Original Medicare when they turn 65 versus Medicare Advantage?

[pe7er]

Another Q plz… Fellow planners, has anyone done their research on Original Medicare when they turn 65 versus Medicare Advantage?

I am in the process of learning and doing some basic research, I am just continuing to look for people smart than me to break it down and discuss the pros and cons.

Thanks for any input!

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[Telecaster]

Medicare Advantage is ripoff.   There are many problems with it, including network restrictions, higher out-of-pocket costs, problems with pre-authorizations, plan changes, and pre-existing conditions might make it impossible to get off it and into a traditional Medicap plan. 

Not only does it cost you more, it also costs the government more, so the current administration will never try to reform it.   

[Rob_bob]

Another Q plz… Fellow planners, has anyone done their research on Original Medicare when they turn 65 versus Medicare Advantage?

I am in the process of learning and doing some basic research, I am just continuing to look for people smart than me to break it down and discuss the pros and cons.

Thanks for any input!

I started Medicare in 2023.  I went with traditional and medigap plan G.  With Advantage plans you need to stay in network and usually need to get referrals for specialists etc.  With T med. you can go to any facility or provider that accepts Medicare.

If you start with an Advantage plan and later decide you want to switch to Traditional you will need to go through underwriting to qualify for a medigap policy.  That's the nutshell reason I went for Traditional and the best medigap policy from the start.

[Cranky]

It depends on your area, in part. My dh has traditional Medicare + supplements that are partially covered by his pension plan. I have an Advantage plan.

We’re in an area where most employer health plans are through one of the HMO systems. My Advantage plan is through one of them. It has an extensive network.

Dh’s plan has a slightly lower OOP max than mine does but costs more per month.

I’m pretty unenthusiastic about going to the doctor so am reluctant to overpay for coverage that’s more than I will use.

[AMandM]

My cell phone number is attached to some of my 90yo father's medical accounts. During Medicare re-enrollment season, I get several calls every day touting Medicare Advantage plans, all promising goodies like free groceries or cash cards. That alone is enough to turn me off.

[G-dog]

Like everyone here - I have HUGE reservations about the advantage plans.   However lots of people who go to a Senior Rec Center I go to love their advantage plans and actually get $ / month beyond the base cost of the policy.  This is a classic “too good to be true” scenario to me.

Advantage plans may be great when you don’t have any significant health issues, not sure longterm.

I have to sign up for Medicare this year.  I am going traditional, probably plus a supplement plan.

[Dave1442397]

My wife's job involves dealing with insurance companies and trying to get them to pay for coverage. She says under no circumstances will we sign up for Medicare Advantage.

[G-dog]

Thanks - good to know.

[Dicey]

I have an Advantage Plan,  but it's through the same provider that we had during my husband's career (Kaiser). It's kind of a hybrid, because it's the same bells and whistles we had when he was working.  When we both qualify for Medicare, we may ditch them, but it's okay for now.

[Cassie]

With an advantage plan you have to stay within your network. I know a few people that are only alive because they could go out of state for the best treatment or surgeon for their needs. They also can require you to undergo step therapy before obtaining the step you need. By the time you get there you are either dead or the treatment you need is no longer going to work because it’s too late. A few states like New York let you switch back to regular Medicare without passing underwriting.

[Greystache]

I think the feasibility of an Advantage plan really depends on the quality of the local network. In my case I am 5 miles away from a huge Kaiser medical center with loads of specialists available. I used the same facilities when I was on ACA coverage so I kinda know what I'm getting into. I would be much less likely to get into an Advantage plan if I lived in a rural area with a skimpy network. My wife and I have been pretty healthy and never required a great deal of medical care. I also have two friends who use the same Advantage plan and seem to be very satisfied. I am well aware of the potential pitfalls of Advantage plans, but for now this seems to be the best choice for us.

[YHD]

Without any information on the strength of the network available, level of care need or desire for flexibility to seek care anywhere in the US, eg Mayo Clinic—my go to recommendation is traditional Medicare with a good Medigap plan.

Even if I knew the above, for us, being able to seek care anywhere without waiting for a referral is worth any extra expense.

[Cranky]

With an advantage plan you have to stay within your network. I know a few people that are only alive because they could go out of state for the best treatment or surgeon for their needs. They also can require you to undergo step therapy before obtaining the step you need. By the time you get there you are either dead or the treatment you need is no longer going to work because it’s too late. A few states like New York let you switch back to regular Medicare without passing underwriting.

I am also in the city in my state that has the best healthcare, as part of the university med school and hospital system, and my Advantage plan is part of that system. So again, your location matters a lot.

[Ron Scott]

I guess if you’re in excellent health and can afford an unexpectedly high medical expense, Medicare Advantage might be worth it for a few years, but why gamble if you don’t have to?

I live in NY—where you can switch between Advantage and original Medicare during the year and even this isn’t enough persuade me from going original + Supplemental. I don’t want to be treated by “the system” in an emergency.

Get original Medicare with a good supplemental plan. If you’re healthy and don’t go to doctors much, Plan N seems reasonable to me.

[Catbert]

What are you used to now?  If you're in an HMO now and are fine with the restrictions, then look for a Medicare Advantage policy with the same HMO.  I've personally had Kaiser for over 50 years in a city where they have a huge presence.   

If I had a non-HMO plan before retirement and especially if I had complicated medical issues and long time relationships with specialists not in an Advantage plan, when I'd be looking at traditional Medicare and a gap plan.

I'd also look for whatever seems simplest.  Cognitive decline is real.  If dealing with medical bills makes your head explode at 50, imagine what it'll be like at 80.

[Cassie]

The problem with saying that you are healthy now and don’t need much healthcare is that it can change quickly. Even if you live in a town with a great healthcare system it doesn’t mean that you won’t be unlucky enough to get a condition where successful outcomes are only available in another state. I know 3 people that would be dead if they had to stay within their state.

[Peony2019]

I work in healthcare finance and would never recommend or purchase a Medicare Advantage (MA) product.  The number of times I have seen patients with cancer and other severe conditions have to wait months for authorizations is too many to count.  MA plans are also causing so many headaches for hospitals/providers that many systems are choosing to no longer contract with them.  Your access could be reduced in two ways: by the payer due to denying or delaying authorizations or because HC systems can no longer afford to deal with these payers.   

Another area people don't consider when signing up for an insurance plan is what their post acute care network looks like.  Often, many Skilled Nursing Homes, Hospices, and Home Health Agencies are not in network so obtaining care outside a hospital or physicians office is more challenging that Traditional Medicare w/ a supplement. 

[Ron Scott]

The problem with saying that you are healthy now and don’t need much healthcare is that it can change quickly.

I’d hate to have a rushed orthopedic surgery with the only available surgeon in that Advantage HMO.

[anotherAlias]

My parents took original medicare with a plan F medigap plan at the advice of an insurance salesman.  At first I was skeptical due to the higher premiums but now am convinced it was the best decision.  My father spent the last month of his life in a hospital.  According to his final EOB, that month cost more than the total of his premiums since he retired.  It was such a relief to not have to worry about medical bills when we were trying to settle his estate. When my mom moved to my state I made sure she had the same coverage on her new plan. 

On the other hand,  my aunt and uncle went with an advantage plan for the lower premiums.  They were healthy into retirement but have started needing more medical care as they approach their 80s.  They have copays for every visit and have had several billing errors that they've had to fight the insurance company about. 

From my limited antidotal experience, original medicare seems like the better choice financially and for ease of use.  If medicare is still around when I'm of age, I'll be signing up for original Medicare.