Like many in her age group, Jenny Li, a 38-year-old who works in retail planning, recently found herself serving as counselor and advisor to her parents, who were approaching age 65 and preparing to go on Medicare.
I did all the research and quickly came to the conclusion that MA was not for us. The gap plan wasn’t very costly BUT, that will increase every year and I worry it could get unaffordable at some point. I suspect a lot of people have no choice but to go MA because they can’t afford the gap plans, but then get screwed with OOP costs. Such a mess.
I've learned if you don't get a supplemental policy, you pay coinsurance of 20% for anything you care through traditional Medicare. I'm still learning the ins and outs of this. My parents have been on a good Medicare Advantage plan for 27 years but we moved them to be near us this year and they are now 1.5 miles outside of the plan coverage area so can't get it without moving again. Their MA plan is good I think because it is a nonprofit hospital system and insurance system in Texas. Since nonprofit and specific to this area they don't appear to play those denial games the others do. Now I have to figure out what to replace it with.
For each and every part c (MA) that individuals are coerced into buying. Centers for Medicare and Medicaid services gives at least $12,000 a year of our taxpayer dollars to the private for profit health insurance companies. Individuals need to realize that the premiums they are paying are in addition to at least $12,000 of corporate welfare.
Traditional Medicare is good for me. $40 monthly medigap high deductible plan G. Part d is zero premium with $400 deductible.
I often use Good rx for prescription drugs.
This confusion is by design of for - profit private insurance companies lobbying so they can continue taking huge amounts of taxpayer dollars and keep this corporate welfare flowing.
Since most of the Medicare Advantage plans have so many problems, what company would you get a medigap policy through? My parents are losing their much loved MA plan because when they moved to be with us this fall, they're now 1.5 miles outside of the coverage area of their plan, even though we have those providers all around us. I could get health insurance with them but we can't get the MA plans here.
I have been very happy with TransAmerica. I’ve had it for 8 years. Even with Medigap you have several policies to choose from and they range in cost and coverage. I chose the plan that covered the most and it is grandfathered in for me but not offered anymore to new subscribers. Still, between my Medigap policy and Medicare, I’ve been 100% covered with zero deductibles, including for a hip replacement. That, of course, is because I bought the high end plan. Increases in my premium have been very modest and are regulated. They have to be approved by the state in live in (NM).
This is very helpful to know. My Mom has several significant health issues so I'm really concerned about trying to find another decent MA plan and I have concerns about pre-existing conditions and a Medigap plan. I doubt another MA plan exists here that would cover her like her Scott & White plan has. We have this one time chance to get her on traditional Medicare after they lost their other policy, so that's what I'm aiming for. Trying to learn costs, etc. now.
With Medicare and TransAmerica I’ve gone anywhere I choose, to any doctor who takes Medicare (I haven’t found anyone yet who doesn’t), don’t have to get referrals for anything except for physical therapy. When I realized it was my hip not my back causing excruciating pain in my leg, I called the orthopedic center of our local hospital and made an appointment to see a hip surgeon. From that appointment through the surgery (which was excellent) through physical therapy, no referrals from my primary care doctor and as a matter of course, they automatically refer you for physical therapy as part of the hip replacement process. The same when I had an atrial fibrillation episode (I’ve had two in 25 years), I went to the ER and everything was covered. Same when I tripped down our flagstone steps and hit my hip hard on the edge of a step…went to the ER on my own for hip X-rays (hip fine), 2 weeks later to a PCP because I still had pain: X-rays and later CT scan of pelvis (fractured pelvis but am fully healed), visit to orthopedic surgeon (no surgery necessary), physical therapy (ordered by surgeon)…zero cost to me, 100% covered by Medicare and TransAmerica. I use the ER of the other hospital in our city than my doctors are associated with. It doesn’t matter. I don’t have to use the hospital they are affiliated with with my insurances. I can choose where to have my x-rays, mammograms, bloodwork and MRI’s, I don’t have to use the places my PCP wants me to use and because doctors are a revolving door where I live, so I’ve had three in the 8 years I’ve lived here, I go to the places I established in the past so that I have one place to pull records from for x-rays, blood work and mammograms. So, at least with my supplemental plan, I am not restricted as to where I can go, and I don’t need referrals. I think this is the same with all supplemental plans but check first. They pay as long as Medicare has been billed and has paid their portion. They pick up the extras depending on which plan you’ve chosen.
Oh, I did have to use the hospital my hip surgeon was affiliated with of course. But I request that my yearly bloodwork referral is sent to Quest, not the hospital lab and the same when they want an x-ray or MRI, I request that they send the order to the place that has done all my x-rays and MRI’s.
No you don't. Go online at medicare.gov and you can look at all the plans - MA and Medigap + original Medicare and compare. Medigap is much more comprehensive and you can go to any doctor or clinic that accepts Medicare.
I did all the research and quickly came to the conclusion that MA was not for us. The gap plan wasn’t very costly BUT, that will increase every year and I worry it could get unaffordable at some point. I suspect a lot of people have no choice but to go MA because they can’t afford the gap plans, but then get screwed with OOP costs. Such a mess.
Spot on. Same here.
This is great info. Are there other resources that explain the pitfall of MA plans? And do all users need supplemental Medicare policies?
I've learned if you don't get a supplemental policy, you pay coinsurance of 20% for anything you care through traditional Medicare. I'm still learning the ins and outs of this. My parents have been on a good Medicare Advantage plan for 27 years but we moved them to be near us this year and they are now 1.5 miles outside of the plan coverage area so can't get it without moving again. Their MA plan is good I think because it is a nonprofit hospital system and insurance system in Texas. Since nonprofit and specific to this area they don't appear to play those denial games the others do. Now I have to figure out what to replace it with.
For each and every part c (MA) that individuals are coerced into buying. Centers for Medicare and Medicaid services gives at least $12,000 a year of our taxpayer dollars to the private for profit health insurance companies. Individuals need to realize that the premiums they are paying are in addition to at least $12,000 of corporate welfare.
Traditional Medicare is good for me. $40 monthly medigap high deductible plan G. Part d is zero premium with $400 deductible.
I often use Good rx for prescription drugs.
This confusion is by design of for - profit private insurance companies lobbying so they can continue taking huge amounts of taxpayer dollars and keep this corporate welfare flowing.
Who do you get your Medigap coverage through?
God damn this country
Since most of the Medicare Advantage plans have so many problems, what company would you get a medigap policy through? My parents are losing their much loved MA plan because when they moved to be with us this fall, they're now 1.5 miles outside of the coverage area of their plan, even though we have those providers all around us. I could get health insurance with them but we can't get the MA plans here.
I buy Medicare Supp High Deductible G through wellabe underwritten by Medico Insurance Company.
You can also ask for advice from your local Council on Aging.
It is awful that Medicare has turned into a private for profit, corporate welfare system .
I have been very happy with TransAmerica. I’ve had it for 8 years. Even with Medigap you have several policies to choose from and they range in cost and coverage. I chose the plan that covered the most and it is grandfathered in for me but not offered anymore to new subscribers. Still, between my Medigap policy and Medicare, I’ve been 100% covered with zero deductibles, including for a hip replacement. That, of course, is because I bought the high end plan. Increases in my premium have been very modest and are regulated. They have to be approved by the state in live in (NM).
This is very helpful to know. My Mom has several significant health issues so I'm really concerned about trying to find another decent MA plan and I have concerns about pre-existing conditions and a Medigap plan. I doubt another MA plan exists here that would cover her like her Scott & White plan has. We have this one time chance to get her on traditional Medicare after they lost their other policy, so that's what I'm aiming for. Trying to learn costs, etc. now.
And do you end up with the same issues with a Medigap plan through an insurance company as you do with Medicare Advantage plans. Denials, etc?
With Medicare and TransAmerica I’ve gone anywhere I choose, to any doctor who takes Medicare (I haven’t found anyone yet who doesn’t), don’t have to get referrals for anything except for physical therapy. When I realized it was my hip not my back causing excruciating pain in my leg, I called the orthopedic center of our local hospital and made an appointment to see a hip surgeon. From that appointment through the surgery (which was excellent) through physical therapy, no referrals from my primary care doctor and as a matter of course, they automatically refer you for physical therapy as part of the hip replacement process. The same when I had an atrial fibrillation episode (I’ve had two in 25 years), I went to the ER and everything was covered. Same when I tripped down our flagstone steps and hit my hip hard on the edge of a step…went to the ER on my own for hip X-rays (hip fine), 2 weeks later to a PCP because I still had pain: X-rays and later CT scan of pelvis (fractured pelvis but am fully healed), visit to orthopedic surgeon (no surgery necessary), physical therapy (ordered by surgeon)…zero cost to me, 100% covered by Medicare and TransAmerica. I use the ER of the other hospital in our city than my doctors are associated with. It doesn’t matter. I don’t have to use the hospital they are affiliated with with my insurances. I can choose where to have my x-rays, mammograms, bloodwork and MRI’s, I don’t have to use the places my PCP wants me to use and because doctors are a revolving door where I live, so I’ve had three in the 8 years I’ve lived here, I go to the places I established in the past so that I have one place to pull records from for x-rays, blood work and mammograms. So, at least with my supplemental plan, I am not restricted as to where I can go, and I don’t need referrals. I think this is the same with all supplemental plans but check first. They pay as long as Medicare has been billed and has paid their portion. They pick up the extras depending on which plan you’ve chosen.
Oh, I did have to use the hospital my hip surgeon was affiliated with of course. But I request that my yearly bloodwork referral is sent to Quest, not the hospital lab and the same when they want an x-ray or MRI, I request that they send the order to the place that has done all my x-rays and MRI’s.
Nanci, do you mind sharing how much your supplemental policy costs you?
No you don't. Go online at medicare.gov and you can look at all the plans - MA and Medigap + original Medicare and compare. Medigap is much more comprehensive and you can go to any doctor or clinic that accepts Medicare.
Medicare gets replaced with Medicare advantage like they’re talking one more seniors cannot afford to retire. This is what they want.