I searched and came up with the following 2019 post:

https://sigforum.com/eve/forum...720070364#7720070364

I am turning 65 later this year and need to determine whether Plan G or an Advantage Plan is the right direction for me.

Was wondering if some of you would be kind enough to provide your thoughts on which of the two you chose and why?

I am currently leaning toward Medicare Plan G as my PCP would be covered in-network.

Thanks in advance.

Plan G.
Advantage plans suck you in with low premiums but have high deductibles and limits on the doctor’s you can see.
They are okay if you’re healthy but at 65, you’re approaching an age where you will need more healthcare.
Once you have existing health problems, you are unlikely to qualify to go back to regular Medicare..

My wife and I retired at 65 and healthy. Now, in our mid 70’s, we’re happy to have Plan G. We both just had colonoscopies, dermatologist visits, I have a back surgery scheduled. We’ve had PT, chiropractic visits and have only been subject to Part B deductibles. My Part D covers the cost of generic medications at a very low premium.

Easy decision.

Plan G. One million percent sure.

quote:

Originally posted by Redhookbklyn:
I searched and came up with the following 2019 post:

https://sigforum.com/eve/forum...720070364#7720070364

I am turning 65 later this year and need to determine whether Plan G or an Advantage Plan is the right direction for me.

Was wondering if some of you would be kind enough to provide your thoughts on which of the two you chose and why?

I am currently leaning toward Medicare Plan G as my PCP would be covered in-network.

Thanks in advance.

Traditional Medicare, as in the Plan G that you referenced, is nine thousand times better than an Advantage plan. With Plan G or similar, you can use any provider that accepts Medicare. You can go directly to a specialist without a referral. You are covered wherever you travel in the U.S. without worrying about being "out of network" due to travel.

The (dis)Advantage plans are full of restrictions, have more limited choice of providers. Many health care providers are dis-enchanted with the Advantage plans, and have withdrawn from them.

This might not be a factor for you right now, but you can't predict the future.

When I was diagnosed with prostate Cancer, I was able to choose the urologist that I wanted, choose the clinic for the radiation series. All at no cost to me.

I was hospitalized for over a week with severe intestinal bleeding. All kinds of tests to find the cause. I picked the hospital and the GI doc. My choice, no cost.

I missed a step getting out of my delivery truck. Ambulance to the hospital that I chose. Surgery to implant support hardware for the fractured hip & femur. Week in the hospital. Month and a half in a residential re-hab place that I (my wife, actually) chose. Many months of physical therapy at the PT center that I picked. Walker, bathtub chair, etc. once I was released to go home. Did not cost me one penny.

Hospitalized for more than a week with Guillain Barré. Heavy-duty IV steroids, couple IVIG transfusions, then physical & occupationl therapy for months. Once again, I, not the plan administrators, chose the providers, and everything was covered.

Cataract surgery with lens implants at the eye clinic of my choice, not the plan's choice. Everything was covered except a $45 fee for the eye-drops that I preferred, this was due to co-pay for the Part D (prescription med) plan that I chose.

If I had taken Medicare Advantage instead of Plan J (no longer available, but Plan G works), the plan administrators would have dictated every choice, there would have been more red tape, I would not have been covered with some of the specialists that I preferred, and there would have been referrals necessary before seeing many of the specialists.

My advice -- the only valid reason for using an Advantage plan, is if you absolutely can not afford the insurance premium (maybe couple hundred bucks / month) for a traditional Medicare supplement, like Plan G.

LINK SIGFORUM
.

I selected a high deductible G plan with Mutual of Omaha.

What is the monthly premium for a plan G?

Good info contained in this thread.

Dont listen to the shister Joe Namath, do our homework

I would not select the high deductible plan. I would select the plan that has no deductible if you can afford it.
BTW the MA plans will soon be more costly. Their stocks have been declining as the goverment puts the squeeze on them.

quote:

Originally posted by 6guns:
I selected a high deductible G plan with Mutual of Omaha.

My deductible for both Part B and G totals up around $400 each year.
I am self-employed and the premiums and coverage gaps I had to deal with from age 55-65 were staggering.
Any traditional Medicare costs seem insignificant to me and the coverage is way better.
If you don't live in or near a major city, the network limitations alone should convince you.
The insurance companies are heavily marketing the Advantage plans because they are so profitable to them. The fact they market them like timeshare sales should be a hint at their target audience.
Nothing's free in this world.

I love this Forum and its members!

Again, I thank you all for the replies.

For the modest premium of $105/month I will go with the low/no deductible Plan G. The ability to choose the doctor or hospital I prefer is important to me.

Now on to Plan D for prescription drugs and then a dental, vision and hearing plan.

What fun!

quote:

Originally posted by Redhookbklyn:
I love this Forum and its members!

Again, I thank you all for the replies.

For the modest premium of $105/month I will go with the low/no deductible Plan G. The ability to choose the doctor or hospital I prefer is important to me.

Now on to Plan D for prescription drugs and then a dental, vision and hearing plan.

What fun!

Dental, vision and hearing coverage will be expensive. I opted to go out-of-pocket for those.
I should add that I have an HSA left from my work that will cover my wife and I for routine things for a good number of years.

Every state has a federally funded program that has unbiased counselors to help you find the best set of coverages for you. As each situation is unique its important to have someone who can guide you. It's important to get it right the first time as there are some things that can't be corrected if done wrong initially.
In SC its called SHIP and can be reached at 800-868-9095. They are not associated with any of the providers and give unbiased advice.

I am 5 years away, but have certainly become more attuned to this topic. Thanks for the insight guys, and that syncs up with what I've heard in general; unless you can't afford options, stay away from Advantage plans.

quote:

Originally posted by Redhookbklyn:

Now on to Plan D for prescription drugs and then a dental, vision and hearing plan.

Re Part D (not "Plan D"), take a look at this one if your Rx costs are not large: Wellcare pushes their Advantage plan; ignore that, but take a look at their Part D. For the current year, I am trying their lowest cost plan. Premium for that is $0.00. Yup, it's free. The only meds I am taking on a regular basis are for blood pressure, and my co-pay for those is also zero, so if things continue, my total cost, including insurance premiums and co-pay, for Part D Prescription Drugs coverage, will be $0.00 for this year.

One nice thing about Part D coverage is that you can change plans and providers each year during the open enrollment period, with no cost penalty.

Medicare has a pretty good tool on their website for comparing Part D plans -- coverage and costs.

I had to learn about Medicare as much as I know about income tax returns because it's my money and no one is going to care more about my money than myself.

Medicare Advantage plans are there for those who are financially constrained. They offer no or low premiums for benefits and disadvantages similar to an HMO plan. The benefits being low costs. The disadvantages are:
1) you are limited to their network and those are geographically defined so if you move to another location, you may have to find another medicare advantage plan and if you have been over a year in Medicare, you have to go through underwriting subject to approval and/or higher premiums. With Traditional Medicare, you can go to any medical provider who accepts Medicare.
2) With a Medicare Advantage plan, you have to get a referral from your primary care physician to see a specialist just like an HMO. With Traditional Medicare, you can go to any specialist who accepts Medicare without needing a referral.
3) With a Medicare Advantage Plan, the insurance company has approval control over what medical treatment you receive. With Traditional Medicare, your treatment is between the medical provider treating you and yourself as long as it's to diagnose or treat a condition.
4) In a congressional hearing, Medicare Advantage plans report the highest profit per enrollee despite the marketing come ons of including vision and dental care along with other perks. The math says the profits and the added benefits has to be funded from somewhere and the only place is the cost of actual medical services provided.

If you have the cash flow, then traditional Medicare is the best choice as you're maximizing the options and quality of medical care for the dollars you are spending.

Besides the $174.70 monthly premiums you pay for Medicare (assuming your Medicare Adjusted Gross Income 2 years ago was below the IRMAA limits of $206,000), you have the $244.60 deductible every year which you'll have to pay under any supplemental plan.

You should get a supplemental plan to limit your out of pocket costs because past the $244 deductible every year, you have a co-pay of 15% of the approved Medicare amount (not what the doctor invoices). Plan G is about the plan that makes sense for just about everyone. But there are two types - Standard Plan G and High Deductible Plan G.

Here's how the math works: For example, Standard Plan G premiums range from $100 to $449 while High Deductible plan G range from $40 to $76. The premium difference is that the Standard Plan G covers 100% of copays for the year while High Deductible Plan G will cover 100% of copays after you pay the Medicare deductible of $244 and the plan deductible of $2,800.

Using the midpoints of the two ranges for our analysis gives us $3,294 for Standard G and $696 for High Deductible G for annual premiums. If you add the annual deductible of $244, you're locking yourself for an annual outlay of $3,538 for standard G and you don't have to worry about copays for the year. For High Deductible G, you have the $696 for premiums plus $244 for the Medicare Deductible plus the $2800 for the plan deductible and , worst case, you have to shell out $3,740 before your plan takes over the copays.

Which to choose between the two? it's a matter of cash flow, cash reserves, and your own assessment of your current and future health prospects. If you're concerned about cash flow, then paying $696 a year is better than $3,294 as that's a difference of $2,598 staying in your pocket. If you're thinking worst case every year, going with the standard G may seem better as you're locked in to spending $3,538 a year with the standard plan whereas you'd have to shell out $3,740 before the high deductible plan takes over.

But the difference in premiums paid is $2,598. That $2,598 at a 15% copay rate translates to receiving $17,320 in health care services at contracted Medicare amounts. If you're sickly and expect to regularly need $17,320 in healthcare services every year, than going standard deductible saves you $202 along with the time of keeping track of copays. But if you prefer the cash flow and have the cash reserves and have the outlook of not needing $17,000 every year in medical care then the high deductible is the better financial choice.

YOu can go to Medicare.gov to look for supplemental plans that are available in your zip code. They have links to go to the company's website but I found that signing up on the company's website is difficult. I think that's on purpose. It's easier to call the company and then ask for discounts like signing up early (you'll need your Medicare number), autopay, and family discounts.

For Prescription plans, it's more complicated understanding but it's easy to change plans every year in contrast to Parts A and B which is more like lifetime so choose carefully because if you want to change plans, you're subject to underwriting approval and higher premiums if you've been in Medicare over a year.

But for Part D prescription plans, you can also go to Medicare,gov search for prescription plans, enter your prescriptions and it spits out the low cost plans available in your zip code based on your prescriptions. But within the plan you select, your total costs are different based on which in network pharmacy you get your prescriptions.

quote:

Originally posted by V-Tail:

quote:

Originally posted by Redhookbklyn:
I searched and came up with the following 2019 post:

https://sigforum.com/eve/forum...720070364#7720070364

I am turning 65 later this year and need to determine whether Plan G or an Advantage Plan is the right direction for me.

Was wondering if some of you would be kind enough to provide your thoughts on which of the two you chose and why?

I am currently leaning toward Medicare Plan G as my PCP would be covered in-network.

Thanks in advance.

Traditional Medicare, as in the Plan G that you referenced, is nine thousand times better than an Advantage plan. With Plan G or similar, you can use any provider that accepts Medicare. You can go directly to a specialist without a referral. You are covered wherever you travel in the U.S. without worrying about being "out of network" due to travel.

The (dis)Advantage plans are full of restrictions, have more limited choice of providers. Many health care providers are dis-enchanted with the Advantage plans, and have withdrawn from them.

This might not be a factor for you right now, but you can't predict the future.

When I was diagnosed with prostate Cancer, I was able to choose the urologist that I wanted, choose the clinic for the radiation series. All at no cost to me.

I was hospitalized for over a week with severe intestinal bleeding. All kinds of tests to find the cause. I picked the hospital and the GI doc. My choice, no cost.

I missed a step getting out of my delivery truck. Ambulance to the hospital that I chose. Surgery to implant support hardware for the fractured hip & femur. Week in the hospital. Month and a half in a residential re-hab place that I (my wife, actually) chose. Many months of physical therapy at the PT center that I picked. Walker, bathtub chair, etc. once I was released to go home. Did not cost me one penny.

Hospitalized for more than a week with Guillain Barré. Heavy-duty IV steroids, couple IVIG transfusions, then physical & occupationl therapy for months. Once again, I, not the plan administrators, chose the providers, and everything was covered.

Cataract surgery with lens implants at the eye clinic of my choice, not the plan's choice. Everything was covered except a $45 fee for the eye-drops that I preferred, this was due to co-pay for the Part D (prescription med) plan that I chose.

If I had taken Medicare Advantage instead of Plan J (no longer available, but Plan G works), the plan administrators would have dictated every choice, there would have been more red tape, I would not have been covered with some of the specialists that I preferred, and there would have been referrals necessary before seeing many of the specialists.

My advice -- the only valid reason for using an Advantage plan, is if you absolutely can not afford the insurance premium (maybe couple hundred bucks / month) for a traditional Medicare supplement, like Plan G.

wow, yer a mess...LOL

quote:

Originally posted by urbanwarrior238:
What is the monthly premium for a plan G?

Good info contained in this thread.

Dont listen to the shister Joe Namath, do our homework

It's up to about 150, and Medicare just went up to about 180. They both just went UP for me...

I turn 65 at the end of the month. I had bookmarked this thread back in April when I knew absolutely nothing about Medicare.

Since then, I have been doing a lot of reading and found a good Medicare "broker" (is that the right term?) who is recommending a Medigap Plan for me (either "G" or "N").

But, in doing my due diligence, I came back to this thread to get some more information. Many thanks to V-Tail and Rey HRH for your excellent and informative posts!

My wife and I have the Advantage plan and are doing well with it so far (I'm 68, she's 72).

Now---if we want to change to a Plan G, can we do so, or are we now stuck with the Advantage plan?

We're in Texas.