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Periodic Contributor

Medigap Plan F vs. Medicare Advantage

Hello,

 

I'm enrolling in Medicare for 2020, and I'm generally familiar with the differences between original Medicare + Medigap + drug plan and Medicare Advantage. My insurance broker and others are strongly recommending original with Medigap Plan F.

 

Maybe it's just because I'm frugal but I'm having a hard time understanding why this route is better. Plan F plus a drug plan would cost me $315 a month, with no dental or vision benfits. There are MA plans that cost $0 and include drugs, dental, and vision. I understand that MA plans are less flexible and you have to stay in network, but I have no particular "must have" doctors.

 

So it seems that I would get a lot more and pay a lot less with MA. What am I missing?

 

Thanks,

Bill 

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@billdz 

 

You aren't really missing anything EXCEPT maybe being able to look into the future and seeing what your health might look like then - when you might be using more health care dollars.

 

Wonder why your broker recommended Plan F Medigap (personallt I don't think Plan F is a good choice now - it is no longer available to new enrollees after 01/01/2020; so only the older/sicker might continue with the plan in the future.  Check out Plan G or some of the other ones.

Medicare.gov - Medigap Plan comparison 

 

Things people have to consider when enrolling in Medicare and making their choice - there are pluses and minuses on both sides - you, your pocketbook, your health, possibly the state where you live Medigap rules - as long as you continue to live there - all of these things and more influence your decision.

 

  • their financial situation (now and into the planned future) to pay MA out of pocket cost OR to pay the monthly Medigap premium
  • their health and how much they they will use the (whichever) choice - (now and into the planned future)
  • based on federal and your state rules, you may not be able to get a Medigap down the road or it could be a whole lot more expensive.   IMO, this may be the biggest.
  • there is NO top limit to your out of pocket cost in original Medicare - not annual, not lifetime.
  • With a MA plan, you can switch every year as need or desire warrants.

If you sign up for original Medicare + Medigap + drug plan, you can always switch to a MA plan - it is the switch back to Original Medicare that has the gotcha' because of the Medigap rules of when you have guaranteed issue rights.

Medicare.gov - Guaranteed Issue Rights (also called Medigap Protection) 

 

Would you pick Original Medicare WITHOUT a Medigap? 

Some people have to do it - There may be NO MA plan available in their area.

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
Periodic Contributor

Gail,

 

Thanks much for the reply. Couple of follow up questions:

 

1) Why might Medigap be a better option in the future "when you might be using more health care dollars"? 

2) Why do you suggest Plan G? Seems to be the same as F except that it does not cover the Part B deductible.

 

I am aware that if I do not go with Medigap now I might not be able to get it later, which is certainly a factor.

 

Some folks are saying that Medigap is better because, in the event of a serious disease, it gets me into the Mayo Clinic, M.D. Anderson, and other "famous" institutions while MA would not. If so, that would be a factor, although I'm not sure it is worth it to pay $315 a month just in case I might want to go to a famous place sometime in the future. 

 

I've seen dozens of comparison pages where you can select and compare various MA plans, but I've never seen one that allows comparison of MA vs. Medigap + drug.

 

Thanks again,

Bill

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@billdz 

 

Your questions:

1) Why might Medigap be a better option in the future "when you might be using more health care dollars"?

 

Original Medicare + a Medicap plan limits ALL your covered cost by whichever plan design you choose.

 

If you choose Plan F, there is actually NO medical out of pocket cost for the beneficiary.  You can go to any doctor that accepts Medicare assignment even without a referral.  As long as the medical procedure is medically necessary and is covered by Medicare, then Medicare will pay their 80% of the Medicare negotiated rate and Plan F will cover the other 20%.  NO, OOP for the beneficiary.

 

If you choose Plan G - the only coverage difference between Plan G and Plan F is that you have to pick up the Part B deductible (for 2020 - that is $ 198) - that's it.  However, there may be some substantial premium savings between Plan F and Plan G, insurer to insurer specific..

 

There is also a Plan F HIGH DEDUCTIBLE PLAN - it is on the list - look it up from the previous link provided.  It will continue to be offered.  It gives good value to the covered Medicare services and your out of pocket is limited to a specific amount.  Premiums should reflect differences in coverage.

 

Any insurer that offers a Medigap plan in your state has to cover the defined GAP benefits as indicated in the various plans.  The plans are set by FED stature, the premiums can change from insurer to insurer even for the same plan.. 

 

Premiums are set in (3) different ways -  the way premiums are rated by insurers can make a difference down the road because they might consider age (or not) as well as medical inflation when setting premiums.  The rating method can affect you - now or later.

Medicare.gov - Cost of Medigap Policies 

 

 

2) Why do you suggest Plan G? Seems to be the same as F except that it does not cover the Part B deductible.

https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies 

"Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans."

 

Down the road, Plan F premiums may begin to rise because of the health of the people still in the plan - they will be older and getting older with no younger and healthier beneficiaries coming in to balance out the healthcare cost of everybody in the plan.  That is conjecture on my part - but it happened to my Mom when her (another letter) plan was discontinued years ago.

 

Helpful hints:

  • Read the Medicare.gov site on Medigap and Medicare Advantage plans.  They are different - but the same - A MA plans has to cover everything that Medicare covers but in a different way.  A MA plan can offer additional benefits on an annual contract basis that Medicare can't offer.  Like vision, dental and perhaps dental, other ones that may be more helpful to some beneficiaries at a specific time or health condition than others.  MA insurers can add or subtract from these extra benefits on an annual basis - it takes a change in law/rule at the Fed level to add, subtract or change benefits in Original Medicare.
  • Deal with a local INDEPENDENT Medicare insurance agent that writes for multiple insurers - not just one.
  • You might also see if your state's Dept of Insurance has a good state reference on Medigap insurance - some states do an excellent job in providing this information and keeping it up to date.  The reason being that although Medicare (Fed. gov) sets the plans and the coverage, it is your state that regulates insurers and thus they make other special rules dealing with eligibility and pricing guidelines for Medigap plans.

MA is network oriented; Medicare is "accepts assignment" oriented.  MA is therefore more locally oriented.   Medicare is nationwide, for (complete) coverage the provider just has to accept assignment - they can be located anywhere.

 

I am no expert - just a senior that has helped others with the decision by giving them some details.

I try to stay up on the ins and outs of Medicare.  The decision is ultimately up to you as is the case of picking any insurance.

 

There are others here that hopefully will give you some other general incite because they work in the field.

 

If you come up with a graphic comparison of Medicare +/- Medigap + PDP vs MA with ot without an included PDP - let me know.

 

Medicare isn't just an insurance coverage plan; It is a Science.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@billdz access to health care is generally more important than just dollars and sense.

 

I can't recall anyone facing a life changing condition asking for the cheapest doctor who can treat me. It certainly doesn't work that way in the movies . . . . or in real life.

 

Advantage plans have a lower premium, often $0, but they come with a price.

 

Deductibles, copay's, networks, high OOP limits ($6700 for many plans), and those caps only apply to IN NETORK APPROVED health care charges. Rx is on top of your health care $$$

 

This message brought to you by the letters HMO and PPO.

 

And yes, you generally will not be able to qualify for a Medigap plan once your health goes south. It's like jumping out of an airplane and then discovering your parachute doesn't work.

 

Most folks love their Advantage plans until they use them.

 

If you can't afford a Medigap plan you can't afford to get sick when you have an Advantage plan.

 

Choose wisely.


Bark less. Wag more.
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Thanks for the replies. Gail, my broker agrees with you that Plan F rates are likely to increase more rapidly as the plan is discontinued and the insureds age.

 

By the way, how are brokers compensated? Do they have any financial incentive to steer customers in a particular direction? And shouldn't the premiums quoted by each broker be the same for the same plan? I'm seeing small but significant differences, like $304 vs. $307. Is that a mistake or do some brokers just charge more?

 

Somarco, obviously I don't want a plan that sticks me with cheap, low quality doctors. How about a PPO Advantage plan, aren't they more flexible on doctor choice than HMOs? Can the average retiree even afford to pay $300 a month for Medigap, plus substantially more for separate dental (not cheap), drugs, and vision plans? Seems there should be a happy medium, something between paying so much for Medigap, drugs, dental, and vision on the one hand and paying zero for all this with Advantage (but getting limited to a network) on the other hand. Guess it depends to some extent on how large is the particular HMO/PPO network and who is in it, but who knows what type of care we will need in future years.

 

Thanks again,

Bill  

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@billdz 

 

Somarco, obviously I don't want a plan that sticks me with cheap, low quality doctors. How about a PPO Advantage plan, aren't they more flexible on doctor choice than HMOs? Can the average retiree even afford to pay $300 a month for Medigap, plus substantially more for separate dental (not cheap), drugs, and vision plans?

 

 

No one WANTS "cheap, low quality doctors" but you can end up with someone less competent regardless of what you pay.

 

PPO plans generally (but not always) have a somewhat larger network but it never approaches anywhere close to the full pool of providers in original Medicare. It is extremely rare that you can find a practice where they accept ALL Advantage plans in the area.

 

When you need care you want to hope you guessed correctly and the par providers are the ones you want and need.

 

If that sounds like a bit of a crap shoot that is because that's exactly what you are doing. HOPING that you guessed right and don't need the doc across the street that is out of network.

 

It really doesn't matter what the AVERAGE retiree can afford, but rather what you can afford.

 

I will say this. If you have a need for ongoing care and have not paid outstanding bills don't be surprised if care is denied until your account is current.

 


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Appreciated your article. I agree completely u pretty much roll the dice when u go with an advantage plan. i would think that if u are very healthy they  may be a smart way to go. But NOT for us. My wife has had a kidney transplant 2 strokes - 2 broken shoulders -and  a hip replacement in the last 4 years. All almost 100% covered with mediare plus the supplimental plan. My wife had her kidney surgery done at the Mayo which did not (at least at that time) have an agreement with advantage plans. We have found that our out of pocket costs are more significant for the many mediations my wife  takes vs. Doctor/hospital costs.

U do have to be careful. We received a bill for the Physical therapy thru the hospital after the stokes saying we had exceeded the number of days.And they also indicated that the bill would be going to a collection company if I did not start making payments. I started making small payment but also  called Medicare and their comment was ABSOLUTELY Do NOT pay that bill as they have a contract with Medicare. I called them back and got the OH comment with let me transfer u to the person that deals with medicare. 

Long story short - He said bill should never have gone to me and I received a full refund of the several hundred  dollars I had already paid.

Make me think of the VERY frail and elderly individuals who may just be too tired and worn down to be able to deal with the medical billings. maybe an advantage plan?

Periodic Contributor

It was kind of funny on Friday, the website for one agent showed $260 for a particular Medigap plan G (United Health AARP), and the website for another showed $236 for that same plan. I phoned them both, they both took my info and came back with the same numbers ($260 and $236), and both insisted that the other must have made some type of error inputting the data. The agent with the $236 quote did not attempt to convince me her agency was cheaper or better, she said the other agent should have the same price as she did for this policy.

 

"In some situations the agent can actually earn more by offering a lower premium plan. For example, a $0 premium MA plan generally pays about 2x what is paid to the broker on a Medigap policy."

Well then, since every agent I've contacted has recommended Medigap over MA, even though this means he will receive a significantly lower commission, that seems to make it clear that Medigap is the way to go.

 

Since everyone seems to agree that dental policies are not worth it, what do people without dental insurance do? Just pay full price to the dentist? That would be financially severe if you need something serious, like a root canal.  

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@billdz 

 

Since AARP/UHC Medigap plans seem to contain a declining discount - maybe that is what the difference represents - one is using it;maybe the other is not.

 

As long as they are both considering the same things - plan, zip code, perhaps AARP membership, new enrollee discount(s), nothing else added on top as additional coverage or benefit like dental ins / separate fitness program - whatever, they should be the same.  You will have to question them more and compare how they are coming out different.

 

I pay for all of my dental, vision, hearing out of my own pocket.  I do put a lot into preventive care into my teeth.  Personally, I would rather pick my own dental, vision, hearing professionals for my care and NONE of them take insurance for most things - they do take Medicare if it is a covered necessary medical service under the program.  

 

If a  Medigap plan gets too expensive for you down the road as premium rise, you can always switch to a MA plan if you want.  That is easy to do - it is going the other way that creates problems, I.e. MA to original Medicare WITH A MEDIGAP plan.

 

 

It's Always Something . . . . Roseanna Roseannadanna
Periodic Contributor

Thanks for the replies. I've pretty much decided on Plan G. Now the question is: from which company should I buy? The price differences are quite large for the exact same Plan G coverage, like $239 to $433. The agent who has been most helpful is suggesting that I not buy from either of the $239 companies (Everence and Capitol Life) and should instead buy from United American or Florida Blue, which are around $270, because they have been around for a long time and the premiums for Everence and Capitol Life are likely to rise more quickly.  Any thoughts on that? Any thoughts on Everence or Capitol Life, are they good companies? Their reviews seem just as good as the more expensive insurers. The agent's argument is that companies new to the market set their premiums low at first and then raise them after a couple of years to a level higher than competitors. He says there should be data on "rate histories" but, if so, I'm not finding it, is it publicly available?

 

As for the AARP/UHC, the agent who quoted $239 insists that is correct, but I'm skeptical, since every other agent has quoted $260 for this Plan G.

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@billdz wrote:

Thanks for the replies. I've pretty much decided on Plan G. Now the question is: from which company should I buy? The price differences are quite large for the exact same Plan G coverage, like $239 to $433. The agent who has been most helpful is suggesting that I not buy from either of the $239 companies (Everence and Capitol Life) and should instead buy from United American or Florida Blue, which are around $270, because they have been around for a long time and the premiums for Everence and Capitol Life are likely to rise more quickly.  Any thoughts on that? Any thoughts on Everence or Capitol Life, are they good companies? Their reviews seem just as good as the more expensive insurers. The agent's argument is that companies new to the market set their premiums low at first and then raise them after a couple of years to a level higher than competitors. He says there should be data on "rate histories" but, if so, I'm not finding it, is it publicly available?

 

As for the AARP/UHC, the agent who quoted $239 insists that is correct, but I'm skeptical, since every other agent has quoted $260 for this Plan G.


Premiums can be different between insurers for the same (standardized) Medigap plan.

Remember I told you the (3) ways the insurers can rate their plans.

https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap/med... 

Each insurance company decides how it will set the price, or Premium, for its Medigap policies. It’s important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future.

Medigap policies can be priced or "rated" in 3 ways:

 
 
 
 
read each one ~ more info at the link too -
Then you have medical inflation that adds to the cost.
You also have the health of everybody in the plan (millions of baby boomer)
You also have the many that are signing up now for the 1st time and unique this year are the (older) ones that are perhaps switching from Plan F to your choice, Plan G.
 

Good companies?????  They have to live up to their 20% or leave the Medigap program - and if they leave, it opens up another guaranteed issue period for you, at least for limited plan choices..

 

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy cove...

You have the right to buy

Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

 

As to the small difference in those (2) AARP branded UHC Plan G's - It could be the discount which they offer - one is including the discount,  the other isn't.

 

Maybe this will help you with your decision.  From the state of Florida - The FAQ is not working.  Don't know if this is for 2019 or 2020 or even what year.  But you can do a search for your county and with your specific info to check it.  It is an estimate (sample) for comparison purposes.

Florida - Medicare Supplement Rates 

 

Good Luck.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@billdz since every agent I've contacted has recommended Medigap over MA, even though this means he will receive a significantly lower commission, that seems to make it clear that Medigap is the way to go.

 

If that is how you want to decide on a plan, picking one that pays the lowest commission, then have fun with that. Seems an odd way of going about getting what is best FOR YOU.

 

what do people without dental insurance do? Just pay full price to the dentist? That would be financially severe if you need something serious, like a root canal.  

 

I don't know what EVERYONE does, just what my clients do.

 

Following a herd mentality never made much sense to me.

 

Good luck!


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RE. Dental _

We do not have insurance but can but found out about a  dicount plans for $180 a year while at the dentist.. Cleanings drop to $49 and all other services have significant decreases in cost. So that is the way we will go.

 

Question to advantage plans include dental?

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as @GailL1  warned, discount plans are cheap for a reason.

 

Very few dentists accept them.

 

Those that do are often hurting for foot traffic and willing to discount with no oversight for recommended services or price gouging.

 

In short, you get what you pay for. There are no free lunches


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@jimbohretired wrote:

RE. Dental _

We do not have insurance but can but found out about a  dicount plans for $180 a year while at the dentist.. Cleanings drop to $49 and all other services have significant decreases in cost. So that is the way we will go.

 

Question to advantage plans include dental?


Just be careful with discount plans - some dentist have been known to recommend more services than what might be necessary. 

 

If you use a regular dentist or other dental specialist on a regular basis for preventive care and pay out of pocket, many of them will give a cash discount without a monthly premium and to save on any applicable paperwork that has to be filed by them or you.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
Honored Social Butterfly

@billdzquestions - black ink, my replies in blue

 

You opened my flood gates - Sorry!

 

By the way, how are brokers compensated? 

By the insurance company -

 

Do they have any financial incentive to steer customers in a particular direction? 

Only if they are one that only sells for one insurance company.  In this regards, they aren't brokers, to me, they are just employees of the insurance company.

 

Otherwise, if they work for many of them, with all options - Medigap (for those who choose Orig. Medicare), PDP, Medicare Advantage plans with (MAPD) and without built (MA) in PDP. 

 

They want to sell you something and, the good ones, will work with a client to help them find the very best one for the beneficiary's needs.  They, if they know their stuff, are also a source of guidance, Q & A, occassional help if the beneficiary encounters a problem with coverage during the year.  I mean look at you here, trying to make a decision.

Medicare is a science - some people do a good job of deciphering it but others, not so much, especially as they get older.

 

And shouldn't the premiums quoted by each broker be the same for the same plan?

I'm seeing small but significant differences, like $304 vs. $307. Is that a mistake or do some brokers just charge more?

Brokers don't charge the individual beneficiary more - their services are paid by the insurance company.

Each insurance company charges their own premiums for whatever the Medigap plan.  Insurance Co. Premiums for Medigap plans are affected by the medical expenses which they have occured in their plans.  Remember the reason why Plan F premiums may escalate in the future - the people who remain within it - older, older, sicker, fewer, no "new" blood.

Premiums are also based on how any specific Medigap plan is rated.  (I gave you this link previously)

  • Community Rated
  • Issue Age Rated
  • Attained Age Related

So there are gonna be differences in Medigap premiums for the same plan and between insurers based on those (2) points.

 

Medicare Advantage plans have a different sort of premium formula base.  Some have NO premiums.  All of them have to be within a benchmark which CMS comes up with after input from the carriers annually - all of this is in relation to geographical area because health care cost are local - some very expensive, other moderately so -

 

Medical inflation affects ALL types of Medicare plans just like it does with other health insurance plans.

 

Somarco, obviously I don't want a plan that sticks me with cheap, low quality doctors. How about a PPO Advantage plan, aren't they more flexible on doctor choice than HMOs? Can the average retiree even afford to pay $300 a month for Medigap, plus substantially more for separate dental (not cheap), drugs, and vision plans? Seems there should be a happy medium, something between paying so much for Medigap, drugs, dental, and vision on the one hand and paying zero for all this with Advantage (but getting limited to a network) on the other hand. Guess it depends to some extent on how large is the particular HMO/PPO network and who is in it, but who knows what type of care we will need in future years.

 

You asked somarco and he is a very good, knowledgeable source.  But I will give you my 2 cents - as a novice.

Medicare Advantage Plans:  Remember, you can pick and choose your MA plan every year so you can try them out if you want - you just pick the one that meets your (whatever) needs this year - doctor in network, medicines, any special benefit offers - dental, vision, maybe hearing.  Next year, review the (same) plan again if it is to your liking - review AGAIN for your needs because they can change from year to year - just like any other health insurance plan.  Need/wants (and perhaps convenience) can be assessed in the type of plan that you may want in some years - HMO, PPO, etc..

 

Medigap -

I quote somarco - "If you can't afford a Medigap plan you can't afford to get sick when you have an Advantage plan." 

So you either pay your dues monthly (Medigap) or you pay your dues in copays and decuctibles (MA)

 

Health insurance of ALL types is insurance - it is suppose to protect you NOT completely cover you - expect to pay something for something.  I often think that it is not insurance that people want for their healthcare seem more that they want it ALL and somebody else to pay for it.  Some people pay nothing for it because they can't - we all foot the bill for them.

 

I have never found a dental, hearing or vision insurance plan that was worth my usage and I have a periodontist and a prosthedontist, both are dentist.  I have worn glasses - trifocals since I was (4).  My mother was deaf and I have severe Tinnitus (too much rock n roll) so I know about hearing, aids, audiologist.

 

However, being self-employed for the vast majority of my working career, I was very intuned to having health insurance and paying the premiums out of my own pocket for what I wanted and needed.  I also saved for my retirement, including a good amount for healthcare cost.

 

We afford what we can afford and have planned for.  Many don't so we also have to cover them out of our taxes.  As baby boomers age and become increasingly lower on funds, there may be many more of those that need that help in coverage.

 

I am also pretty knowledgeable of other (industrialized) country's health care systems - I do a lot of research and reading - I could tell you many things which they use to control health care cost - we do few, if any, of these in our Medicare program - well, perhaps MA plans do a few.  You don't want to get me started on this area so I will leave it at that only to say, that we perhaps need to set some priorities on where this spending goes and on what - if we want other benefits, we may have to cut cost somewhere else - IMO, many of these cost reduction wouldn't be a big deal to most beneficiaries - one I will mention, having to get a referral to a specialist from a primary care doc would save a lot of money in Orig. Medicare- how much ?  but maybe enough to add in some minimal coverage for dental or vision.  Set priorities -

 

When a person on Medicare has very low income, there are special programs to give EXTRA HELP, like paying for their Part B premiums and/or (help or all) their meds and then if their income is low enough they can become dual eligible meaning that they have Medicare and Medicaid picks up ALL the rest.  We all pay for this as citizens over and above our own cost.

 

BTW, do not think that a MA plan works just off of premiums - Medicare (CMS - our government - We, the people) subsidizes these insurers up to the same amount at least that we spend on those in the Original program.  The insurers make money by managing the care with networks, co pays, deductibles, incentives.

 

Medicare is a science - lots of nooks and grannies.  Here is a bit of the cookie dough.

  • Medicare Part A (HI - Hospital Insurance part of Medicare) is premium free for those who have worked long enough and paid in their (and the employers) payroll taxes.
  • Your Part B premiums (Doctors, Durable Medical Equipment, Outpatient care, etc.) represent only about 25% of the cost of the program - the remaining 75% is covered by our government (Us - We, the people) General Fund.
  • Part D - the Medicare prescription drug program works similar to Part B -
  • Part C - Medicare Advantage plans - paid for by your premiums, if any, and what Medicare pays the insurer to take care of you.

BTW, those with higher incomes (over $ 85,000 / year) pay higher Part B and D premiums based on their income - IRMAA - Income-Related Monthly Adjusted Amount.

 

Everybody should have to learn all about these thing and given a test before their benefits start.     Woman Wink     Woman Tongue

I could go on and on and on . . . . .Again, Sorry - but you asked.  Woman Frustrated

It's Always Something . . . . Roseanna Roseannadanna
Periodic Contributor

Thanks, Gail, appreciate your time. A few more:

 

"By the way, how are brokers compensated? 

By the insurance company -"

Yes, but how? Is there a flat fee per policy, or do they earn more if for example they sell you a policy with a high premium?

 

"Brokers don't charge the individual beneficiary more - their services are paid by the insurance company."

I'm talking about the exact same policy from the exact same company. I'm seeing different prices in the quotes from different brokers for the same policy. Software glitch or are some brokers somehow able to offer a better price?

 

"So you either pay your dues monthly (Medigap) or you pay your dues in copays and decuctibles (MA)"

Several MA policies in my area (the broker says policies here in Florida have much lower co-pays, deductibles and OOP max than in northern states) have $0 co-pay and low deductibles for most services, and it would take an awful lot of usage for the outlays from this type of MA policy to end up costing anywhere close to the $300 a month for a Medigap policy. If it is just Medigap premium vs. MA co-pays and deductibles, MA wins, I think. The issue is whether, as Somarco believes, MA means lousier care.

 

"I have never found a dental, hearing or vision insurance plan that was worth my usage"

Agreed, and that's a shame, as dental, hearing, and vision are just as important as other health needs. Even my broker does not recommend buying a dental plan to supplement a Medigap policy. The dental plans he showed me are expensive and do not provide great coverage. This seems to be a point in favor of MA, as Medigap with no dental means you pay a lot more in the event of a root canal or something serious, and even just for cleaning.

 

 

 

 

 

 

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@billdz 

"By the way, how are brokers compensated? 

By the insurance company -"

Yes, but how? Is there a flat fee per policy, or do they earn more if for example they sell you a policy with a high premium?

 

 

A service fee is built into every premium. Either that fee goes to the writing agent or the carrier retains it to help offset the cost of the folks who answer phones.

 

In some situations the agent can actually earn more by offering a lower premium plan. For example, a $0 premium MA plan generally pays about 2x what is paid to the broker on a Medigap policy.

 

 

"Brokers don't charge the individual beneficiary more - their services are paid by the insurance company."

I'm talking about the exact same policy from the exact same company. I'm seeing different prices in the quotes from different brokers for the same policy. Software glitch or are some brokers somehow able to offer a better price?

 

 

Could be any number of explanations, including:

Broker made a mistake

Broker had no idea how to properly rate the coverage

Quoted tobacco rates when the risk was non-tobacco

Quoted non-tobacco rates when the risk was tobacco

Quoted HH discount rate without knowing if the applicant qualifies for discount or not

Quoted incorrect effective date

Failed to include any application fee

 

Pick one, or several

 

Brokers do not have any leverage to generate lower than book rates. Nor are they allowed to pad their rates to generate higher compensation.

 

Likewise, you will not pay a lower premium when you go direct to the carrier.

 

 

 The issue is whether, as Somarco believes, MA means lousier care.

 

"Lousier" is subjective, and is your term, not mine.

 

If you believe limited access to care is no different than unfettered access then it really doesn't matter what I think.

 

 

 

 

"I have never found a dental, hearing or vision insurance plan that was worth my usage"

Agreed, and that's a shame, as dental, hearing, and vision are just as important as other health needs. Even my broker does not recommend buying a dental plan to supplement a Medigap policy. The dental plans he showed me are expensive and do not provide great coverage. This seems to be a point in favor of MA, as Medigap with no dental means you pay a lot more in the event of a root canal or something serious, and even just for cleaning.

 

 

 

If you believe the dental/vision plans baked into MA plans is valuable then you are in a class by yourself.

 

My opinion is that NONE of the individual dental/vision plans, including ones thrown in to an MA plan at no charge, are worth having. This is based on years of reviewing  plans and talking with folks who have paid plans as well as those thrown in at no charge with MA plans.

 

In all my years in this business I have never had one person tell me they were pleased with their plan and were glad they had it.

 

As Robert Ripley so famously said, "You can believe it or not".

 

 


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@billdz wrote: - again black (you) and blue (me)

 


By the way, how are brokers compensated? 

By the insurance company -"

Yes, but how? Is there a flat fee per policy, or do they earn more if for example they sell you a policy with a high premium?

Don't know - you will have to get a response from somebody that knows that part of it.

I think on commission basis but what it is based on, I don't know.  The guy I paid a nickel to (somarco) will know if he is willing to share this info.

 

"Brokers don't charge the individual beneficiary more - their services are paid by the insurance company."

I'm talking about the exact same policy from the exact same company. I'm seeing different prices in the quotes from different brokers for the same policy. Software glitch or are some brokers somehow able to offer a better price?

Advantage plan or Medigap ?

A few guesses from me

- might be that they are looking at it in slightly different zip code.

- Some AARP/UHC Medigap plans have a declining discount - perhaps one is using it and the other isn't.  You have to be a member of AARP to buy an AARP-branded UHC Medigap plan.

Have you asked them?

somarco might know better.

 

"So you either pay your dues monthly (Medigap) or you pay your dues in copays and decuctibles (MA)"

Several MA policies in my area (the broker says policies here in Florida have much lower co-pays, deductibles and OOP max than in northern states) have $0 co-pay and low deductibles for most services, and it would take an awful lot of usage for the outlays from this type of MA policy to end up costing anywhere close to the $300 a month for a Medigap policy. If it is just Medigap premium vs. MA co-pays and deductibles, MA wins, I think. The issue is whether, as Somarco believes, MA means lousier care.

From what I hear and read, Florida is the utopia of seniors and MA plans - in many parts of FL, seniors with MA plans are treated as kings and queens. 

Sun-Sentinel 10/24/2019 - Medicare Advantage plans tout Apple Watches, Fitbits, meal delivery and ot... 

In many parts of FL, there are tons of providers to develop a pretty good network, they usually include the PDP - I don't know about MA plans being sub-par in care.  That depends on the providers in the network - they give the care.  They maybe the same providers that participate in Original Medicare.

 

The concept of MA plans is to manage care - private insurance is much better in reviewing claims than Original Medicare because their profit relies on it.  That is not to say that care will be denied - all I am saying is that the docs have to have the right diagnostic codes to correlate with the diagnostic codes that they are using to treat the beneficiary.  Otherwise, it is gonna be questioned.

 

Sometimes, insurers may want a step-therapy.  Meaning XXX has to be tried before YYY is approved.

 

Same is true when a prior authorization is needed, the diagnosis code is important to get the pre-auth.  It has to be medically necessary.  It has to be an approved regiment of care defined by science.  Suppose to be that way in Orig. Medicare too - Private insurance companies also process Orig. Medicare claims on a contract basis but do they do it with the same watchful eye as the ones which they process for their own company???

 

Whatever plan you decide on - READ THE PLAN and understand it.

 

As to your comparison of the premium cost of the two - MA & Medigap.

You pay your Part B premiums for both.

The reason that Medigap plans are harder to switch to later on, if it is possible at all and doesn't cost a tremendous amount,  is because we don't want sicker and older beneficiaries to cross the line back to Original Medicare when their copays and deductibles start to mount up exponentially.  That is why "Guarantee Issue" is limited in most states by time and/or circumstance. 

 

A beneficiary can switch back to Original Medicare from a MA plan easily, no problem - but it is not always possible to get a Medigap plan or if you get one, may cost a whole lot if you are outside the guarantee issue rules set by Medicare.

 

So if a beneficiary is paying more and more for care under their MA plans because they have began to need it more and more after they get older / sicker - they can go back to Original Medicare and if they can't get or can't afford the premiums of a Medigap plan to go along with Original Medicare, they will have to cover the 20% and other cost that Orig. Medicare does not cover, also considering that there is NO maxium OOP under the Original program - Are they really any better off than under the MA plan, financially speaking? 

 

There are a few times when Orig. Medicare takes over from the MA plan and covers 100% of the cost - Pallitive, End of Life care and I think, if you are diagnosed with End Stage Renal Disease (ESRD) and perhaps a few others - they are listed on the Medicare site but I am too tired to look it up.

 

Again, insurance is there to protect you with some cost sharing for those times when cost mount up.  When coming into the progam, most people are more healthy than when they get to their 70s, 80's & 90s and above.  Your decision as to your guess of what the future may bring. 

 

Medigap and the guarantee issue periods, meaning the time or the defined situations, when you cannot be denied a Medigap policy by using your health, is the bargaining chip

here.

 

"I have never found a dental, hearing or vision insurance plan that was worth my usage"

Agreed, and that's a shame, as dental, hearing, and vision are just as important as other health needs. Even my broker does not recommend buying a dental plan to supplement a Medigap policy. The dental plans he showed me are expensive and do not provide great coverage. This seems to be a point in favor of MA, as Medigap with no dental means you pay a lot more in the event of a root canal or something serious, and even just for cleaning.

 

I don't know how inclusive the dental / vision or hearing plans are with a MA plan.  Guess that would depend on what you need and what the coverage is - I have never found one that I would consider.  It isn't gonna cover a mouth full of implants, does it cover dentures - partials or full.  Where is covered?  Most likely network too - I like to pick my own dentist, opthalmologist / optician.  Most medical conditions with hearing / dental and vision are covered under the actual plan of medical treatments.

 

Some people here also like the gym/exercise benefit that some MA plans provide on a yearly basis.

 

Remember that anything that Medicare covers is a covered condition under a MA plan, it is just paid for in a different way - anything that Medicare does NOT  cover like gym/exercise program, dental, vision, hearing and some other special offerings by specific MA insurers are done on a contract basis and can change from year to year with the MA policy.

 

Medicare is a Science and it is also a gamble to pick the right plan or combination at 65 - when it maybe 95 when you need what you picked.  Woman Wink

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not in ny

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@somarco wrote:

 

 

If you can't afford a Medigap plan you can't afford to get sick when you have an Advantage plan.

 


Love it - Is that an original ?  The perfect UNDERinsured statement.

Copyright it ! 

I wish I could give you more than just one Kudo !

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 wrote "I wish I could give you more than just one Kudo !"

 

I take PayPal . . . .


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@somarco wrote:

@GailL1 wrote "I wish I could give you more than just one Kudo !"

 

I take PayPal . . . .


That's a NICKEL, right?  Woman Wink

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Probably time to raise my prices

 

Lucy Doctor is In Peanuts snoopy Vinyl Car Sticker Decal -4 Pack  2.5"

 


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I think plan F is being discontinued.  I'm in ny and snowbird to fla.  

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