quote:

Originally posted by Flash-LB:
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.

Assuming she can pay for it, I agree. Medicare is easy enough to understand if you put in the time. Going through a broker means you're opting out of any discounts you get by going directly to the medigap company.

Medicare Advantage plans are generally low cost and appear to offer a lot of additional benefits. But the reason is not because they are a charity and want to keep their profits low. They're the HMO plans which limits you to their network and their referral requirements. If you move and have to change plans after your first year, you have to go through underwriting which means the new company does not have to accept you.

All Medigap plans are standard and it's a matter of how much each company charges and whether you're confident the company will be around throughout your lifetime. The most popular medigap plans are Standard Plan G and High Deductible Plan G with the standard plan having higher premiums but kicks in after the $230 deductible. The High Deductible has lower premiums but kicks in after the $230 medicare deductible and the plan's deductible $2,490. If you're sickly and will incur $12,450 invoice for the year which will generate the 20% deductible of $2,490 then you might opt for the standard plan G.

You can go to Medicare.gov, set up an account for your mother and look up the companies offering plans available to her. The company links on the medicare.gov site doesn't link directly to the plan; I had to call for mine. But I got discounts for having my wife and I with the same company and for doing autopay.

For Prescription Drug D, you can go to Medicare.gov every October, enter the prescriptions you're taking and the system figures out which plan is the cheapest considering the premium and the deductibles for your prescriptions.

quote:

Originally posted by sse:
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.

To clarify, the premium cost does vary between companies, IMHO just not enough for the cost to be a big factor in the choice of which company to go with.

quote:

Originally posted by sse:
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.

I've not compared this years, but in previous years, with my plan I've seen deductibles were less compared to regular medicare. Zero co pay for PCP visits, $20 for specialists max out of pocket for the year is capped. All less than medicare according to the chart. But hey, I'm not here to sell any plan. No dog in the fight so to speak. Do your research and get what fits for your situation. All I can say I'm fine with the plan I have. I'm actually surprised how much they pay with no hassle and zero denials even on some charges I'd consider questionable.

Well if I am understanding this correctly I'm already screwed. This isn't her first Medicare plan. She turned Medicare age around the turn of the century so this is a second plan already.
I did find out that out of network is a disaster. She isn't going to be a traveler though so I perhaps naively don't think this to be a big issue.

Everyone's situation is different, and the exact option that person A found to be horribad in their case, might be perfect for yours.

Best thing to do is to get information rather than opinions. A good start (I had to do this research for myself earlier this year) is this book: "Get What's Yours for Medicare"

I found it to be very valuable as most of the terminology, programs and options were entirely unknown going in. The quality of my questions greatly improved, and I wound up finding a broker who could answer my remaining questions and we got squared away quickly.

I'm not going to promote Plan Z over Medicare Advantage This-N-That (made both of them up) because what fit for me might be overkill/underkill and/or might not be available or have much of a network where you are.

My advice: Spend $9 and get the Kindle version of the book (or find a copy in a library) and read with an eye to the details that fit your/your mom's situation.

quote:

I did find out that out of network is a disaster. She isn't going to be a traveler though so I perhaps naively don't think this to be a big issue.

^^^^^^^^^^^^
I mentioned MD Anderson earlier. Many people want to travel there for cancer treatment. They take traditional Medicare but only one MA plan that I never heard of. Most subspecialists are also out of network.
MA plans make money by LIMITING your care. They get paid by the government each month to take care of you. The less they spend the more they make for their shareholders.

You need to call 1-800-963-5337 and they will help you get to the correct Shine program for the county she/you are in. The Shine program is called SHIP in other states.
Program is free, unbiased and confidential.
These are Federally funded which is how they are free.
That 800 number is only good for Florida but if you're in another state just search the web for your states SHIP program.
For those of you transitioning to Medicare for the first time it's really important to take advantage of these resources and get it right. There are some mistakes that are easy to make that can't be undone. Do your due diligence up front.

This message has been edited. Last edited by: Powers77,

In general, the whole system is horrible.

Seven or eight years ago I needed a femoral arterial bypass surgery done on my left leg. I have Medicare and Plan L gap insurance. The Vascular surgeon I picked came highly recommended and I liked him. We were in his office discussing the surgery when I asked about my insurance and was he comfortable with it. He assured me he was fine with it but then he said he will not accept Medicaid or any Medicare Advantage plans, they were just not worth his time.

My Brother and SIL dropped their medicare and gap coverage a few years ago and signed up with a Medicare Advantage plan some broker told them about. Just last month she was complaining about all the deductibles and copays they had and it was killing them plus the fact that their choice of doctors was shrinking every year. The BIL had to go to an ENT and he said he didn't know where the guy was from but could barely understand a word he said. He was not happy.

Investigate it thoroughly would be my advice.

I don't like surprise bills and jumping through hoops,I don't mind paying a bit more to avoid a problem.
Both my Wife and I went with Medicare A&B with the plan G supplement.
Other than a once a year deductible (about $200) and approx. $200 per month (each, in addition to the normal Medicare monthly payment) we are good to go.
I have had 4 eye surgeries (3 at the Cleveland Clinic) and have never paid any additional UN-covered charges.

Before we retired, my wife and I visited with our local ‘Council on Aging’. They had a wizard who could explain the pluses and minuses of the various plans. She made it perfectly clear to us what we needed. Check with your local resources for a wizard - the advice was free.

quote:

Originally posted by mcrimm:
Before we retired, my wife and I visited with our local ‘Council on Aging’. They had a wizard who could explain the pluses and minuses of the various plans. She made it perfectly clear to us what we needed. Check with your local resources for a wizard - the advice was free.

Having worked with Senior Citizens for 42 years at SSA, this is the best advice I could give. Every state has an Office on Aging. It goes by other names in other states. As far as I know, every county has an office. They get federal funds for various senior services. One of the services they offer is advice on purchasing Medicare supplement plans. The advice is free. The person providing the advice is not a sales person and has no agenda. They have no financial incentive to recommend one plan over another. I have heard nothing but good things from people who have gone to their Office on Aging for advice.

Good advice thanks guys.

quote:

Originally posted by sse:
In general, the whole system is horrible.

Okay, that's your take. I've had major surgery in the tune of 1.5 million and out of pocket was less than $500. I don't know what more one could expect. Zero out of pocket, and a $10,000 check for inconvenience? You can have any level of coverage, but there is no free plan. Someone pays. And if the government says they pay... guess what, they have no money other then what they extract from the people. I guess it's what side of the deal you're on.

quote:

Originally posted by ZSMICHAEL:

I mentioned MD Anderson earlier. Many people want to travel there for cancer treatment. They take traditional Medicare but only one MA plan that I never heard of. Most subspecialists are also out of network.
MA plans make money by LIMITING your care. They get paid by the government each month to take care of you. The less they spend the more they make for their shareholders.

I have Memorial Hermann Advantage; you'd think Anderson would accept it, but they only accept Kelsey Seibold.

^^^^^^^^^^^^^^
It is about money and controlling the healthcare market. A chemo nurse told me that if Anderson really cared about patients they would not charge 40 dollars for parking.

Lots of information here from well meaning folks. However as an old insurance broker, I would suggest that you first select which medical organization your mother will use.
Then ask them who is the best Medicare provider for health concerns she has.
Go in that direction.

That makes sense. I gotta read that book and start making calls. This kind of dropped in my lap. I figured when I was making these decisions it would be for me and the wife so I had plenty of time to level up my knowledge.

quote:

Originally posted by NavyGuy:

quote:

Originally posted by sse:
In general, the whole system is horrible.

Okay, that's your take. I've had major surgery in the tune of 1.5 million and out of pocket was less than $500. I don't know what more one could expect. Zero out of pocket, and a $10,000 check for inconvenience? You can have any level of coverage, but there is no free plan. Someone pays. And if the government says they pay... guess what, they have no money other then what they extract from the people. I guess it's what side of the deal you're on.

Point well taken. But, there is quite a bit of red tape to get signed up for the first time, not easily understood...my cynicism was showing.

Best of health going forward to you, Sir...