Medicare Advantage (MA) replaces Original Medicare in the sense that the MA becomes your insurance company and pays your claims as opposed to the government. But you must maintain both Part A and Part B (meaning pay those premiums!) in order to be enrolled under an MA. If you lose either SSA reports that to CMS who reports the loss and a termination to the MA.
Would appreciate some answers to my Medicare options.
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Thanks to ICACharleston, Hopes, JJ2713, russelltw, and StephanieCJ for your answers, I very much appreciate it. Things are clearing up a bit.
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- #13
I turned 65 and signed up Medicare Part B and have been billed $402 .00 for 3 months of coverage. I have not paid any of the premium because I have been trying to decide whether to buy a Medicare Supplement or a Medicare Advantage plan. So far it's my understanding....
Already answered, but, you'll want to pay it. It's "the foundation of the building."
1) one of the main differences in the Supplements vs Advantage plans is the Advantage plans seem to be limited in their coverage if you have to go out of your local care area if you have a need for specialized treatment. Is this true? Yes - they are mostly network-based plans (HMO - restricted network, PPO - in-and-out of network benefits. I live the Dallas area and have local access to major hospitals. I'm thinking because of this an Advantage plan would be ok because of my access olcally and the chance I have to travel to get treatment is lower than if I lived in a rural area. Just check [or have your agent] (a) your preferred docs, and (b) your preferred hospital prior to enrolling.
2) Aren't the extra dental, vision, workout plans on Advantages plans really just "teasers" that can't pay out much because of very limited calendar year limits? Not necessarily. Some have real value. Two cleaning per year is a few hundred bucks - the money spends no matter how we slice and dice it. Some plans offer money for new glasses, I've seen up to $175 - with free eye exam. That saves a bit right off the back, especially with $0 premium. Again, it all should be factored in to your decision.
3) If I make a decision to go with a Advantage or straight Supplement, I won't need to pay the $133 monthly premium for Part B, correct? No - already answered, but you'll still need to pay the 134. Because the Advantage and/or Supplement plan replaces Part B and along with it the $133.00 premium?
4) I am healthy, athletic, run and cycle several times a week, presently take no medications, no diagnosed diseases other than recommended cataract surgery. I feel like I've heard this before from other T65s... just don't forget, anyone can have a stroke... However, I am way overdue for a through physical exam and plan to have this done in a few months when I have made my decisions and have coverage in place. If you were me, what plan would you go with? I'm leaning towards an Advantage plan , because
1) there are o premum plans in my area, that's enticing 2) with a large amount of local access, seems the negative about Advantage plans not have the same coverage nationally is negated also good, just be aware that can change - not saying it will, just know, it can 3) If my health changes and/or I in the future, needed medications on a daily basis, can't I change each open enrollment period to another plan that covers out of pocket drugs? Not sure what you mean exactly... yes, you can change Rx coverage from 1 mapd to another mapd during open enrollment, but that doesn't mean you can switch from a MAPD to a Med Supp + PDP. To do that, you'll need to go through underwriting - i.e., answer health questions.
So... if you do the MAPD, then 4 yrs later try to switch to the Med supp because you got the big cancer diagnosis, sorry, but it doesn't work that way. You'll either be declined or rated up. Med supp, with no health questions, is 6 initial months....
Any corrections, comment and answers would be very much appreciated. Thanks!
PS If I sign up for an Advantage or Supplement in a week or so... do I still need to pay the $402 premium for Part B?
My recommendation: Find an agent that can work with you, and let him/her earn approx $300 per year helping you. Trust me - they earn every penny.
Already answered, but, you'll want to pay it. It's "the foundation of the building."
1) one of the main differences in the Supplements vs Advantage plans is the Advantage plans seem to be limited in their coverage if you have to go out of your local care area if you have a need for specialized treatment. Is this true? Yes - they are mostly network-based plans (HMO - restricted network, PPO - in-and-out of network benefits. I live the Dallas area and have local access to major hospitals. I'm thinking because of this an Advantage plan would be ok because of my access olcally and the chance I have to travel to get treatment is lower than if I lived in a rural area. Just check [or have your agent] (a) your preferred docs, and (b) your preferred hospital prior to enrolling.
2) Aren't the extra dental, vision, workout plans on Advantages plans really just "teasers" that can't pay out much because of very limited calendar year limits? Not necessarily. Some have real value. Two cleaning per year is a few hundred bucks - the money spends no matter how we slice and dice it. Some plans offer money for new glasses, I've seen up to $175 - with free eye exam. That saves a bit right off the back, especially with $0 premium. Again, it all should be factored in to your decision.
3) If I make a decision to go with a Advantage or straight Supplement, I won't need to pay the $133 monthly premium for Part B, correct? No - already answered, but you'll still need to pay the 134. Because the Advantage and/or Supplement plan replaces Part B and along with it the $133.00 premium?
4) I am healthy, athletic, run and cycle several times a week, presently take no medications, no diagnosed diseases other than recommended cataract surgery. I feel like I've heard this before from other T65s... just don't forget, anyone can have a stroke... However, I am way overdue for a through physical exam and plan to have this done in a few months when I have made my decisions and have coverage in place. If you were me, what plan would you go with? I'm leaning towards an Advantage plan , because
1) there are o premum plans in my area, that's enticing 2) with a large amount of local access, seems the negative about Advantage plans not have the same coverage nationally is negated also good, just be aware that can change - not saying it will, just know, it can 3) If my health changes and/or I in the future, needed medications on a daily basis, can't I change each open enrollment period to another plan that covers out of pocket drugs? Not sure what you mean exactly... yes, you can change Rx coverage from 1 mapd to another mapd during open enrollment, but that doesn't mean you can switch from a MAPD to a Med Supp + PDP. To do that, you'll need to go through underwriting - i.e., answer health questions.
So... if you do the MAPD, then 4 yrs later try to switch to the Med supp because you got the big cancer diagnosis, sorry, but it doesn't work that way. You'll either be declined or rated up. Med supp, with no health questions, is 6 initial months....
Any corrections, comment and answers would be very much appreciated. Thanks!
PS If I sign up for an Advantage or Supplement in a week or so... do I still need to pay the $402 premium for Part B?
My recommendation: Find an agent that can work with you, and let him/her earn approx $300 per year helping you. Trust me - they earn every penny.
- Thread starter
- #15
Thanks again to everyone that have replied to my initial questions. If any of you are in the Dallas area, I would like to hear what Supplement (MS) plans you find to be the most competitive priced? Same question for Advantage (MA) plans?
Having ask those questions. aren't all the MS plans' benefits standardized, therefore the only factor is their pricing?
But with the MA plans, don't you have to weight what the out of pocket maxs and co-pays are, plus the premium (if any) are?
To simplify, for this year, I know I'm going get a standard yearly check up, will have a colonoscopy, may have cataracts removed and vision corrected at the same time, and may need other tests such as MRI...... so..I'm trying to take advantage of this situation and get the best priced coverage that will cover the most of what I know I'm certain to need tests and serviceswise for the coming year.
Any specific plan recommendations? So far I have info on Cigna, UHC, Humana, and Ameriprise to look at.
Thanks again.
Having ask those questions. aren't all the MS plans' benefits standardized, therefore the only factor is their pricing?
But with the MA plans, don't you have to weight what the out of pocket maxs and co-pays are, plus the premium (if any) are?
To simplify, for this year, I know I'm going get a standard yearly check up, will have a colonoscopy, may have cataracts removed and vision corrected at the same time, and may need other tests such as MRI...... so..I'm trying to take advantage of this situation and get the best priced coverage that will cover the most of what I know I'm certain to need tests and serviceswise for the coming year.
Any specific plan recommendations? So far I have info on Cigna, UHC, Humana, and Ameriprise to look at.
Thanks again.
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Last I checked, premiums are pretty low in Texas, well compared to Florida. Being in the insurance industry, I’ll assume you are semi successful and not broke. I don’t know how you would not choose a med supp.
Check out Plan N, it’s what I would choose. Or maybe even Hi F.
Btw if you are a non smoker in the Dallas area you can get a Plan N from Aetna for $95. Done and done. I wish we had it that cheap.
Check out Plan N, it’s what I would choose. Or maybe even Hi F.
Btw if you are a non smoker in the Dallas area you can get a Plan N from Aetna for $95. Done and done. I wish we had it that cheap.
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- #17
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My approach is to have an HDF and also a savings account which I call something like my emergency medical fund. I increase it each month by something like the premium difference between an HDF and a Plan G. In 2020, If my health permits a plan change I will evaluate HDG options. Keep in mind that you will need to choose a PDP option too (if you wish to avoid penalties later for not having creditable drug coverage since you turned 65).
Love this comment and it's why I like working with HNW clients. $200/Mo and everything is covered and I can go anywhere?? I thing Medicare was hard....
You never said if you were Male or Female, Tobacco or non-tobacco. I'm going to assume non-tobacco. Here are both Male and Female rates for Plan F and Plan G. I would suggest Plan G over F.
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