I did a search on retirement questions in the Lounge but none of the older threads seemed relevant enough to resurrect so please bear with me.

I hit 65 next month and face mandatory retirement (airline pilot). Wife is a couple years younger, works part time but no health benefits. I am retired Coast Guard so have TriCare for Life (TFL) as a secondary insurance after Medicare and the wife will stay on Tricare Select until she is eligible for Medicare.

Several of my Academy classmates who have already reached Medicare age and are also on TFL have signed up for Medicare Advantage plans in order to get dental and vision coverage (not provided by TFL). Their particular plan has 0 premiums and a kickback of 100-150 per month. They have TFL for drug coverage and secondary insurance after the Advantage plan.

My wife is a long time Physical Therapist and works in a hospital with predominantly elderly patients in the outpatient portion of the clinic. She has a definite prejudice against the advantage plans, but can't exactly articulate why. Mostly she is afraid of delays getting approval for rehabilitative care in the event of bad accident or bad outcome after surgery. Both of us have heard stay away from advantage plans for as long as we can remember, but not exactly sure why.

My question for you who have tried an Advantage Plan is what were the pros and cons for your particular situation?

All of my current doctors are in network for the plan so on paper I don't see any downside, but it just seems odd that they would pay us 100 a month to be on a plan with zero premiums and all of my doctors accept. Having the dental and vision included saves quite a bit as well.

Certainly I am missing something and appreciate any thoughts those of you on one of these Advantage plans have to share.

Thanks

I hit 65 next month as well and have been looking at Advantage plans. I'll be interested to hear what folks have to say. It seems like a no brainer option but there has to be a catch somewhere?

I have traditional Medicare with a Part G supplement.
You're getting old. No matter how healthy you are now, your needs will increase as you age. You can go to pretty much any doctor or facility on Medicare with a small annual deductible (about $200 + $200) and you're done.
If you are on Advantage and find you want to switch and have some health issues, you can't, with few exceptions. They have high deductibles, provider restrictions and other copays.
The only real advantage I see is that the premiums can be lower but you end up paying more later.

quote:

Originally posted by 220-9er:
I have traditional Medicare with a Part G supplement.
You're getting old. No matter how healthy you are now, your needs will increase as you age. You can go to pretty much any doctor or facility on Medicare with a small annual deductible (about $200 + $200) and you're done.
If you are on Advantage and find you want to switch and have some health issues, you can't, with few exceptions. They have high deductibles, provider restrictions and other copays.
The only real advantage I see is that the premiums can be lower but you end up paying more later.

I am getting ready to retire on 12/31/2025. I am strongly looking at a Medicare Part G & D. From my research, and I could be very wrong, but the advantage plans I've looked at you have to stay "in network". My son and daughter-in-law live in Dallas. My daughter and son-in-law live in Maui. We plan on spending a fair amount of time with both plus we want to do some road trips. We're thinking supplement instead of an advantage plan. I'll be paying close attention to this thread. A ton on knowledge in this forum so I'll be staying tuned in.

^^^^ What he (220-9er) said. With Medigap (aka Medicare Supplement) you can see almost any doctor anywhere, plus you can go see a specialist without needing referral from your PCP. Not so with Medicare Advantage. With Advantage, you have to see docs in their approved network.

You’ll also notice that these companies will always try to steer you in the Advantage direction. Insurance companies trying hard to sell you a plan over something else should tell you something.

We have Humana Medicare supplement through USAA, primarily for people on both Medicare and Tricare for life.

Our plan includes dental, so I was able to drop my Dental insurance thru the military @ $70 per month. We have now been seeing our dentist for 1.5 years, including 2 crowns and a couple of fillings and 6 month cleanings.
Vision also included, but we haven't tested the limits, only 2 annual checks..
Able to continue our coverage with our family doctor and, so far we have had no issues with ANY medical services. My wife had emergency Gall Bladder surgery, Emergency Room and 4 nights in patient with CT, MRI and a follow-up scope of her pancreas duct. I had a total hip replacement done. No bills at all. There is a Pharmacy benefit but with Tricare and military Pharmacy on base we don't use the plan.

Plan also includes an OTC benefit. About $150 per quarter...free OTC items and free shipping.

We also don't have the full Medicare deduction fron our Social Security. Without looking it up, I belive our deduction is about $60 less.

So far, since January 2024 we have spent ZERO DOLLARS.

Yes to the above. Given my circumstances I too went with a supplement through Mutual of Omaha. The high deductible G plan with the mandatory D plan. It's very low cost and 1/2 dollar/month for the drug plan.

I think the advantage plans sound good on the surface, but over time can be limiting and once you're into an advantage plan, it's harder to go back to a supplement plan.

quote:

Originally posted by 12131:
^^^^ What he (220-9er) said. With Medigap (aka Medicare Supplement) you can see almost any doctor anywhere, plus you can go see a specialist without needing referral from your PCP. Not so with Medicare Advantage. With Advantage, you have to see docs in their approved network.
.
You’ll also notice that these companies will always try to steer you in the Advantage direction. Insurance companies trying hard to sell you a plan over something else should tell you something.

Listen up, this is the answer. I'm 77 and have had a Medigap plan for 12 years, with hypertension, AFib and just recently an aortic valve job (TAVR) I would have been hosed on any other plan. Oh yeah, I had heart ablations in 2015 and 2017. Forget Advantage.

Johnny are you on a Supplemental Plan or an Advantage Plan through USAA?

Also, according to my research you can switch back and forth between regular Medicare and Medicare Advantage plans each open enrollment period, or every year.

Also it appears that I can go to out of network doctors and facilities but the copays and such would be higher. With TFL those would be offset, but again every doctor I go to is in network for the Humana Advantage plan I am considering. Upside is it would only be until the end of the year (5 months) before I discontinued it and went with straight Medicare in 2026.

I don't see the advantage of a Supplemental when I already have TFL. Am I missing something here as well?

Medicare (DIS)-Advantage Plans can give you a lot of grief.

• They might assign a primary care physician, where traditional Medicare Supplement plans allow you to choose any doctor that accepts Medicare.
  
  
• Traditional Medicare Supplement allows you to go to any specialist who accepts Medicare, no referral required. Advantage plans require referral to an in-network specialist.

My wife and I (she was a health care provider, and knew whereof she spoke) chose traditional Medicare supplement years ago, when each of us reached Medicare eligibility age, and we have not regretted it. Everything we needed, from cataract procedures to several hospitalizations, extended cancer treatments, ER visits, lab tests, emergency care walk-ins ... everything has been covered, always at the provider of our choice (not the insurance company's choice) at almost no cost whatsoever. Advantage plans can not, do not, compete with this.

Q (12131) is a physician. Read his post, above.

My wife is a retired medical practice administrator i.e. she knows the Medicare racket inside and out. She is death on Advantage plans. The only advantage is to the peddlers of it.

We have Farm Bureau Plan G

Medicare Advantage Plan
• PPO H5216-235
USAA® Recommended
Humana USAA Honor Giveback (PPO)
Medical coverage only
A plan that is backed by USAA and provides care to those who have served. This plan adds money back to your Social Security check with the Part B giveback benefit.
Monthly premium
$0.00
Maximum out-of-pocket
$3,400.00
Part B giveback
Up to $65.00
Primary care copay
$0
Specialist copay
$25
Medical deductible
$0

Add your doctors

Add your facilities

Plan benefits

Routine dental exam

$2000/yr. dental allowance

$150 glasses or contact lens allowance

Coverage for hearing aids

See any doctor who accepts Medicare

Emergency benefits that go where you do

SilverSneakers membership

I have not spoken to any representative of any company. The only people I have talked to so far is my classmate who is on this plan and 2 others also trying to decide in the next month.

The general consensus of Medicare Advantage Plans is that they suck, don't cover anything, and can't be used more than two blocks from your house.

They are all different and you need to do your own due diligence. I'm very happy with mine. I can use it anywhere, with anyone that takes Medicare.

I spent a few days in renal failure in the hospital in March. Total billed - $52,196.00. My cost - $175.00.

Drug coverage has the same $2K cap as any part D. I'm on cancer and heart failure meds that cost over $12K/month. After January, I pay $0.00.

PCP visits are $0.00, specialists are $5.00. Dental and vision coverage are included and I have the same doctors I've had for 25 years (unless they retired or died).

My cost for the plan is $57.00/quarter. I've been on it for 5 years, have zero complaints, and no claims have been denied. Advantage plans are all different depending on where you live. Don't discount them without research based on what's available at your specific location. Some suck, some don't.

quote:

Originally posted by Sigfan Roy:
I have not spoken to any representative of any company. The only people I have talked to so far is my classmate who is on this plan and 2 others also trying to decide in the next month.

Each State has a Federally funded program, usually called SHIP or Shine in FL. They have volunteers who will help you analyze your options. No affiliation with any of the companies. My wife has worked in this arena for years. You want to reach out to this program to make sure you do things correctly. There are some decisions that can't be corrected later if you blow it initially.
She has generally NOT been a fan of the Advantage Plans. Original Medicare with supplements is the usual recommendation but everyone's situation is different and needs individual analysis.
Ironically when I became eligible this year I ended up in an Advantage Plan despite her dislike of them. This was largely because if I denied the Advantage Plan my old company offers, she would lose her eligibility for their health insurance and would have to go to the marketplace.
The other thing I know from listening to her help people for years is that you should have started this analysis several months ago, so you really need to get some help from SHIP/Shine ASAP.
ETA: I became eligible in February. She started working on my transition in November.

quote:

Medicare (DIS)-Advantage Plans can give you a lot of grief.
They might assign a primary care physician, where traditional Medicare Supplement plans allow you to choose any doctor that accepts Medicare.

Traditional Medicare Supplement allows you to go to any specialist who accepts Medicare, no referral required. Advantage plans require referral to an in-network specialist.

My mother had an advantage plan. Restrictions on days in hospital, restrictions on assisted living. When she passed her estate had to pay over $10000 to the hospital.

18 months ago my wife passed out from an infection in her ear that progressed into her brain. Her undiscounted billings from Vanderbilt totaled over $1,500,000 for the 5 surguries, and 2 months in intensive care. Her Medicare & Supplemental thru USAA paid all but the $240 annual deductable. The Supplemental even paid the annual hospital inpatient deductable.

I went with the plan G. One reason was no surprise bills.
You could go to the hospital for surgery and have other people in the operating room that are not a part of your coverage, you won't even know who they are or that they had anything to do with your procedure, until you get a big bill from them.
The plan G covers this.
I also like that its good anyplace anytime (USA).
Plan G is the same coverage no matter what insurance company you chose. Every year you can shop around for a better price.

I don't have Medicare Advantage but I have studied the Medicare health insurance system enough that I have as good a working knowledge as any insurance agent and maybe even more.

I'll save the biggest argument for the last point.

As already stated, the difference between Medicare Advantage and regular Medicare is like an HMO / PPO versus a health insurance plan that lets you go to any doctor or specialist that you want without getting a referral.

With Medicare Advantage, the insurance company gets a say on the approval of any treatment even if allowed under Medicare. With regular Medicare, your treatment is between you and your doctor as long as it's allowed under Medicare. The net is Medicare Advantage can be more restrictive as the insurance can withhold authorization for any treatment, usually the more expensive ones.

Under Medicare Advantage, if you move to a different zip code, you may have to apply for a new Medicare Advantage program as where you move to may be out of network under your old Medicare Advantage program. Under regular Medicare, you can go to any Medicare doctor in the whole country.

In terms of expense, the bugaboo with regular Medicare is there is no limit to the annual copay of 20% after your regular deductible of $257 a year for outpatient care. But that is 20% of the approved Medicare amount, not whatever the doctor's invoice is. Also, you can cap your copay by getting a supplemental medicare insurance plan. There are two kinds - regular supplemental and high deductible supplemental. All supplemental plan types offered by all companies are the same; the difference is in the premiums paid. The regular supplemantal plan premium is relatively high but it covers your copays for the year after your $257 deductible. The high deductible has lower premiums but adds another level of deductible you have to satisfy before it kicks in. If you're sickly and will incur a lot of treatment, you might as well get the regular standard supplemental plan with its high monthly premiums but zero extra deductible. If you are relatively healthy and want to simply protect yourself from catastrophic situations, then get the high deductible. You're signing up to pay yet an additional premium for not much benefit but when shit hits the fan for the year, then your out of pocket copays are capped.

Here's the last point: Most Medicare Advantage plans tout additional benefits besides covering your healthcare. They offer prescription drugs coverage which you have to buy separately under regular Medicare. They may offer low premiums or even refund you your Medicare premium. They may give you vision care, grocery, free rides to appointments, extra. Sounds like a good deal, right?

But in congressional meetings, it has been established that Medicare Advantage plans have the highest profit per enrollee compared to other plans. Do you see the math? Medicare Advantage plans offer a lot more benefits than you would get under regular Medicare and they still have the highest profit per enrollee. That can only happen when they fund the costs of the other benefits and their profits by decreasing what they pay out for medical care. This last point is why, if you can afford not to get Medicare Advantage, you're better off under regular Medicare and getting a supplemental plan.

Nope, wife said we have to ge a Medigap Plan (Supplement Plan) over an Advantage plan. Not sure why - her department.

quote:

Originally posted by smschulz:

Nope, wife said we have to ge a Medigap Plan (Supplement Plan) over an Advantage plan. Not sure why - her department.

Your wife is correct.

My wife chimed in when we were evaluating this stuff. My wife was (now retired) a health care provider. Every working day, every day, she saw the problems that patients had with Medicare Advantage, while those with traditional Medicare sailed right through the system with very few problems.