Medicare Advantage vs Supplemental plan

[Bibimbap]

Can someone explain to me in simple words what these plans are because I’m really confused.

I have Medicaid Plan A and B and a supplemental plan through Blue Cross Blue Shield. I just talked to the insurance broker (yes, found a random number and called) and I’m told that there is something called Advantage plan which I could choose instead of a supplemental plan and that it will cost me $0. I can’t have both supplemental and advantage plans. Can someone explain to me the difference and why a plan would cost $0?  My supplemental plan costs me $650/quarter and it doesn’t include prescription and dental. The advantage plan does and it costs $0.  The advantage Plan this broker tells me I qualify for is AARP UnitedHealthcare Medicare Advantage Walgreens PPO.
I’m so confused. Can someone explain this to me? Is this some kind of scam?

[Greystache]

Not an expert but I have been studying the issue. I'm still 4 years away from Medicare.  The advantage plans are basically HMOs that have limited networks of suppliers. Depending on where you live, these networks may be very small and restrictive. Regular Medicare and supplement plans are more expensive but tend to provide more flexibility and a larger potential set of suppliers.  One problem with a restrictive network of suppliers is for people who travel extensively or snowbird. They may find themselves far away from their network when they need care.

[Bibimbap]

Not an expert but I have been studying the issue. I'm still 4 years away from Medicare.  The advantage plans are basically HMOs that have limited networks of suppliers. Depending on where you live, these networks may be very small and restrictive. Regular Medicare and supplement plans are more expensive but tend to provide more flexibility and a larger potential set of suppliers.  One problem with a restrictive network of suppliers is for people who travel extensively or snowbird. They may find themselves far away from their network when they need care.

The Advantage PPO plan I mentioned is not HMO. You can use it anywhere in the US. So I'm still confused.

[Cranky]

Is this Medicaid or Medicare?

If you go to the Medicare website, they have a list of all the Advantage plans in your area and what they cover. There's big range. They are not all $0. They do not all cover the same things. They do not all have a wide network.

Essentially, you still pay for Part B, and the Advantage plan expands on that. Take a look at what is available to you. You can see what your prescriptions will cost through each plan, too. The ones that are PPOs instead of HMOs seem to have pretty high co-pays for out of network care.

My dh is retiring this summer, so we'll transition onto Medicare. He has supplemental insurance through his retirement plan, but I'm going to use an Advantage plan, and there are a lot of options in the area we are moving to.

[Sibley]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

[Bibimbap]

Is this Medicaid or Medicare?

If you go to the Medicare website, they have a list of all the Advantage plans in your area and what they cover. There's big range. They are not all $0. They do not all cover the same things. They do not all have a wide network.

Essentially, you still pay for Part B, and the Advantage plan expands on that. Take a look at what is available to you. You can see what your prescriptions will cost through each plan, too. The ones that are PPOs instead of HMOs seem to have pretty high co-pays for out of network care.

My dh is retiring this summer, so we'll transition onto Medicare. He has supplemental insurance through his retirement plan, but I'm going to use an Advantage plan, and there are a lot of options in the area we are moving to.

It's Medicare. Yes, I looked at plans available to me. Thanks. I'm thinking of ditching my supplemental plan for one of the Advantage plans.

[Bibimbap]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

[Bibimbap]

I'm now confused about Medicare Part D. Is this something I need to enroll in?  My Medicare card says I have Part A and Part B.  If I have Part D would it also say on the card? How do I know if I have it? The broker tells me that I have to have Part D otherwise I'll pay a penalty if I enroll now (in October it be more precise). According to Google the penalty is added to the monthly premium at a rate of 1% of $33.06 (I'm forgetting what this number represents) for each day that passed from the day one was eligible to enroll (at age 65). That would be 20 years for me which means my premium would be over $2400 on top of the actual plan cost. Really? Is this possible?  One must be enrolled in a plan that one has no use for? I guess I just want to know how I would find out if I've had Part D all these years. How do I find out?  Does anyone know?

[Cranky]

What? Part D is the drug coverage. You haven't had a prescription filled in 20 years? You're 85yo?

If you enroll in an Advantage plan, it may or may not include drug coverage. That's because some people have drug coverage from another source, like their pension plan.

[Bibimbap]

What? Part D is the drug coverage. You haven't had a prescription filled in 20 years? You're 85yo?

If you enroll in an Advantage plan, it may or may not include drug coverage. That's because some people have drug coverage from another source, like their pension plan.

That's correct. I'm 85 and haven't had any prescription filled in 20 years. Few times a doc wanted to give me a prescription for something, like recently for acid reflux but upon finding out that I have no prescription coverage he just told me what to get over the counter instead. So I never needed coverage.
The Advantage plan I'm looking at includes drug coverage but they are telling me that I will pay a hefty penalty.

[Cassie]

The problem with a Advantage plan is that the plan gets paid a fee to treat you. The less it spends the more money they keep. They can require step therapy if you have cancer for instance and by the time you get to the step you need it could be too late or the treatment you need is out of network. You can’t go back to a regular Medicare plan without passing underwriting. It’s a case of you get what you pay for.

[Sibley]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

Hope they can help you out. But there are many other groups that do the same thing, that's just the one my family is using. My sister has been pretty happy with them, she's handling all the insurance stuff.

[Bibimbap]

The problem with a Advantage plan is that the plan gets paid a fee to treat you. The less it spends the more money they keep. They can require step therapy if you have cancer for instance and by the time you get to the step you need it could be too late or the treatment you need is out of network. You can’t go back to a regular Medicare plan without passing underwriting. It’s a case of you get what you pay for.

So the insurance company dictates how a patient is treated and not a doctor?

[Bibimbap]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

Hope they can help you out. But there are many other groups that do the same thing, that's just the one my family is using. My sister has been pretty happy with them, she's handling all the insurance stuff.

Do you have to pay them?

[Sibley]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

Hope they can help you out. But there are many other groups that do the same thing, that's just the one my family is using. My sister has been pretty happy with them, she's handling all the insurance stuff.

Do you have to pay them?

Nope. I think they're nonprofit. I wouldn't use any navigator if you have to pay them actually, that's a sign to me that they aren't impartial.

[Cranky]

So, I think you should look online at all the plans available to you. They show you ratings for each plan, too.

And then I think you should actually call Medicare and talk about the penalty. The issue is that because you didn't sign up for a drug plan when you turned 65/retired, you will have to pay more, but you should go over that with a Medicare representative, IMO.

[Bibimbap]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

Hope they can help you out. But there are many other groups that do the same thing, that's just the one my family is using. My sister has been pretty happy with them, she's handling all the insurance stuff.

Do you have to pay them?

Nope. I think they're nonprofit. I wouldn't use any navigator if you have to pay them actually, that's a sign to me that they aren't impartial.

Thanks, I'll call them tomorrow.

[Bibimbap]

So, I think you should look online at all the plans available to you. They show you ratings for each plan, too.

And then I think you should actually call Medicare and talk about the penalty. The issue is that because you didn't sign up for a drug plan when you turned 65/retired, you will have to pay more, but you should go over that with a Medicare representative, IMO.

Thanks. Yes, I looked at all the plans available to me. I know what they are. I was just confused between Advantage vs Supplemental.
I'm aware that because I didn't sign up for a drug plan at 65 I would need to pay a fine if I wanted to sign up now. I'm just baffled how can there be such a law that forces one to get something they don't need. Regardless, I'll call Medicare, as I can't even figure out whether I have drug coverage or not, I assumed I didn't since it's not written on my Medicare card but it seems that if you have Part D they don't write it on the card. Can't figure out what this is so cryptic.

[Dee18]

I had to make this decision recently and I went with Supplemental (also sometimes called Medigap) rather than Advantage.  Friends of mine had Advantage and when the husband got cancer they discovered that their plan would not pay for treatment from MD Anderson cancer center in Houston which was the recommended place at the time for the cancer he had.  I remember their dismay at having to mortgage their paid off house to get the care they wanted. Medicare Advantage plans can be HMOs or PPOs.  Where I live there are only 3 Medicare Advantage plans available and all are HMOs. 

[marion10]

Medicare Advantage replaces Medicare A and B. The reason premiums are so low is that the government is paying the insurance company - and if they can treat you for less, then they make a profit.  It is difficult if not impossible to switch back to regular Medicare from it.

Part D is probably not worth it with the penalty you would have to pay- but that is a guess.

If you are really healthy right have other insurance than Medicare Advantage could work for you- but you give up choosing your own doctor, etc. I have a friend who gets most of his healthcare from the VA, Advantage works for him, because he doesn’t pay anything and gets things like a gym membership out of it.

[Cranky]

So, I think you should look online at all the plans available to you. They show you ratings for each plan, too.

And then I think you should actually call Medicare and talk about the penalty. The issue is that because you didn't sign up for a drug plan when you turned 65/retired, you will have to pay more, but you should go over that with a Medicare representative, IMO.

Thanks. Yes, I looked at all the plans available to me. I know what they are. I was just confused between Advantage vs Supplemental.
I'm aware that because I didn't sign up for a drug plan at 65 I would need to pay a fine if I wanted to sign up now. I'm just baffled how can there be such a law that forces one to get something they don't need. Regardless, I'll call Medicare, as I can't even figure out whether I have drug coverage or not, I assumed I didn't since it's not written on my Medicare card but it seems that if you have Part D they don't write it on the card. Can't figure out what this is so cryptic.

They didn't force you to get it if you haven't had it for the last 20 years, right? But like all sorts of insurance, if you wait until you know you're going to cash in on it, it's going to cost more.

[Bibimbap]

There are organizations that their entire purpose is to help seniors sort this stuff out and figure out what works best for them. To get my parent's Medicare sorted out, we (mostly my sister) used Boomer Benefits, which was recommended by people here. There are other orgs.

Good luck. Medicare is really complicated, which is particularly helpful since the people who are on it are much more likely to be dealing with age related cognitive decline. (I'm be sarcastic if you can't tell.)

Thanks, I'll call Boomer Benefits on Monday.

Hope they can help you out. But there are many other groups that do the same thing, that's just the one my family is using. My sister has been pretty happy with them, she's handling all the insurance stuff.

Thanks Sibley. Don't get me wrong when I say this as I appreciate you telling me about Boomers Benefits. I just talked to Boomers Benefit and they are an insurance broker. In any case they are not licensed in my state so they couldn't help me but I can find another broker.

[Daisy]

My parents had been paying high premiums for an AARP supplemental plan for years. Then a few years ago they switched to one of the $0 advantage HMO plans. The broker we spoke with explained that in some areas she recommends the supplemental plan and in other areas she suggests the advantage HMO plans. She said in large urban areas the HMO plans made more sense since the hospital networks are usually on the HMO plan. However, she sells plans to people living in smaller cities in our state and in those cases she recommends the AARP plan as a sick person may have to travel elsewhere to get care and the HMO plan in their area does not cover that.

My parents live in a large urban area where most of the major hospital networks were on the advantage plan, so it made sense to switch. They were in and out of the hospital multiple times over the last few years, and we did not see a big change in what was covered between the old AARP supplemental plan vs advantage HMO plan.

A good broker should be able to show you the differences between plans in the area you live.

[Daisy]

Their broker also mentioned in the rare case my parents would want to see a specialist that wasn't on the HMO plan, they could pay out of pocket for that visit, and still come out way ahead. They were paying like you around $600/month for the AARP plan, so that's quite a bit of savings throughout the year.

[Cranky]

My parents had been paying high premiums for an AARP supplemental plan for years. Then a few years ago they switched to one of the $0 advantage HMO plans. The broker we spoke with explained that in some areas she recommends the supplemental plan and in other areas she suggests the advantage HMO plans. She said in large urban areas the HMO plans made more sense since the hospital networks are usually on the HMO plan. However, she sells plans to people living in smaller cities in our state and in those cases she recommends the AARP plan as a sick person may have to travel elsewhere to get care and the HMO plan in their area does not cover that.

My parents live in a large urban area where most of the major hospital networks were on the advantage plan, so it made sense to switch. They were in and out of the hospital multiple times over the last few years, and we did not see a big change in what was covered between the old AARP supplemental plan vs advantage HMO plan.

A good broker should be able to show you the differences between plans in the area you live.

The Medicare website shows you the features of all the plans in your area.

I'm comfortable with an Advantage plan because the one I'm choosing is run by the university medical system, which is large and excellent, and has all the specialists I'm ever likely to need.

[Cassie]

I know 2 people only still alive because their insurance allowed them to go out of state for treatment. Medicare advantage plans are cheaper for a reason.

[Cranky]

I feel like this is a bigger point in your 60s than in your 80s, perhaps. At that point I’m not planning to travel out of state for unpleasant treatments- quality rather than quantity, IMO.