It is just not in my budget to pay an extra $200 or so per month for a supplement. I had ups and downs with my previous MA provider (Humana; good riddance). Hoping for a better experience this year with a UHC HMO-POS plan, premium beyond Part B (deducted from social security) is zero.
I would guess there are emergency circumstances where a person who has an MA plan can go out of network and get coverage. Personally, I want to know that I can go to a provider I choose and not have to get approval to go out of network. I believe that many MA plans have strict rules about going out of network. That was the case when I retired and was looking at Medicare supplements vs. MA plans in my state. Iām not an expert on this and donāt pretend to be.
I worked for 5 years for the patient communications department of a very large HMOāin fact, it was one of the first HMOs in the country. One of the things I learned was that not all plans the HMO offered were the same. Large employer groups often got this HMO to include benefits in their employee plans that small employers or people who purchased individual plans didnāt get.
I imagine that still happens todayāmoney talks.
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Yes, and this also happens with large group Medicare Advantage plans.
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That was my point. Guess I didnāt make myself clear.
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What would be an example of a large group MA plan? Iāve never heard of those. Or are there some employers who offer a MA plan for their retired employees?
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However, out of network provider use with a PPO can be very expensive.
MA plans include PPO as well as HMO plans. However, traditional Medicare does have the largest ānetworkā of providers.
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I get my insurance through the state teachers retirement board. It is not free (just putting that hereā¦because it usually comes up). The retired teacher group is something like 30,000 people.
This state also uses MA for some retired state employeesā¦that is also a very large retiree group.
These types of groups negotiate their plans on behalf of the large groupā¦and can get some things that individuals might not be able to.
My plan, for example, is a very high level PPO MA Planā¦because that is what was negotiated with the vendor. For example, our plan has no in and out of network. It is taken by any physician, hospital, clinic, pharmacy who takes Medicare.
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I have a friend who is retired from Lucent, now AT&T. They just started offering their retirees a MA plan. That would be a large group.
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Large employers can negotiate decent MA plans, especially when unions are involved as well. But that may not guarantee that the employer may not later renegotiate the MA contract which may affect retiree benefits. I had a client who had the state employee benefit retirement plan, and they changed from BCBS MA to a UHC MA and the client experienced increased problems when it changed. But those who are able to have excellent retiree health plans,whether from government or corporate employers, are fortunate, assuming they are happy with their plan. But again, the focus of this thread was the unscrupulous stuff MA companies do to bilk the government . It comes out our pockets.
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Some MA plans are indeed PPO. Butā¦ some of the retirees on FB group I monitor have some pushback if āAdvantageā is heard by the billing dept. Time will tell how it goes for them.
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I am very lucky to have an insurance broker who deals with medicare (sheās licensed in 22 states if any of you want help). She helped my parents for years and they were paying $250/mo, EACH, for years, plus their deduction from their SS checks for $99. Switched them to MA about 5 years before they died and it was the right choice for them. Both had a lot of medical issues and most were covered. My mother had breast cancer, broke a hip, eye issues, and all were covered (with her paying the deductible but even that was waived sometimes).
She came over when I turned 65 and walked me through the plans, mostly MA. My limitation was that all my doctors were at the one hospital that only took Aetna so I went with that. I have a $4000 max, I do have to pay a co-pay and have to pay for an ER visit, a hospital stay, etc. Also, the $4000 max OOP doesnāt include prescriptions.
Any hospital in town takes the insurance. I donāt need a referral to any specialist (I actually switched to other doctors on Jan 1 for everything but my surgeries, which were already started at the first hospital).
So no complaints from me. Iām pretty sure Iāll hit the $4000 this year in co-pays and treatments, and Iām hoping to get everything done in one deductible year. The coverage is good for dental, hearing aids, therapies (except mental health), ambulance rides, etc.
A friend did choose a traditional medicare plan because she has a lot of prescriptions and was afraid of falling into the donut hole, but I donāt know - she pays a lot in premiums (I donāt pay anything, and most of the MA in our area donāt pay anything).
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Great to hear, thanks!
So you pay $4000 a year in deductible costs (in a bad year), which is remarkably close to my husbandās costs for Part B, Part D, and a supplement with a $240 deductible. Actuaries do know what they are doing to make all the options be about the same over time and the whole population!
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I have to pay the $175/mo to medicare too (Part B?), so if your husband only has a $240 deductible he may do better than me. But yes, in a āgoodā year, Iād pay very little for basic care (PCPs have no co=pay)
I think the big downside to MA is the prescription donut hole that some could fall into.
Also, I have had NO problems getting appointments. My PCP kept saying I would, and that I should stick with that hospital and be happy with the appt 6 weeks out they offered me. Nope. Switched to another group closer to my house (and much better parking) and was offered a choice of several doctors to see within days. The one group Iāve had trouble getting appointments with is the ophthalmologists. Every time I go, I see a different doc so Iām looking for a new group. I really am the consumer and I feel I donāt have to ātake it or leave it.ā And I dumped that PCP too. I felt she wasnāt listening to me.
I do think I was very lucky that the surgeon that was assigned pushed things through for me, and I got 2 MRI within 2 weeks (and one was at 6:45 am, so I think they invented a time for me before the day really began). When she said her next surgery appointment was Jan 18, I just looked at her, she left the room and came back with Dec 28. I thanked her and she seemed very appreciative for my (very genuine) thanks, that I just said āThank you, I know you are advocating for me.ā I had surgery before the āfirst available appt to even see a doc is in 6 weeksā date they originally gave me.
I am learning how to get to the front of the line. It does take my being willing to take any appointment time, being willing to be flexible, following up, calling the insurance company with questions.
I donāt have to make my Medicare/MA decisions for a few years. If things stay the same, Iāll have a decent MA PPO choice for employer. Iām not too concerned about the early years, when Iād hopefully have the ability to be a good consumer and sort through options. I donāt like the idea that (except for a few states, not mine) it is a lifetime decision. If Iām a frail widow someday relying on help from the kids, I like the idea of old reliable and well accepted Medicare.
Honestly, my bottom line with Medicare Advantage is that insurance companies wouldnāt be spending all the money trying to get me to sign up with that they are if they werenāt expecting to make money off of me. Exceptions exist, especially large public employee MA plans. I know that is true of supplement plans too, but I never get ads for them and I get so many pitches for MA.
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I remember the day when I said to myself, after all this time, I am going to start costing my MA company serious money. And since then, despite all efforts to stay healthy, Iāve been on the wrong end of the balance sheet for whatever MA company I signed up with. Maybe thatās why I donāt get a monumental amount of junk mail, lol. Maybe Iām on the naughty list!
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For the benefit of other users, I want to mention my husbandās latest experiences with his Advantage plan in Maine.
He had to go to the ER after cutting his hand badly.
The total charge was $2,219.15.
Insurance paid $355.85.
The insurance adjustment was -$1,768.30!
So my husband owes all of $95.00.
On the other hand, with my crappy Anthem insurance (not Medicare), I owed about $1500 for EACH of two ER visits more than a year ago. So Iām paying off the balance $120/month for a couple of years.
Also, DH gets $650 through his Advantage plan in 2024 for anything related to fitness. I looked it up, and he can get reimbursed for the scuba diving he will be doing on our cruise next month. 
I did ask my older friends again how itās going with their Advantage plans (turns out they are on two different ones). They said theyāre very happy with them. They go with different plans because one is better for veterans, and the other has an excellent allowance, $2,500 for a hearing aid.
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Glad that works for them. Maybe Maine has good regulations. The other side is this : Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR.
I have a friend who is uber wealthy but for some reason she and her Dh chose an advantage plan. She has back issues and some procedure she heeded took MONTHS to get approved. But they are stuck with their plans b/c her DH now has parkinsons and she has several issues that would likely prevent her from being able to switch to traditional medicare. But they regret their choice.
This is probably why it is OK for us: āOnly four states ā Connecticut, Maine, Massachusetts and New York ā prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.ā
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