cost for me. I am happy with my MA plan (which is offered by a Johns Hopkins-related unit.) However, the comments here about Supplements and Medi-Gap will keep me attentive to my other options each year. Thanks for everyone’s inputs.
Retiring as a single female at 70 to a life plan community (a.k.a. CCRC: continuing-care retirement community), I aimed to simplify and avoid unexpected costs. I chose Medicare plus Medigap for the reasons Rick Moberg and Andrew Forsythe listed. For my Medigap Plan G (at Mutual of Omaha), the premium is the same every month (about $150/mo in 2022). I set it to autopay from my bank account. My Plan G has an annual deductible set by Medicare (which my CCRC pays), and beyond that I incur $0 out-of-pocket costs. For example, in 2022 I had a total hip replacement and knew all the associated costs would be completely covered. The bills up to the Plan G deductible went to my CCRC, and all bills after that went directly to Medicare and Medigap — simplicity and security.
Edits: (1) The Plan G premium is about $130/mo in 2022. (2) And of course there’s the Part B monthly premium set by Medicare, taken out of my Social Security benefit.
The goal I have above all in retirement is flexibility and resilience. We should have a strong enough balance sheet when I stop working to afford traditional Medicare + medigap with a high-deductible gap plan. For many of the reasons Rick Moberg mentioned, this should be optimal for us.
Traditional Medicare covers 80% and you are responsible for the other 20% with no limit. However, if you get medigap plan G-HD, this plan does add a max OOP limit on the remaining 20% that Medicare did not pay..
I think the lower upfront premium costs and expanded benefits of Medicare Advantage plans are great as long as you never get seriously sick or injured. Inasmuch as that’s unlikely as we age, I like traditional Medicare with a Medicare Supplement plan for the following reasons:
First, your out-of-pocket expenses with an Advantage plan could be significant if you get sick or injured. Your exposure to out-of-pocket expenses is much lower with a Supplement plan.
Second, there are no networks or referrals with a Supplement plan. You can go to any hospital or doctor that accepts Medicare. You are covered if you wish to seek treatment in other states that have hospitals and specialists you might need.
Third, Medicare Supplement claims are processed by the Centers for Medicare Services and not your insurance company. Once CMS covers a claim, your supplement insurance company must pay the unpaid balance regardless of whether they would have approved the claim for their Advantage plan holders.
Fourth, Medicare Advantage plans expose you to underwriting risk. If you start with an Advantage plan and then get very sick and want to switch to a Medicare Supplement plan, your insurance company may require medical underwriting. If so, the insurer will look at your medical history and current health status. If it determines the risk of covering you is too great, it can refuse to sell you a plan or it may charge you much higher premiums. In fairness, this is less of a problem if you live in MA, CT, NY or ME.
Lastly, Medicare Supplement plans are portable. You can take them to another state if you move and like your plan.
I’m learning about Medicare complexities in prep for when I reach 65. You say MA is great as long as you never have a serious condition. Is it true that MA sets an out-of-pocket maximum but traditional Medicare and Medigap does not? If so, wouldn’t MA be better to cover catastrophic?
Kurt – with traditional Medicine you likely want to purchase a Medicare Supplement policy to cover those cost risks.
I’ve been happy with my Medicare Supplement: no referrals, choice of any Dr. who accepts Medicare rather than being locked into a network, no pre-approvals, etc. The hassles are really minimal. I just signed up my wife for a similar plan. And if we have more medical problems down the road, I think we’ll be even more glad we went with the Supplements.