Wellness

[Carmie]

There is so much misinformation on this thread about Advantage Plans.

There is no Advantage Plan sold anywhere that doesn't cover the first few days of an inpatient stay.

Perhaps the skilled nursing facility benefits ( SNF) are what confused the poster.  With both types of Medicare you must have a three day inpatient stay before you can enter a SNF for rehab or skilled care.  If you do not have a three day inpatient stay, SNF will not be covered.

Also, there are no Advantage plans that will not cover you if you go out of your area or out of network.

The payment level might be different, but it is not legal to deny claims if the type of provider is covered.

I, personally have an Advantage plan that covers my expenses in and out of area.  I have zero deductible or copays.  It includes dental, vision and RX drugs and a gym, plus hearing aids.

It also pays me through a gift card at the end of every year for preventive services I  receive.  The services include vaccinations, mammograms GYN exams and colonoscopies.  I get either $25 or $50 per depending on the service.  

I used to have Traditional Medicare and a supplement.  It was a great plan...Plan C, but I was missing, Dental and vision and my husband wears hearing aids.  The cost was over $100 a month.

My Advantage plan is $47 a month this coming year.

All Medicare plans with supplements sold today require you to pay the Part B deductible which will be $240.  Unless you have Supplement Plan C or H, which is no longer offered,  you will pay this for your outpatient services. 

So, with my Advantage Plan, for only $47 a month, all my services are paid 100% in all 50 states.  I have coverage out of the country too. I get dental, vision, gym membership, hearing aids,  RX and money in my pocket for preventative services.

and, I will not be responsible for that $240 Medicare PART B DEDUCTIBLE.

My plan is not available to everyone, but I can guarantee you it is better than EVERY supplement with Traditional Medicare.

Advantage Plans might not charge you monthly, but they are not considered "free" because you must pay Medicare $174.70 or more out of your SS each month.

[conlt]

@Carmie There are Medicare Advantage plans that only cover a certain regions. We have seen it happen many times in Florida where we have many out-of-state visitors. We have to jump through hoops to get the patient covered or they pay out of pocket.  If you purchase an Advantage plan, make sure that it fits your needs and understand that you will have a heck of a time getting back on a Medicare and supplement plan. 

From Medicare Interactive.org:

Once you have joined a PPO, you should receive a benefit card from your plan. You will use your PPO benefit card instead of your Medicare card when you go to the doctor or hospital.

After enrolling in a PPO you can see any provider, but you generally pay more when seeing out-of-network providers. PPO plans typically offer fixed copayments when you use the plan’s network.

There are two types of Medicare PPO plan:

• Regional PPOs, which serve a single state or multi-state areas determined by Medicare
• Local PPOs, which serve a single county or group of counties chosen by the plan and approved by Medicare

Both types of PPO must have a maximum out-of-pocket limit for all of your in-network care and a combined in-network and out-of-network care limit.

Medicare PPOs are not available everywhere. Call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) to find out if there is a PPO available in your area. To enroll in a PPO, call Medicare or the plan directly. Be sure to make an informed decision by contacting a plan representative to ask questions before enrolling.

[Carmie]

@conlt   I worked for 25 years for a health insurance in customer service.  

I advised people on plans and what they cover.  I am aware of how Advantage plans and Traditional Medicare and supplements work.

My coverage is exceptionally great.  I have zero deductibles and no copays in or out of network.  I pay nothing out of pocket for medical care.

My dental and vision have copays and maximum dollars amounts they will pay each year.  My RX  coverage also has copys on some drugs, but not all.  I don't take any drugs except for Vitamin D3, so I don't use it.  It is creditable coverage.

I have volunteered on the SHIP hotline and have also helped in person at senior resource centers.

I know that I can switch back to Traditional Medicare if I desire with no issues.  The problem with switching is with the supplemental coverage.

Insurance companies will charge you more for coverage based on your age....so, it will cost me more for the supplement than it would have cost if I had a supplement at age 65.

I can live with that.  My insurance coverage is super affordable and just about everything is covered at 100% for all types of providers.

I normally don't use my health insurance much, but had a knee replacement and physical therapy this past year....plus some preventative services.  My out of pocket was zero for medical and I paid $15 out of pocket for drugs....pain killers and antibiotics, related to the knee surgery.

I am totally happy paying $47 a month for my Advantage plan.

[Bibione]

Carmie, you have a great plan. Can you share which one it is? I am from Italy, where medical assistance is free for everyone, regardless of age. 

I am very confused about the choices. i am staying on my husband' s plan , but maybe I need to sign up for some plan now that I am turning 65 soon. Thanks.

[chlema]

@Carmie The Advantage plans sure look good but at my age I am afraid to switch from traditional Medicare.  Case in point - I was looking into the Humana plan - until I found out that the huge hospital in my state no longer accepts Humana, and also read that this is happening elsewhere with hospitals & physicians offices.  Of course this is the hospital in my area that I would use, only 1 of 2 and I do not care for #2.

[Carmie]

@chlema   if you have Traditional Medicare and a supplement you're happy with, I think you should stay put.

I get my Advantage Plan from my employer as part of my retiree benefits.  If I didn't, I would have Traditional Medicare.

Advantage plans are all so different.  Mine pays 100% in and out of network, so doctors and hospitals do not have to accept.  They get paid 100% anyway.

I am very fortunate.

[Carmie]

@Bibione  You may be eligible for Medicare but it can get complicated.  Are you and or your husband a US citizen?  Have you or he worked 40 quarters in the US?

These are questions that the answers will determine your eligibility.

If your husband is still working and gets insurance at work,  you can probably stay on that plan even at age 65 and over. Have your husband check with his employer.

When he retires, you both will need different insurance.  His employer should be able to help you with this.

[Sage04]

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@Carmie wrote:

@Bibione  You may be eligible for Medicare but it can get complicated.  Are you and or your husband a US citizen?  Have you or he worked 40 quarters in the US?

These are questions that the answers will determine your eligibility.

If your husband is still working and gets insurance at work,  you can probably stay on that plan even at age 65 and over. Have your husband check with his employer.

When he retires, you both will need different insurance.  His employer should be able to help you with this.

@Carmie  anyone who also is a Permanent Resident and have worked here usually qualify for Medicare.

Someone I know came to the US very late in life as a Permanent Resident. Hadn't worked the required amount of time but decided to collect SS at 66 and also applied for Medicare. Doesn't get that much for SS. Only about $687 a month but she needed the Health benefits. She enrolled in an Advantage plan which gives her free rides to her appointments and about $230 a month in additional cash to buy over the counter medicine and other stuff.

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[judianne]

I love my Advantage Plan and at only 104 a month l get all my rx free .vision with $150 for glasses, no copay for pmd visits ,$50 every 3 months for OTC stuff . Dental including cleaning, filling , caps , etc . Small copay for hospital stays $200 covers every thing , room , surgery drugs procedures etc.  I dont understand why people complain . My husband has traditional medicare it costs him $287 a month and $38 for part D rx . He has no copay on anything . He does have copay on RX . 

[conlt]

@chlema I would not change to an advantage plan because with an advantage plan, you often have to use the "in plan" doctors and hospitals. Sometimes you do not get the best. Plus if you leave traditional Medicare, you may find it difficult to go back on traditional Medicare with a supplement. The supplement company can deny you due to existing conditions, health history. 

Today, I as at the foot doctor. The lady in front of me was on an advantage plan and had to pay $100 for her visit. I paid nothing because I am on Medicare and a G supplement. 

In my opinion, Medicare and a supplement is the way to go. 

In my company, we dropped United Health Care and do not accept those patients because United Health Care does not pay us to cover our costs. 

Advantage plans may be OK for someone who is fairly healthy, however, I have had patients who have a lot of medical needs left with what I consider substandard care from the advantage plans. 

I have 43 years experience as a nursing manager in home health care dealing with Medicare and Advantage Plans (since they came out). I am not a novice on this topic. 

In fact, I am very passionate that our seniors (I am a senior now) receive adequate care and are not misled but Medicare Advantage companies. 

Every senior that I have dealt with on Medicare Advantage thinks it works the same as Medicare but it does not.