Medicare with Supplement vs. Medicare Advantage - I've done both

[dedylan27704]

For 9 years I had original Medicare with a Supplemental Plan F (BCBS) and separate Part D. Over time the premiums for the Supplemental Plan rose so much that I finally decided to switch to an Advantage Plan. Chose one of the UHC Insurance AARP PPO plans. Worst decision I ever made. Continually had copays for everything from Specialists to Radiology to Outpatient Surgery and higher copays on certain medications. I'm still getting late bills from 11 months ago because my health system and UHC never got billing correct until now. My healthcare concerns became more about expense than quality of care.

I also was disgusted by the pressure to use the subsidiary of Optum Rx (United Healthcare owns United Healthcare Insurance and Optum Rx) which they continually spent my healthcare dollars advertising to me by telephone, email and USPS. My copay was so high for one generic (of which there are over 20 options), I switched that script to Mark Cuban's CostPlus  and saved over $100 each time I got it filled.

(I highly recommend for all generics: https://costplusdrugs.com)

I have switched to an Aetna PPO and have same issues. The "free" OTC quarterly dollars (which obviously come from the moneys we pay in to the system) can only be used at CVS. Many of the OTC products I routinely use for eye care and skin care issues are not covered, because CVS has no own-brand product. Guess what the corporate relationship is between these two companies is.

Three new prescriptions prescribed by my new dermatologist and new ophthalmologist are not on formulary. The two options from the ophthalmologist were either $100/mo or $126/mo copay, so I'm not filling either.  Fortunately a different generic form from the dermatologist was on formulary, so he agreed that I could switch, although he didn't think that form was as appropriate for me.  In the past I was able to compare all available Part D plans annually and change to the one that would cost me least. With new prescriptions, that was still a crap shoot, but at least I knew what my costs would be for my ongoing meds. 

Unfortunately I don't think I can get a Supplement Plan F anymore. And at my current age, the premiums are even worse than had I kept my old plan. 

True, not one choice is right for everyone. But I had better healthcare options under original Medicare and regret switching to private insurance. 

[GailL1]

@dedylan27704 wrote

True, not one choice is right for everyone. But I had better healthcare options under original Medicare and regret switching to private insurance. 

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But wouldn’t that be “Original Medicare WITH a MediGAP plan” - otherwise you are exposing your finances to perhaps a very big health care bill.

MediGAP = Medicare Supplemental Plan - a GAP financial protection insurance that pays what original Medicare does not cover as defined under the [whatever] lettered plan.

That is the dilemma for many beneficiaries today - either original Medicare with a Medigap plan or a Medicare Advantage plan,   Few people have only original Medicare unless they are able to pick up the rest of the healthcare cost out of pocket.

[Spring2025]

3 comments (3/9/24) @dedylan27704 , I am so sorry about your experience. I have Original Medicare and Aetna's SilverScript. Your post really helped. Thanks!

Nicole  👵

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[*** @dedylan27704 wrote:

For 9 years I had original Medicare with a Supplemental Plan F (BCBS) and separate Part D. Over time the premiums for the Supplemental Plan rose so much that I finally decided to switch to an Advantage Plan. Chose one of the UHC Insurance AARP PPO plans. Worst decision I ever made. Continually had copays for everything from Specialists to Radiology to Outpatient Surgery and higher copays on certain medications. I'm still getting late bills from 11 months ago because my health system and UHC never got billing correct until now. My healthcare concerns became more about expense than quality of care.

I also was disgusted by the pressure to use the subsidiary of Optum Rx (United Healthcare owns United Healthcare Insurance and Optum Rx) which they continually spent my healthcare dollars advertising to me by telephone, email and USPS. My copay was so high for one generic (of which there are over 20 options), I switched that script to Mark Cuban's CostPlus  and saved over $100 each time I got it filled.

(I highly recommend for all generics: https://costplusdrugs.com)

I have switched to an Aetna PPO and have same issues. The "free" OTC quarterly dollars (which obviously come from the moneys we pay in to the system) can only be used at CVS. Many of the OTC products I routinely use for eye care and skin care issues are not covered, because CVS has no own-brand product. Guess what the corporate relationship is between these two companies is.

Three new prescriptions prescribed by my new dermatologist and new ophthalmologist are not on formulary. The two options from the ophthalmologist were either $100/mo or $126/mo copay, so I'm not filling either.  Fortunately a different generic form from the dermatologist was on formulary, so he agreed that I could switch, although he didn't think that form was as appropriate for me.  In the past I was able to compare all available Part D plans annually and change to the one that would cost me least. With new prescriptions, that was still a crap shoot, but at least I knew what my costs would be for my ongoing meds. 

Unfortunately I don't think I can get a Supplement Plan F anymore. And at my current age, the premiums are even worse than had I kept my old plan. 

True, not one choice is right for everyone. But I had better healthcare options under original Medicare and regret switching to private insurance. ***]

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[GailL1]

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@Spring2025 wrote:

(3/9/24) @dedylan27704 , I am so sorry about your experience. I have Original Medicare and Aetna's SilverScript. Your post really helped. Thanks!  😎

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Then. how do you pay for the amount under Original Medicare that the plan does not pay?  

That’s the dilemma for many people -

• they don’t have the money to pay out of pocket IF it is extremely high
• they can’t afford a MediGAP plan especially one that has really high escalating premiums throughout their life
• they don’t ;like the managed care part of MA p[lans
• they don’t qualify for Medicaid as a secondary payer

IMO - it is best to choose a Medigap plan that isn’t the Cadillac of plans where premiums stay pretty reasonable but you have some out of pocket cost higher than just the deductible

OR

Pick a Medicare Advantage plan that has been rated at least 5 STARS - PPO type and then save the out of pocket cost that will be assessed. 

’

[Spring2025]

(comment deleted by poster)

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[GailL1]

@Spring2025 

The problem with your plan to decide later when you get settled is that MEDIGAP insurance (Medicare Supplemental Plans) are only available WITHOUT underwriting for a short period of time after one is eligibile for Medicare - you may have missed your window on this one - if you want one now, you will have to go through underwriting which probably means a higher premium that when you 1st signed up for Medicare and they can even refuse to sell you a Medigap plan.

Medicare.gov- Get ready to buy - Your Medigap Open Enrollment Period

So your only [reasonably priced] plan now maybe a Medicare Advantage plan - but in Florida, that may not be too bad - I hear seniors in FLorida love their highly rated (5-star) Medicare Advantage plans.