Do Medicare Advantage plans work for Retirees and FTers like ads show

[wagonmaster2]

With all the TV ads for Medicare Advantage plans with no monthly premiums, return of the $144/month on Social Security, and all the "0" pay medical coverages, how does this work for traveling retirees and full timers?


Sounds almost too good to be true.

[vsheetz]

Typically a Medicare Advantage program works similar to a HMO. You have a specific medical group to use in network, anything else is out of network - with reduced coverage.

Regular Medicare with a supplement (aka medigap) provides full coverage wherever you travel.

[jcussen]

Originally Posted by vsheetz

Typically a Medicare Advantage program works similar to a HMO. You have a specific medical group to use in network, anything else is out of network - with reduced coverage.

Regular Medicare with a supplement (aka medigap) provides full coverage wherever you travel.

Agree, with a supplement plan, you can travel anywhere and use a doctor that accepts medicare. Many times with no co-pay. I use the N plan and no problems wherever I go. But it does cost me about $130 a month.

[UTTransplant]

I haven’t seen an Advantage plan where I live that doesn’t restrict coverage to a geographic area and a (sometimes short) list of approved facilities and providers. My husband and I have BC/BS plans with national coverage. It was one of the real requirements we had for Medicare plans since we travel a lot.

[Gary RVRoamer]

I've used a Medicare Advantage plan for years and traveled widely. Mine is a PPO from Aetna with a nationwide network; furthermore, any Medicare provider can provide service at Medicare standard rates.


As for all those claimed benefits, you don't get all of them in one package. You can choose a low benefit plan that returns much or all of your Part B premium, or you can choose a plan that gives you extra coverages, e.g. vision, dental, etc. with no reduction in premium. Or some variation in between.

[sbleiweiss]

There is another reason why advantage is a bad idea. At sign up time you can get medicare and supplement regardless of your health. To switch later on requires medical underwriting. So once you choose advantage you may be stuck there forever.

[wagonmaster2]

Currently I'm paying $341 for supplement with United Healtcare, both wife and I. But this amount has been going up each year in the last 3-4 years as the amount contributed by my past employer decreases. And that contribution was to disappear completely in the next 5 years, but now the employer has come up with a new wrinkle by changing all retirees to a United Heathcare Advantage Plan. The supplement has always worked very well for us, traveling or at home. Never any additional out of pocket payments to be made. Not sure I like the past employer's ideas.


I had thought if it didn't work out the next year I could then drop it and go back to a supplement with Medicare, but this may not be true. May be lots of headaches switching back to Medicare after being in an Advantage Plan. Wonder who I should talk to for all my questions?

[Bamaman]

No Advantage Plan for me. Hospitals in our region are dominated by one large hospital, and they control 1700 physicians and nurse practioners. They don't accept Advantage plans of any kind. Many patients have to travel 50-100 miles to a city where they can get taken care of--after their home town doctor has sold his practice to the hospital.

[BCam]

You've asked two questions with different "There is another reason why advantage is a bad idea. At sign up time you can get medicare and supplement regardless of your health. To switch later on requires medical underwriting. So once you choose advantage you may be stuck there answers. Most retirees will be OK for travel as long as they obtain routine care within their plan's service area. Emergency and urgent services are covered anywhere within the US by mandate.

For full-timers and "extended-timers" it gets a bit sticky. The following link lays things out pretty succinctly:

https://www.medicareinteractive.org/...-with-medicare

If I was a full-timer or "extended-timer" would I choose a Medicare Advantage plan, no. As an occasional traveler for a few weeks or a month or two at a time, yes, and I have (Kaiser, Northern CA). I say this after a career as a managed care contracting director for a major west coast not-for-profit hospital system.

Note: Not all Medicare Advantage plans are created alike, once you get past the Medicare mandates, so investigate a plan's coverage carefully before signing up.

[BCam]

Originally Posted by sbleiweiss

There is another reason why advantage is a bad idea. At sign up time you can get medicare and supplement regardless of your health. To switch later on requires medical underwriting. So once you choose advantage you may be stuck there forever.

This is simply not true. According to Medicare.gov:

"Between October 15—December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7."

Other, more limited changes can be made after December 7. Full information can be found here (pages 12-13):

https://www.medicare.gov/Pubs/pdf/12...tage-Plans.pdf

By and large, Medicare.gov does a pretty good job of explaining things so I suggest you rely on its publications for the most accurate information.

For those who've never been covered by an HMO or other form of managed care, Medicare Advantage can represent a major change in how one obtains healthcare.

For those like me, who were covered by an HMO in my working and pre-Medicare retirement years, it's pretty painless. One day I was covered by Kaiser's HMO and the next I was covered by Kaiser Medicare Advantage. My doctors and hospitals didn't change, how I accessed care didn't change and, for the most part, my coverage didn't change significantly, except for copay and deductible amounts.

If you're a full-timer or "extended timer" please read my comments in post #9.

[baraff]

Originally Posted by Gary RVRoamer

I've used a Medicare Advantage plan for years and traveled widely. Mine is a PPO from Aetna with a nationwide network; furthermore, any Medicare provider can provide service at Medicare standard rates.


As for all those claimed benefits, you don't get all of them in one package. You can choose a low benefit plan that returns much or all of your Part B premium, or you can choose a plan that gives you extra coverages, e.g. vision, dental, etc. with no reduction in premium. Or some variation in between.

So far I've been pretty happy with my Aetna Medicare Advantage PPO. In my area, there is a "free" version and an upgraded version which costs $59/month but has lower copays and prescription costs. I can go to any doctor in my plan and there are a lot. It even has emergency coverage for overseas travel and within the US. If traveling in country, there is a nationwide network. And my plan has dental and some vision coverage.
MA plans are probably not a good choice if you anticipate heavy medical costs in the future (not that anyone has a crystal ball) but if you are healthy and have a good family medical history I think they're fine.

[Gary RVRoamer]

I suggest that all of you read what Medicare.gov has to say about Medicare Advantage plans in general. It is Medicare and subject to all the rules that apply to Medicare providers. An Advantage plan is often referred to as Medicare "Part C".

https://www.medicare.gov/sign-up-cha...dvantage-plans


An Advantage plan may not be the right answer for everybody, but it deserves an honest evaluation compared with traditional Medicare. I keep my wife's insurance as traditional Medicare + a UHC supplement because she needs extremely expensive care that makes the supplement very valuable to us. My own health is decent ahd I use only routine care, so the savings of an Advantage plan outweigh other considerations.

[Camper25]

I have an Advantage plan and am well pleased with it.

[hohenwald48]

Originally Posted by BCam

This is simply not true. According to Medicare.gov:

"Between October 15—December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7."

Other, more limited changes can be made after December 7. Full information can be found here (pages 12-13):

https://www.medicare.gov/Pubs/pdf/12...tage-Plans.pdf

By and large, Medicare.gov does a pretty good job of explaining things so I suggest you rely on its publications for the most accurate information.

For those who've never been covered by an HMO or other form of managed care, Medicare Advantage can represent a major change in how one obtains healthcare.

For those like me, who were covered by an HMO in my working and pre-Medicare retirement years, it's pretty painless. One day I was covered by Kaiser's HMO and the next I was covered by Kaiser Medicare Advantage. My doctors and hospitals didn't change, how I accessed care didn't change and, for the most part, my coverage didn't change significantly, except for copay and deductible amounts.

If you're a full-timer or "extended timer" please read my comments in post #9.

After you read pages 12 and 13, you might want to read page 25 too.