Showcase Listing

The ultimate 55+ lifestyle you’ve always dreamed of is now available at Valencia Sound in sunny Boynton Beach, Florida. Discover the beau...

Image
Showcase Listing

Located near one of America's top college towns - Chapel Hill, NC - Fearrington Village is a planned community of nearly 2000 people, cra...

Image
Showcase Listing

Set amidst the picturesque, quintessential landscape of Lancaster County, Traditions of America is excited to introduce Traditions of Ame...

Image
Showcase Listing

Just four miles from Bethany Beach, Millville by the Sea strikes the kind of balance you might spend your whole life looking for, a new-h...

Image
Showcase Listing

Named "One of the Nation's Best Residential Communities" by the prestigious Urban Land Institute, as well as "The Best Neighborhood to Li...

Image
Showcase Listing

Traditions of America is excited to bring the 55+ Live Better lifestyle to Bethlehem with its latest community - Traditions of America at...

Image

Medicare Open Enrollment Period is Coming. Prepare Now to Choose Best Plan for You

Category: Health and Wellness Issues

September 3, 2019 — Lately we have had a mini-avalanche of comments and questions about Medicare. They are mostly to do with which is the best plan to choose – Regular Medicare, or one of the many choices under Medicare Advantage? With plans ranging from A – N, it can all be downright confusing. So, to help you prepare for the upcoming Medicare Open Enrollment period (starts October 15 and runs through December 7), we are fortunate to have a Q and A article with a real Medicare insurance expert (now available). Tom Cretella of Cretella and Belowsky will try to answer many of the questions we have seen come up on this issue. Stay tuned, it should be very helpful! (Also, see list of related articles in our Medicare series at end)

New Medicare Comparison Plan Tool Announced by Medicare.gov.

More Blog articles like this…

While we await this article you can go to https://www.medicare.gov/plan-compare and you will find a new tool to help you choose your Medicare coverage and pick a plan. That includes buying a Part D or Medicare Advantage plan.

As a review, there are 2 main ways to get your Medicare coverage—Original Medicare and Medicare Advantage.

Original Medicare includes Hospital (Part A) and Medical (Part B) insurance. If you want drug coverage, you can add a separate drug plan (Part D). You can also add a Medicare Supplement Insurance (Medigap) policy to help pay your out-of-pocket costs.

Medicare Advantage Plan is an all-in-one alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Most plans offer extra benefits— like vision, hearing, dental, and more.

Your comments and questions. Meanwhile, we are adding the Medicare comments here that were made to another post (7 Deadly Retirement Sins), because they deserve their own place. You will see that several people posted multiple times to reinforce their positions – there are many different opinions on which plan is best!

What are your Medicare and Medicare Advantage questions? Please tell us in the Comments section below and we will attempt to answer them in next week’s article. Just in time for Open Enrollment!

For further reading:

Posted by Admin on September 2nd, 2019

30 Comments »

  1. From Clyde: (we apologize to those who seen this comment and others related to Medicare twice. We moved all of them to this post so this important conversation can keep going! You will also see that several people posted multiple times to reinforce their positions – there are many different opinions on which plan is best!)
    Because medical costs can negatively affect retirement, it’s important to make sure the Medicare plan you’re on is the best one for your situation. I encourage those over 65 to consider Medicare Advantage (aka Part C) when enrolling for the upcoming year’s plan. Sometimes the terms are much better than regular Medicare. Copays can be lower, drugs are often fully covered and there is a maximum out-of-pocket amount for each year. Most Medicare Advantage plans are HMOs, but the network providers in many such plans are extensive and may cover most if not all physicians and hospitals in your area. If you are outside your network area, emergency services are covered at network costs. In areas with quite a few retirees, there are often several plans offered, due to competitive factors. A Medicare Advantage plan could save a significant amount on premiums (mine are $0 per month), and limit your overall medical and drug costs to a maximum amount of out of pocket costs per year, with no annual limit on medical fee payouts.

    by Clyde — September 2, 2019

  2. I strongly disagree with those urging others to sign in to Medicare Advantage. Why would you give up your freedom to go to ANY doctor you choose? I would urge people to buy the best Medigap supplement they can afford. We are lucky to be able to afford Plan F and, in CA, Blue Shield has this year added vision, hearing, identity theft protection and emergency response system with its Plan F Extra. When my husband had cancer two years ago, he went right to Stanford for treatment – no begging administrators for “permission” to go out of network. Don’t give up your original Medicare’s option of seeing any doctor you need or want!

    by Claudia — September 2, 2019

  3. With regard to Medicare Advantage: It is likely that if you travel a lot, your coverage may not follow you as many Advantage programs tend to only include local providers.

    by Lynn — September 2, 2019

  4. My wife and I have always carried Medicare Supplements, Plan F. No copays, no deductibles. And we choose where we go for any medical service. Unless we absolutely had to, I would not choose a Medicare ‘Advantage’ Plan ( the Advantage accrues to the insurance company, not the subscriber).

    by Thom — September 2, 2019

  5. I am divorced, work part-time and had to take SS early due to a job elimination. At 64 it is hard to find a full-time job with benefits. My part-time job is three days a week and offers no benefits. I still have to pay for insurance. Medicare starts Sept 1 and I opted for the Part N Medi-gap insurance supplement. I could have taken part F but it will have much higher premiums in the future as will part G with guaranteed issue. Part N offers much the same benefits as part G with a few variances that I can handle for the lower premiums. I have to pay for these things and watch my income at the same time to stay below the SS limit as my FRA is in 2020. It has been difficult, but fortunately with the SS, I will make it.

    by Jennifer — September 2, 2019

  6. I disagree with those who are panning Medicare Advantage Plans. Of course the advantage accrues to the insurance company. That is the case in ALL insurance plans. I have an advantage plan for which I pay no premium. I can go to any doctor I want to and do not need referrals. Do your homework. Do not take others’ word for it.

    by Linda — September 2, 2019

  7. I want to point out something regarding my previous post about Medicare
    Advantage (MA). One commenter mentioned that there were some of us who were “urging others to sign in to Medicare Advantage.” That is not the case. In my post I used the words “encourage you to consider” MA. I was simply offering that readers look at all options regarding Medicare insurance plans. A major benefit of MA is that there is a maximum out of pocket (MOOP) ceiling on annual medical and drug costs for the insured. There is no MOOP on Original or Medigap policies. My annual MOOP is $3400 for the year. If I have paid that much, then I will pay no more medical/drug costs and there is no maximum limit after that. When so many retirees 65 and over complain about the exorbitant and ever-growing costs of medical and health care ruins no their retirement plans, it is good to know that Medicare Advantage limits the amount you might pay out of pocket each year. And my network has hundreds of excellent physicians; my primary care physician is a summa cum laude graduate of Princeton and then Columbia University Medical School, with a residency at Yale University Hospital. She’s been practicing about 20 years. My hospital network includes the University of Miami Sylvester Cancer Center, Cleveland Clinic Hospital and many other highly rated medical facilities. And, as I mentioned, I can get emergency care anywhere in the US at in-network prices. So I state again that Medicare Advantage should at least be considered by those looking at 2020 insurance plans this fall. Under my plan (Humana), there is $0 copay for primary care visits and urgent care, and a $10 copay for specialists. Not matter what situation I find myself in, I will not pay more than the $3,400 maximum amount per year for medical care and drugs, even if I ran up a bill of $2 million dollars, which sometimes can happen these days. And to mention again, my monthly premium is $0. I’m simply stating my experience. It’s also appropriate to point out that Medicare insurance salespeople by law receive the same commission for any Medigap or Medicare Advantage plan they sell, so there is no improper incentive for them to push one plan over another.

    by Clyde — September 2, 2019

  8. Clyde, from what I have learned about Medicare Advantage plans is that many are not portable and if one wants to travel this can become a problem. If you are treated in the Emergency Room of a hospital outside of your area of coverage, then you would get the full bill because perhaps none of tyour doctors would be in your network and when one is very ill or possibly unconscious–say from an accident of some kind they would not be in a position to ask or to deal with this. Medi-gap policies are fully portable in all of the 50 States and US Territories where Medicare is in place. If a physician or hospital participates with Medicare and accepts full assignment, then they also must accept your Medi-gap plan by law. Medicare Advantage also tends to raise their premiums more often and at a higher rate or based on your age. Medicare Advantage plans as of 2019 also require pre-authorizations for all inpatient and outpatient procedures. Your treatment can still be denied by your Medicare Advantage plan. Without this you pay the FULL bill. Medicare Supplement (Medi-gap plans) do not require pre-authorization. See the link below that explains this. The information is current.

    by Jennifer — September 2, 2019

  9. Jennifer, you are right about Medicare Advantage concerns. And be aware that one on Medicare Advantage, changing to Medigap may not be possible or could be very expensive. For the most part, MA plans are best for folks who don’t expect to travel. Policies vary state to state and company to company, so make sure to understand all limitations and fine print. We started with an MA policy and were fortunate that later coverage changes by my previous employer allowed us to move to Medigap. The problem we encounted was that while still with the MA policy, we traveled 5 hours by car to a neighboring state where I had a heart attack followed by triple bypass. When my wife called from the hospital to ask for that the surgery be covered, she was told that it didn’t “sound” like an emergency and because we were out of state, out of network, they might not cover. Fortunately the excellent physicians and coronary care facility where I was lucky enough to be taken by the EMTs jumped in and turned that around so we did not get stuck with the $200K bill. I had asked the cardiologist about returning home for the surgery. His response was that if he put me in an emergency vehicle with two med techs for the trip, he would give me about a 50% chance of survival. After six years, I will always be thankful for the excellent care I received and feel fortunate that insurance clerk didn’t get the final say. We changed to Medigap at the first opportunity.

    by RichPB — September 2, 2019

  10. I don’t want to belabor the point about Medicare Advantage (MA) or Medigap policies. My posts have been based on my actual personal experience with MA, whereas other posts not favorable to MA are from readers who have not had MA, so far as I can tell. My purpose in bringing up the MA option relates to this article’s idea of “sins” you don’t want to commit in retirement. It could be a very costly budget sin if you pick a Medicare plan inappropriate for you. It’s best to go to a RELIABLE source to ultimately get your information. I’ve listed two such sources below (Consumer Reports and Investopedia) that compare pros and cons of Medigap vs. Medicare Advantage. In addition, talking with a competent and qualified insurance advisor during the Medicare open enrollment period (October 15 through December 7) is advisable.

    https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

    https://www.consumerreports.org/cro/news/2014/10/medigap-vs-medicare-advantage-consumer-reports/index.htm

    https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

    by Clyde — September 2, 2019

  11. @Jennifer, perhaps you should learn more about Medicare Advantage Plans. I’ve had one for years. My first one was portable, because I lived in two states. My current one covers 80% of out of network expenses.

    by Linda — September 2, 2019

  12. I traveled alot in the states and had problems with
    Different advantage plans
    Did ALOT of research now have United Healthcare plan F Coveres me anywhere in the states, all doctors and hospitals, no deductible and out of country with equals but they reimburse in most all country’s
    Been excellent for me ….

    by Bill Bradley — September 2, 2019

  13. @Linda, I chose Plan N with United Healthcare because Plan F will no longer be available after Dec 31st of this year and while I could go with Plan G, (covers everything except the $183 Medicare Part B deductible) this will now be considered as guaranteed issue for those who can no longer apply for Plan F. Since it nearly covers everything that Plan F covers, more people will apply for Plan G, and there will y be higher premiums because they have to accept those who can no longer get Plan F This means higher premiums than Plan N. Plan N covers everything with the exception of the $183.00 Part B deductible and there is up to a $20.00 Co-pay for doctor’s office visits and $50.00 copay for ER visits (unless you are admitted to the hospital–then the co-pay is 0.) I can handle that. Plan N is 30% less than Plan G and they also do not cover excess fees. I would only go to a doctor that accepts Medicare as full payment so no problems there.
    Medicare Advantage plans look appealing at first, but as you have read from previous posts, they are really not portable and the extra benefits like Silver sneakers are often eliminated now.

    Requiring pre-authorization for procedures is also a BIG problem with MA especially if you are traveling out of your region. I think I have made the best choice for me. Others need to be made aware of MA problems. Also you would have to be underwritten to change plans and pay higher premiums. I am within the six months of initial issue so I do not have to be underwritten at this stage of my life–I will 65 in September. With medi-gap I can take it anywhere in the country and use it with any Medicare doctor and facility that accepts Medicare. This is the freedom I wanted.

    by Jennifer — September 2, 2019

  14. Does anyone know if you are currently in Plan F and keep it after that option goes away if the grandfathered person can change to Plan G or N without underwriting? I am asking because we are currently in Plan F and if prices go thru the roof, I would consider changing plans if that option is possible if premiums go crazy.

    by Louise — September 2, 2019

  15. Hi Louise:

    You would have to be underwritten to change from Plan F to G or N if you are already on Medicare. I did ask my broker for you. The only time this does not occur is when you first sign up at age 65, as I just did. I was originally signed up for Plan G with Mutual of Omaha, then I was made aware that with only a couple of changes Plan N was nearly the same coverage. A good broker will inform you of these things. They do not make money from us, but from the insurance companies. So I had nothing to lose. Plan G will be guaranteed issue–meaning they have to accept everyone who won’t have Plan F, since it is not available for new subscribers as of Jan 1, 2020. Plan G will then have more of the applicants who want nearly full coverage –except they do not pay the $183.00 deductible, so the Plan G rates will rise faster than Plan N.

    Plan N does not pay the $183.00 deductible, nor the excess fees for doctors who do not accept Medicare assignment as payment in full. The only other difference is up to a $20.00 co-pay for doctors office visits (some do not charge this) and $50.00 copay for Emergency Room visits IF YOU ARE NOT ADMITTED. If you are admitted to the hospital then no co-pay. For a 30% less premium, I opted for Plan N.

    Congress wants Seniors to have more skin in the game, as they found that Plan F users went to the doctor more than other Medicare supplements where more out of pocket money was required. In times to come, more of the plans offered will be like Plan N. Congress wants to eliminate any plan eventually that covers the deductibles and excess charges by non participating (Medicare) doctors. They fell the patient will be the better consumer and watch their costs.

    I also read that Medicare will go up in 2020 to $144.00 from $135.00 for those of us who do not pay a three figure income. I felt I better rein in all the predicable costs that I could. I hope this helps someone else. I do not take any prescription medications so I also bought United Healthcare Plan D for under $15.00 month for any possible coverage I may need in years to come. I would have incurred a possible penalty if I had not bought it within six months of signing up initially at 65 for Medicare. I will be 65 later this month.

    by Jennifer Lee — September 3, 2019

  16. In years past, MA plans were typically just HMO’s, which meant you had to stay mostly instate for coverage. Now there are PPO’s in MA which allow you to find in network providers across the country. I have checked various locations that we travel to and can find coverage for a lot of issues that might be needed. The savings in premiums is huge and the network is large.

    by Bill — September 3, 2019

  17. I have a couple of comments to add to this discussion. If you have any questions about your current Medicare coverage or if you are new to Medicare you should get in touch with a SHIP or SHINE counselor in your area. These are trained volunteer counselors who have no incentive to steer you in any one direction. They can also help you apply for assistance to pay premiums if you qualify. All Medicare enrollees should check their drug coverage every year as these coverage change every year.

    Second comment-insurance agents do get paid more to to sell Advantage plans and they also receive recurring revenue for every month the enrollee stays on the plan. Make sure you get a couple of opinions before you select your plan-Advantage or supplement.

    by Roberta — September 3, 2019

  18. My experience with Medicare has been somewhat limited compared to a number of others on this site: however, I believe the choice I made was a wise one. My selection was made through AARP’s United Health Care options and after careful research, a couple of phone conversations with an AARP/United rep and a meeting with a very good broker, I chose a United’s Medicare Supplement Plan G. My monthly premiums, along with my monthly Medicare premiums are less annually than what I paid on my employer’s health plan each year (combine my employee contributions monthly toward my premium, deductibles, office visit co-pays, and 20% of any medical procedures until I hit my annual out-of-pocket cap of $3,500). I have no copays for anything, pay a once annual deductible of $183 and am generally very healthy. That being said, I did need to have a somewhat complicated foot and ankle surgery in January. The bill was over $35,000.00 when all was said and done . That was outpatient surgery. I had a brilliant surgeon and am so grateful for his skills. My cost was $0. You never know what curves life will toss your way and I felt not only well-prepared but so well looked after with this coverage. Had I still been with my former employer, on a “gold level health plan,” my costs would have substantially more than what I paid. I can choose any doctor who accepts Medicare anywhere in the nation and I have a one time limit of coverage while abroad, of $50,000, if needed. This insurance is so much better than anything I had during my working years and I am very thankful.

    by Barb — September 3, 2019

  19. My experience with Medicare Part G and AARP’s United Health Care has been the same as Barb’s. I purchased this insurance in one state, and had no problem switching to the same plan in a different state with less than a $5 difference in pricing when I relocated. The cost of Part G, Part D, and regular Medicare combined is also less than my employee co-paypai — without the medical deductibles. It’s been great not to have copays for doctor visits, labwork, tests etc. As a surprise bonus, my prescriptions have even been cheaper under Part D than my former employee drug plan’s cost.

    by Kate — September 4, 2019

  20. This is a great thread of posts with lots of good info. Thanks Clyde for the links of the pros and cons. When I took over care for my aging mother 8 years ago I learned how good Medicare Advantage was, I was just not familiar before that. She had very limited funds and had chronic conditions in her 90’s including a broken hip and ICU visits, etc. Coverage was great, her out of pocket very manageable. So, I considered all of that for my husband. He was on a great supplement, but the price kept climbing as he aged. He is very healthy, 84 and on zero prescriptions. The supplement plus drug plan inched up to $700/month, years earlier when he was 65 just $250/month. I switched him to UHC/MA (HMO-POS) for $9/mo 5 years ago. We saved $9000 per year in monthly fees or $45,000 now, probably more because that supplement would have kept increasing. Everyone needs to do what is best for their situation, but do look and learn about all options. Consider those Pros & Cons, your health, age, travel intentions, etc.

    by ljtucson — September 4, 2019

  21. So many good comments. My earlier post about having a Medigap Plan F …. I do believe it is the best choice if one can afford it. The state in which you live also makes a big difference. We CHOSE to retire in one of the ‘worst’ states (Cape Cod Massachusetts) because this state is home for us. And I have been told that we can change Medicare plans whenever we want during the year, no waiting for open enrollment. This is a model other states could study rather than let the insurers call the shots.

    by Thom — September 4, 2019

  22. As a Medicare Outreach Specialist I can attest to the fact that many salespeople conduct Medicare presentations to find new clients. If you want UNBIASED information, call the SHIP helpline on the back of your Medicare & You book or look it up on google. These are agencies that have no vested interest in which product you select. Too many people are getting steered towards Medicare Advantage plans and once their health changes, they will not be able to get a Medicare supplement. Yes you may pay more for a supplement but you also won’t see many if any bills. You can go literally anywhere in the US that accepts original medicare, perfect for snowbirds.

    by Tracy — September 4, 2019

  23. Tracy, I have a question, sounds like you would know the answer. Does MEDICARE legally prevent seniors from switching back and forth between Advantage plans and Medigap plans or are those rules written by the state in which a person lives..? The insurance counselor at our local senior center told us that we can change plans according to our circumstances. (No underwriting involved.)

    by Thom — September 4, 2019

  24. Thom,
    When I went to see a Medicare advisor last year, I ended up switching from Medigap to MA. She said that once I switched to MA, I had only one year to switch back to a Medigap plan, if I wanted to. After that I would stay with any MA plan I wanted. I assumed it was a Medicare wide plan, not by state. After reading the previous posts, I am researching which way to go this coming year.

    From what I can see, my MA PPO plan has quite a few providers in most specialties in various zip codes that we go to, including Florida in the winter and Indiana in the summer.

    by Bill — September 5, 2019

  25. I chose one of the United Healthcare MedicareComplete Access MA plans through AARP. It’s an HMO, but my doctor and hospital are in it and the premium is zero. They have reciprocal arrangements in 40 states and emergency out-of-network is covered and a MOOP of $3600. No real health issues at present, so not paying for coverage I don’t need.

    by Peder — September 5, 2019

  26. From what I’ve read, one can switch from Medigap to MA or back during any open enrollment period or during the disenrollment period early the following year.

    by Peder — September 5, 2019

  27. I worked for SSA for many years & volunteer now with my county’s elder benefit specialists. One thing to consider is that Medicare Advantage plans can offer benefits such as vision, dental, and hearing that are not covered under original Medicare. You can change MA plans or go to or from MA or original Medicare during the annual enrollment period from October 15 to December 7. There are additional times a person can disenroll from MA and go back to original Medicare. The elder benefit specialists have told me that it isn’t a problem for people to buy a Medicare supplement/Medigap plan even if they are no longer in the guarantee issue period. There is lots of info on Medicare.gov such as: https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf?

    by Jean — September 5, 2019

  28. Hi Jean:

    One thing you have not mentioned is that most people will have to be underwritten to change plans. My Broker told me that is something that needs to be addressed as well as the fact that MA require pre-authorization or will require it before a procedure can be done–even if the doctor is in network. Medi-gap plans do not require this. You don’t need to trust me or anyone on this. You will find out for yourselves when you make the changes. I think everyone here agrees we must do what is best for us, as we are paying the bills. Since I work for an oral surgeon three times per week, I have learned a lot about dental insurance. Most policies only cover preventative care, not crowns or implants and they cap what they will pay to between $1200-$1500 per year. Check the limits on your so MA plans for vision and dental.

    by Jennifer — September 6, 2019

  29. Jennifer is correct, if you decide to switch from MA to Medigap, say in the 3rd year, then medical questions and underwriting can come into play. So, best not to assume that you can switch back and forth. Again, know the rules for your state because there are a handful that do not allow that underwriting. I’m turning 65 next year and I’ll go with Medigap and Part D because it isn’t too expensive when younger, then like most I will evaluate it annually. I will be thrilled to drop my private insurance and save over 50% – yeah Medicare!

    by ljtucson — September 6, 2019

  30. Our interview with To m Cretella is now available: See “Original Medicare + Medigap vs. Medicare Advantage: Which is Better for Me

    by Admin — September 8, 2019

RSS feed for comments on this post. TrackBack URL

Leave a comment