I had a similar experience over the summer: serious abdominal surgery required on short notice; I shudder to think what hoops I would have had to go through had I been enrolled in a MA plan (the ordinary hoops I had to go through were bad enough!)
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As an aside, I do not know one single healthcare provider/former/retired healthcare provider who has a MA plan. Having to deal with these plans has soured most of us from the provider side. Traditional Medicare is relatively easy to deal with, or at least comparatively so.
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So H met with an agent today and has applied for a Medigap policy with Anthem and a drug plan. The agent told him there were so many MA plans and new insurers without a proven track record that he was steering anyone who could afford the premium to stay with traditional Medicare and a supplemental policy. An agency we share space with really pushes the āfreeā MA plans - I think the agent benefits far more financially from those plans.
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My employer has introduced a MA/PPO plan that seems better than most. I have been following retiree FB discussions. To me the scary thing is that after the first year trial of the MA plan you can never go back to traditional medicare (except in a few states).
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Like I posted earlier, everyone I know in Maine loves their Advantage plan and some of these folks have serious issues. Theyāve had the plans for years. I will post if we ever have any difficulty with ours.
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Iām not sure this is totally true. But check. I think you canāt just decide to switch back in some states. It requires underwriting.
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I think as with everything, mileage will vary. I was simply sharing the option H went with as it was the best option for him in our area.
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Ah, yes. Thanks for the clarification. Baked into my thought process was the fact that the desire to change to the much more expensive traditional Medicare would be based on a severe health change down the roadā¦ ie might fail new underwriting tests.
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Not so much a limitation on going back to traditional Medicare, but the need to go through medical underwriting to buy a Medicare supplement policy (this is also the case if you want to buy a higher benefit supplement policy after having a lower benefit one).
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My mom thought about switching to an advantage plan.
She kept her traditional supplement but was told by her benefits coordinator that she probably and most likely would not be able to pass underwriting if she kept the MA. She has numerous health issues.
I understand different states have different laws.
The problem is that people want to switch after theyāve experienced significant health issues. And then switching isnāt possible because of underwriting
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My father (retiree from same company) asked me about MA during open enrollment period. The lower cost premium had caught his eye. Iām too young for it myself, but I follow the topic on a large retiree FB groupā¦. highly encouraged him to stick with traditional medicare due to age (96) and convenience (all his meds and billing, handled by younger wife, are tied to current plan). This week he fell and fractured his hip. Glad he did not switch as the recovery is going to stretch well into the new year.
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So many here seem to assume that if they had a major medical issue and had a MA plan they would be in trouble. I donāt get it. My husband has a MA plan from BCBS and he has had no issues. He has major heart problems and has had one surgery and is currently seeing a cardiologist at a major Boston teaching hospital and itās all been easy and paid for. When he periodically sees his cardiologist and has his battery of tests, he only pays a $10 copay. His MA plan is much easier to work with than my regular health plan. It has fewer restrictions and lower copays. We are looking forward to when I turn 65 and can get on the same plan as him.
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What is coming to light is that MA plan A doesnāt equal MA plan B. Different areas of the country have different networks and apparently different policies for going out of network.
This makes it super important to look into all the nuances, turn over the rug and examine the super fine print. I think most here are capable of doing just that. I do wonder about those seniors who are not technically savvy or are unaware of the differences. If that group of folks gets a mailer that says āhey, instead of paying XYZ you can pay WAY WAY less if you sign up for this wonderful planā they might very likely switchā¦not know what might have been given up or forfeited.
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I know many people are happy with their MA plans, even with knee replacement surgery etc. However there are also situations Iāve read about that require cumbersome MA pre-approvals. It seems a lot can depend upon your area (doctors, hospital networks etc)
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From what Iām gathering, the people who like MA plans tend to be in the New England/Maine part of the country. The rest of the country not so much.
I appreciate all viewpoints, as Iām still a ways from Medicare. But Iām learning a lot!
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I had knee replacement surgery; open gallbladder surgery with hospital stay for pancreatitis, a reaction to endoscopy; outpatient surgery for nasal polyps; a variety of other hospitalizations for post-covid symptoms; four procedures to kill varicose veins in both legs all followed by ultrasounds. A bunch of ER visits too. Two different MA plans, everything covered. For sure several years I reached the maximum payment ($8kish) and then everything was covered 100 percent.
Edited to add that ER visits and hospitalizations were in three different hospital networks in NYC.
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My 90 year old mother switched to a MA plan for a short period of time this year. It was with a big carrier and she could keep her primary doctor. Shortly after switching she was hospitalized briefly and then the doctors wanted her to go to rehab. The whole process was a nightmare. They would not approve the place everyone wanted her to go. A place sheād been to a year ago without question when she was on regular Medicare. They denied it and then as a family we had to appeal. When I called to make the appeal I was clearly talking to someone working from home. It was loud, there was a child yelling, etc. She was not really interested in what I had to say and was rushing through it. The next morning my sister got a voicemail saying our appeal was denied - which was weird because I made the appeal and gave my contact information. So she was moved somewhere else which was awful. Then a couple of days later I got a call from the first person I talked to saying our appeal was denied because left the hospital. When I told her she left because we were told the appeal was denied she had no idea what we were talking about. She said they hadnāt even looked at the appeal yet. We have since moved her back to regular Medicare.
Talking the the staff at her assisted living they do not like the MA plans, especially for people with more complicated medical needs.
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^^^^^
This! 
Every time we dealt with my mom after her fall and subsequent rehabilitation stay, it was like supplement was the magic word.
Admission, phew, she can be admitted right away. No pre approval.
When discharged, no you have to have the home health aids approved, oh itās a supplement, great take home the items that were prescribed.
Itās not the things that are expected and planned. In our experience, it was the unexpected issues that needed addressing.
There is also a supplement plan available in some states , a G HD (high deductible) plan with low premiums. Traditional Medicare pays 80% of the Medicare approved amounts first then you pay the 20%. The max out of pocket changes slightly every year, I think it was $2700 this past yr., not including the premium. Underwriting is necessary in my state if you switch out.
Kaiser MA is excellent in CA.
By law, MA plans are supposed to cover everything that Original Medicare covers. Now, since most are HMOās, they may include some pre-cert hoops, as do all HMOās, but if you need knee replacement, you need knee replacement. The MA plan just may take a tad longer for approvals.
btw: some Original Medicare patients jump thru hoops as well. Our good friend who uses a major medical center has to book her annual mammogram at least six months in advance.
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