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(@golich428)
Eminent Member Customer
Joined: 2 years ago
Posts: 32
Topic starter  

I realize this is more of a how to use Pralana forum but I am curious about what retirees have selected for their Medicare insurance. I am in the process of signing up and my current thoughts (given my situation) is to buy a medigap (supplemental) plan and stay with original medicare. I live in a fairly small community so the networks are not large. I also travel out of U.S. which is a problem for advantage plans in my area. I also have an account from my previous employer that pays for premiums only so again, this does not work well with many Advantage plans. The advantage plans do not seem to work well if you travel outside your local area.

I am currently considering a Medicap Plan G which covers everything except the Part B deductible.

I would be interested in other's thoughts on what they do about Medicare. Thanks in advance.


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(@hines202)
Estimable Member Customer
Joined: 2 years ago
Posts: 158
 

Hi Greg, have you run it by your local, free SHIP counselor? https://www.shiphelp.org/

Medicare can be a complicated topic. Advantage plans sound great, despite those *horrible* commercials from folks like JJ Walker and Joe Namath. But they're not good if you have a lot of health problems, in many cases. One Part D plan can be the wrong choice versus another depending on what prescriptions you have.

I usually give my clients my best generic guidance, but refer them to a good Medicare specialist who does only this type of analysis. They are essentially insurance agents who look at your exact situation and give you the best plans for *you*, and it's usually free, because they get commissions on some of the private plans such as Advantage. However, a good ethical one will tell you if simple Part A/B are the right choices, which D is best, and they get nothing for that advice.

So, like with anything else, I'd seek out those folks in your area using Google, and look for one with lots of positive Google/Yelp reviews with keywords like "honest", "ethical", etc. The one I use is Joys Medical Navigation and she (Joyce) covers PA and a few other states. Tell her I sent you if you reach out!


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(@giovanelli766)
Trusted Member Customer
Joined: 2 years ago
Posts: 91
 

@golich428 First, as of Jan. 1, 2020, Medigap plans sold to new Medicare beneficiaries aren't allowed to cover the Part B deductible.

I am not yet old enough for Medicare but when I am I will be using a Medigap plan and a stand-alone Medicare Part D prescription drug policy. I think the pros to Medigap outweighs Part C (Advantage) plans. From

https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

"While this may be the more expensive option, it has a few advantages. Both Medicare and Medigap insurance plans cover you for any hospital or doctor in the U.S. that accepts Medicare, and the great majority do. There is no need for prior authorization or a referral from a primary care doctor. Coverage includes the entire U.S., which may be important for anyone who travels frequently or spends part of the year in a different locale. This option is also attractive to those who have particular physicians and hospitals they want to use."

You chose the stand-alone Part D plan that matches up with your prescription needs. Can can change your stand-alone Part D plan annually if needed. If the Advantage plan has drug coverage (not all do) you need to make sure it covers your prescriptions. If not you may have a problem.

Also from www.investopedia:

Most Medicare Advantage plans operate as a health maintenance organization (HMO) or preferred provider organization (PPO) insurance. HMOs limit members to using the doctors and hospitals in their networks. PPOs generally let members get care outside the plan's network, but members may have to pay more for such care. Some plans require prior authorization for specialist care or procedures, or a referral from a primary care doctor. Plans might not cover care given outside of the network’s geographical area. Extra benefits not covered by regular Medicare, such as eyeglasses, routine dental care, or gym memberships, may be offered.

My biggest concern with Advantage plans is the need for prior authorization. I have friends on Advantage plans where their doctor recommended a specific procedure and the insurance plan said NO, use a different procedure. Which in one friend's case made the situation worse because of the delay (the alternate procedure did not work and the original procedure, which was subsequently approved, was no longer effective).

When you first sign up for Medicare, either an Advantage plan, Medigap, or just straight Part A & B, insurance companies are generally obligated to sell you a policy, regardless of your medical condition. But in subsequent years they may have the right to charge you extra due to your age and preexisting conditions, or not to sell you a policy at all if you have serious medical problems. So if you want to switch later from an Advantage plan to a Medigap plan or regular Medicare , you may have a problem. However, if you start with Medigap and later switch to a Medicare Advantage, you are guaranteed to be approved on any Medicare plan at the best price. The reverse is not always true. https://www.senior65.com/medicare/article/can-you-switch-from-medigap-to-medicare-advantage


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(@golich428)
Eminent Member Customer
Joined: 2 years ago
Posts: 32
Topic starter  

@giovanelli766

@hines202

Thanks for the information. I did contact SHIP but found the Medacare.gov website very useful and I also met with a Health Insurance specialist (agent) and she confirmed that Medigap Plan G was the best option for me to start with. I am familiar with Medicare since my Dad and Sister have both used it so I did not find it too difficult to navigate for myself.

I am still curious if individuals selected other options (Advantage and/or Medigap Plan other than G). I live in Arizona and the rates for Plan G are similar to the other letter options, but the coverage is not as good.

Pizza Man, thanks for the link to the question about switching from one plan to the other. I think the approach to start out with Medigap gives you more options going forward if things change. One thing that I did not like about the Advantage option was all the "possible" costs if you do need a lot of medical care. For me, the Advantage plan had a maximum annual cost of $10,000 compared to the Medigap Plan G premiums plus Part B deductible of less than $1,800. I would need to use little medical care to make the advantage plan work out. I realize there are some other perks with Advantage but because I have an account that can "only" be used to pay premiums, a low premium option does not work for me until that account is depleted.


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(@hines202)
Estimable Member Customer
Joined: 2 years ago
Posts: 158
 

@giovanelli766 That's great info. For sure, factors like how much you travel (even internationally) should factor into which option is the "right" one, as well as your overall health and medical needs. Making the wrong choice can lock you out later, such as not being able to be turned away for preexisting conditions at first choice, but later trying to circle back if your chosen option doesn't work out, only to find the door is closed due to those preexisting conditions.

We have to be careful not to make choices based on what has worked great for friends, relatives, coworkers, etc. Their situation is often very different. And definitely not based on what JJ and Joe Willy say!

Find a good, honest, ethical advocate and let them use their expertise to your advantage.


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(@rpmcfadden1)
Active Member Customer
Joined: 2 years ago
Posts: 6
 

Stay far away from Medicare Advantage. Each state is a little different with regular plus supplement plus part d, but that is the best to go with in my opinion. I worked with a private consultant and Boomer Benefits. Boomer found me the best and cheapest plan.


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(@giovanelli766)
Trusted Member Customer
Joined: 2 years ago
Posts: 91
 

Very good overview article by Morningstar on Medigap plans: https://www.morningstar.com/articles/1082157/how-to-evaluate-medigap-plans


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