As I approach decision time, I think back upon the discussions on this board about Medicare vs. Advantage. It’s clear to see the incentives that Advantage plans have; how they are structured (they say “no” unless you argue, in which they are often quick to change their minds…but old people don’t argue).
It’s also easy to see why straight medicare should be better; no middlemen to pay, etc.
Reading what I’m given from Medicare.gov, they sure do seem to be hustling me toward an advantage plan. Advantage certainly seems cheaper.
So I’ll be 65, take no medications, don’t have particularly high risk for anything (except maybe prostate cancer) and can afford whatever is best in the long run. What are the latest opinions amongst you all about which way to go? I have about a week to decide.
I went with USAA Supplement G. With the Advantage plans, you have to stay in network or risk getting a bill from the out of network provider/facility for some of the unpaid portion. With a supplement plan you can see any physician you want. Your network is local only with the Advantage plans. If you are traveling in the US and require medical care outside your local area, Advantage plans won’t cover. With a supplement you usually have coverage because Medicare is accepted everywhere in the US. Its very confusing when you sign up. The person who is helping you decide should be able to advise you on the pros and cons. Search the internet and read all you can. HTH…doc
There have been several articles exposing how Medicare Advantage insurance providers deny coverage for serious (often astronomically expensive) ailments. This never happens with Medicare as long as the provider accepts Medicare.
I chose Medicare with a Plan G supplement since that is the safest alternative.
Medicare Advantage plans often cover vision, dental and wellness (i.e. gym memberships) within their networks, which original Medicare generally doesn’t (some supplement plans do support gym memberships even with original Medicare). Plus, the Advantage premiums generally cost less - many Advantage plans even give you refunds of some/all of the Medicare premium that is taken out of your SS check, rather than having to pay additional for a supplement plan.
I would disagree with this - the insurance companies make money off of the ‘Medigap’ supplement plan you choose. But it’s probably not as much as they are making off of an Advantage plan they would sell you.
Well, there are (or would be) if a beneficiary needed no care whatsoever between signing up and their ultimate demise. The MA plans are cheaper and tout all manner of whistles, flashing lights and gimcracks to bamboozle the unwary into signing up. If you read/hear positive reports from folk who have it’ll be along the lines of “Well, I’ve never had a problem”.
Most everyone can think of examples where theyve never had a problem … until they did. Oh to have the rude good health I thought I had when approaching 65.
Except supplemental plans aren’t mandatory. I can’t fathom anyone not using the risk modification they offer…but, then again, folk sign up for MA plans with their inherent risks for both the compromise in coverage and out-of-pocket expenses so there are probably more than a few who opt for just trad Medicare alone.
The reason for foregoing the risk modification is generally because they don’t feel like they can afford the supplement plan. In that case, given that Medicare Advantage plans tend to refund some/all of the Medicare premium that is taken out of SS checks, I don’t see anyone signing up for original Medicare without a supplement plan “to save money” when it would cost them less in up-front premiums to sign up for a Medicare Advantage plan.
I went for straight Medicare with no supplement. Plus the required drug plan (I just got the cheapest one available). So parts A, B, and D. I’m very happy never having to deal with an insurance company.
Despite extensive medical issues recently, the cost has been quite reasonable. I have no idea how doctors can make a living off of Medicare patients.
Thanks to everyone for your input thus far. In a fair and rational world, straight Medicare would be a no-brainer, but this is health-care; one of the most distorted industries that we all must deal with*.
To IGU’s rhetorical point: we don’t know how doctors can make a living off of Medicare? This is quite a worry. If they can actually make a living (any doctors on this thread…perhaps with big school loans?), great. If they can’t, are we going to find it difficult to find service if we are far from home (especially in some of the southern states)?
Secondly, and IGU is the only one who specifically mentioned it, is the required drug plan. I don’t need any drugs and am generally drug-averse, but both of my 86 year old parents would have been long dead (younger than I am now) without modern medicine, so I can see why I might change my mind in the future. If I don’t take the drug coverage now, I pay more later. Is there a break-even analysis that anyone has done?
*distorted? the monthly cost for our Obamacare plan is $6.01/month. I will shortly be forced onto medicare at a cost of $165/month…plus supplementals…and still $6.01/month for my wife, who goes on Medicare in April, at which point we’ll have experienced a many-thousand percent increase in our monthly health care expense. There is some funny accounting in there somewhere.
You are getting a massive subsidy from the ACA. The cost of Medicare is also subsidized but more along the lines of 20% patient,80% government.
It may be helpful to look at your next ACA bill and notice about a$1700 per month subsidy on your $6 net bill.
Great planning to receive the ACA subsidy does not constitute “funny accounting “
I hope you have some time to contact your local SHINE office. Each State has their own SHINE organization. Here is the link for SHINE in Massachusetts → https://shinema.org
That link should give you a good idea of the free services that they offer to assist people with the decisions around Medicare. The volunteers with SHINE in MA have been very helpful to DW and me re: our decisions for our healthcare insurance.
I hope you can locate the SHINE organization win your state and make an appointment with them to get great information.
I’m a bit drug-avers also and don’t have high-cost ones now, but things chage. For now, I signed up for Silver Scripts which is only $4 per month. I don’t even use it, just taking the store price is cheaper.
All the other available plans had a $500 deductible anyway so there’s that cost to consider. If I end up needing a high-cost drug at some point, hopefully I’ll be able to switch to a different plan that has a corresponding formulary.
Tough to do a real cost-benefit analysis given the unknown factors.
Any analysis would depend entirely on the costs of the drugs. So unless you can forecast your need for drugs and their costs accurately, any analysis is pretty pointless. As an example, I was talking to my neighbor (on Medicare) the other day, and she’s on a chemo drug that costs $16,000/month to keep her alive. On the drug, she’s still quite active - gardening, walking her dog, mowing the lawn, and you wouldn’t know anything was wrong just by looking at her. Without the drug, she’d probably be in hospice, if she hadn’t already died.
The drug plan is mostly paying for it (some co-pays), but if you had to cover that drug for even 1 month (much less 10 - 12 months, depending on when during the year you were diagnosed), because you didn’t have a drug plan and were diagnosed with some type of cancer that required that drug, all of your savings from not paying for Part D, even over many years, would be completely wiped out and then some. And while there are risk factors that can predict a higher tendency to get cancer, people without any risk factors can and do get cancer. So I would say that you forego Part D at your own financial risk. You can minimize your cost by looking for the cheapest part D plan that is provided in your state.
Which may be significantly adjusted once you file your taxes, depending on how realistic your income estimate was when you applied for your ACA policy. If you underestimated what your actual income ends up being, you may have to pay back a significant portion of the subsidy that the insurance company was given on your behalf. On the other hand, if you overestimated your actual income, you may actually get that $6.01/month back. So be careful if you are doing anything like Roth conversions or donating appreciated stock to a charity (which shows up on your AGI, but the taxes can be greatly reduced/eliminated using charitable deductions - but any AGI based payments, like ACA subsidies, are still impacted). I will note that you also have to be aware of this type of income when you are on Medicare to avoid being hit by IRMAA.
I guess you could call subsidies funny accounting. I call it tax law.
THIS!!! Same for me. I enrolled in the least expensive plan that I could, so that I don’t get penalized for not joining a Part D plan. But I don’t use it at all. I find GoodRx or Blink or other providers that are less expensive.
Fact - when you tell your pharmacy that you have SilverScript, the price ALWAYS is higher. Not sure why??
Turns out that shouldn’t scare you. You are responsible for “the 20% Medicare does not pay”, but it’s 20% of what the hospital actually gets paid, not the invented huge numbers that the hospital supposedly charges.
So, as an example, a robotic hernia surgery I got last year was billed by the hospital at $95,000+. Medicare paid them $6100. I paid $1556.
Nobody should make a choice on Medicare coverage without reading intercst’s Medicare posts. Of course they’re a couple of years old now, but invaluable nevertheless.