Hey brain trust, I have some questions for the collective.

My elderly mother recently moved into my neighborhood. She moved from California to Florida so her insurance plan had to move as well. I don’t know dick about Medicare. I went through all the offered plans and picked a Medicare Advantage plan that seemed reasonable and has plenty of local Dr’s and hospitals.

On a thread in what’s your deal those guys were basically saying avoid Medicare Advantage like the plague. Did I make a mistake?

She is being enrolled right now as a special enrollment period due to her move. The yearly enrollment I believe starts Oct 15-Dec 7 so if I have made some huge error I think I can correct it.

Any guidance or tips or points to ponder would be appreciated. I have 3 siblings and they help but it seems I’m being left to make the choices and while I’m not a smart man I know what I don’t know.

Any info will be appreciated. Thanks gents.

What plan did she have before? Regular Medicare is the more expensive plan for a reason.
Two years ago the local hospitals refused to accept ALL MA plans. A large sign at the hospital conveyed the news. Most local specialists will not see MA patients because of low fees and required authorizations for care. There is absolutely no way I would reccomend MA plans. MD Anderson will accept only ONE MA plan. So, yeah you made a mistake.

Living in California she had Kaiser Permenente.

Well the Dr we called for her first appointment takes the plan so I'm not sure they are denied out here. I need to check around.

If I go the straight Medicare route do I have to buy a separate Plan D plan for prescription drugs or is it part of straight Medicare?

Depends specifically where you live and in urban/suburban areas with lots of healthcare options, Advantage may work OK.
Otherwise I'd get a regular Medicare A&B with a quality supplement( Medicare Part G or Medigap) and also a Part D drug plan.

Since she has moved and won't have to qualify this one time, I'd use that option. If she has or develops problems, she won't be able to qualify after the fact.

For me, Advantage plans only offer one benefit, a cheaper premium. If she needs to use it, much of that savings may be eaten up with higher deductibles and the lack of providers that will take her particular plan. As others have mentioned, there's a reason for that lower price tag.

Advantage plans differ according to state. So do the prices, and coverage. Before my wife retired she spent days studying all the Medicare Advantage options here.

We ended up with a plan from a well known health insurance company that we pay $0/month for. So far it has covered all routine dr visits, with $5 copay for specialists, and it's covered all our prescriptions.

Last year, my wife required an ambulance trip to the ER & spent two days in the hospital. It only cost his a little over $300. So you do your homework. It can save you a boatload of money.

I signed up yesterday. I had been researching the last few years, and last month, August 1st, was the 1st day of the 3 months before my birthday in which to begin the enrollment process. Being retired, I had lots of time to research, learn and crunch numbers.

I researched the heck out of it. I ruled out the Advantage plan. I see why it’s attractive, but the devil is in the details. Forget about the so called free stuff. That stuff did not interest me. I talked to every Doctor I use as well as their Business and Billing person. They were less than optimistic for Advantage, and much more happy with Medigap/Supplement. They would not, of course, recommend a particular plan but gave me broad advice, yet clear, of their experiences.

You’ll pay more up front for the Medigap/Supplement plans, and petty much Zero for your care as events happen, there may be some $$$ for you to pay, but not often or much, all things considered. The Advantage plans are super cheap monthly costs but you have copays, deductibles and this and that fees.

Bottom line, you need to sit down with a Medicare Specialist/Broker and talk. They will load up all your Mothers info, crunch the numbers and print out her best options $$$-wise.

I asked friends and family who had signed up within the last 3 or 4 years who they used and either recommended or disapproved of, based on their experiences. I also got tons of snail mail letters offering me to come to a live seminar, get a free meal or drink, and listen to their presentation. After all that, I picked one of the personally recommended Reps. I’m glad I went that route. Of all the solicited free seminars I attended, each one left me feeling like I was meeting a used car salesman or time share bozo. Some were actually dishonest, some lied to me. That's just my personal experience.

A far as costs, my Plan D drug cost is $13 a month. I’m very pleased with that. For the Supplement, I chose BCBS for $134-ish per month. I chose the Plan G. I’m happy with that.

I do see where Advantage may work well for some people, it wasn’t for me. I’m not trying to steer you one way or the other, just saying how my experience was and how I made my decision. You’ll just have to get in there and learn all you can and do make your (moms) decision.

I'm a numbers nerd, a researcher, and when I started I realized everything was about as clear as mud. As time went by things became clearer to me. Over this last weekend, when I realized I had come to the point of Paralysis by Analysis, I made my decision. Signed up yesterday.

Best wishes to you and Mom.

Edit to add: My experience, if a Broker is talking to you about your Medicare options and starts to talk about other plans, such as long term this and that, disability, daily reimbursement and other things to consider in addition to your actual Medicare decision, walk out. This happened to me, I *think* thats illegal, it muddies the water even more. I felt the timing for that was wrong, it was like trying to deal with the F&I person when trying to buy a car, or a salesman trying to sell me an extended warranty. That's my experience and opinion. Take care of Medicare first, be clear for that, and save the other stuff for another day.

Edit to add: FWIW, and its something you need to understand, regular Medicare and Advantage plans are not the same boat, so to speak. It is a Distinction with a Difference. Regular Medicare, the Traditional Medicare, is through the US Government, so to speak. Advantage plans are NOT the same. If you choose an Advantage plan, then Medicare pays the Insurance Company a monthly fee to administer the Advantage plan to you. You will not have a traditional Medicare ID card, it will show as the Insurance company you choose. The Insurance company will be who you deal with, not Medicare.
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My best advice is to find a local broker to help you research her options.

MA plans can be great for the right person who lives in the right area. Both my parents had MA plans and here in St Louis the networks were strong. The $0 premium was affordable to them and they didn't mind using the MA plans contracted physicians.

MA plans can be very bad for the wrong person. If someone is used to complete autonomy in seeing doctors, and won't change, they are setting themselves up for failure. Regular Medicare + a Supplement + a Part D RX plan are best for these type of people.

quote:

Originally posted by h2oys:
My best advice is to find a local broker to help you research her options.

MA plans can be great for the right person who lives in the right area. Both my parents had MA plans and here in St Louis the networks were strong. The $0 premium was affordable to them and they didn't mind using the MA plans contracted physicians.

MA plans can be very bad for the wrong person. If someone is used to complete autonomy in seeing doctors, and won't change, they are setting themselves up for failure. Regular Medicare + a Supplement + a Part D RX plan are best for these type of people.

This is my experience also.I used a reputable broker.

Our supplemental plans and drug coverage cost us about $200 a month for my wife and I (each).
The coverage is good. I had an outpatient surgery this year; the bill was $40k and it cost me $1500.

quote:

Originally posted by pedropcola:
Living in California she had Kaiser Permenente.

Well the Dr we called for her first appointment takes the plan so I'm not sure they are denied out here. I need to check around.

If I go the straight Medicare route do I have to buy a separate Plan D plan for prescription drugs or is it part of straight Medicare?

Talk to a Broker. If your Mom currently has Medicare coverage, it's good at any hospital that accepts Medicare (pretty much every hospital in the USA accepts Medicare, 99.99% of all) all over the USA. And if that Hospital accepts Medicare, i *think* they have to, and will accept whatever Supplement she has. It's the law, as I understand it. I'm talking A & B acceptance, thats in-hospital (Part A), and B which is outside of the hospital coverage.

Ok. Sounds like I find a broker is a good start. My mom can afford to pay for better plans so that is one less concern. She is old school so once she goes to her GP that will be her Dr for life most likely.

I live in east central Florida so I am assuming living in the land of old people the networks are pretty robust. That is just a guess though.

So broker, do I just google Medicare broker and wade through them or does anyone have any targeted advice?

I wouldn't bother with a broker. One of the guys I shoot with talked to one and she talked him into an Advantage plan.

A couple of months later, he was pissed at his new insurance and pissed at the broker for recommending it. He switched during open enrollment later in the year.

If you have an Advantage plan, you need referrals for a lot of things, you're limited in who you can go see and deductibles tend to be high.

Get a supplement and go where you want, when you want. That's important when you get older.

^^^ A Broker is especially helpful when choosing a Plan D prescription drug plan

They can input all your Mom's meds, the system will crunch the numbers, and give a print out of results. The issue is that some drugs, depeding on Tier Level, 1 through 5 Tier level, the prices can vary not just for the plans monthly cost, you can have a good idea of monthly costs at the Pharmacy for each prescription.

If your Mom takes few prescriptions, and they're cheap generics, that's not much of an issue at all. That's cheap. If she is on expensive drugs, it makes a difference. For example, I am on Eliquis, which is an expensive mo-fo if you have to cash pay for it, around $550-ish per MONTH. If your Mom is relatively healthy and but gets sick and needs expensive meds, you need a good Plan D. You need to learn and understand crystal clear the "donut hole". It's important. A good Broker is very valuable here.
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Still 3 years out, but lots of Good Info. Thanks everyone.

I guess it all depends on where you live and if you travel a lot. I can't speak to your particular area, but in DFW there are zero issues with providers not accepting advantage plans. I've yet to be denied. Everything from a dermatologist to a heart and lung surgeon with care given at very highly rated UT Southwestern. At our age, we see doctors pretty regularly. A few years back I had major surgery. The total of expenses for that 12 hour surgery, 7 days in ICU plus additional 15 day hospital stay was about 1.5 million. My out of pocket for surgery, pre and post op visits, tests and rehab over 10 months was about $500.

If you travel a lot, this can be a concern as seeing doctors in other parts of the country or overseas will probably result in higher out of pocket expenses. So if travel is frequent, for sure opt for regular medicare.

I'm sure the hospital/provider community doesn't prefer advantage plans, since they carry high deductibles that results in billing the patient to the tune of thousands, which ends up in collection.

^^^^^^^^^^^^^
That is one factor. The other is the required authorizations for specialized care and the lower fees paid to the doctor.

quote:

Originally posted by TomV:
Still 3 years out, but lots of Good Info. Thanks everyone.

I'm a year and a month out, but like Tom, I appreciate the discussion and info.

I first went with a plan from Mutual of Omaha. It was a great plan, but getting more expensive each year. In 2020 I switched to an advantage plan. It is through a major hospital in Houston. All of my doctors except 1 accept the plan. Right after I switched, I went into the hospital for back surgery, and spent 3 weeks in TIRR for physical therapy. Other than the $300 hospital payment, the rest was no charge. I went into the hospital in May for a heart procedure. Again, I paid $300 up front and the balance was covered.
Also, I don't need a referral for specialists.

For each plan and zip code (it's all about the zip code), the costs and benefits, being regulated, are the same from company to company.

The thing is, it’s vital you make the right decision from the start. It’s critical.

When you originally enroll, you are Guaranteed acceptance for any plan you choose. No matter what health conditions you have, such as cancer, kidney or liver disease, etc or whatever, you are absolutely 100% guaranteed granted whatever plan you choose, and the cost is the same for everybody, no matter what. You pay no more.

Having said that, if later on you want to change plans, you are allowed to do so. Sounds great, but the devil is in the details. This is typically glossed over by the sales folks trying to sign you up. You will have to apply and you will have to clear an Underwriters review and they do not have to accept you. in fact, they probably won’t. And if they do, you’ll pay probably much higher costs. ( There are exceptions and this and that details, but they’re not easy or common.)

You’d better be as well educated as you can be, and get it right, for you the first time is your only time.
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