MA HMO or PPO??

[LostDollar]

" ..........(how old are you, anyway?) ....... "

Hey!, be nice, some of us have just been around a bit longer than others.
(And rousemark is just a youngster!)

I can see the draw:

When your money is a bit limited,
When You start hearing about Part B givebacks,
When You're in a closed book Medigap plan where the carrier keeps upping the rates,
When agents start talking about how many kitchen sinks of benefits are going into 2023 MA plans,
When maybe you're in a more expensive PDP because of some of your meds,
And ..... whatever ....................

It becomes most challenging to just close your eyes and follow the opinions of Mom and Somarco. It's possible to start wondering what's going on with the other coverage group and if you should be second guessing your prior choices.

 

[kgmom219]

Hey!, be nice, some of us have just been around a bit longer than others.
(And rousemark is just a youngster!)

I can see the draw:

When your money is a bit limited,
When You start hearing about Part B givebacks,
When You're in a closed book Medigap plan where the carrier keeps upping the rates,
When agents start talking about how many kitchen sinks of benefits are going into 2023 MA plans,
When maybe you're in a more expensive PDP because of some of your meds,
And ..... whatever ....................

It becomes most challenging to just close your eyes and follow the opinions of Mom and Somarco. It's possible to start wondering what's going on with the other coverage group and if you should be second guessing your prior choices.

Oh I get it. Do you think I don't have parents, grandparents, aunts, uncles, etc with the same questions.

There's nothing wrong with asking questions.

But when you know your OOP is going to be $3900 at a minimum, drug costs roughly equal, then moving from Original Medicare, Medigap and Part D to save a maximum of $600 is just dumb. That's why you get expert advice.

 

[somarco]

"My bankruptcy started with back surgery. I had several medical tests that my insurance did not cover. This caused me to fall behind in my medical payments. The next thing I knew, the bills began piling up. I got to the point I owed more than I was making on Social Security."
Why are so many Americans over 65 declaring bankruptcy?


We find that medical expenses more than double between ages 70 and 90 and that they are very concentrated: the top 10 per cent of all spenders are responsible for 52 per cent of medical spending in a given year. In addition, those currently experiencing either very low or very high medical expenses are likely to find themselves in the same position in the future.

In the last 12 months of life, average medical spending is $59,000,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680320/

 

[Bob L]

Oh I get it. Do you think I don't have parents, grandparents, aunts, uncles, etc with the same questions.

There's nothing wrong with asking questions.

But when you know your OOP is going to be $3900 at a minimum, drug costs roughly equal, then moving from Original Medicare, Medigap and Part D to save a maximum of $600 is just dumb. That's why you get expert advice.

You are leaving an important part out of the calculation. IF all his providers are par, the UHC Plan 1 in his area (of which I am a member myself) is an excellent choice. My plan has $2K dental coverage, $200 eyewear, big discounts on hearing aids, $400/yr OTC benefit, free meals after a hospital stay, free annual eye and hearing exams, nurse hotline, telehealth, the help-I've-fallen-and-I-can't-get-up gizmo, etc. If someone needs new dentures, and/or gets his hearing and vision checked from time to time, needs some medical supplies or vitamins and such, the value of all those extra benefits should be considered. And lots of the benefits have zero copays, such as PCP, lab work, diagnostic procedures and tests, and so forth.

When I enrolled myself in this plan, I also bought a cheap GTL hospital indemnity plan which means that if I have a heart attack tonight, get rushed to the hospital and spend a month there, when the dust settles I will not owe a dime. Wayyy less cost than a Med supp plus PDP. I don't take any Rx drugs, but if I did, my plan has no deductibles and a very competitive Part D. This plan rocks!

 

[somarco]

The GAO report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care as the leading reasons for leaving.

"People who are sicker are much more likely to leave [Medicare Advantage plans] than people who are healthier," James Cosgrove, director of the GAO's health care analysis, said in explaining the research.
As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans

“The best candidate for Medicare Advantage is someone who's healthy," says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. "We see trouble when someone gets sick."
https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

 

[LostDollar]

You are leaving an important part out of the calculation. IF all his providers are par, the UHC Plan 1 in his area (of which I am a member myself) is an excellent choice. My plan has $2K dental coverage, $200 eyewear, big discounts on hearing aids, $400/yr OTC benefit, free meals after a hospital stay, free annual eye and hearing exams, nurse hotline, telehealth, the help-I've-fallen-and-I-can't-get-up gizmo, etc. If someone needs new dentures, and/or gets his hearing and vision checked from time to time, needs some medical supplies or vitamins and such, the value of all those extra benefits should be considered. And lots of the benefits have zero copays, such as PCP, lab work, diagnostic procedures and tests, and so forth.

When I enrolled myself in this plan, I also bought a cheap GTL hospital indemnity plan which means that if I have a heart attack tonight, get rushed to the hospital and spend a month there, when the dust settles I will not owe a dime. Wayyy less cost than a Med supp plus PDP. I don't take any Rx drugs, but if I did, my plan has no deductibles and a very competitive Part D. This plan rocks!

My Medicare and You book (Kansas) shows a UHC choice plan. Under OOP it says $3,900/$10,000. What does that mean?

For those of us that have moved on beyond T65, what does the cheap GTL Hospital Indemnity Plan cost when you get up to the 78-80 age range? (I happen to be of an age with rousemark)

GTL Hospital Indemnity Plan again, how long does it take for the benefit to reset after use?
Say I go to the hospital 4 times in a row with spacings of 30-45 days between admittances--how much coverage do I have for my 4 visits under the GTL plan you are talking about?

With UHC Dental, it is important to note that the degree of benefit one might obtain from a $2,000 policy will depend on the network. In my area, (my quadrant of my metropolitan area), dental professionals accepting the UHC standalone plans are quite limited. Also, the UHC allowed amounts are less than allowed amounts for BCBS (and likely for Delta). The net effect being that the real life benefit provided by a $2K UHC MAPD dental coverage may not be what someone expects when they hear $2K of dental coverage.

 

[XpressInsurance]

My Medicare and You book (Kansas) shows a UHC choice plan. Under OOP it says $3,900/$10,000. What does that mean?

$3900 is in network MOOP and $10K if you go out of network

 

[Bob L]

@LostDollar -- My Medicare and You book (Kansas) shows a UHC choice plan. Under OOP it says $3,900/$10,000. What does that mean? The Choice plan is a PPO, and it means if you stay in-network, your OOP is $3900. It's $10K for in- and out-of-network combined.

For those of us that have moved on beyond T65, what does the cheap GTL Hospital Indemnity Plan cost when you get up to the 78-80 age range? (I happen to be of an age with Rousemark.) For KS, to cover the $250/day five-day inpatient copay, $250 outpatient surgery benefit, and $300 ambulance, looks like $44.05/mo for a 78-year-old. I'm paying something like $26 since I started at 65. (Side note: Air ambulance rides incur the same copay as a trip across town on the ground. That's cool.)

GTL Hospital Indemnity Plan again, how long does it take for the benefit to reset after use? Say I go to the hospital 4 times in a row with spacings of 30-45 days between admittances--how much coverage do I have for my 4 visits under the GTL plan you are talking about? The benefit matches up with Medicare benefit periods. From the Definitions section of my policy, it states:

One Period of Confinement: Relative to the Hospital Confinement Indemnity Benefit, with respect to the Hospital Confinement Maximum Benefit Period, One Period of Confinement begins when You become Hospital Confined. One Period of Confinement ends when there has been no additional Hospital Confinement for sixty (60) Days in a row whether or not the number of Days in the Hospital Confinement Maximum Benefit Period have been paid.

With UHC Dental, it is important to note that the degree of benefit one might obtain from a $2,000 policy will depend on the network. In my area, (my quadrant of my metropolitan area), dental professionals accepting the UHC standalone plans are quite limited. Also, the UHC allowed amounts are less than allowed amounts for BCBS (and likely for Delta). The net effect being that the real life benefit provided by a $2K UHC MAPD dental coverage may not be what someone expects when they hear $2K of dental coverage. That would be true of any MA plan's dental coverage that uses a network. I can say that in my part of TN, there is a decent group of dentists who are par. Also, don't forget that network negotiated prices are lower than street. For example, an extraction that would be $95 for someone with no insurance might be $50 for a participating dentist. So that $2K dental benefit may well be worth something like $3K-$4K in walk-in-off-the-street fees.

MAPDs are not for everyone, but are growing hugely in popularity. When I started doing Medicare stuff 15 years back, probably 75% of my book was Med supps plus PDPs. I recently checked my database and now it's 83% MA. More and more providers are signing on since to refuse is peeing against a tidal wave.

 

[somarco]

I wonder how sick people feel about Advantage plans. I know the folks that call me, wanting to change, some at the suggestion of their doc, are not real happy.

Perhaps those who respond to surveys about why they wanted to leave an MA plan are lying? Or the surveys are made up . . .

How often do agents convert a sick person on a Medigap plan to MAPD?

Someone with a chronic or serious illness doesn't give a rats ass about dental benefits.

And Louis doesn't live in a metro area. I believe the last few times he was hospitalized it was in a hospital 50 miles away from his home.

 

[rousemark]

I wonder how sick people feel about Advantage plans. I know the folks that call me, wanting to change, some at the suggestion of their doc, are not real happy.

Perhaps those who respond to surveys about why they wanted to leave an MA plan are lying? Or the surveys are made up . . .

How often do agents convert a sick person on a Medigap plan to MAPD?

Someone with a chronic or serious illness doesn't give a rats ass about dental benefits.

And Louis doesn't live in a metro area. I believe the last few times he was hospitalized it was in a hospital 50 miles away from his home.

Yes. three out of the last four were in Knoxville. How do six people convert from an MA plan to a sup plan? How are they going to pass underwriting?