Medicare advantage? More like disadvantage

@himom I hope you do realize that most Americans do not have access after retirement to the very robust plan the federal government provides to your family. They just don’t.

RE: Medicare Advantage…this topic has been discussed annually on this forum and many folks paint it with a very one size brush. This is not the case for everyone.

I also have a Medicare advantage plan…but it is as a member if a very very large group which was able to negotiate the package. It’s a PPO, no in and out of network (anyone accepting Medicare must take it). In our group, we can choose to switch back to regular Medicare and the supplement with no underwriting or penalty. This is done annually during the open enrollment period. Our plan covers us in all states and territories.

So far (4th year) we have been very happy with this plan and we have had some expensive medical needs. Coverage is very good, and cost is as well.

We do keep an eye on this…as it could change but you folks purchasing drug plans and medigap also need to keep a watchful eye.

This large group will be negotiating again for the 2024 calendar year. We shall see where that goes!

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The large group you are a member of, is it a professional group you belong to?

Just curious, my mom is always trying to figure out the best plan for her. She’s a former state employee and as such had access to some sort of guidance from her union as to the best plan available for her.

She was counseled to keep her traditional supplement for her medical needs. If she switched to an advantage plan, there wasn’t much opportunity to switch to a traditional plan.

As everyone knows, prices go up every year which is a strain on her income.

Unfortunately as a former state employee, her state has changed what they offer retirees. Unlike the federal government’s retirees

I read an article that suggested that although you can switch out of an advantage plan back to medicare, you may not be able to get medigap or supplemental insurance again if you have a preexisting condition. So it isn’t as easy as it seems to give it a try and then switch back if you don’t like it.

I have no personal experience yet, but am following this topic closely to help with our own decisions.

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I believe this is true for many. But with this large group, we are able to switch back and get the offered medigap without underwriting.

@deb922 this is a state retired teachers plan. And NO it’s not free.

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I am a federal retiree and Medicare Part B person. My government plan (NALC) is pushing Aetna Medicare Advantage, but says we can switch back to what we currently have at any time. Supposed to be cheaper but I haven’t read the fine print yet. I lean towards keeping things as is because we travel some and I worry about in/out of network.

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Personally, I’ve been happy with my insurer for the past 36 years and haven’t found a compelling reason to switch plans. I know we could save money by dropping Medicare A&B but we prefer to be over-covered than having unexpected gaps in coverage.

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Yes, but does that combine all MA plans together?

There may be different levels of satisfaction between:

  • MA plans from employer or union retirement benefits.
  • Kaiser MA plans.
  • Non-Kaiser HMO MA plans.
  • PPO MA plans.

Next summer I qualify for Medicare so am reading this thread thoroughly - it’s overwhelming. Why must it be so complicated? I’m eying the policies offered by AARP - they seem to be able to present them in an understandable way. I went to a seminar recently presented by a broker. Truly made it more complicated! I don’t think he was well prepared. I’ll probably take him upon the offer to sit one on one and compare/contrast policies. Not looking forward to it.

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Probably because you have more choices of medical plans than you had as an employee or individual buying an ACA plan, unless you worked at the national or a large state government.

I am another satisfied Medicare Advantage plan member. Mine has a PPO but with huge deductibles. It’s from Humana and every hospital network in NYC has absolutely no problem taking the HMO. I still (again) work, and my income and nest egg are much, much lower than most here. I had no health insurance at all for several years (my daughter qualified for Child Health Plus so she was covered), and reaching Medicare age was a huge relief for me.

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I spoke to an insurance agent before going on Medicare in 2020 in order to choose a supplemental plan. She told me I could choose any of the plans initially, but if I wished to change plans in the future, I’d be subject to health questions. Exactly one year later I was diagnosed with cancer and had a massive pulmonary embolism two days after surgery. You could say, I’m committed now. Fortunately, I like my plan!

My parents currently have traditional Medicare + a supplement. They are moving to a new state and I’ve been trying (unsuccessfully) for several weeks to find a primary care doctor in their new area who will take new patients with traditional Medicare. Only a small percentage will accept new patients at all. The last few years have been very hard for primary care doctors, and the limits on Medicare reimbursements have caused many to limit how many Medicare patients they see.

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Because opacity makes it easier to hide the fact that your pockets are being picked.

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I also qualify next summer, so reading intently. And very confused! Also, my H will still be working and we have good insurance through his job, and I have no idea how that plays into what I need/can do.

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At least I don’t have employer sponsored insurance to complicate things further!

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My understanding is that what someone is working, their insurance is primary and any Medicare secondary. Once the person retires, Medicare generally becomes primary. That’s how it was for us — the employed person’s HR and/or insurer can confirm.

In our case, H didn’t even get Medicare B until after he retired and his insurer would keep trying to send claims to them and have it bounced.

H is turning 65 next fall, and our financial planner will be scheduling a meeting to discuss options during the first quarter of 2023. If you have a financial planner, they may offer a similar service. He doesn’t sell plans - he has an employee who walks clients through the options & helps make sense of everything.

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The Office on Aging in every state (often connected to dept of health) should have an office that helps provide unbiased advice about medicare options and assistance programs available in your state.

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That’s similar to what I just went through, @kelsmom. Our FA referred me to their plan-neutral resource who walked me through my options. DH went through this last year on his own. The resource saved us money by recommending that DH switch to a better plan with the benefit of a family discount for having us both on the same one.

Coverage for me begins January 1st. I scheduled my long-awaited hip replacement for January 3rd. Can’t wait!

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for the about to be newbies to Medicare, check out your State SHIP which offers free, unbiased advice.

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