I'm still 4 months away from 65, so still learning on this topic.

Sigfan, if you will be traveling in retirement, be sure to investigate the costs and limitations on Advantage plans out of your home area. Included would be the implications of a health event overseas and then what is/isn't covered when you get home.

(We always buy a good travel insurance plan every year that covers medical costs abroad plus repatriation medevac costs, and I am not sure how this meshes with any Medicare benefits. Possibly a total non-issue).

We currently have Christian Healthcare Ministries coverage, and upon my going on Medicare I can keep a supplement plan for very cheap, something like $100/month that pays everything not covered by Medicare A and B, no limits. But, I believe, won't cover any gaps in Advantage plans. So, when you look at the whole big picture, you might find the situation is worth paying a little bit more for B and a gap plan, ending up with no exposures to big costs.

I wish I had more solid information for you, but these are some of the details we are looking at.

My wife is staying on the CHM top tier plan after I go on Medicare. Something like $275/month with unlimited max coverage, just a $1250 deductible. And, pre-existing conditions have a 2 yr moratorium period when you first sign up.

Thank you for all the comments so far. I have Tricare for Life (TFL) which is essentially a supplemental plan, so I am not considering buying another supplemental plan.

Also, I have been researching this for a while, my wife and I have both been strongly opposed to the thought of getting an Advantage Plan.

Seems too good to be true, obviously the companies are making enough from the government to offset the give backs and I'm sure denying claims would be one way to make that higher profit margin. We are very skeptical.

I thought I would see if anybody here had opted for an Advantage Plan and see what they thought of it. What I am hearing from those with an Advantage Plan is that they are very happy with them. My classmate has serous health issues and is very happy with his Advantage plan in VA. My SIL has one in PA and she seems quite content with her plan.

What sucks is that my "free" healthcare for life after 20 years in the military started costing about $35 bucks a month 5 or 6 years ago and now that I'm hitting 65 its going to cost me another 400 for the privilege of getting on Medicare. Seems like military retirees should just be able to stay on Tricare.

Anyway, I'm blessed and better off than a lot of folks, but if I can reduce my Medicare premium and still see all of my current docs while picking up vision and dental I am hard pressed to turn it down. At least for the next 5 months to try it out and then revert to regular Medicare and TFL in 2026 during open season.

Again, anybody with experience with an Advantage Plan I would appreciate your thoughts and experiences.

Thanks

I posted on the first page, but I'll add that my sister and BIL have an Advantage plan that they are happy with. They travel every winter and have used their coverage without issue. I'm happy for them. But from what I've read, they are some of the exception.

As I said, I'm very happy with my high deductible G plan.

I did a bunch of research last year as I turned 65.

A lot of folks call Advantage plans, Medicare DISadvantage plans.

Knowing I was going to need to have some lingering medical issues addressed as soon as I got on Medicare, I chose a Supplement (Plan G) and have been very satisfied with it.

The Medicare Advantage plans make extensive use of prior authorization for many procedures and for certain referrals. If you want some pencil necked geek deciding on whether your receive the care reccomended by your doctor, these plans are for you.

Blue Cross of Tennessee Advantage plan for us… It has been AMAZING!

Wife and I both had surgery under it… mine was ~40K I paid ~ 600 bucks and that included all co-pays and an original Emergency room visit. Wife's was similar. Scheduling and approvals were virtually instant.

No reference needed to see a specialist. Hell, I haven't even had a PCP for years since mine retired. -Just pick someone who is in network-

And a really nice touch is a thing by a local very large medical corp… you only get one bill ever, not 40 from 20 different labs, dr or etc after they have collected and processed everything.

We could NOT be happier!

It may be weak on Drug payments no idea, but neither of us have any Regular prescription drugs.

No premiumS other than the routine SS part withheld.

quote:

Originally posted by 12131:
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.

That right there is a BFD and an extremely important point. The wife and I are noticing that Advantage is hard sell as hell. That's why we're shying away from them. Thanks 12131!

I’m going to go against the grain here, but for a specific reason.
I am a retired cardiologist, as many of you know. Almost my whole career was with the Kaiser Permanente Organization, which has contracts with Permanente physician groups as the primary provider of medical care. Over the time I’ve been in practice, KP has improved the quality of its care dramatically; so it now ranks at the top of medical care in most market it’s in.
BUT those are limited markets. KP failed its attempt to expand to countrywide coverage in the 90’s.

Knowing KP from the inside as well as out, I know that I get excellent care here in San Diego; and would in many other facilities in both northern and Southern California. Nevertheless I would be reluctant to be limited to KP facilities and Permanente physicians in some places in California; and don’t really have enough knowledge to judge the facilities elsewhere, which is in Oregon, Washington, Colorado, Maryland/Virginia, and I think still in Georgia.

So if we were to move to another area, I would NOT get a Medicare Advantage plan from KP; I would want the choice. But then, we have been so happy with our KP coverage that it is actually a strong motivation for us to remain in California, and either in the San Diego or Sacramento areas.

In theory, Medicare Advantage plans are what Medicare should be pushing, because capitated payment rather than fee-for-service is the only way Medicare can avoid bankruptcy.

The country will in the not too distant future go bankrupt, because the public, that is the voters, will not tolerate any limitation to their government goodies. When that happens our economy will tank, and those same voters will rue the day they pushed to keep their “entitlements” unlimited.

I find it a bit interesting that a folks on here who would normally rather get a root canal than do business with the government are favoring government run health insurance over private health insurance simply because they turn 65. Especially since the private insurance (in this case anyway) appears to offer better benefits and lower cost. Who cares if the insurance company makes money? Are we really surprised that a private company could figure out how to provide the insurance more efficiently than the federal government? It seems the government is fine handing off the administration of health insurance for seniors to these insurance companies.

Now if the coverage is lacking and there are legitimate pitfalls, then I can understand not choosing the private insurer. As I mentioned earlier, my wife who has been a PT in our local hospital for 23 years is dead set against the advantage plans, but she she is relying on the same stories that several folks on here have mentioned.

However, it appears that the 3 or 4 who are actually on an advantage plan are actually quite pleased with their coverage.

So far the biggest issue I have found is that I would have to file with TriCare myself for my supplemental coverage with the advantage plan. That alone just about kills the deal for me, but still willing to consider.

I applied for Medicare on May 1st, the first day I was eligible. I was approved on May 7th. I've received two different letters with my IRMA figures and today I got my first Medicare Bill: $1110 for Aug-Oct due on Jul 25th and I don't even turn 65 until late Aug. Ouch.

The advantage plan would reduce that cost while adding vision and dental coverage that otherwise I need to go purchase on top of the Medicare and Tricare premiums.

I appreciate all the insight and please keep the comments coming, especially if you have experience with an Advantage Plan.

Thanks again

Sounds like your mind is made up so go on with it.

Our local hospital had a Medicare Advantage contract. They are the only local option for both outpatient and inpatient care. In January every local clinic and the hospital itself decided they would no longer accept MA plans. All about the money and certain contract details I presume. You could then drive 100 miles for care. Six months to work it out.

No my mind is not made up, hence the continued requests for info. I'm actually leaning toward regular Medicare because I really don't feel like having to file insurance claims with Tricare. Downside there is I need to find dental and vision coverage for my wife and I.

I've got some more digging to do.

quote:

Originally posted by Johnny 3eagles:
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.

Johnny this sounds like an Advantage Plan not a Supplemental. Can you clarify that?

quote:

I find it a bit interesting that a folks on here who would normally rather get a root canal than do business with the government are favoring government run health insurance over private health insurance simply because they turn 65. Especially since the private insurance (in this case anyway) appears to offer better benefits and lower cost. Who cares if the insurance company makes money? Are we really surprised that a private company could figure out how to provide the insurance more efficiently than the federal government? It seems the government is fine handing off the administration of health insurance for seniors to these insurance companies.

I think you might be misunderstanding the medicare program. All the insurance companies....or maybe all offer both Advantage AND Supplement. There is no "government" insurance company. I have the supplement and it's provided by Mutual of Omaha. I could have picked, Humana, United Health, Blue Cross....etc.

Read up on your options.

^^^^ To clarify what 6guns said, original Medicare, which is Part A and Part B, is indeed provided by the government, but Advantage and Supplement are provided by private insurance companies, as is Part D (aka Prescription Drug Plan).

Part A covers in-hospital care.

Part B covers outpatient care.

The reason for all other plans beyond original Medicare is that the original Medicare doesn’t pay for everything.

"What Is Original Medicare?

Medicare is the government health insurance program available for people age 65 and older, people with qualifying disabilities and people with either Lou Gehrig's disease (also called amyotrophic lateral sclerosis, or ALS) or end-stage renal disease (permanent kidney failure requiring dialysis or transplant).

Original Medicare comes in two parts: Medicare Part A and Part B.

Part A covers a portion of hospitalization costs.
Part B covers doctor bills and other medical expenses, such as lab tests and some preventive screenings.
Individuals who opt for original Medicare also usually purchase a Medicare Part D prescription drug plan since most medications are not otherwise covered under Medicare except for medications used during hospital stays. You can also purchase a Medicare supplement plan, also known as Medigap, to help cover any costs not covered by Medicare, such as copays and deductibles.

With Medicare, patients can also see any provider in the country that accepts Medicare with no restrictions.

Read: How to Choose the Best Medicare Advantage Plan
What Is Medicare Advantage?

Medicare Advantage plans, also known as Medicare Part C, are run by private insurance companies regulated by the government, and they must offer coverage comparable to original Medicare."

The above from US News and World Report. Bold added by me.

Hence my comments about government vs private insurance.

I understand completely the difference between Advantage plans and Supplemental Plans. I don't need a supplemental, I have Tricare for Life as a supplemental.

Were I to go with an Advantage Plan, I would use Tricare for Life for my part D and my wrap around part G.

From my experience, Medical Advantage plans should be avoided except under special circumstances.

I have had a number of major surgeries over the last few years and I asked every single surgeon I had their opinion on those plans and they told me they do not accept any of the Advantage plans. They told me they pay less than Medicade does. Friends who own the farm down the road have the Advanage plan and the only Cardioligst in the area they could find that accepts it was from India and spoke such poor english that they had to ask the nurse come in to translate. I'm not making that up.

My BIL had open heart surgery some years back and shortly after that they dropped their regular Supplemental plan to go with Advantage. A year ago he started having heart problems again and his primary Surgeon would not accept their Plan. The only doctor they could find was in KU Hospital up in Kansas City, a seven hour round trip drive for them. His wife started having other issues and she had the same problem. His heart problems got worse and they actually sold their house down here and moved up to the city it was such a headache.

In my view, that plan would only make sense if you lived in a large metropolitan area with lots of doctors and hospitals around.

quote:

Originally posted by Rey HRH:
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.

Informative. Thanks!

quote:

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.

Sort of.

When you first become Medicare eligible or you move into a different geographic region, you don't have to medically qualify during open enrollment.

Medically qualify in plain English; you don't have any serious existing health problems.
If you sign up for Advantage at 65 or decide to switch later, you could switch back during open enrollment if you "medically qualify", meaning are healthy.

If not, IE you've developed some health problems, you won't qualify and are stuck with Advantage from that point on. For ever.
So if you feel like you can read the future or like gambling, have at it.