Medicare vs Medicare Advantage plan

[KentuckyWoman]

I've been on Medicare a few years and tried various Advantage plans. The only one worth anything was Kaiser Permanente when I lived 2 years in Atlanta.

As we talk about "medicare for all" I want to be sure we are doing the math.

When you see the doctor look at how much is not paid by straight Medicare and make sure it is more than your copayment in the Advantage plan. Look at the costs of all your copays, deductables and co-insurance. Is it more than what you would pay for a supplemental to cover you when things go really bad (and expensive)

For me, I figured out straight Medicare was my cheapest way to go. Medicare paid all but $7 of primary care. It paid all but about $27 on my cardiologist. My drug plan is hit and miss. I use Good RX a lot.

Do the math. And if we are going to successfully sell Medicare for all, we really need to talk about the math for those under 65.

It only adds up with Medicare negotiates drug prices and puts a lot more rules on the advantage plans.

[brewens]

1. There is no math. No real MFA plan has been proposed yet. They call it MFA.

That doesn't mean we would end up with a national health care plan that is exactly the same Medicare is now.

[Voltaire2]

14. Both the senate and house bills, introduced every session,

are fairly detailed. Both are comprehensive and universal. They essentially cover everything except cosmetic surgery. There are no premiums copays or deductibles except for a small prescription copay.

[PoindexterOglethorpe]

2. Keep in mind that Advantage plans vary a great deal,

depending on where you live.

But you do need to do your homework to figure out what works best for you.

It should not be this complicated.

[KentuckyWoman]

11. I agree completely! It's far more complicated than it should be.

And every area is unique. Every person is unique. That's why I'm encouraging people to do the math and keep an open mind.

In my dream world if you are inside the US of A you can see a doctor with no costs beyond your taxes. If you are here visiting, then other arrangements can be made.

That isn't likely to happen any time soon, but we can work in that direction. In the meantime, do the math.

[PoindexterOglethorpe]

15. I am turning 71 on Friday.

I have the amazing good fortune to be annoyingly healthy. Honestly, were a genie to appear and grand me one wish, I'd go for something like "Let no one have less good health than I do." I know, I know, a lot of good doctors would need to find new employment, but I'd still wish for that.

I think what outrages me the most is that ANYONE should go bankrupt because of medical expenses.

[mopinko]

3. boy howdy. just having this conversation w someone yesterday.

medicare for all is not a good slogan for a lot of people who are on medicare.
just turned 65, and still havent figured out what i am going to do.
medicaid for all would likely be a much better way to go, at least medicaid in blue states.

just how hacked up and convoluted the whole thing is gives me the heebie jeebies about what single payer could end up being after a few decades of assholes chipping away at it.

got 2 doctors that i love and depend on, and having trouble finding a plan that includes both.

[enough]

4. The main reason I have gone with Medicare Advantage

instead of straight Medicare is for the difference in coverage for hospital care in the event of serious illness or injury. The premium is a lot lower than any comparable Medigap or other supplemental plan i’ve seen.

I’d be interested to know other DUers’ experiences with this. Thanks for this post, KentuckyWoman.

[droidamus2]

5. It requires changes

I think the idea of 'Medicare for all' is not just moving everybody to the current form of Medicare but is to expand and fix the current Medicare to give everybody free health care at the point of access. To do this you would remove any premiums, mine is currently $123 per month, no deductibles and no copays everything would be paid through taxes. They would also add vision, hearing and psychiatric care.

[mwooldri]

6. I still prefer National Health Service maths....

$0 copay to see doctor. $0 copay to see specialist. About $10 copay for a drug, or $150 for a year's prescription drug prepay certificate... Or $0 copay in Scotland and Wales.

Premiums are 12% of earnings over $215 a week, after $1250 they drop to 2%.

I like this easy maths...

[unc70]

7. My Advantage plan does much better

I realize plans vary from county to county, even from the same insurer. My Advantage plan from Aetna is $0 per month, $10 deductible for most doctor visit, $0 or $15 for most prescriptions.

[Sherman A1]

8. I'm using Essence currently but I will check to see if Aetna has a plan available in my area

just turned 65 and Essence seemed to be the best option as it was $0 per month, $5 for my primary and $35 for specialists visits. My Rx's are $0 right now as they are generics.

Thanks for the tip on Aetna.

[LiberalBrooke]

9. I went with traditional Medicare.

All of the Advantage plans had very narrow choices of doctors. Also limited hospitals in their coverage. The networks were just too small. I realize that is how they save money but I wanted and needed a larger pool of doctors to meet all of my medical conditions.

[elocs]

10. I would have been screwed with straight Medicare.

With $1000/month income I am under the 100% federal poverty level so the state would pay my $135/month for part B but my Medicare deductible would have been $2000 every 6 months--1/3 of my income if I needed the care.

So I saw all the ads for am I getting all the benefits I deserve so I went with United Healthcare dual care coverage where what Medicare doesn't pay, Medicaid picks up the rest.
No monthly premium and my only cost is $3.40 for prescriptions. I also get dental and vision coverage as well as $800/year for over the counter healthcare items.
So my Advantage plan saved me big time and I don't see how Medicare for all would make anything better for me so I beware the Law of Unintended Consequences.

Not that I'm likely to ever see Medicare for All become a law in my lifetime, but it's a nice campaign promise and not one who supports it will ever explain how it would ever become law.

[YOHABLO]

13. In what State, may I ask do you live? Are you on SSDI?

[elocs]

17. I live in Wisconsin & retired at 62 collecting SS.

From 62-65 I was on BadgerCare, Wisconsin's Medicaid for adults without children whose income is under the 100% federal poverty level.
It paid for everything except a $1.25 copay for prescriptions.
So at 65 I go on Medicare which I paid in to for decades when I was working. Suddenly huge deductibles and copays under traditional Medicare. So I am far, far better off with the Medicare Advantage plan with United Healthcare and actually better off than I was under BadgerCare.

[YOHABLO]

19. Well all sounds good. I'm debating on whether I need to go on Med.Advan. myself.

[El Supremo]

12. Just remember that Advantage was created by Repubilcans in...

their attempt to privatize Medicare. They partially succeeded.

[Hermit-The-Prog]

16. health care would be cheaper if we didn't buy executive mansions

We pay for all health care, everywhere, for everyone, plus we pay for giant, flashy skyscrapers for each insurance company, plus all the other perks they grab, plus an army of claims deniers, plus mountains of profit, plus golden parachutes and mansions and yachts.

[Vinca]

18. I've found the same thing. If you weigh what an Advantage plan might cost vs. anticipated

bills you will be on the hook for, sometimes it's better to have straight Medicare. I've also got the impression - and it certainly could be wrong - that some providers bill less for services for straight Medicare patients. I know the amount I'm on the hook for is not at all unreasonable and I've been on it for almost 6 years. Things change, of course, but for now straight Medicare is working out well for me.

[KentuckyWoman]

20. Please find out the rules on supplementals

Some states put an age limit on being able to switch to advantage plans or buy supplemental policies without a medical exam. Once you hit that age, the insurer can jack up the rates quite a lot or refuse to cover anything "pre existing".

Th reality is beyond a certain age you are far more likely to end up in an expensive situation. In my personal case, a supplemental premium with no additional out of pocket costs is the way to go. They will cover everything Medicare doesn't pay for what A & B covers. If your income is low enough, you might qualify for Medicaid instead.