Medicare with Medigap or Medicare Advantage?

[alarmguy]

I already gave examples in my earlier post of the type of catastrophic event that could lead to an Advantage denial. I'll link one again here:



Note that were talking about extended care in a skilled nursing facility after a hospital stay, not long-term care. You are correct that neither Medicare nor Medicare Advantage provide long-term coverage, but they both do provide extended care in a skilled nursing facility.

Or, at least, original Medicare does. Advantage is supposed to but is notorious for drastically shortening or outright denying this sort of care, and the linked video provides an example of this. You should watch it.

I'm well aware of how Medicare costs increase, I carefully collected data for the MOOP used in my analysis, and I used a well-researched average Advantage plan cost for me in my zip code. And, as you can see (if you did read my analysis), I did conclude that Advantage does usually come out cheaper that original Medicare.

But, as you can see in the chart I created, you are focused on cost savings in the lower part of the curve. Those savings are real. However, my focus is on getting insurance that covers what I need when I need it when I get to the point where my health needs are in the shaded part of the curve:

View attachment 218012


Note that your confidence that you can afford to pay the deductible for such an event doesn't work if you are denied coverage in the way described in the linked video. Once you are denied, there is no deductible-- you're on the hook for all of it.

And, if you don't think Advantage is good at denying claims in the shaded part of the curve, watch this video as to the ways they can do it:



So, again, if you keep telling us how great things are for you right now, you're missing the point. I already agree with that, and I would say that you're undeniably correct.

Instead, you should tell us how you have concluded that your Advantage plan will cover you when you are in the shaded part of the curve-- like a catastrophic health event that would require a month of extended care in a skilled nursing facility 20 years from now (as described in the video).

If you have information on that, I would be very interested!

I already gave examples in my earlier post of the type of catastrophic event that could lead to an Advantage denial. I'll link one again here:



Note that were talking about extended care in a skilled nursing facility after a hospital stay, not long-term care. You are correct that neither Medicare nor Medicare Advantage provide long-term coverage, but they both do provide extended care in a skilled nursing facility.

Or, at least, original Medicare does. Advantage is supposed to but is notorious for drastically shortening or outright denying this sort of care, and the linked video provides an example of this. You should watch it.

I'm well aware of how Medicare costs increase, I carefully collected data for the MOOP used in my analysis, and I used a well-researched average Advantage plan cost for me in my zip code. And, as you can see (if you did read my analysis), I did conclude that Advantage does usually come out cheaper that original Medicare.

But, as you can see in the chart I created, you are focused on cost savings in the lower part of the curve. Those savings are real. However, my focus is on getting insurance that covers what I need when I need it when I get to the point where my health needs are in the shaded part of the curve:

View attachment 218012


Note that your confidence that you can afford to pay the deductible for such an event doesn't work if you are denied coverage in the way described in the linked video. Once you are denied, there is no deductible-- you're on the hook for all of it.

And, if you don't think Advantage is good at denying claims in the shaded part of the curve, watch this video as to the ways they can do it:



So, again, if you keep telling us how great things are for you right now, you're missing the point. I already agree with that, and I would say that you're undeniably correct.

Instead, you should tell us how you have concluded that your Advantage plan will cover you when you are in the shaded part of the curve-- like a catastrophic health event that would require a month of extended care in a skilled nursing facility 20 years from now (as described in the video).

If you have information on that, I would be very interested!

Hey, lets be clear, your starting to sound like you are unhappy that I am happy with my plan. Pick your poison. My advantage plan works like any corporate health insurance. Anyone that wants to pay more, that is fine with me but watching YouTubers and other sensationalism is not my thing. My health insurance is almost free of charge minus $4,500 in any year that I get close to $500,000 in medical bills, works for me, in the greatest health network country in the world.
You're making assumptions on dramatic videos.... and that is ok, the less people that sign up for them the better the rates... right now 51% or Americans choose Advantage C... and I hope Congress doesnt ruin it, like they did the federal deficit. *LOL*

From your videos, in forums, even in here, even you and me, we try to impress a point but leave out information. I guess it's natural, look at this chart from your video.

Since this is a YouTuber against Advantage plans, let's see how honest this chart is.
1. No network, true assuming they take medicare - Medicare Advantage he uses the word "Restrictive Network" and what does that mean to someone???? Restrictive? REALLY? My plan is accepted by any medical group and hospital in my my two state area that I live including Duke and I can tell you right now, Aetna is generally a national health insurance company just like UHC.
So is=f I am across the USA someplace and in an emergency I WILL be covered until I can be transferred elsewhere IF and only if they do not take my plan. This is NO different than health insurance provided by almost any corporation.
So got to love the words "generally restricted" its almost comical.

2. Prior Authorization for Advantage C I would yes that is correct. Same as my working career company health insurance. With that said, if medicare covers a procedure Advantage C MUST cover it too. But the chart doesnt show that because it doesnt fit his agenda.

3. "Very Low out of Pocket Costs" for Medigap, true but by the time you get to the age you are concerned about your paying hundreds more every month the rest of your life. For Advantage C you have an out of pocket that you do not pay unless you get really sick. Some I notice he shows "up to $7500. But doesnt add it can be as low as $3000
How come under Medigap he doesnt mention the hundreds of dollars a month the plan cost over Advantage C

4. "Guaranteed Renewable" what does that mean for Advantage C you can choose a different plan every year if you want. No one gets kicked out of the system.


5. Medigap says no referrals needed. Well if you want a Advantage C plan with no referrals needed then chose a plan with no referrals *LOL* I never needed a referral from my primary to see a specialist and even if someone did, your doctor isnt going to tell you no he wont *LOL* But again, for convenience I make sure I dont need referrals

Ok, I am out of here... spending to much time, but its raining outside. Choices are great, My advantage c plan works just like any corporate health insurance I had when employed but I am not saying if you one to concern yourself that choosing Medigap is wrong. I just hate misinformation and skewing of stuff like in this chart. One thing for sure, the doctors and hospitals and drug companies would LOVE for there to be no Advantage C plans, maybe this is even one of their spokespersons. Can you imagine if Advantage C plans were prohibited from negotiating prices for services? How well does that work out? You would see your Medigap costs go through the roof

Nowhere on this chart does it say if Medicare covers a procedure Advantage C plans do to. It's all bogus because the all procedures are covered. One exception is traditional medicare might cover experimental treatments and Advantage C not, no different than corporate insurance. Also note many Advantage C plans have better out of country coverage if you need treatment while traveling. Typically $250,000 to $500,000 even though some Medigap plans have been stepping it up but still have large deductibles.

For those that do not know, Medigap policies are the same private insurance companies that provide Advantage C
Hospitals and Doctors would love for Advantage C plans to go away so they could raise prices unlimited. There is a reason your company health insurance is negotiable just like Advantage C plans.

BTW- dont take this friendly discussion any other way than friendly discussion. We all pay for what we wish to spend our money on. Im good with my free health care. Dont want to spend hundreds a month on stuff I never will use or dont need.

 

[fantastic]

Both are excellent points.
Here's another one with facts..
A family member's dental doc who they have been seeing for over 5 years dropped their MA C plan because of the reimbursement rates. They have an apt. to go to another in-network provider now so it's fine but this situation is happening across the US. More & more companies are refusing to accept MA plans due to low reimbursements or non at all. Doctor or hospital dropping your MA plan right in the middle of severe care would be an awful situation. Humana reduced the OTC benefit by $25 each month. The "advantage" seems to be reduced or eliminated when profits are at stake. Now, all that being said they do intend to stick with a MA plan since it is cost effective & can't afford to be on OM with no out of pocket limits or a Medigap plan.

 

[alarmguy]

Both are excellent points.
Here's another one with facts..
A family member's dental doc who they have been seeing for over 5 years dropped their MA C plan because of the reimbursement rates. They have an apt. to go to another in-network provider now so it's fine but this situation is happening across the US. More & more companies are refusing to accept MA plans due to low reimbursements or non at all. Doctor or hospital dropping your MA plan right in the middle of severe care would be an awful situation. Humana reduced the OTC benefit by $25 each month. The "advantage" seems to be reduced or eliminated when profits are at stake. Now, all that being said they do intend to stick with a MA plan since it is cost effective & can't afford to be on OM with no out of pocket limits or a Medigap plan.

The only fact here is a family member had to move to a different plan because the dentist stopped accepting it. That is certainly possible. But at least they have dental insurance. With Medicare or Medigap you have no dental insurance.
Dental practices also at any given time can decide not to accept any given dental plan.

These type of things have happened even before advantage plans, insurance companies contract with practices all over the country. Those practices can decide whether to accept a plan and do business with them or not.

Companies are in business to make money, but you failed to point out. Medigap policies are also private insurance. So in the case of Medigap, since they have no benefits to reduce, they raise your rate..

With Humana advantage c if you find out that next year’s plan doesn’t offer as good as they previously did, you can easily switch into a plan that still would work for you. All it takes is a couple clicks of a mouse and the government handles it for you instantly.

With Humana Medigap part G you would simply have to pay a higher rate.

 

[Jim Rogers]

Hey, lets be clear, your starting to sound like you are unhappy that I am happy with my plan. Pick your poison. My advantage plan works like any corporate health insurance. Anyone that wants to pay more, that is fine with me but watching YouTubers and other sensationalism is not my thing. My health insurance is almost free of charge minus $4,500 in any year that I get close to $500,000 in medical bills, works for me, in the greatest health network country in the world.
You're making assumptions on dramatic videos.... and that is ok, the less people that sign up for them the better the rates... right now 51% or Americans choose Advantage C... and I hope Congress doesnt ruin it, like they did the federal deficit. *LOL*

From your videos, in forums, even in here, even you and me, we try to impress a point but leave out information. I guess it's natural, look at this chart from your video.

View attachment 218022
Since this is a YouTuber against Advantage plans, let's see how honest this chart is.
1. No network, true assuming they take medicare - Medicare Advantage he uses the word "Restrictive Network" and what does that mean to someone???? Restrictive? REALLY? My plan is accepted by any medical group and hospital in my my two state area that I live including Duke and I can tell you right now, Aetna is generally a national health insurance company just like UHC.
So is=f I am across the USA someplace and in an emergency I WILL be covered until I can be transferred elsewhere IF and only if they do not take my plan. This is NO different than health insurance provided by almost any corporation.
So got to love the words "generally restricted" its almost comical.

2. Prior Authorization for Advantage C I would yes that is correct. Same as my working career company health insurance. With that said, if medicare covers a procedure Advantage C MUST cover it too. But the chart doesnt show that because it doesnt fit his agenda.

3. "Very Low out of Pocket Costs" for Medigap, true but by the time you get to the age you are concerned about your paying hundreds more every month the rest of your life. For Advantage C you have an out of pocket that you do not pay unless you get really sick. Some I notice he shows "up to $7500. But doesnt add it can be as low as $3000
How come under Medigap he doesnt mention the hundreds of dollars a month the plan cost over Advantage C

4. "Guaranteed Renewable" what does that mean for Advantage C you can choose a different plan every year if you want. No one gets kicked out of the system.


5. Medigap says no referrals needed. Well if you want a Advantage C plan with no referrals needed then chose a plan with no referrals *LOL* I never needed a referral from my primary to see a specialist and even if someone did, your doctor isnt going to tell you no he wont *LOL* But again, for convenience I make sure I dont need referrals

Ok, I am out of here... spending to much time, but its raining outside. Choices are great, My advantage c plan works just like any corporate health insurance I had when employed but I am not saying if you one to concern yourself that choosing Medigap is wrong. I just hate misinformation and skewing of stuff like in this chart. One thing for sure, the doctors and hospitals and drug companies would LOVE for there to be no Advantage C plans, maybe this is even one of their spokespersons. Can you imagine if Advantage C plans were prohibited from negotiating prices for services? How well does that work out? You would see your Medigap costs go through the roof

Nowhere on this chart does it say if Medicare covers a procedure Advantage C plans do to. It's all bogus because the all procedures are covered. One exception is traditional medicare might cover experimental treatments and Advantage C not, no different than corporate insurance. Also note many Advantage C plans have better out of country coverage if you need treatment while traveling. Typically $250,000 to $500,000 even though some Medigap plans have been stepping it up but still have large deductibles.

For those that do not know, Medigap policies are the same private insurance companies that provide Advantage C
Hospitals and Doctors would love for Advantage C plans to go away so they could raise prices unlimited. There is a reason your company health insurance is negotiable just like Advantage C plans.

BTW- dont take this friendly discussion any other way than friendly discussion. We all pay for what we wish to spend our money on. Im good with my free health care. Dont want to spend hundreds a month on stuff I never will use or dont need.

Let me first assure you that your Medicare choices are very low on the list of things that affect my happiness. I can also assure you that I take all discussions as friendly and am rarely provoked into anger by any discussion. So, no problem there.

Finally, I can also assure you that I have no association with any insurance company or health provider. As I said in my first post on this thread, I knew absolutely nothing about Medicare four months ago, and anything I share here is based on what I've learned since January this year. Thus, no one here should consider anything I write to be advice on what they should do, I'm just trying to contribute what I've learned to this conversation.

As for the substance of your post, I'm afraid you wasted a lot of time writing it as you are once again missing the point. In order to avoid arguing past each other, let's try to focus:

Look carefully at this diagram:

The line represents how healthcare costs increase with healthcare need (which is usually related to age).

Do you see the shaded area under the highest end of the curve? That is the area that shows how the costs get very high as the healthcare needs get more uncommon and more expensive.

Do you see how that area is labeled "Advantage Denials? It's labeled that way because when a healthcare need is more uncommon and/or more expensive, Advantage plans tend to deny claims. I'm not making that up-- it's a well-documented problem (more on that below).

Do you see the unshaded area under the lower part of the curve? That is the area that shows how the costs are relatively low for healthcare needs that are common and inexpensive.

Do you see that this area is not labeled as an "Advantage Denials" area? That's because Advantage plans generally pay in this area without problems.

If you have all that down, then you should be able to understand that the whole point of everything I've written here on Medicare is based on the hypothesis that there is not one Medicare analysis to be made, but two-- one for the shaded area of the curve, and one for the unshaded area.

I provided a complete mathematical analysis (including both fixed and variable costs) in my first post in this thread showing that Advantage plans are far cheaper than original Medicare if your health needs are in the unshaded area, and only slightly more expensive if you are in the shaded area.

So, that means I'm not arguing anything about costs. I've conceded that you are correct on that, and Advantage plans are lower in cost.

Do you see that that means you don't have to make any more arguments about cost? That I've already agreed with you on that?

After considering cost, I then went on to explain my actual concern with the Advantage plans-- that they have a bad reputation for denying coverage for health needs in the shaded area.

I provided a video example of what I was talking about and said that I was willing to bear the higher cost of traditional Medicare in order to make sure that my healthcare needs would be covered years from now when I'm older and most of my needs are in that shaded area.

I asked you to provide us the results of your research that led you to conclude that you would have no problem with your Advantage plan years from now when your healthcare needs are more likely to be in the shaded area, as that would be a direct rebuttal to my analysis.

Instead of doing that, you dismissed my video example as "dramatic" and then provided a long analysis on the superiority of Advantage plans based on....................cost!!

So, since I wasn't making any arguments about cost, I'm afraid you wasted your time on that argument.

Yes, the video example I chose was dramatic, but two points:

1) It was not cherry-picked. These stories are very common. I could provide many more examples. What I can't find was any independent Medicare broker that says that Advantage plans are better in these types of "dramatic" situations.

2) "Dramatic" situations are exactly the ones we buy insurance for! If I argued that, despite the expense, you should buy car insurance because you could injure someone in an accident and be sued, would you say that argument was bad because I picked something "dramatic?" Those "dramatic" situations are exactly why you buy any insurance! If you knew you would have no dramatic events in your life, you could just skip buying any insurance at all.

Ok, I hope we're clear now on what we're debating. Just in case it's not, I'll repeat: We're not debating cost, we're debating dependability of coverage in those "dramatic" situations that are likely to happen as we near end of life.

With that understanding, I can even give you a way to win the debate: Can you find any independent broker that does advise that Advantage plans are generally satisfactory and therefore recommended in catastrophic health situations (such as a stroke) that require extensive hospitalization followed by extended care in a skilled nursing facility? And, if so, how do they support that claim?

(This is what I asked you for in my last post-- hopefully it is clear to you now why that should be the focus of your debate with me, as that would address the point I've been making.)

I could find no such recommendation from any independent broker, and, in fact, it was quite the opposite-- they all say that the #1 problem with Advantage plans is that they are terrible at covering exactly these situations.

So, if you can find a counterexample, it would go a long way to proving me wrong.

(And, as I hope is clear by now, providing yet another example as to how Advantage plans cost less will not help your case at all.)

 

[alarmguy]

Let me first assure you that your Medicare choices are very low on the list of things that affect my happiness. I can also assure you that I take all discussions as friendly and am rarely provoked into anger by any discussion. So, no problem there.

Finally, I can also assure you that I have no association with any insurance company or health provider. As I said in my first post on this thread, I knew absolutely nothing about Medicare four months ago, and anything I share here is based on what I've learned since January this year. Thus, no one here should consider anything I write to be advice on what they should do, I'm just trying to contribute what I've learned to this conversation.

As for the substance of your post, I'm afraid you wasted a lot of time writing it as you are once again missing the point. In order to avoid arguing past each other, let's try to focus:

Look carefully at this diagram:

View attachment 218035

The line represents how healthcare costs increase with healthcare need (which is usually related to age).

Do you see the shaded area under the highest end of the curve? That is the area that shows how the costs get very high as the healthcare needs get more uncommon and more expensive.

Do you see how that area is labeled "Advantage Denials? It's labeled that way because when a healthcare need is more uncommon and/or more expensive, Advantage plans tend to deny claims. I'm not making that up-- it's a well-documented problem (more on that below).

Do you see the unshaded area under the lower part of the curve? That is the area that shows how the costs are relatively low for healthcare needs that are common and inexpensive.

Do you see that this area is not labeled as an "Advantage Denials" area? That's because Advantage plans generally pay in this area without problems.

If you have all that down, then you should be able to understand that the whole point of everything I've written here on Medicare is based on the hypothesis that there is not one Medicare analysis to be made, but two-- one for the shaded area of the curve, and one for the unshaded area.

I provided a complete mathematical analysis (including both fixed and variable costs) in my first post in this thread showing that Advantage plans are far cheaper than original Medicare if your health needs are in the unshaded area, and only slightly more expensive if you are in the shaded area.

So, that means I'm not arguing anything about costs. I've conceded that you are correct on that, and Advantage plans are lower in cost.

Do you see that that means you don't have to make any more arguments about cost? That I've already agreed with you on that?

After considering cost, I then went on to explain my actual concern with the Advantage plans-- that they have a bad reputation for denying coverage for health needs in the shaded area.

I provided a video example of what I was talking about and said that I was willing to bear the higher cost of traditional Medicare in order to make sure that my healthcare needs would be covered years from now when I'm older and most of my needs are in that shaded area.

I asked you to provide us the results of your research that led you to conclude that you would have no problem with your Advantage plan years from now when your healthcare needs are more likely to be in the shaded area, as that would be a direct rebuttal to my analysis.

Instead of doing that, you dismissed my video example as "dramatic" and then provided a long analysis on the superiority of Advantage plans based on....................cost!!

So, since I wasn't making any arguments about cost, I'm afraid you wasted your time on that argument.

Yes, the video example I chose was dramatic, but two points:

1) It was not cherry-picked. These stories are very common. I could provide many more examples. What I can't find was any independent Medicare broker that says that Advantage plans are better in these types of "dramatic" situations.

2) "Dramatic" situations are exactly the ones we buy insurance for! If I argued that, despite the expense, you should buy car insurance because you could injure someone in an accident and be sued, would you say that argument was bad because I picked something "dramatic?" Those "dramatic" situations are exactly why you buy any insurance! If you knew you would have no dramatic events in your life, you could just skip buying any insurance at all.

Ok, I hope we're clear now on what we're debating. Just in case it's not, I'll repeat: We're not debating cost, we're debating dependability of coverage in those "dramatic" situations that are likely to happen as we near end of life.

With that understanding, I can even give you a way to win the debate: Can you find any independent broker that does advise that Advantage plans are generally satisfactory and therefore recommended in catastrophic health situations (such as a stroke) that require extensive hospitalization followed by extended care in a skilled nursing facility? And, if so, how do they support that claim?

(This is what I asked you for in my last post-- hopefully it is clear to you now why that should be the focus of your debate with me, as that would address the point I've been making.)

I could find no such recommendation from any independent broker, and, in fact, it was quite the opposite-- they all say that the #1 problem with Advantage plans is that they are terrible at covering exactly these situations.

So, if you can find a counterexample, it would go a long way to proving me wrong.

(And, as I hope is clear by now, providing yet another example as to how Advantage plans cost less will not help your case at all.)

I guess the only thing I can say is I can't discuss or debate your points because they are not based on statistics or factual matter that is documented for specific care. You're using generalizations based on thoughts, opinions and "stories" Kind of like that nice girl who got a bad reputation based on what someone said.

Anyway, I cant discuss smoke and mirrors in the sense. Tell me specific treatments denied by Advantage vs Medigap. BTW - we need proper terminology too. Medigap is not Medicare. It's private supplemental insurance.

SO I am trying to understand what you are talking about with lets say the care of an "incapacitating stroke" of Medigap VS Advantage.
Maximum care you can get is 100 days with Medigap Plan G then you are responsible for 100% of the cost.

You see, your graph is a graph but it doesnt mean it is factual comparison to Private Medigap which isnt on the graph.

It's all good, clearly you are not in the camp that is going to use an Advantage Plan but at least anyone reading the posts can look up information that may be important to them. If you can tell me what Medigap is going to cover and what Advantage Plans will not I would be able to have a conversation because both plans have to offer what Medicare requires.

SOURCE = https://www.medicare.gov/health-drug-plans/medigap/basics

PS. I did find one thing if you are concerned about long term care that you maybe talking about.
One must remember though to pick what works for you.
With Medigap G you are covered 100% for up to 100 days of skilled nursing care, then responsible for 100% of the cost after that.
With Advantage plans there are big variables depending on what you choose. Many plans only pay the first 21 days at 100% then $203 per day up to day 100. This can cost you up to $16,000 if you are concerned.
or other plans offer you to pay the first 21 days at a cost of $5000 and then no cost up to 100 days.

Choice is good if the above is a concern and nothing else.

 

[Boomer]

Wife and I both have Plan F and would NEVER want an advantage plan. Never get a bill for anything, can go ANYWHERE medicare is accepted with no problem. I believe if you choose Advantage when you are 65, you cannot later on go to Medigap Insurance.

 

[alarmguy]

Wife and I both have Plan F and would NEVER want an advantage plan. Never get a bill for anything, can go ANYWHERE medicare is accepted with no problem. I believe if you choose Advantage when you are 65, you cannot later on go to Medigap Insurance.

Partially correct, if you choose an Advantage Plan and decide within the first year you want Medigap you can switch to a Medigap Plan guaranteed. Meaning there is no underwriting and the cost is what you see.

After the first year there is no guaranteed acceptance and it goes to underwriting to see if you are accepted by any particular company and if you are that is fine. Also the rate isnt guaranteed.

and ...
there are a handful of other exceptions. Such as if your plan pulls out of the marketplace and no others available or you move to an area with no plans avalable, stuff like that and one would have to read up on it. I haven't paid much attention to it.

Choices are wonderful
Serious choices and the government website is fantastic, you can spend weeks studying it.
For those who haven't yet.

Welcome to Medicare

The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.

www.medicare.gov

 

[CKN]

I was on original Medicare. It wasn't cheap after all the supplemental insurance needed. Looked at an Advantage Plan, it had the same Doctors, Hospitals, etc., as my Original Medicare plan-but was 100's less.
I am seeing no disadvantages to these plans in my instance.

 

[Pablo]

Unfortunately, those advantages will almost certainly begin to fade...............

You seem really certain of something that goes against a written contract. Maybe you should contact some state insurance commissioners?? Just saying.

I believe if you choose Advantage when you are 65, you cannot later on go to Medigap Insurance.

Wrong. I can change, but no real need.

 

[fantastic]

Companies are in business to make money, but you failed to point out. Medigap policies are also private insurance. So in the case of Medigap, since they have no benefits to reduce, they raise your rate..

With Humana advantage c if you find out that next year’s plan doesn’t offer as good as they previously did, you can easily switch into a plan that still would work for you. All it takes is a couple clicks of a mouse and the government handles it for you instantly.

With Humana Medigap part G you would simply have to pay a higher rate.

Both are excellent points.
Here's another one with facts..
A family member's dental doc who they have been seeing for over 5 years dropped their MA C plan because of the reimbursement rates. They have an apt. to go to another in-network provider now so it's fine but this situation is happening across the US. More & more companies are refusing to accept MA plans due to low reimbursements or non at all. Doctor or hospital dropping your MA plan right in the middle of severe care would be an awful situation. Humana reduced the OTC benefit by $25 each month. The "advantage" seems to be reduced or eliminated when profits are at stake. Now, all that being said they do intend to stick with a MA plan since it is cost effective & can't afford to be on OM with no out of pocket limits or a Medigap plan.

I did & that's my point. When profits are lower than expected the "Advantage" gets reduced. Weather That's getting booted from the doctor or dentist you've been seeing, b/c they're not paying their rates via denial or severely reduced, or reduced benefits like the OTC. That's the facts I've witnessed. I've failed nothing in my post & specifically pointed out "Profits". We all understand they're for profit companies. Again, when profits are low things go on the chopping block. I've specifically pointed out towards the end some of the benefits of a MA plans so I'm the last one to not understand the pro's but I'm not going to ignore the cons either.

 

[Jim Rogers]

I guess the only thing I can say is I can't discuss or debate your points because they are not based on statistics or factual matter that is documented for specific care. You're using generalizations based on thoughts, opinions and "stories" Kind of like that nice girl who got a bad reputation based on what someone said.

Anyway, I cant discuss smoke and mirrors in the sense. Tell me specific treatments denied by Advantage vs Medigap. BTW - we need proper terminology too. Medigap is not Medicare. It's private supplemental insurance.

SO I am trying to understand what you are talking about with lets say the care of an "incapacitating stroke" of Medigap VS Advantage.
Maximum care you can get is 100 days with Medigap Plan G then you are responsible for 100% of the cost.

You see, your graph is a graph but it doesnt mean it is factual comparison to Private Medigap which isnt on the graph.

It's all good, clearly you are not in the camp that is going to use an Advantage Plan but at least anyone reading the posts can look up information that may be important to them. If you can tell me what Medigap is going to cover and what Advantage Plans will not I would be able to have a conversation because both plans have to offer what Medicare requires.


View attachment 218052

SOURCE = https://www.medicare.gov/health-drug-plans/medigap/basics

PS. I did find one thing if you are concerned about long term care that you maybe talking about.
One must remember though to pick what works for you.
With Medigap G you are covered 100% for up to 100 days of skilled nursing care, then responsible for 100% of the cost after that.
With Advantage plans there are big variables depending on what you choose. Many plans only pay the first 21 days at 100% then $203 per day up to day 100. This can cost you up to $16,000 if you are concerned.
or other plans offer you to pay the first 21 days at a cost of $5000 and then no cost up to 100 days.

Choice is good if the above is a concern and nothing else.

Yes, I'm sure you failed to produce the requested independent broker recommending Advantage plans over traditional Medicare in end of life/extended care situations because I failed to use enough "statistics and factual matter" in my arguments.

And, in your PS you present yet another cost argument, so I guess I also failed at making myself clear that that wouldn't address my particular question.

So, rather than risking a third strike by trying again, I'll just leave you with this:

I think you did a lot of homework and put a great deal of thought into your Medicare decision. But I also think that you did all that homework without the benefit of considering my "two Medicare situation" hypothesis, and instead focused on cost analysis under the assumption that no claim would be denied.

I think that's the real reason you are avoiding my claim denial argument and want to focus on cost analysis of covered claims-- because in that area you have your arguments down and are ready to debate.

The critical area of claim coverage, however, is something you clearly have not looked at (and I'm not sure you even understand), so you're writing it off as "smoke and mirrors" and trying to draw me into a cost argument between the two coverages for a specific case because that's where you really know what you're talking about.

While I believe you have worked hard, in my reading, there are several tells that belie the idea that you've applied a comprehensive analysis to your Medicare decision:

--You didn't know the difference between long-term care and extended care.

--You regularly call your plan "Advantage C" which is not a term (and makes no sense)-- Medicare Part C is Advantage, there is no such thing as an "Advantage C" program.

--You offer the fact that Advantage is structured like the corporate plans you had when you worked as evidence that you will not be denied end of life care-- a total non-sequitur.

--You believe that your Advantage rates will be lower if fewer people enroll (violating the basic premise of all insurance).

I'm not trying to come off as superior with these comments-- as I said, I'm no expert either and there's a good chance I have some things wrong in my analysis as well. If I do, I hope someone will point them out to me in no uncertain terms.

What I am suggesting, however, is that you show many signs that you should perhaps be a little more humble in your assumptions of your own understanding of these things. While you have strong understanding of Medicare in some areas, in others you are glaringly weak.

As such, you might consider taking others' points of view under advisement before dismissing them as "spewing misinformation," "leaving out information," and coming from people easily fooled by "generalizations based on thoughts, opinions and 'stories'."

Arguments such as those occasionally have their place, but I would say that in your debate with me they just confirm that you're struggling to come up with a reasoned response and are trying to use indignation to cover that fact.

In my last post I told you how to rebut my argument and win the debate. I still welcome you to respond with that, and if you are successful, I'll be the first to acknowledge it!

 

[Jim Rogers]

Wife and I both have Plan F and would NEVER want an advantage plan. Never get a bill for anything, can go ANYWHERE medicare is accepted with no problem.

That's true, but note that Plan F is now a "closed book" plan, meaning that since 2020 there are no new enrollees.

That means the pool of enrollees is getting smaller, older, and sicker, which means that rates for that plan are really going up (despite alarmguy's assertion to the contrary).

However, there's not much you can do about that as changing Medigap plans in a cost-effective way is pretty much impossible (a few states are an exception to that rule).

So, you're going to be paying a lot for that plan, but, on the flip-side, you do have a plan with zero out of pocket cost, so you'll be able to enjoy that!

I believe if you choose Advantage when you are 65, you cannot later on go to Medigap Insurance.

You can in theory, but in most states you have to go through medical underwriting to switch, and even if you're approved, you're probably going to get a very high rate in your new Medigap plan.

Some states eliminate that barrier, but then make everyone pay more for all plans.

Unfortunately, there is simply no free lunch in any healthcare payment scheme.

 

[Jim Rogers]

You seem really certain of something that goes against a written contract. Maybe you should contact some state insurance commissioners?? Just saying.

I addressed that in my first post on this thread (in the OTHER, NON-FINANCIAL ANALYSIS section). There, in part, I wrote:

As with any insurance, you can't look at just the cost-- you also have to consider what is covered. Alarmguy is correct that Advantage plans by law must cover any medically necessary plan that traditional Medicare covers.

But the words "medically necessary" are doing a lot of work here.

In traditional Medicare, if any treatment or procedure is covered and your doctor deems it to be medically necessary, the treatment or procedure will be covered. Period.

On the other hand, if you have an Advantage plan and your doctor deems a treatment or procedure to be medically necessary, the Advantage plan carrier has veto power over that decision. And the Advantage providers are not afraid to exercise that veto power as the savings that come from denying treatment that isn't truly necessary is where the providers get the funds to support that $0 premium.

You should read the whole section.

Bottom line is that, yes, there is a contract, but it has a loophole in it big enough to drive a truck through.

You don't need to consult any insurance commissioners, just listen to any independent Medicare broker. They will all advise you of this problem with Advantage plans-- especially as your healthcare needs get more expensive and you get closer to the end of your life.

 

[fantastic]

I addressed that in my first post on this thread (in the OTHER, NON-FINANCIAL ANALYSIS section). There, in part, I wrote:



You should read the whole section.

Bottom line is that, yes, there is a contract, but it has a loophole in it big enough to drive a truck through.

You don't need to consult any insurance commissioners, just listen to any independent Medicare broker. They will all advise you of this problem with Advantage plans-- especially as your healthcare needs get more expensive and you get closer to the end of your life.

And to add from what I've seen is that what Should happen w/Medicare Advantage rarely does for a certain income class billing protections. Often I've seen them argue their way around what they think they know but don't. Part C plans are suppose to protect QMB status folks & is often misunderstood by the plan staff unfortunately. I learned everything I could about how it was supposed to work & mind blown b/c it wasn't working the way it was supposed to. Just thinking out loud & don't expect anyone here to understand what I'm talking about. Just to point out that some throw out "it's a contract" & "It's supposed to cover everything Original Medicare does"...But....Reality is not the case. As you pointed out there are probably loopholes or exceptions to the rule they take advantage of and again all leads back to profits.

 

[Jim Rogers]

And to add from what I've seen is that what Should happen w/Medicare Advantage rarely does for a certain income class billing protections. Often I've seen them argue their way around what they think they know but don't. Part C plans are suppose to protect QMB status folks & is often misunderstood by the plan staff unfortunately. I learned everything I could about how it was supposed to work & mind blown b/c it wasn't working the way it was supposed to. Just thinking out loud & don't expect anyone here to understand what I'm talking about. Just to point out that some throw out "it's a contract" & "It's supposed to cover everything Original Medicare does"...But....Reality is not the case. As you pointed out there are probably loopholes or exceptions to the rule they take advantage of and again all leads back to profits.

Yeah, there's a reason why the insurance industry is the most highly regulated industry in the country. Lots of room for dispute even if all parties are acting in good faith.

But since insurance provides great opportunities for profit from bad faith, it means that the regulatory laws have to be particularly strong (and usually complicated).

Congress right now is looking into new regulations for both Medigap and Advantage programs. I'm hoping that there are improvements for both the industry and the customers before I reach enrollment age (in just a few years!).

And, honestly, I hope they can fix the Advantage problems and make it competitive on coverage (it's already a winner on price). My political philosophies lean heavily toward free market solutions, so I would really like to have a market-based Advantage plan.

Unfortunately, "market failure" is a real economic phenomenon, and healthcare is the prime example of it. That reality means that it's unlikely that there will ever be a workable market solution for old-age health coverage, and we'll have to depend on government solutions.

But my hope springs eternal that, with a little help from the right regulatory structure, the free market might come through on this!

Fingers crossed!

 

[alarmguy]

I did & that's my point. When profits are lower than expected the "Advantage" gets reduced. Weather That's getting booted from the doctor or dentist you've been seeing, b/c they're not paying their rates via denial or severely reduced, or reduced benefits like the OTC. That's the facts I've witnessed. I've failed nothing in my post & specifically pointed out "Profits". We all understand they're for profit companies. Again, when profits are low things go on the chopping block. I've specifically pointed out towards the end some of the benefits of a MA plans so I'm the last one to not understand the pro's but I'm not going to ignore the cons either.

That goes for your Medigap coverage too, they are the same companies
So I’m not sure of the point of your post.

Technically, it’s also not accurate
Dental plans all over this country negotiate contracts with dentists for services at a certain price. The doctor has the option after the contract ends to not renew it and at that time, if the dentist chooses not to renew it like any dental plan, you choose a different dentist or in many cases, you can pay the difference

It is not, and I repeat not your dental coverage, refusing to pay the dentist fees. It’s your dentist who decides not to continue to provide contract services with that company.

This is basic healthcare plan stuff. It’s not unique to advantage or your corporate health insurance.

 

[Jim Rogers]

That goes for your Medigap coverage too, they are the same companies

Wow-- I should add that one to the list of tells I posted above!

 

[alarmguy]

Yeah, there's a reason why the insurance industry is the most highly regulated industry in the country. Lots of room for dispute even if all parties are acting in good faith.

But since insurance provides great opportunities for profit from bad faith, it means that the regulatory laws have to be particularly strong (and usually complicated).

Congress right now is looking into new regulations for both Medigap and Advantage programs. I'm hoping that there are improvements for both the industry and the customers before I reach enrollment age (in just a few years!).

And, honestly, I hope they can fix the Advantage problems and make it competitive on coverage (it's already a winner on price). My political philosophies lean heavily toward free market solutions, so I would really like to have a market-based Advantage plan.

Unfortunately, "market failure" is a real economic phenomenon, and healthcare is the prime example of it. That reality means that it's unlikely that there will ever be a workable market solution for old-age health coverage, and we'll have to depend on government solutions.

But my hope springs eternal that, with a little help from the right regulatory structure, the free market might come through on this!

Fingers crossed!

Since I’m already in advantage plans, I hope Congress keeps their hands off it because anything they touch becomes more expensive.
I’m thrilled with my plan along with over 10 ++million Americans and for Congress to try to fix something when they can’t even fix a $35 trillion deficit well let’s just say I hope they keep their hands off
But to each their own!
Good conversation

 

[Jim Rogers]

Since I’m already in advantage plans, I hope Congress keeps their hands off it because anything they touch becomes more expensive.
I’m thrilled with my plan along with over 10 ++million Americans and for Congress to try to fix something when they can’t even fix a $35 trillion deficit well let’s just say I hope they keep their hands off
But to each their own!
Good conversation

You're happy now, but I keep warning you that your current happiness with Advantage in no way guarantees your future happiness with Advantage (when you're older, sicker, and costing your Advantage plan far more money).

This is exactly the part that I'm hoping (but am doubtful) that they will fix. If they do, I'll likely join the ranks of the Advantage customers.

And if you're not lucky enough to die peacefully in your sleep, you might one day be glad for reforms yourself!

I agree this is a good conversation, and we should continue it over many years to see how the arguments play out. If I'm wrong about anything, I want to know ASAP.

Debating the issue on a public forum is a great way to find any weaknesses in my understanding, so I'll definitely continue to participate in this thread over many years.

 

[alarmguy]

@Jim Rogers
Sounds good, everybody has a different opinion on insurance and I respect everybody’s opinion. It’s only disinformation or lack of better words lack of information that bothers me.

We all buy what we like, including different forms of insurance. Some people will buy a service contract on every appliance they purchase or extended warranties on cars. I’m not that kind of person.

So it’s all what we’re comfortable with.
The only difference for me in my area currently between Medigap and advantage with the same Aetna insurance company is the 100 day nursing. No plan offers more than that. Other than that, I get the same care same doctors same four major hospital networks here with any of the plans

There are areas in expensive metropolitan areas where your costs will be higher, but that will pertain to both types of plans

There are also some states such as New York where you could switch back into traditional Medigap insurance from an advantage plan at any time. So if there’s any change in laws, it can come from the federal side, but individual states can mandate that as well and for what it’s worth I have no problem with that. Since someone can freely go into an advantage plan, they should be able to freely go out of an advantage plan MAYBE as I can see the system being fleeced by people putting off expenses and then moving back into Medigap once done with those expenses, moving back into advantage.

Whether or not your state offers that option, there are a handful of them and should be easy to find on an Internet search.

Either way currently if you are unhappy with your Medigap plan, you cannot switch to another company if you are not happy with your current company without going through that other companies medical underwriting to another plan and they can deny you or not even entertain your application

With advantage if you are unhappy with your plan you could switch to any other plan or any other company without underwriting.
In fact, you don’t even have to talk to anybody a couple mouse clicks on the government Medicare website takes care of it for you with instant approval