Medicare what do you use?

[Billdit]

I have plan “G” and have had it since 2017. My understanding is that the advantage plans have negatives beyond what has been stated here. You have to pay every time you go to a doctor, both GP and specialists. You also cannot make an appointment with a specialist unless you are referred by your GP or internest. There are other restrictions all of which make them much less desirable than “gap” plans unless you are not able to afford the premiums of gap .

[amboyna]

I have plan “G” and have had it since 2017. My understanding is that the advantage plans have negatives beyond what has been stated here. You have to pay every time you go to a doctor, both GP and specialists. You also cannot make an appointment with a specialist unless you are referred by your GP or internest. There are other restrictions all of which make them much less desirable than “gap” plans unless you are not able to afford the premiums of gap .

I have the advantage plan. I pay $27 a month for it. Sometimes I have a copay. Of course specifics might be different from state to state. But of the dozen plus trips I have made to the doctor this year I have had only 4 copays. And one of those was to the ER at 5:30 in the morning. Had an MRI, Lungs and Heart checked and paid an $80 copay. That was the only bill I got for several hours worth of tests. The other 3 copays were $40, $20 and $20.
I am unfamiliar with the Gap plan. Is that like Supplemental?
As for referrals I have always needed the GP to recommend a specialist. Even when I was on company insurance.

[dickg1]

Bill.

A number of MA plans do not require a referral and I have seen this option included in more plans each year. You are correct that a copay is required at each medical visit, but it should be considered that it would take a significant number of visits to specialists (for example)to match the premium plus the $185 (2019) deductible that you are paying. The payoff with your plan is that it covers a catastrophic hospital stay and subsequent lengthy stay in a Skilled Nursing Facility. One plan in New Jersey costs $515 per day for three days then pays 100% from then on. Again compare the $1545 against your expenses, premium plus Part B deductible,

A significant sales pitch for Plan F is that you get no bills, with plan G it is the convenience of no bills after your B deductible.

One last point. Your premium increases as you grow older. For this very reason I have a number of people switching (during Annual Enrollment) from Medigap to Medicare Advantage. MA plans have the same premium for a 65 year old and a 95 year old and they do not use Medical Underwriting. As I stated previously the only medical reason a MA plan will refuse enrollment is for ESRD (kidney failure and on dialysis)

Dick

[mountainbreeze]

I have a gap plan (Plan G). When I first went on Medicare it seemed like the safest choice at the time. I like knowing I can go to ANY doctor I choose that accepts Medicare and not having to go through the referral process. The advantage plans are enticing and I may switch over in a year or two.

One thing I am not clear on (just haven't bothered to look it up) is coverage abroad. A friend of mine (with a gap plan) just got back from a trip to the British Isles. While in Edinbourou he had some heart issues and was taken to the hospital. He needed a stent and was told he would have to pay the full bill out of pocket! He opted to cut his trip short and come home for the needed care. A bit risky if you ask me. Do advantage plans cover you for something like this while abroad?

[JPG]

. . . Do advantage plans cover you for something like this while abroad?

Or, 'out of area'?

[dickg1]

JPG (aka Red),

In New Jersey we have MA plans from Aetna, AARP, et al, that include worldwide emergency coverage. This is a new addition and I cannot explain what is covered other than "emergency". I know that the answer is vague and I am looking into what, specifically, is covered. If you are at any time interested in a MA plan it would pay to ask the plan provider what "emergencies" are covered and to what extent.

Your "out of area" question can be answered more comprehensively. If you have an emergency either with Medicare or with a MA plan you would go to the emergency room. If you are on Medicare there is no further action. If you are in a MA plan, the emergency room will call the issuing company to determine if the "emergency" you are presenting will be paid by the plan.
If the "emergency" would be paid if you were in network it will be paid out of network. Otherwise, no.

An "out of network" visit to a non-participating physician will cost you the full bill because Medicare and the MA plan will pay nothing.

Dick

[edma194]

Only Medicare because my wife still works and has excellent health insurance coverage. It's so good that hardly anything makes it through to the Medicare coverage. She says she'll retire eventually but I don't know when, she's one of those weirdos who likes her job so much if they don't force her out she'll never quit.

[garys]

Whenever people ask questions like this, my first response is that you need to check what plans are available in your area. Whatever somebody elsewhere is using has no bearing on what is best for you because it might not be available for you.
It isn't fun, but you should do a lot of homework before making a decision.

[Ed in Tampa]

Whenever people ask questions like this, my first response is that you need to check what plans are available in your area. Whatever somebody elsewhere is using has no bearing on what is best for you because it might not be available for you.
It isn't fun, but you should do a lot of homework before making a decision.

I more or less agreed with you, however not having to pay for supplemental “gap” insurance is attractive when looking at advantage type plans. However I have heard horror stories about people not getting the treatment they need because their HMO type insurance would not allow it. I have heard similar stories about PPO's. Also Gap insurance is only guaranteed at initial Medicare, if you leave you may or may not get back in should you decide you do not like advantage plans.
That said many doctors in my area are getting into Accountable Care Organizations where they try to reduce care costs by controlling your medical care as much as they can. Read this to say they reluctantly recommend care that may be costly but beneficial, and get paid to do so.

Lastly many doctors are joining doctor groups that try to control patient access to doctors outside their doctor group. In which case an HMO type of care may be superior.

So when I asked this question my hope was people would respond with I have advantage and love it or I hate it because of this and such. Likewise with Gap coverage. Also part D insurance is a house of cards. I have access to 20 or so plans most vary by monthly cost and co-pays and initial deductable. But some have far better deals on some drugs. One company may list manufacture cost at $30 and others $120 for same drug. Plus I have had drug plans change their formulary mid stream, so far always in my favor but…..

[jack888]

Sorry for reviving this thread. Did anyone have any problems with Medicare frauds lately?