The Medicare Thread

[Nobody Famous]

I never thought I'd see a bunch of geezers talking about Medicare on TGR. sad so so sad

And I never thought I'd be at an age where I should pay attention to this subject, but I am.

[bigdude2468]

One day you may place more priority on hospitalization and less on 300 in frames or contacts. Nothing wrong with an advantage plan. Just realize it’s not actual medicare and you don’t have a supplement. Your original benefits are suspended while you’re in the plan. You can return to Original medicare the 1st of any yr. You most likely will have to answer health questions for a supplement though.

Look, I’m not trying to scare anyone out of medicare advantage. I get paid a lot to sell them, I don’t fight it anymore. I just want people to understand it’s different.

I sold a mapd yesterday, today the woman called back and switched to a supplement after her sister scared her. Whatever. The point is to find what fits.

I may join an advantage plan myself. But I have to be direct because one of you grouchy fucks may have cancer and how the fuck will I know that?

When my moms aorta blew I switched her due to a loop hole while moving without health questions, to a supplement and I don’t worry about shit anymore. Never seen a bill, never have to worry about what fucking doctor or hospital she goes too. Worth every penny.

Maybe I am missing something, what are the shortcomings of an Advantage plan?

The two advantage plans I have had I (or my wife) never had to answer a health care question. There is no annual maximum amount the plan will pay. In four years with the current plan we have never had a denied claim nor has Aetna ever not paid the provider promptly. The statements I receive are quite simple, It shows the amount they paid, they amount they disallowed for being more than the Medicare reimbursement amount and what if anything I owe. Then in big letters it says "do not pay any amount beyond what is shown as your portion".

[up an down]

Maybe I am missing something, what are the shortcomings of an Advantage plan?

The two advantage plans I have had I (or my wife) never had to answer a health care question. There is no annual maximum amount the plan will pay. In four years with the current plan we have never had a denied claim nor has Aetna ever not paid the provider promptly. The statements I receive are quite simple, It shows the amount they paid, they amount they disallowed for being more than the Medicare reimbursement amount and what if anything I owe. Then in big letters it says "do not pay any amount beyond what is shown as your portion".

+1.. I am very happy with my advantage plan

[Cono Este]

Maybe I am missing something, what are the shortcomings of an Advantage plan?

The two advantage plans I have had I (or my wife) never had to answer a health care question. There is no annual maximum amount the plan will pay. In four years with the current plan we have never had a denied claim nor has Aetna ever not paid the provider promptly. The statements I receive are quite simple, It shows the amount they paid, they amount they disallowed for being more than the Medicare reimbursement amount and what if anything I owe. Then in big letters it says "do not pay any amount beyond what is shown as your portion".

It’s simple. On an advantage plan the bills go to an insurance company. If you like insurance companies then you have nothing to worry about. You’ve “replaced”medicare with the benefits in your plan. Your medicare card wont work anymore. Your benefits are suspended. On original medicare the bill goes to medicare. From my experience, that is a very, very big deal to some, and not so much to others, then about 50% don’t even get the explanation. They call Broadway Joe on TV. Such a nice man.

To most, they don’t care, but too some, they’ll get so mad they’ll talk lawsuits for not getting told.

I’ve been on 2000 appointments. A lot of people joined advantage plans 10 yrs ago that were advertised as “free supplements”. They are not. I get called to the house to explain shit and they get steaming mad. They paid for a supplement for 10 yrs for nothing, can’t get it back, and now they are at an age where the free plan is no longer free, they’re generating copays, and not using the gym.

No wrong answer here, both good insurance, but for 1-25, a very big difference.

Remember, I go into homes where people are on oxygen, dialysis etc, and there is no advantage to advantage for those people. I walked out on a guy whose wife had liver cancer and demanded an Mapd.

[Bunion 2020]

It’s simple. On an advantage plan the bills go to an insurance company. If you like insurance companies then you have nothing to worry about.

Very simply put and understandable.

Thx.

[4matic]

UNH has part G that includes the extra fringes like renew active (gym) etc. so those perks are not exclusive to advantage. I called UNH to make sure.

[bigdude2468]

Very simply put and understandable.

Thx.

Except your supplement plan is also an insurance company. For the five years I have been in Aetna's MAP including the year when I had $200,000 of claims the dental benefit which I have used every year has exceeded my total out of pocket for that year. Maybe other advantage plans have issues but i have not. I have received statements indicating a provider has not submitted the necessary documentation or perhaps a coding error but in those cases the providers have never sent me a bill requesting payment. In fact I never get a bill from a provider until they have been reimbursed by Aetna. If there is a copay due they bill me after Aetna has paid their portion.

[Cono Este]

Except your supplement plan is also an insurance company. For the five years I have been in Aetna's MAP including the year when I had $200,000 of claims the dental benefit which I have used every year has exceeded my total out of pocket for that year. Maybe other advantage plans have issues but i have not. I have received statements indicating a provider has not submitted the necessary documentation or perhaps a coding error but in those cases the providers have never sent me a bill requesting payment. In fact I never get a bill from a provider until they have been reimbursed by Aetna. If there is a copay due they bill me after Aetna has paid their portion.

I sell those plans, nothing wrong with them.

It’s a personal choice, but people deserve to know the differences because if you have pre existing conditions, you often only get one chance to buy a supplement with no health questions.

[Bunion 2020]

Random question. Went in today to get Covid & Flu shots. When I registered online I was asked if I wanted any "free" Covid tests. WTF says I, yeah, I will take 4. Get to the pharm and they give me 8. Now I know they sell these same tests at the counter for like 12 bucks, so did someone (yeah them) pay for those or is this paid for by the first second or third Covid relief bills. Or in other words, we all did.

[4matic]

I have a derm that I really like. With advantage HMO I will have to get a referral every time I go for a routine visit. With PPO I can go whenever I want. It’s a minor inconvenience but I’m not sure it’s worth the risk. -$1k a year more for top of the line PPO. Less for a higher deductible.

[Cono Este]

UNH has part G that includes the extra fringes like renew active (gym) etc. so those perks are not exclusive to advantage. I called UNH to make sure.

Yes, it makes it a slam dunk in my area. You can probably go cheaper than a plan G if anyone is being a tight wad.

[Cono Este]

I have a derm that I really like. With advantage HMO I will have to get a referral every time I go for a routine visit. With PPO I can go whenever I want. It’s a minor inconvenience but I’m not sure it’s worth the risk. -$1k a year more for top of the line PPO. Less for a higher deductible.

Plans vary by territory, but the PPO are what’s getting better. They used to all have a monthly premium and higher out of pocket, now they are 0 premium, with slightly higher out of pockets. Some still have a $500 deductible on hospital and some other things.

I tell the people who want maximum value to still go with the hmo. The ppo often has that deductible plus you don’t get some things like the quarterly credit to buy shit with.

Minor minor differences though 90% of picking a plan is original medicare vs advantage decision.

[Hopeless Sinner]

I ended up w a Medigap plan , Plan G. Still don't completely understand the differences btwn MAdv and MGap but I "think" I did the right thing.

[Cono Este]

I ended up w a Medigap plan , Plan G. Still don't completely understand the differences btwn MAdv and MGap but I "think" I did the right thing.

A client once told be that sounded like the “conservative” choice. And it is, because in most cases, you won’t get another chance to do that without answering health questions, and Medicare Advantage takes everyone. So what’s the hurry?

However, if you feel you understand what the differences are , and know you really don’t want to pay for a supplement, or may cancel it if it goes up, (and it will), then advantage plans have a lot of free shit. And who doesn’t like free shit.

[Bunion 2020]

I ended up w a Medigap plan , Plan G. Still don't completely understand the differences btwn MAdv and MGap but I "think" I did the right thing.

After working my head around this from 7 different direction I am of the opinion its all about guessing how healthy you are when Medicare kicks in or if you need a bunch of care in the near term.

[whipski]

Basic Medicare and United Health via AARP has been my approach. Prepay the deductible of around $225/yr and haven't had any bills. Be sure to get the most out of your free annual visit to your PCP with all the screenings and vaccinations. If your doc is a hottie like mine you might enjoy the prostrate screening : )

[fomofo]

A few things which might be of interest...

Which to Choose: Medicare or Medicare Advantage?
11/20/22 NYT article - Try browser reader view if you get paywalled

Medicare Agents and Brokers

Agent Commissions in Medicare and the Impact on Beneficiary Choice


New versions published every year - check your public library

[Cono Este]

A few things which might be of interest...

Which to Choose: Medicare or Medicare Advantage?
11/20/22 NYT article - Try browser reader view if you get paywalled

Medicare Agents and Brokers

Agent Commissions in Medicare and the Impact on Beneficiary Choice


New versions published every year - check your public library

That’s very accurate, but I missed where they point out that medicare advantage pays more, and pays for life. Vs a supplement that pays less and for only 6 yrs. The difference is 2-3x the commission and that’s why everyone and their mother wants you to join an advantage plan.

[fomofo]

Cono, your posts in this thread are very high value, and worth re-reading for anyone who's trying to sort this shit out. Particularly #38 and #50. Huge bonus to have someone on the inside weighing in!

For someone who wanted to find a broker to work with, what would be the best way to do that? I've had some friends recommend an agent that signed them up for this or that MA plan, but I'd like to focus on traditional medicare coverage options with a supplement first.

[Cono Este]

Cono, your posts in this thread are very high value, and worth re-reading for anyone who's trying to sort this shit out. Particularly #38 and #50. Huge bonus to have someone on the inside weighing in!

For someone who wanted to find a broker to work with, what would be the best way to do that? I've had some friends recommend an agent that signed them up for this or that MA plan, but I'd like to focus on traditional medicare coverage options with a supplement first.

A good independent agent will spend 90% of his time with you explaining both options. Original medicare vs medicare advantage. They will look up your drugs in ALL plans in case something stands out.

I don’t trust other agents etc. If you want to do that yourself pm me your zip code and I’ll tell you who the best deal is on supplements where you live. If you pm me your drugs I’ll tell you which drug plan to join. Takes me 5 minutes.

[Cono Este]

On a side note. Be careful calling medicare. They are trying to funnel business to themselves but often give bad advice. They are un licensed and don’t know what they are talking about.

I have a woman right now who was told by medicare she had a united healthcare supplement, but after I looked into it she does not. Now she’s paying 20% for chemo thanks to that govt twit.

The one thing about advantage plans. And I have nothing against them, is that you give up your right to a guarenteed supplement. That’s very important to understand. In most circumstances, if you have health issues, you will be stuck in the advantage plan for life.

So it pays to know the rules. Etc. start with a supp you can always switch to advance. But not the other way around.

[Bunion 2020]

The one thing about advantage plans. And I have nothing against them, is that you give up your right to a guaranteed supplement. That’s very important to understand. In most circumstances, if you have health issues, you will be stuck in the advantage plan for life.

Again, thanks for answering these very confusing questions in a way most of us can understand.

[mcski]

On a side note. Be careful calling medicare. They are trying to funnel business to themselves but often give bad advice. They are un licensed and don’t know what they are talking about.

I have a woman right now who was told by medicare she had a united healthcare supplement, but after I looked into it she does not. Now she’s paying 20% for chemo thanks to that govt twit.

The one thing about advantage plans. And I have nothing against them, is that you give up your right to a guarenteed supplement. That’s very important to understand. In most circumstances, if you have health issues, you will be stuck in the advantage plan for life.

So it pays to know the rules. Etc. start with a supp you can always switch to advance. But not the other way around.

Thanks for mentioning the part about supplement vs advantage. The advantage plans seemed to cover pretty well from what i saw helping my buddies podiatry practice, but getting locked in is significant. There should be some legislation to remove that

Don’t get locked into an advantage plan unless you are totally sure it works for you long term!

There seems to be an explosion of the number of supplement options in the last few years that has added s ton of confusion as well

[Cono Este]

The problem is that medicare doesn’t spend billions on tv marketing. Advantage plans also look familiar to people coming off group coverage. Dental etc. original medicare is truly unique in that it cuts out the middleman.

I talked to a guy today, had a supplement through me for about 5 yrs,l. He called telling me his girl friend gets a free gym membership on her advantage plan and wtf. I was more than happy to put an advantage plan In the mail to shut the guy up. He can blame his GF. . I get tired of that shit. Worth probably $2500 to me vs like 50 bucks a yr now on the supp.

Then he mentioned his cancer. Cancer treatments, and I told
Him the usual shit and he went from being interested to telling me “no” like i was trying to sell him. He doesn’t want to lose his supplement and never get back again.

I’m a very bad sales guy.

[fomofo]

Don’t get locked into an advantage plan unless you are totally sure it works for you long term!

Who can know how long the "long term" will last, or what it will bring, or when? You don't buy fire insurance for your house because there's a fire coming up the valley. All the little up front bells and whistles, (and some dental would be a nice B&W), provided by MA are great, but isn't catastrophic coverage what most people are concerned about? (Or should be?)

I’m a very bad sales guy.

Maybe you're just an "honest" broker. ;-)

As a friend of mine used to say...

You'll get your reward. In heaven.