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Recognized Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

664 Views
Message 21 of 31

When you consider how you want to get you Medicare health coverage consider not how healthy you are the day you purchase a plan but consider long term what your health could be like in the future. Because you may not be able to switch back to a better plan due to being underwritten or denied coverage.

 

If you chose a Medicare Advantage plan and then decide later to switch to Original Medicare and a Supplement plan outside of Medicare Supplement open enrollment and Guaranteed Issue Situations, Supplement plans may medically underwrite policies and turn you down.

 

 

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

677 Views
Message 22 of 31

john258 wrote:

 

 

 

Read your support article and you say this is a pitfall when you go back to Original Medicare. The friend I have talked about in here went from Original Medcare to an MA plan in CA, then back to original Medicare. He got local help and they were able to find a way to get around that problem. That is why a person should seek a local expert when they have a problem, and you should tell everyone that. He had no pitfall as you say. There are ways around a lot of regulations which the local expert will know about. When you do not tell people that you are giving them bad advice.


There are any number of conditions which would trigger a guaranteed issue status.  They are enumerated and described on the Medicare.gov site.

 

You can always go back to original Medicare from a Medicare Advantage plan.

 

It is the guaranteed issue rights which determines whether or not you will have access to Medigap coverage without underwriting.

 

I bet if you contact your friend he can describe his situation when that occurred and you can see how it happened, if that is what happened.

 

Not everybody can fall within these special rules.  Thus you may return to original Medicare from a Medicare Advantage plan but you might not be able to get a supplemental plan unless you meet a guaranteed issue stipulation or IF you are approved for a Medigap plan, there maybe a timed stipulation on a pre-existing conditon and most likely a heft premium.

 

Medicare.gov - Guaranteed Issue Rights for Medigap coverage

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

686 Views
Message 23 of 31

GailL1 wrote:

Sorry for the delay in continuing this IMPORTANT discussion for all seniors.

 

Mavolta wrote:

Yes, I can change plans or return to Original Medicare A + B + D + Supplement Plan.

 

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There are pitfalls in Medicare when choosing a MA plan initially and then later on (after a year) deciding to go on Original Medicare and purchase a Medigap plan to help cover your cost of medical care since Original Medicare has NO annual out of pocket limit.

 

Kaiser Family Foundation 2016 - Traditional Medicare . . . . Disadvantages?


Read your support article and you say this is a pitfall when you go back to Original Medicare. The friend I have talked about in here went from Original Medcare to an MA plan in CA, then back to original Medicare. He got local help and they were able to find a way to get around that problem. That is why a person should seek a local expert when they have a problem, and you should tell everyone that. He had no pitfall as you say. There are ways around a lot of regulations which the local expert will know about. When you do not tell people that you are giving them bad advice.

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

659 Views
Message 24 of 31

oudeman wrote:
What insurance specialist did you speak to? I need one ...

The first thing that I did was to call my state's SHIP office (look for the number on the back of your new Medicare book). They provided additional information and answered many of my questions about enrolling in Medicare for the first time. I read the information in the Medicare book, and then went to the Medicare.gov website and compared plans, and also the insurance company Medicare websites. With so much information, I decided to sign up for a free Medicare presentation by an independent insurance agent who specializes in Medicare. He helped me narrow my choices and I came to a decision. 

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Info Seeker

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

653 Views
Message 25 of 31
What insurance specialist did you speak to? I need one ...
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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

847 Views
Message 26 of 31

GailL1 wrote:

Sorry for the delay in continuing this IMPORTANT discussion for all seniors.

 

Mavolta wrote:

Yes, I can change plans or return to Original Medicare A + B + D + Supplement Plan.

 

-----------------------------------------------------

 

There are pitfalls in Medicare when choosing a MA plan initially and then later on (after a year) deciding to go on Original Medicare and purchase a Medigap plan to help cover your cost of medical care since Original Medicare has NO annual out of pocket limit.

 

Kaiser Family Foundation 2016 - Traditional Medicare . . . . Disadvantages?


Yes, that's true. It is also true, according to my insurance rep, that if one changes back to Original Medicare and wishes to buy a supplemental plan, the premiums may be higher than those offered originally. 

 

It is highly unlikely that I would ever want to change back to Original Medicare since I live in a place where there are at least two competing companies with extensive networks. If I ever want to move, I would have to carefully weigh the options available, or choose to stay put.

 

This is why, IMHO, Medicare is so unfair. There are too many pitfalls, including the lack of portability, and lack of protective coverage, for openers. Even with expert guidance, one still has to choose what risks one is willing to take.

 

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

815 Views
Message 27 of 31

Sorry for the delay in continuing this IMPORTANT discussion for all seniors.

 

Mavolta wrote:

Yes, I can change plans or return to Original Medicare A + B + D + Supplement Plan.

 

-----------------------------------------------------

 

There are pitfalls in Medicare when choosing a MA plan initially and then later on (after a year) deciding to go on Original Medicare and purchase a Medigap plan to help cover your cost of medical care since Original Medicare has NO annual out of pocket limit.

 

Kaiser Family Foundation 2016 - Traditional Medicare . . . . Disadvantages?

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

891 Views
Message 28 of 31

GailL1 wrote:

Good answer, Mavolta - sounds like you understand the difference and weighed your preferences.

 

Medicare can seem overwhelming to a newcomer. I would advise speaking with a professional. They can help you find and compare the plans available in your zip code.

 

So every year, you can look at the plan to make sure it is giving you what you want as you describes and if not you can decide if you want to switch to another.

 

Yes, I can change plans or return to Original Medicare A + B + D + Supplement Plan.

 

Would you think that a person who has a lot of health care cost would like your MA plan and be pretty well off with it rather than Original Medicare, with a supplemental and a prescription drug plan?

 

Advantage does provide a good amount of coverage in network, however, most plans are HMO and require a PCP. In my area, the PPO plans have pretty much disappeared.

 

A person with health issues that requires specialists, are probably better suited to Original Medicare w/supplement, since it does not require them to have a PCP or involve any network. They would need to confirm that their doctors or specialists accept Medicare. Likewise, they may need a Part D that best covers the drugs that they need.

 

Many people new to Medicare like Medicare Advantage plans especially if they are relatively healthy - guess that is why the numbers keep going up on participation.

 

Yes. My insurance guy said that he has signed up a lot of new retirees with Advantage plans. These are typically people with minimal health issues, and live in areas with large networks available to them. People like $0 premiums! 

 

Also, if I travel on an extended vacation, or out of country, I take out travel insurance with a health rider. People who travel a lot might prefer Original Medicare for the flexibility.

 


 

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

905 Views
Message 29 of 31

Good answer, Mavolta - sounds like you understand the difference and weighed your preferences.

 

So every year, you can look at the plan to make sure it is giving you what you want as you describes and if not you can decide if you want to switch to another.

 

Would you think that a person who has a lot of health care cost would like your MA plan and be pretty well off with it rather than Original Medicare, with a supplemental and a prescription drug plan?

 

Many people new to Medicare like Medicare Advantage plans especially if they are relatively healthy - guess that is why the numbers keep going up on participation.

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Valued Social Butterfly

Re: Why did you choose a Medicare Advantage Plan over Original Medicare?

913 Views
Message 30 of 31

Yes, I chose the Medicare Advantage Plan. This has been my first year in Medicare, and it has worked out well for me. I live in a large urban area with a large network of health care providers, and that includes my PCP, and all of the services (lab, x-ray, all local hospitals) that she typically uses. It also provides prescription drug coverage. I only have one, and it is a very low cost one at that. 

 

I went over all of the plans with an insurance professional who specializes in Medicare. He explained the premium supports for Advantage by the federal government, so I have $0 in premiums. The benefits are adequate to meet my needs, and there is a max annual in-network out of pocket limit that suits me. Hospital copays are reasonable, and limited to 5 days. 

 

Had I gone the alphabet soup route, it would have cost me around $280-ish per month for a supplemental policy, plus around $20 or so per month for Part D. While it allowed for more flexibility, the benefit coverage was similiar.

 

 

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