Medicare + supplement or Medicare Advantage Plan?

dewrlw

Earning My Ears
Joined
Dec 31, 2005
I will be eligible for Medicare soon, and I was wondering if you can share your opinion/experience - which is better?
 
My mom had Medicare Advantage and loved it. They threw in free vision and dental.
 
In the past I normally could figure out which Healthcare Plan was best for me.

But picking a Medicare Plan was much more complicated because there are so many

options to choose from. I ended up finding (online) a Medicare Healthcare Plan Broker.

He was able to come to my home (my choice) and discuss which Medicare Supplement

or Medicare Advantage would be best for me . . Based on my age and my income.

The Medicare Healthcare Broker's time (wage) is paid by the Healthcare Plan.





 
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I have to sign up for Medicare this fall. I really don't understand how it works.

I will be retiring in two years.

What do I need to know?
 


Medicare Advantage plans over-ride your regular medicare plan. The Government still takes @112/month out of you social security check and you can't use regular medicare. I had a BCBS PPO Medicare Advantage plan for my first year. They told me that my PC and Urologist were both in the plan. When I went to my PC, I found out that he didn't accept the plan. I went to the BCBS website and called 3 other doctors that were supposed to be in the plan. None of them accepted the plan. Here is where things get really crazy.
BCBS Medicare Advantage PPO cancelled on 11/29/2016 but BCBS is still taking EFT out of my checking account. (see below)
11/29/2016
called to find out how to cancel my policy because I was switching to a Medicare Supplement Plan G with another company. I was told that BCBS would cancel the policy effective 12/31/2016, and was given a cancel code #nnnnnnnnn (20 minutes)

12/28/2016 got new card in mail. Called and was told to ignore because my policy was being cancelled on 12/31/2016. I was told that I was switched to statement billing so that no EFT would be taken out. (40 minutes)

1/4/2017 called and filed grievance because $74 EFT was taken out of my checking. Grievance#nnnnnnnnnn (filed with Roger) I was told that I would get the $74 back in an EFT within two days. (55 minutes)

1/6/2017 called and spoke with supervisor who told me that BCBS would not send the money back via EFT. I was told that I now needed to fill out a dis-enrollment form and they would mail me a check for $74. (50 minutes)

1/11/2017 Received the form in the mail, filled it out and mailed it back on the same day using the pre-addressed envelope that BCBS sent.

2/4/2017
called and spoke with supervisor about another $74 EFT being taken for February. Was told that BCBS didn’t receive my dis-enrollment form and they couldn't stop the EFT. They said that they now needed my welcome letter for my supplement. Also told that it would be March before I was converted to statement billing. Told that I would get a check from BCBS for both EFT’s once you received the letter. (1 hour 10 minutes)

2/5/2017 Faxed this page and welcome letter from my new supplement to BCBS Medicare Enrollment 1-855-674-9192.

2/8/2017 got call from BCBS Medicare welcoming me to the program. I told them that I cancelled 11/29/2016 and asked them to stop calling.

2/8/2017 CVS made a mistake and tried to process a prescription for $36 with BCBS and it was denied. In the past BCBS paid $18 for this. Sounds like I was no longer a member.

2/9/2017 got another call from BCBS Medicare wanting to discuss my new drug plan. I hung up.

2/9/2017 got letter from BCBS Medicare about grievance and 12/28/2016 call, stating that I would be switched to statement billing on 3/1/2017. The policy was cancelled on 12/31/2016 based on the call on 11/29/2016.

2/16/2017 got letter from BCBS saying that they received my request to be dis-enrolled from their plan. They will make it effective on 3/1/2017. There is no mention of refunding the payments that they took from my bank account in January and February of 2017.

2/17/2017 got letter from BCBS verifying that I would be dis-enrolled from their plan effective 3/1/2017.

2/18/2017 got a bill from BCBS for $74 for coverage 3/1/2017.

Stay with Medicare since you will be paying for it anyhow. Get a supplement to cover what Medicare doesn't cover.
 
Thank so much for the information. It has helped a lot. This reinforces what I have heard from other sources.
 
Medicare with a supplemental insurance to pick up the 20% Medicare doesn't cover is the way to go.
If you don't want to go that route be certain to inquire about prior authorization for lab work, prescription drugs, testing etc.. Way too many regulations now.
 


I work in billing for several skilled nursing facilities and I can tell you, on the provider's end, Medicare Advantage Plans are a nightmare! There are so many "extra rules" and hoops to jump through to see if your plan will cover things, you usually need to get authorization on everything beforehand, and if you can get them to agree to cover something, getting them to actually pay is another battle all together. Even if they say they "follow medicare guidelines, they still have their own set of rules and regulations on top of that. Supplement plan to cover the 20% is the way to go....especially if you ever need any kind of therapy.
 
I have to sign up for Medicare this fall. I really don't understand how it works.

I will be retiring in two years.

What do I need to know?

I am 64 and my husband is 66. I retired in May 2016. He's basically retired but does occasional contract work.

When he was 65 he signed up for Medicare Part A but did not have to sign up for Part B because he was covered under my health insurance plan (BCBS federal employee program). Once I retired he had up to 7 months to sign up for Part B because he was still covered under my plan (which I am keeping in retirement and he will be covered on it too).

Next year when I turn 65 I will sign up for Part A and B and keep my BCBS Fep as our supplement.

So, if you are still covered under a health plan from your job just sign up for Part A at 65 (no cost to you) and then add Part B when you retire and no longer have employer coverage and add a supplemental plan (or Medicare advantage plan).

Medicare.gov has all the information that you need.
 
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I have used a Humana Advantage plan since I turned 65. It's been FANTASTIC. I had sepsis 5 years ago and spent a week on life support with a zillion doctors treating me. My out of pocket costs - ZERO.

Medicare Advantage Plans vary by state. The state I am now in has a zero co-pay for PCP, $20 for specialists, $75 for ER, $5 for PT. There are two medical schools in my city (New Orleans) so there are many, many great doctors that are local. My premium for the supplement is ZERO. I get a $20 a month credit to spend on OTC health goods (vitamins, toothpaste, dental floss, OTC pain relief). Dental and vision are included. I also could get transportation (taxi) for several visits per year if I needed it.

I have many health issues (I am old) but my out of pocket expenses for excellent care (copays and premiums) are less than $150 a year.

But if you live in an area where the in network doctors for an Advantage plan are scarce - then it's probably not for you.
 
As a PT working in nursing homes advantage plans are a nightmare. The insurance company will request our therapy notes and might cut off someone's coverage without much notice. They look at how much progress is being made not if the patient is safe to go home. With standard Medicare we have flexibility to keep someone on therapy longer if we feel it is justified. I did an evaluation one time and wrote the patient (that lives alone) needed contact guard assist (hands on) to walk 100 feet w/ a rolling walker and was at high risk for falls based on balance testing. Her advantage plan said she did not qualify for skilled nursing treatment. The social worker then had to approach her with paying over $200 a day out of pocket to stay or go home alone and get home health.

I understand that cost is an issue sometimes and advantage plans are great you're in good health. If money is really tight I would say use an advantage plan for a few years then as your health may be declining switch to standard Medicare. If cost is not an issue stick with standard Medicare.

Good luck.
 
I turned 65 last year. I have Medicare Parts A and B and AARP United Healthcare for my supplement (Plan F). I also have United Healthcare for my Prescription Drug Plan (Part D). So far, so good. It is my understanding that Plan F is the most comprehensive plan.

Good luck!
 
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As an experienced health care worker, I would advise anyone, myself included, to stay with straight MedicareA and B!!
 
So many conflicting posts how's a person to know what to do?? Gladly I'm not of an age where I have to worry about this; and I HOPE, but I doubt it, things get better by the time I am of age. Good luck to you who have to make a choice.
 
I turned 65 last year. I have Medicare Parts A and B and AARP United Healthcare for my supplement (Plan F). I also have United Healthcare for my Prescription Drug Plan (Part D). So far, so good. It is my understand that Plan F is the most comprehensive plan.

Good luck!

Thanks for the recommendation! I'm also signing up for Medicare-just received my card today. When I called for info, AARP United Healthcare was very polite and answered all my questions thoroughly without pushing. CIGNA, on the other hand, defined "pushy sales".
 
As a PT working in nursing homes advantage plans are a nightmare. The insurance company will request our therapy notes and might cut off someone's coverage without much notice. They look at how much progress is being made not if the patient is safe to go home. With standard Medicare we have flexibility to keep someone on therapy longer if we feel it is justified. I did an evaluation one time and wrote the patient (that lives alone) needed contact guard assist (hands on) to walk 100 feet w/ a rolling walker and was at high risk for falls based on balance testing. Her advantage plan said she did not qualify for skilled nursing treatment. The social worker then had to approach her with paying over $200 a day out of pocket to stay or go home alone and get home health.

I understand that cost is an issue sometimes and advantage plans are great you're in good health. If money is really tight I would say use an advantage plan for a few years then as your health may be declining switch to standard Medicare. If cost is not an issue stick with standard Medicare.

Good luck.
I was just going to post something like this. I'm an SLP working in nursing homes, and the Medicare Advantage plans just seem to cut people off with no notice for no reason!

People like their advantage plans till they actually need them. Even then, they might not realize that they got less therapy than they would have on regular medicare.
 
I work in Medical billing and cannot recommend just sticking to regular medicare as well!

When you sign up for a Medicare Advantage/HMO Plan, you are then allowing the INSURANCE company to have control over EVERYTHING!
 
You will get a pamphlet from Medicare.gov. Set aside a quiet time to call the number and talk to someone there. Take notes. A very nice lady went over everything with me and gave the pros & cons of different types of coverage without actually recommending any particular one to me.

A small forest will die and be made into paper for all the different pamphlets and letters you will receive.....
 
Medicare Advantage plans can be a nightmare according to some of our friends. We have Medicare and then a supplemental and, so far, we have had no problems. Thankfully, we haven't had 'long term' needs, so hope things continue to go well.

We would never sign up for an advantage plan - start having to worry about in/out of network stuff - no one seems to understand the half of it. :confused3

Agree with pp, unbelievable how much 'paper' we receive and don't need/understand the majority of it.
 

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