Referring back to this thread, “Medicare Advantage Plans - anybody have one - pros and cons please” is a couple months old but I’d like to add my experiences to it.

My Advantage plan up until the end of October has usually been pretty routine, doctors visits, prescriptions, annual tests, etc, nothing too outlandish.

End of October, now things get interesting. Two ER visits one day apart, one kidney stone related, one cardiac, that one was intense. Bus ride twenty five miles interhospital transfer, two stents and five days hospitalization. Released, a week later I received another “bus ride” to the local hospital, BP meds took it too low.

While I’m still waiting for the ER doctors bills (they didn’t have my insurance information) the hospitals billings showed up. Around 140k the insurance company paid out. My portion, $1650.00

While I had two ambulance transports I’m assuming that the interhospital one was covered in the hospital billing. The second one, home to hospital, that cost me $300 after the the insurance picked up the majority of it.

Cardiac rehab program, from what I’ve been told I’m covered 100% from November through early March.

So, at least so far is my real life experience.

I have nothing but good things to say about my M Care advantage program. Although coverages are a very personal choice.

My mother had an advantage policy & her estate had to pay about $10000 in deductables when she passed.

My wife had an ear infection that went into her brain. She spent 2 months in intensive care and 1 month in assisted nursing care. This was after 4 operations that saved her life were performed by Vanderbilt's chief otolaryngologist & neurosurgeon surgeons. Standard Medicare and Supplemental Insurance paid all but the $243 annual Medicare deductable. Also Advantage policys require you to only see program doctors which may not be available where you are traveling.

As Anush indicates it is generally when you need care during travel where some of these plans come up short.
So, if you snowbird somewhere you need to make sure you are going to have coverage in both places for example.
The other downside is that once you go on an advantage plan you generally can't get back to original medicare plans even if you'd want to .

I've only been on my Aetna Advantage plan for 6 months but no complaints so far. I've paid nothing for my Rx's and the twice weekly physical therapy I've been receiving at the provider 2 miles down the road cost me just the $15 co-pay each visit.

No serious health issues to-date, knock on wood.

quote:

Originally posted by Powers77:
As Anush indicates it is generally when you need care during travel where some of these plans come up short.
So, if you snowbird somewhere you need to make sure you are going to have coverage in both places for example.
The other downside is that once you go on an advantage plan you generally can't get back to original medicare plans even if you'd want to .

This is incorrect. You are always allowed back into original Medicare.

You may have to undergo medical approval for a new SUPPLEMENTAL plan, but not original Medicare plan.

You will be covered by original Medicare after returning from an Advantage plan.

It was my thread that was referenced in the op. I am currently on straight up Medicare. I am also covered by Tricare for Life (TFL) which acts like a supplemental plan.

Big difference though is that I can get an advantage plan and still use TFL. Sort of like having a supplemental and an advantage plan at the same time, which is normally not possible.

I have some academy classmates with very serious health issues (cancer) that are very happy with their advantage plan. It provides them with vision and dental plus refunds part of their Medicare premium. They are still able to use TFL as secondary insurance (similar to a supplemental plan).

Definitely an individual choice on which way to go. Googlefu says 54% of Medicare people are on an advantage plan. This checks with the 2025 edition of Prepare for Medicare, written by Matt Feret, who is a self proclaimed 20 year veteran of the Medicare insurance industry. His wife is a health insurance agent, so have to take that into consideration. Fly-Sig recommended his book in my original thread on the advantage plans and it was very helpful in distinguishing the differences in the various plan types and nomenclature, although he doesn’t have much info on TFL - just recommends finding an agent with experience with TFL.

I may go with an Advantage for 2026 but still mulling it over.

When I started out with regular Medicare my first shock was the mid term rise in my supplemental coverage, while I don’t remember how much it went up it was enough to make me say “whoa”! Second year, Advantage plans were still not available in my county so similar shock mid year together with again having to pay for drug coverage as a separate policy and the same for vision and dental.

Once Advantage plans came available my insurance broker suggested we go with that. While I had some reservations at the time we went that way.

While I was in the hospital I called my broker. They offered to help me file my claim for my in hospital reimbursement and told me that my maximum out of pocket expenses would be $5300 with my plan. I’ll admit that I slept a lot easier that night (if that’s possible in the ICU!) knowing that.

When I first got on Medicare I also had a Blue Cross supplement . It was totally worthless . We changed to an Advantage plan from United Health and it has been great . My wife had a knee replaced and a terrible accident that required shoulder surgery and there has been zero issues ..

Shovelhead, I am glad you're still here!

Those $ numbers aren't bad. Overall, advantage probably comes out cheaper for most people than regular Medicare plus supplement a plan. My sister was on Medicaid, who paid for an Advantage plan. As her guardian, I saw all the bills and was generally impressed with the coverage.

I expect the government will move traditional Medicare ever more towards the Advantage type of coverage, with pre-approvals required and approved providers. My biggest concern with Advantage is the delay and limitation of care which could result in less effective treatment of a serious condition.

Emergency care, from what I've seen with my mom and sister, is blind to which Medicare coverage one has.

I have BCBS Garnet, no complaints

I've had an Advantage plan for the last 5 years. Received notice that the plan is being discontinued on 12/31, so I switched back to standard Medicare with a plan G supplemental and Part D prescription for 2026. While there have been no major issues with the Advantage plan, and it certainly was less expensive, the following items are true:

1) As I progress through cancer treatment, more and more bills are being kicked back to providers for "more information".

2) It seems that these plans run for 4 or 5 years and then are discontinued. I don't want to go through this hassle every 4 or 5 years.

3) With my cancer diagnosis, there will be more and more visits. There are no surprises with Medicare and if I have to travel for treatment, it's covered.

4) The Advantage plan being discontinued allowed me to switch back to Medicare without underwriting review of any Medigap policy I choose.

quote:

I expect the government will move traditional Medicare ever more towards the Advantage type of coverage, with pre-approvals required and approved providers.

I suspect that many (all) medical insurance plans will evolve to what is now the norm for on-line pharmacies. That when faced with a claim, they will bid it out to a list of pre-selected providers and choose the low-cost responder. This is the same model used by many "gig" services where, for example, a ride-share company will offer the requested ride to a range of bidders.

How this benefits the patient, other than driving costs down, is hard to see.

Many physicians, perhaps seeing this coming, are moving to "concierge practices." These are generally not covered by insurance. I have lost two long-time PCP's and a specialist to this phenomenon in the past few years.

Best option is to not get sick or old, and if you do get seriously sick, to die quickly.

quote:

Originally posted by Sigfan Roy:

quote:

Originally posted by Powers77:
As Anush indicates it is generally when you need care during travel where some of these plans come up short.
So, if you snowbird somewhere you need to make sure you are going to have coverage in both places for example.
The other downside is that once you go on an advantage plan you generally can't get back to original medicare plans even if you'd want to .

This is incorrect. You are always allowed back into original Medicare.

You may have to undergo medical approval for a new SUPPLEMENTAL plan, but not original Medicare plan.

You will be covered by original Medicare after returning from an Advantage plan.

Technically correct. You can go back to original Medicare BUT you will have to go to Medical Underwriting if you want a Supplement Plan to pick up the 20% above Medicare. They generally make this possibility very cost prohibitive.

quote:

Originally posted by architect:

Many physicians, perhaps seeing this coming, are moving to "concierge practices." These are generally not covered by insurance. I have lost two long-time PCP's and a specialist to this phenomenon in the past few years.

Best option is to not get sick or old, and if you do get seriously sick, to die quickly.

My regular doc is concierge. She doesn't take any insurance at all. She is dialed into various specialty or testing practices that offer very inexpensive cash-pay services. Things like MRI, blood tests, and such.

Medicare sucks beyond belief for patients and providers. The big insurance companies and hospital conglomerates are getting wealthy but we're getting screwed on price and service.

The best option to not get hosed by the system is to have enough money you don't have to be in the system!

Shovelhead I’m glad that you appear to be on the mend. I think we can all agree that choosing which plan is best for each of us is a highly personal decision and several factors come into play.

I’m fortunate that one of my sisters has been in the Medicare insurance game for over 30 years and is as knowledgeable as anyone on earth. She has recently walked me through the various options available to me and has spent quite a bit of time educating me on the various options. Like you I have recently signed up for a Medicare Advantage plan that is free to me ( of course I still have to pay the Part B payment like everyone else). This actually saves us over $200 per month compared to what my portion of the health plan was with my wife’s employer.

Anush you posted this..

quote:

Also Advantage policys require you to only see program doctors which may not be available where you are traveling.

Actually that is incorrect. In the MA world there are two types of plans, HMO’s and PPO’s. In the HMO plans you are strongly encouraged (required?) to use in network practitioners. In the PPO you can use out of network providers but you will have to pay slightly more so if you are traveling and need medical assistance of the non emergency variety you might have a higher copay. In an emergency situation the costs are the same. At least that is my situation.

quote:

Originally posted by Powers77:

quote:

Originally posted by Sigfan Roy:

quote:

Originally posted by Powers77:
As Anush indicates it is generally when you need care during travel where some of these plans come up short.
So, if you snowbird somewhere you need to make sure you are going to have coverage in both places for example.
The other downside is that once you go on an advantage plan you generally can't get back to original medicare plans even if you'd want to .

This is incorrect. You are always allowed back into original Medicare.

You may have to undergo medical approval for a new SUPPLEMENTAL plan, but not original Medicare plan.

You will be covered by original Medicare after returning from an Advantage plan.

Technically correct. You can go back to original Medicare BUT you will have to go to Medical Underwriting if you want a Supplement Plan to pick up the 20% above Medicare. They generally make this possibility very cost prohibitive.

With all due respect, it’s correct, period. You always qualify for Medicare. Supplemental plans are of course another matter. But when you conflate having to undergo underwriting for a Medicare Supplemental (also known as medigap plan) with not being able to get back to Medicare you are comparing apples and oranges. And those seemingly subtle differences are actually two wildly different things.

Your contention that going back to straight Medicare and a Medicare Supplemental plan after having left a Medicare Advantage plan would be very expensive is based on speculation, unless you’ve actually done it, and will vary widely based on the individual’s health. Will it be expensive? Maybe, probably. But if you are relatively healthy for your age it might not be a big deal at all.

Also, those Medicare Supplemental plans, while providing catastrophic coverage (which is excellent for people in poor health and severe medical costs already), they aren’t free and nobody seems to mention the multiple thousands they pay in premiums for those plans when they compare them to straight Medicare. Certainly those premiums are cheaper than the unlimited potential costs of straight up Medicare, but they aren’t insignificant.

Also, for those of us with essentially the free Suplemental of Tricare for Life, an advantage plan may be a much better value, as we are already protected from the potentially unlimited cost of straight up Medicare, thus absolutely no need to pay for a Medicare Supplemental plan.

My wife is a physical therapist and she is dead set against Medicare Advantage plans based on what she hears around the other workers at the hospital. But I haven’t heard a single bad word about them from people I know who actually have an Advantage plan. The only naysayers are those who have chosen straight Medicare with or without a Medicare Supplemental plan, perhaps because they have heard all these stories about not being able to get care without pre approval or go back to straight Medicare. Things that are not necessarily true.

Again supporting the idea that these are deeply personal decisions based on the health of the individual and the availability of a particular advantage plan in your particular zip code. There are hundreds of advantage plans across the country, so it’s difficult to make generalizations about them when you don’t have any idea what may be offered in a county across the country or across your county.

Many physicians, perhaps seeing this coming, are moving to "concierge practices." These are generally not covered by insurance. I have lost two long-time PCP's and a specialist to this phenomenon in the past few years.
^^^^^^^^^^^
Yep. Most docs did not go to school for so many years to argue with some pencil necked geek at an insurance company. In addition to conceirge practice there are many opportunites in medicine that do not involve seeing patients. Legal testimony,contracted disability evaluations etc.

The Advantage plans make sense if you are in/near a major metropolitan area. Out in rural areas, not so much. I've looked at these plans each enrollment period but one thing I've seen is this. Over the last 10 years, I have had five major surgeries, two of them required hospital stays. Two inner ear surgeries, Femoral bypass surgeries on each leg and one hernia surgery So, I asked each of these surgeons if they accepted Medicare Advantage. Every one said no. My vascular surgeon, very highly recommended, just laughed and said they pay less than Medicade.

MY BIL had open heart surgery around 10 years and sometime after that his wife switched from a supplemental plan to an Advantage plan. About three years ago, he started having chest pains and other issues. His primary surgeon told him he does not accept Advantage plans. The nearest Heart surgeon he could find that does accept it was at Kansas University, just outside Kansas City. After a year of back and forth 6 hrs of driving, they were forced to sell their home here at the lake and move up to Kansas City.

MY point is do your research and talk to the talented surgeons and make sure they accept it. The last thing you want is dealing with someone from Nairobi who can't speak decent English.

quote:

Originally posted by losvaqueros:
I have BCBS Garnet, no complaints

We have the exact same and it has served us very well