Medicare Advantage vs Medigap Coverage

[Laurian]

I'm 66 and my husband is 71 and we are in the market for Medicare add on insurance for the first time because my husband's company is moving retirees off their group health plans. The company is giving us an annual allowance for the purchase of this coverage. They are probably pushing the old folks out so they can get better rates for their group plans. Inconvenient for us, but I can't complain since we've basically had free health insurance coverage for 40 years.....a luxury now that was once a common employment benefit.

I have no real health issues (yet) and take no prescriptions so I feel a Medicare Advantage policy will be fine for me at this time.

My husband, however, has COPD which requires careful monitoring and treatment. He has also started having memory problems and difficulty grasping details, so this decision is pretty much left to me. I'm thinking he should have the more expansive Medigap coverage which will allow him to keep his current doctors and afford better coverage overall. He would also need an add on prescription drug plan with the Medigap coverage but would benefit from that since it would cover more of his numerous prescriptions.

Has anyone here made the choice between Medicare Advantage and Medigap? Any advice?

[GeorgeGist]

1. Switching in the future can be difficult and expensive.

When you leave an Advantage plan to return to Medicare with a Medigap plan, you do have to qualify medically by answering health questions in most states. So it is crucial to have an understanding of whether you would “qualify” before pursuing this change. Different companies screen for different pre-existing conditions, so the health questions vary from company to company and state to state.

[Laurian]

2. Thanks! The people contracted to lead us through this transition

did tell us that because we are coming off a group plan, we could go to Medigap with no personal medical review this time only and that this would be the time we could get the best rates. Makes we wonder if maybe we should both go with a Medigap plan. Although I have no medical issues now, I can't expect that to continue indefinitely.

Much to ponder.

[napi21]

8. GREAT that you pointed that out! We started out with an advantage plan, but

2 years ago, one of my docs what having difficulty getting paid by the co. we had, and after fighting with them for a year, he finally quit accepting their insurance. It was Oct. so I paid the full bill and just change to a supplement in Dec. Well, I didn't know that everyone was eligible for the supplement when they first enroll but if you enroll in an advantage plan, you have to go through underwriting. I I have 2 medical problems. 1. severe back pain which i take tramadol for the pain, & 1. Neuropathy in my legs & feet that gives me balance problems so I use a wheelchair (NO MEDS!). I had a terrible time getting any supplement ins. Thanks to a medicare supplement ins. specialist, he found United Health Care through AARP didn't ask about wheelchair use.

I don't know WHO put that underwriter requirement in almost all plans, but IMO, it's BS! At the very LEAST, that info should be made prominently available to ALL new Medicare applicants.

Because of my experience, I would recommend that you go with a supplement from the getgo.

[JayhawkSD]

3. "health care reform" attempted to do away with Medicare Advantage

It was retained because Florida legislators would not sign on to the legislation if MA was cancelled, but the government wants to cancel it and will probably do so at some point. What impact that will have and how it will be done, I have no idea, but...

[Laurian]

4. Thanks for the input, I wasn't aware of that.

Last edited Fri Nov 7, 2014, 03:56 PM - Edit history (1)

Another factor to consider. Maybe we should both sign up for a Medigap plan to avoid another upheaval should the Advantage option be eliminated. Change can be hard.

[SheilaT]

5. My advice is going to be to look very carefully

at exactly what is offered in either type of plan available to you.

I have an Advantage Plan and I'm immensely pleased with how it is working for me.

I found this site on line that has a nice chart giving the differences between an Advantage Plan and Medigap. http://www.ehealthmedicare.com/about-medicare/compare-medicare-advantage-and-supplement/

[blackcrowflies]

6. I'm late

I have Medicare + AARP Medigap Plan F + AARP Plan D. Unlike Medicare Advantage, there are no networks to worry about and I don't need pre-approval for imaging tests. Plan F has no copays, no deductibles. This is kind of the cadillac what me worry? set of plans. I was in the hospital a couple of years ago and it cost me $0.

[Laurian]

7. Thanks....we ended up choosing very similar coverage.

Although I have no health issues (currently), my husband does and we chose Medigap plans so as not to have to change doctors. We can always drop back to Advantage plans if finances dictate it, but I understand it may be difficult and more expensive to switch from Advantage to Medigap.

Whew! I'm glad that chore is done for the upcoming year. I wish they'd have mercy on us old folks and streamline/simplify this process.

[leftyladyfrommo]

9. My friend's Medical is a lot more expensive.

She told me it just went up to $260 a month.

But when she has surgery or is sick she never pays anything.

And I think with the Advantage plans you pretty7th have to stay in network or it costs you.