It’s time for me to sign up for Medicare. In the past, the arguments for standard Medicare versus a Medicare Aadvantage policy through a private insurer have been compelling. Would somebody be willing to explain the drawbacks of private Medicare insurance, or direct me to a website or article that does so? I’m convinced that standard Medicare is the proper choice for me, but before I sign up, I’d like to review my options.
In addition, if you’d like to share what choices you made, including supplemental insurance to cover excess costs, that would be great.
With Medicare and the supplement , you can go to any provider that accepts Medicare. Also Part D for drugs.
Medicare Advantage usually means a preferred provider list. Prices are lower, often much lower, and more into preventive care. Gym membership, dental, hearing aids, eye glasses included. But out of network costs can be high. Are your providers in network? Your drugs covered, etc.
Medicare Advantage is cheaper but you have less latitude. If your need is not covered it can be costly.
Do you intend to travel? Where? Within the US, standard Medicare–because that covers any doctor that accepts Medicare.
No travel, or minimal, then look at what is/isn’t covered in the Advantage programs offered. My plan has 94+% of all state doctors in the plan. However so do many other plans. My plan paid for a Medicare-approved test because their plan covered “Medicare-approved” tests/testing. They did NOT specify “in” or “out” of network. I LOOKED for that–and it was not specified. NOW, they state “in” and “out” of network coverages for tests/testing. Their extra payout was likely $100-$150 max–because the test was “Medicare-approved”, which means the the cost was heavily discounted (from $350–full cost of test).
Part D will vary wildly. See which drugs are/are NOT covered. Insulin costs are going DOWN, so should Part D insurance prices. Some years ago, I saw a variety of plans from the same insurer with various monthly premiums. The difference? Dental and maybe vision coverage. When a patient had a higher premium (from the same company), the difference from the lowest-priced to the highest-priced version was almost entirely explained by the higher dental and vision benefits. Whichever one you picked, you LOST (because the insurance company ALWAYS got their profit). My plan only has one premium for the metro area (MN) and a benefit of $400 for dental (per yr–no network because any legitimate dentist qualifies) and $100 or so for vision (i.e. glasses, contacts, etc. Also, no network because any legitimate ophthalmologist is accepted). One vision exam per year is covered by Medicare. For dental, you pay to have the work done. Then submit the bill with paperwork to the insurance company and they will reimburse you up to $400 (max). Same for glasses, etc. They do NOT pay any dental or vision bills directly. They only reimburse up to the amount paid (per year) or the max payout, whichever is LESS.
I’d hardly call these an investment in preventive care…rather a bunch of whistles and flashing lights designed to bamboozle the unwary. Frequently available with Medicare Supplemental plans.
I used to have Medicare Supplemental and Part D. I save about $2K/yr with Medicare Advantage. Medicare Advantage includes annual visit at my home from a visiting nurse. Some supplementals do include gym membership. I’ve not seen one that included dental and hearing aids. At least mine didn’t. Dental insurance is a major plus.
Are there many participating dental providers in your area? How does reimbursement work? I know that for primary care physicians, the practice receives a fee for each patient who joins the practice…whether the patient ever visits the office or not ( the hope being that the unused funds on behalf of the infrequent users will more than offset the sink hole created by the frequent flyers) That set up doesn’t work with dentistry which is basically a surgical, procedure-dominated field. I haven’t spoken to a single dentist who is/has been a MA participating provider.
See, all these frills and gimcracks on offer for MA plans are basically all low cost items as far as the insurance companies are concerned. My office manager used to call them…the dental plans, at least…“throw 'em a bone giveaways”. Up until the time I retired, most plans still had an annual maximum of $1000…occasionally $1500. Not a huge exposure for any company. I doubt that any dental benefits on offer by a MA plan are going to be significantly greater. Personally, I don’t think this is a worthwhile trade off given the compromise to the actual medical benefits that’re squeezed.
I’m concerned about introducing the private insurance company into the decision making process. I imagine that a time may come where a doctor might recommend treatment and an insurance company will be able to deny that treatment.
I am also unhappy with the current mode of operation where one must seek approval to see a specialist. Like I’m going to see the urologist for frivolous reasons. Currently I have to see my doctor to get a referral, or at least ask for it over the phone. Then the insurance company has to approve the referral. It’s so much more complicated than health care was 30-40 years ago.
With Medicare, it seems I will have considerably more autonomy and freedom in decision making, which makes things simpler.
Another example of what insurance company involvement has done …this time to language usage. Time was, a referral was the introduction of a patient…usually from a GP/primary care physician (which is most folks’ initial encounter when a problem is discovered)…to a specialist, together with a breakdown of tests done, clinical impressions etc. Usually to the correct specialist.
Seems like a redundant statement but prior to the days when primary care physicians became viewed as nothing more than gatekeepers…barriers even…to access to specialty services, it wasn’t unheard of for patients to self refer to the wrong specialist (vague bellyaches could be due to a number of reasons that require a modest differential diagnostic exercise ahead of deciding whether it’s general GI, hepatology, GYN, psychiatry etc). Or, right specialty but without the need for specialist intervention. Hugely wasteful of resources and time.
Seems to have become reduced to a permission slip.
