Not old enough quite yet but was wondering if Clark said he doesn’t like Medicare Advantage Plans ? Was wondering why ? If so what is a better alternative ?
I had Kaiser most of my working life and now have it in an advantage plan and it seems to be fine for me. Still very easy to use.
Original Medicare plus a supplement is generally a far better choice than an advantage plan. With original Medicare, you can see pretty much any doctor; with an advantage plan, provider choices are limited. With an advantage plan, more pre-approval are needed…everything from seeing a specialist to physician recommended tests and procedures. Sure, they provide low cost extras; but when it comes to actual medical coverage? Jump through hoops or be denied.
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Advantage is like a restaurant where they fill you up on bread and salad… gym memberships, routine dental, eyeglasses, that’s all low cost.
Chemotherapy? Denied.
Heart surgery? Denied.
Mental health services? Denied.
The better, new drug that your doctor wants for you? Denied, you have to use the old generic
Your doctor not in-network this year any longer? Too bad. Find a new doctor.
All the hospitals in your city not taking Advantage this year any longer? Too bad. Drive two hours for care.
Oh, co-pays and deductibles.
It runs like that.
Health insurance companies get paid per capita, by Medicare… then they dole out the very least amount of care possible. So they are ripping off the USA.
And Dr. Oz owns $500,000 of health insurer stock, and has advocated in the past putting EVERYONE IN THE USA into “Medicare Advantage for All”.
This is why I have nightmares. If my wife can’t get to high-end cancer care when she’s on Medicare in 2026, she dies prematurely. Her illness is that bad. It needs cutting-edge therapy, the clinicians are magicians at MD Anderson Cancer Center. Three years ago she was expected to live three years. Now she’s in remission, but it’s fragile. It requires the best care.
Once you are in Advantage, you can leave… but you need underwriting to get a Medicare Supplemental policy, and if you try to go without a Supplemental Policy, it gets really tough. You owe an open-ended 20% copay. So $1,000,000 in cancer care? You own $200,000 without Supplemental. Oh, we blew past $1,000,000 long ago. We’ve lapped that figure.
Basically, all of the US healthcare including Medicare is a hodge-podge kluge which functions terribly for patients and doctors.
I think it’s possible for Advantage to function well, though - if you live in a major city with lots of high-quality in-network providers, and you don’t have expectations to be able to get the very best, most high-end care, just “standard or average” care then yeah, maybe its OK.
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For those who have not “got it” yet, go back up two posts. I second what Silkies and ochotona had to say. Let it sink in just WHY it is big biz peddling so-called “advantage” plans that are not Medicare at all. Bait you with cheap “free” bennies and then if you really get to be in need, deny, deny deny! Not only that but for most procedures you have TWO gate keepers: The insurance company (by their PCP) and Medicare itself. Generally there is not coverage if Medicare does not cover.
By contrast, the straight Medicare may very well cost you more, especially if you buy a supplement which I think is a good idea. After watching EOBs for a couple of years, I wonder why I am paying out a couple hundred for Plan G and they are paying out $20 or $30… The answer is that you are paying for catastrophic coverage if and when you need it.
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If Medicare won’t cover something, then neither will the supplement.
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I initially liked Kaiser Medicare Advantage because it was one stop shopping to go to their clinic for routine checkups or minor issues and get sent to one of its hospitals for more advanced testing. I had and have no serious or continuing medical problems. Then Kaiser dropped everyone in my county which is nearly adjacent to Denver.
I had to shop around for an alternative and at nearly the same time, I had started doing more traveling around the US and internationally. I got a Cigna Medicare Supplement Plan F (no longer offered I believe) which has a high deductible but well covers my routine care and also provides some international emergency benefits which Advantage or Primary Medicare don’t. I believe Plan G may be somewhat similar.
Well over a year later, Kaiser decided to reinstate coverage for my county, but I laughed and ignored their offer.
So, for basic care for someone who isn’t going to move away or travel a lot, I thought the Kaiser Advantage plan was fine. But my circumstances changed, and Kaiser’s decision to terminate my coverage area wound up being a blessing in disguise. I believe if Kaiser hadn’t dropped my area, it would have been very difficult for me to change plans as I would have had to pass medical underwriting.
Daniel
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My alternative to a supplement is Tricare For Life. There are a few things that Tricare covers that Medicare does not. But the list is short.
Boy! Where in the news have we heard that recently?!
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FYI, The four states that prevent Medigap underwriting for Medicare Advantage patients trying to switch back to traditional Medicare are: Connecticut, Maine, Massachusetts, and New York.
I have posed the idea elsewhere that if you get into a jam trying to get a Medigap policy due to underwriting, you possibly could temporarily relocate to one of those four freer States (couch surf with a friend or relative long enough to get a driver’s license, register to vote, etc) get your Medigap, then go home. Untested, but may be worth considering.
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Short story, Clark doesn’t recommend them.
Seems like advantage plans are a bit of a scam? All they do is give a private insurer with high overhead/profit motive a cut of the money. Sure, Some people are happy with Medicare advantage. But others are not because the middle man/private insurer denied their. My guess is the people happy with there Medicare advantage plan are the people that haven’t had their car denied yet.
Doesn’t seem like the advantage plan provides an advantage to them customer. Rather, advantage goes to the insurer. Until, the private insurance can provide a consistently better product than government funded Medicare. I’d stay aware from the private Medicare advantage.
Retirees who are in early years of retirement and who are healthier are happy with Advantage. Those approaching The End and who are seriously sick with cancer, organ failure, whatever it may be, are unhappy with Advantage.
So you have to ask yourself… which group do you want to be in?
1 ADVANTAGE - healthy
2 ADVANTAGE - sick
3 Original Medicare - healthy
4 Original Medicare - sick
OHHH but here’s the trick… groups 1 and 3 don’t last! Everyone gets sick!
Since you can’t get back into Medigap easily or at all, it’s like the insurers have gamed your psychology… they are playing on the fact that you are anchoring on your age 65 health (which may be good) and you are doing the behavioral financial thing of Recency Bias… assuming that recent states will persist.
Go ask 85 year olds if they are in good health. Some are. Then ask 90 year olds. Etc.
Exactly the same as “the S&P 500 went up 20+ % the past couple of years, so I can count on it outperforming like that into the future… I’ll be a HODLER of VOO and/or BTC for the next 20 years… then retire to an island at age 45!” Yeah buttercup, just wait for the next 50% drawdown then we see if you have The Iron Hands.
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Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many “closed block of business / closed risk pool” (deadpool) policies the company has.
This is done because the current book of business have people who have become older and therefore have more illnesses meaning more claims (higher loss ratio). Insurance companies close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.
In most states you will be unable to change supplement insurance companies without medical underwriting. A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.
Thank you all for the info.
The health care system in this country is a disgrace. (all facets)
How much is a medi gap plan for a male age 65 ? (I’m not yet).
Does it go up every year based on age ?
My mom’s Medigap is $295.25 per month. AARP-branded UnitedHealthcare (gulp) Medigap. It’s not dependent on age or gender or pre-existing conditions SO LONG AS YOU DON’T MISS THE INITIAL ENROLLMENT PERIOD!!!
Initial enrollment begins three months before your 65th birth month. It ends three months after your birth month.
I turn 65 in May of 202X. Therefore, I can sign up on February 1, 202X. I will be doing so on that day!
If I were to wait until after August 202X, I would be in a world of hurt. Medical underwriting questions for the Medigap, and lifelong Medicare Park B and Part D penalties!
It does go up every year. I don’t know the basis of the inflation factor, but I don’t think it’s based on the individual.
Does your mom’s payment include the 185.00 part B premium ? Or is her total 480.25 total for the two ?
With a medigap policy is there any additional out of pocket costs ? I would think (hope) that there wouldn’t be with almost 6K a year in premiums.
I have a bit of time, all so overwhelming.
Yes, the total is 480.25 for the two.
There is a SMALL annual Part B deductible. Beyond that, nothing.
Don’t forget to sign up for Part A (Medical hospitalization). There is no contribution required by the retiree. That’s the one whose trust fund is going to run out of money relatively soon. Part A has its own set of deductibles and rather complex rules surrounding those.
Part D, Prescription drug plan… you can shop for one based on the meds you take, and therefore minimize the cost that way. I’m going to take a different route. My meds are all generic, I’m going to pay cash to Mark Cuban Cost Plus Drugs, forgo Medicare, and buy a cheap Part D plan and use it for catastrophic purposes only. If it’s a bad fit after a year, I will look for a different one during Open Enrollment.
I"m 67 and have been on an advantage plan. My carrier BCBS of Kansas City, stopped offering them so I could change to a supplement without underwriting if I want. But I went to a Humana plan. I don’t travel a lot but they have something like 90,000 doctors in my plan.
I have lived with the “denial” system all my work life so that would be nothing new. I am at peace that if I get a serious condition, I will use what I have here. I know with a Supplement I could go to MD Anderson or teh Mayo Clinic, and they might not accept mine, but the last thing I think I’d want to do if I’m sick is travel. I’m relatively healthy, but I several of the people in my cycling group are in their late 70’s and 80’s and have Advantage plans, and all seem to like them.