# Medicare Supplement / Advantage Plan Experiences



## Rich29 (Oct 30, 2018)

I am in the process of making the decision to either renew my Advantage Plan for 2019 or switch to a Medicare Supplemental Plan
plus a Prescription Drug Plan. I'm 73 and in good health but worry about possible future medical events. I would really be interested in hearing
about real life experiences (good or bad) with coverages from either Medigap or Advantage Plans


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## Butterfly (Oct 30, 2018)

I have had an Advantage plan since I first became eligible for Medicare 7 years ago.  I am in generally very good health also, but I have osteoarthritis and in 2013 I had both hips replaced.  I had excellent treatment and an excellent outcome, and I paid very little out of pocket (about $1,000 for both surgeries put together, and a big chunk of that was the Medicare hospital deductible).  I DID have to pay a  bit more out of pocket than someone with a supplement plan might have had to, but I know that the little bit more at that time was more than made up for by the fact that I wasn't paying huge premiums for a medicare supplement.

There's no way I would change my Advantage plan for a supplement.  For me, it just doesn't make good financial sense to do so.


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## Rich29 (Oct 31, 2018)

Butterfly said:


> I have had an Advantage plan since I first became eligible for Medicare 7 years ago.  I am in generally very good health also, but I have osteoarthritis and in 2013 I had both hips replaced.  I had excellent treatment and an excellent outcome, and I paid very little out of pocket (about $1,000 for both surgeries put together, and a big chunk of that was the Medicare hospital deductible).  I DID have to pay a  bit more out of pocket than someone with a supplement plan might have had to, but I know that the little bit more at that time was more than made up for by the fact that I wasn't paying huge premiums for a medicare supplement.
> 
> There's no way I would change my Advantage plan for a supplement.  For me, it just doesn't make good financial sense to do so.



Thank you for your insightful comments


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## Happyflowerlady (Oct 31, 2018)

We have an Advantage plan also, and both myself and my husband think it is wonderful.  Our insurance agent will sit down with us and go over anything that he thinks might be a better plan for us, so we just upgraded our present United Healthcare plan for a HUmana one which will start in January. 
The UHC one is actually really great, too. It includes $2500 dental, $200 eye exam and glasses, $250 each quarter allowance for OTC meds (cold meds, vitamins, knee braces, etc), plus it pays for our membership at the fitness club where we go just about every day. 
The new Humana one also covers all of those extras, plus it is $100 per month allowance for OTC items, and gift certificates for completing routine exams, and also for things like going to the fitness center. 
Our plan also covers rides to the doctor if we needed that as well as phone or online consultations; but we have not used those benefits thus far. 

I am currently enrolled in UHC plan for heart failure patients, and they are sending me a special scales and tablet to record weight changes and other information about my heart. I think that Humana has a plan like that also, but I can’t check that out until we change over in January. 
Our agent  said that they are not supposed to talk about an advantage plan unless the customer specifically asks about one, so you might need to bring that part up when you are talking with your insurance agent about which plans work best for you.


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## Rich29 (Nov 1, 2018)

Happyflowerlady said:


> We have an Advantage plan also, and both myself and my husband think it is wonderful.  Our insurance agent will sit down with us and go over anything that he thinks might be a better plan for us, so we just upgraded our present United Healthcare plan for a HUmana one which will start in January.
> The UHC one is actually really great, too. It includes $2500 dental, $200 eye exam and glasses, $250 each quarter allowance for OTC meds (cold meds, vitamins, knee braces, etc), plus it pays for our membership at the fitness club where we go just about every day.
> The new Humana one also covers all of those extras, plus it is $100 per month allowance for OTC items, and gift certificates for completing routine exams, and also for things like going to the fitness center.
> Our plan also covers rides to the doctor if we needed that as well as phone or online consultations; but we have not used those benefits thus far.
> ...




Thank you for sharing your experience. I will be sure to ask the questions you mentioned with my agent.


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## terry123 (Nov 1, 2018)

Love my Humana PPO advantage plan as it includes a drug plan. My drugs are free since they are tier 2 and I get a 90 day supply at a time. My doctor likes the plan as he can make changes to my meds while I am there in the office as we discuss it. For short term meds Walgreens is the pharmacy this year for the plan.  I plan on keeping it for 2019.


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## GreenSky (Nov 8, 2018)

I've sold hundreds of advantage plans with great benefits.  I'll be on Medicare on 12/1/18 and guess what?  I went with a supplement.  I want the option of going anywhere for care.  My health is worth the price.

Instead of an advantage plan which will always have a restrictive network, go with Plan N (and ignore those who worry about excess charges) or maybe a High Deductible Plan F.  

Many and probably most people love their advantage plan mainly because it's generally little or no premium.  Those same people may bitch and moan if they have a serious illness.  I want to choose my oncologist, cardiologist, and hospital.  If going out of state (I live in Nevada with generally crappy medical care) provides me with better care I can go and not worry about coverage.

That being said, I still help people find the "best" advantage plan if that's what they want.  But it's not what I want for myself, wife, or anyone I care about.

Rick


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## Ken N Tx (Nov 9, 2018)

Yes, you really have to do your research and shopping!!


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## Aunt Bea (Nov 9, 2018)

I'm shopping right now and it is definitely confusing/complicated.

At this point, I'm leaning towards an advantage plan from Excellus BCBS.  The plan covers my current needs, they have a large network up and down the east coast, my basic prescriptions are free, the monthly premium is only $35.00 and the maximum annual out of pocket is $6,750.00.  If my health becomes worse in the years ahead I may consider switching to a plan with a higher monthly premium and lower annual out of pocket caps.

We'll see!


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## ClassicRockr (Nov 9, 2018)

No Advantage Plan for us. In some forum, don't remember where, a lady said she worked for Medicare for years and NOT to get an Advantage Plan. So, we just have Medicare A & B, Florida Blue (supplement) and Humana Walmart for Rx. Florida Blue will pay our total hospital admission cost, if either of us has to be admitted into a hospital, however Humana Walmart Rx doesn't cover much, if any cost, on some prescriptions we bought.


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## Happyflowerlady (Jan 19, 2019)

Since I have had atrial fibrillation, tachycardia, and heart failure for quite a few years, it is important to me to have a good Cardiologist, as well as good coverage for medical care. 
I have always had an advantage plan ever since I first qualified for Medicare, and they have paid for all of my heart medications, plus the heart surgeries and cardioversions, and any other thing that I need, as well as all of my medical tests. 

Since there are all of the extra benefits with my advantage plan, and no downsides that I have ever seen or experienced, I would totally recommend looking into an advantage plan. 
Our health insurance agent was able to look up our doctors and make sure that they were on our plan, so even if someone is concerned about their doctor being on the plan, all you have to do is check and see. 

I think that this is where it is so important to have a local health insurance agent, and they are able to look at all of the available plans offered for Medicare, and help you find the one that works best for you. 
Our agent has changed us twice now, because better plans became available for us.


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## GreenSky (Jan 19, 2019)

Happyflowerlady said:


> Since I have had atrial fibrillation, tachycardia, and heart failure for quite a few years, it is important to me to have a good Cardiologist, as well as good coverage for medical care.
> I have always had an advantage plan ever since I first qualified for Medicare, and they have paid for all of my heart medications, plus the heart surgeries and cardioversions, and any other thing that I need, as well as all of my medical tests.
> 
> Since there are all of the extra benefits with my advantage plan, and no downsides that I have ever seen or experienced, I would totally recommend looking into an advantage plan.
> ...



Agreed.  Find an independent agent that will help.  I probably have helped 1,000 people find the most appropriate advantage plan.

However, if you want the BEST cardiologist, etc. then the better choice is a Medicare supplement.  There are no networks so you won't be constrained in who you can see.

It's incorrect to say there are no downsides to advantage plans.  A restrictive network even if it doesn't affect you currently is a BIT downside.

Rick


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## Butterfly (Jan 19, 2019)

GreenSky said:


> Agreed.  Find an independent agent that will help.  I probably have helped 1,000 people find the most appropriate advantage plan.
> 
> *However, if you want the BEST cardiologist, etc. then the better choice is a Medicare supplement. * There are no networks so you won't be constrained in who you can see.
> 
> ...



Well, it's not a problem if the best physicians, i.e., your cardiologist, are in your network.

  My advantage plan, a local one, includes most of the physicians in Albuquerque.  I've been on my plan for 7 years now (approaching 8) and have never encountered a situation where I haven't been able to utilize exactly the physician I want. Neither has my sister, who has multiple medical problems much the same as outlined by Happyflowerlady above.

It all depends on the particular plan and the breadth of its network. 

And one of the BIG downsides to most of the supplements, for me, at least, is their cost.


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## terry123 (Jan 20, 2019)

I have never had a problem with my Humana PPO advantage plan either.  Each year I check to be sure my docs are still in network and the hospitals too.  It is not offered everywhere here in Texas, I understand.  I worked 14 years as a collection specialist in a hospital before retirement so I had a ton of experience dealing with Medicare, supplements, and other insurance companies.  I spent so much time explaining to patients what their plans covered and did not cover that I finally got through to the admitting office to do this before they admitted a patient as most people do not know what they are responsible for until someone like me bills them for their part.  Then all of a sudden they are mad at me for doing my job.


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## GreenSky (Jan 20, 2019)

Butterfly said:


> Well, it's not a problem if the best physicians, i.e., your cardiologist, are in your network.
> 
> My advantage plan, a local one, includes most of the physicians in Albuquerque.  I've been on my plan for 7 years now (approaching 8) and have never encountered a situation where I haven't been able to utilize exactly the physician I want. Neither has my sister, who has multiple medical problems much the same as outlined by Happyflowerlady above.
> 
> ...



I'm glad you and others have a wonderful plan with wonderful doctors.  My question to you is if the doctor that has the best track record for a particular surgery (let's think brain tumor) is out of your network what would you do?  What would you do if the person who was on an HMO and had this issue was your granddaughter?

I'm not knocking advantage plans but there is no doubt there is less choice in care when you are in a network.  Period.  You can argue all you want (and you have) that you have the best plan, the best doctors, the lowest cost, etc.  But you have to understand you don't have the choices a person who can afford a supplement will have.

Again, I've helped at least 1,000 people enroll in HMO plans so it's not like I'm completely against them.  But don't ever think you will always have the access to the care you might need.

Rick


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## terry123 (Jan 20, 2019)

I would never have  a HMO plan as its too restrictive.  I stay with a PPO plan that has all my docs and does not require referrals.


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## mathjak107 (Jan 21, 2019)

and lets not forget the fact you have a for profit insurer as the gate keeper with advantage plans  to your treatments in many cases and not for profit gov't medicare . big difference when issues come up .

the best example is a co-worker had pituitary gland cancer . the surgeons wanted to remove both halves as they always do since the other side was not in great shape .

the advantage plan denied both sides being done . they only approved one side .

her doctors argued that is nuts and medicare always approves both halves . but since she has an advantage plan and not medicare it is impossible to say what medicare would have approved in her case so the advantage plan wins and  now she is living with a ticking time bomb and will likely have to start all over with another surgery very soon .

with advantage plans nothing is ever a problem -until it's a problem .  if i could afford not for profit medicare and supplement i would never take an advantage plan over it .


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## JB in SC (Jan 24, 2019)

Physicians and hospitals go in and out of Advantage networks, with traditional Medicare and a supplement a person can avoid those surprises.


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## terry123 (Jan 25, 2019)

JB in SC said:


> Physicians and hospitals go in and out of Advantage networks, with traditional Medicare and a supplement a person can avoid those surprises.


 I check mine each year to avoid that very thing.  I cannot afford a supplement and the PPO Advantage plan works for me.


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## Butterfly (Jan 25, 2019)

terry123 said:


> I check mine each year to avoid that very thing.  I cannot afford a supplement and the PPO Advantage plan works for me.



So do I, terry123.  I also check the benefit particulars (co-pays, etc.) so I don't get surprises.


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## terry123 (Jan 25, 2019)

Butterfly said:


> So do I, terry123.  I also check the benefit particulars (co-pays, etc.) so I don't get surprises.


I check those too. My copay for specialist went down 10.00 this year. One office tried to charge me $45.00 and I replied they evidently did not verify my benefits as it was supposed to be $35.00 in network.  They were surprised I knew my benefits.  I told them I did not work 15 years doing that for nothing!


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