# Medigap vs Advantage



## ChasE (Oct 15, 2017)

In my life i’ve found that in general, you get what you pay for.  Just wondering if there’s any Advantage Plan that matches Medigap in coverage and portability?  I have an Advantage Plan now with no premium, no cost for two generic, inexpensive drugs, but with high copays.  We split our time now between Florida and Upstate NY.  I had to change physicians in NY because my previous MD didn’t participate in my present plan.  And we travel extensively...often outside the US.  Bottom line is I’m much more concerned about future unknowns, portability, and access than about monthly cost.  I’m consulting with an agent on Wednesday who advertises himself to be objective re: recommendations.  Looking for some opinions/suggestions.  Thanks


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## GreenSky (Oct 17, 2017)

Nothing says portability like Original Medicare and a supplement.  It's great to have zero premium but as you've found out, you may not be able to see the providers you wish, both at home or on the road.

Despite what others may tell you, a supplement does not have to be terribly expensive.  Most people have Plan F and generally it's the worst value.  Depending on where you live Plan G and especially Plan N will be a better choice.  And don't discount the high deductible plan f.  While you do have to pay the share of cost it is limited to $2,200 and usually can be bought for under $35 per month.  I have a number of clients on that plan and I will use it myself once I turn 65 in a year.

Let me know if I can help with pricing and coverage.

Rick


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## NancyNGA (Oct 17, 2017)

I have plan F.   What I like is not having to worry about meeting annual and hospital deductibles, or Dr's hassling you with charges beyond what is standard for the procedure, and having to wait out a decision whether the doctor is going to pursue it or not. They didn't offer plan G here when I enrolled. Said it was discontinued. Maybe a state by state thing?

 I've never paid any extra bills in 5+ years.  My parents both had plan F and it was a blessing for me not to have to handle extra bills for them.  If anyone ever has to handle my bills I want that for them too, even if the premiums are higher.  But that's just my preference.  Maybe it will change when I get older.  They may drop some of the regulations on insurance companies by then.   Who knows?


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## Butterfly (Oct 17, 2017)

I have a Medicare Advantage plan that is tied to the largest hospital here, and which has a huge number of physicians which accept it.  It has worked VERY well for me in the 6 years I've had it.  I've had a negligible amount of out of pocket outlay for care in these 6 years, and that includes two major orthopedic surgeries (hip replacements).  

I have a friend with a supplement who insists she has better coverage, but her plan costs her a bit more than $400 a month, which figures out to be $4800+ per year, and that cost is more than 4 times what my out of pocket total has been in the 6 years I've had my Advantage plan (which has no premium at all except the Medicare premium).


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## GreenSky (Oct 18, 2017)

NancyNGA said:


> I have plan F.   What I like is not having to worry about meeting annual and hospital deductibles, or Dr's hassling you with charges beyond what is standard for the procedure, and having to wait out a decision whether the doctor is going to pursue it or not. They didn't offer plan G here when I enrolled. Said it was discontinued. Maybe a state by state thing?
> 
> I've never paid any extra bills in 5+ years.  My parents both had plan F and it was a blessing for me not to have to handle extra bills for them.  If anyone ever has to handle my bills I want that for them too, even if the premiums are higher.  But that's just my preference.  Maybe it will change when I get older.  They may drop some of the regulations on insurance companies by then.   Who knows?



Just curious.  If you paid a $200 annual deductible in exchange for saving $500-700 in premium would you still consider Plan F to be the best plan?

Also, it's not going away for people that have it.  It will just continue to get more and more expensive.  

It's already not the best value compared to Plan G or N, but it will certainly become worse as the years go on.

Rick


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## GreenSky (Oct 18, 2017)

Butterfly said:


> I have a Medicare Advantage plan that is tied to the largest hospital here, and which has a huge number of physicians which accept it.  It has worked VERY well for me in the 6 years I've had it.  I've had a negligible amount of out of pocket outlay for care in these 6 years, and that includes two major orthopedic surgeries (hip replacements).
> 
> I have a friend with a supplement who insists she has better coverage, but her plan costs her a bit more than $400 a month, which figures out to be $4800+ per year, and that cost is more than 4 times what my out of pocket total has been in the 6 years I've had my Advantage plan (which has no premium at all except the Medicare premium).



She does have a "better" plan in that she has no restrictions as to who she can see for care.  However, $400 is absurd!  I've never helped anyone with a supplement where they pay more than about $250 - and even that is too much.

Rick


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## Don M. (Oct 18, 2017)

GreenSky said:


> She does have a "better" plan in that she has no restrictions as to who she can see for care.  However, $400 is absurd!  I've never helped anyone with a supplement where they pay more than about $250 - and even that is too much.Rick



Just curious...since you seem to have some knowledge in these areas.....these "alphabet" plans...F, G N, etc., all are Medigap Plans...and not Medicare Advantage....is that correct??


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## GreenSky (Oct 19, 2017)

Don M. said:


> Just curious...since you seem to have some knowledge in these areas.....these "alphabet" plans...F, G N, etc., all are Medigap Plans...and not Medicare Advantage....is that correct??



Yes, they are all Medigap plans and accepted by any and all Medicare providers.  While I've helped hundreds find the most appropriate advantage plan I am always a bit worried that they won't get the care they need due to network limitations.

I've been working with Medicare beneficiaries since 1993 so I hope I've picked up a bit of knowledge about various plans.

Getting back to Medigap, if premium payment is taken out of the equation then by all means go with Plan F.  However, most of us are paying the premium ourselves and in that case it's important to look for value.  The Medicare Part B deductible is $183 currently.  It's great that Plan F pays it but for most people it costs $300-600+ more than Plan G.  Why give the insurance company so much money simply to avoid a deductible of less than $200?

Plan N does not pay the deductible either and requires up to $20 for office visits and $50 for some ER visits.  It won't pay excess charges but since 96% of physicians accept assignment I've never heard of any of my clients (80% have Plan N) being hit with extra costs (at least not legally).

I'm happy to review coverage for anyone who asks.  There is no obligation and since I'm only licensed in about 1/3 of the states I may not even be able to help you apply.  I simply can furnish information.

Rick


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## StarSong (Oct 27, 2017)

GreenSky said:


> Yes, they are all Medigap plans and accepted by any and all Medicare providers.  While I've helped hundreds find the most appropriate advantage plan I am always a bit worried that they won't get the care they need due to network limitations.
> 
> I've been working with Medicare beneficiaries since 1993 so I hope I've picked up a bit of knowledge about various plans.
> 
> ...



I turned 65 last month.  Having been a member at Kaiser Pemanente for the past few years, I enrolled in Medicare A & B plus their (free) Advantage plan.  However, I'm starting to feel some buyer's remorse.  I really don't understand my financial vulnerabilities.  Should I reconsider Kaiser (an HMO) in favor of private docs and Medigap plans?  

Thanks in advance.


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## mathjak107 (Oct 28, 2017)

GreenSky said:


> Nothing says portability like Original Medicare and a supplement.  It's great to have zero premium but as you've found out, you may not be able to see the providers you wish, both at home or on the road.
> 
> Despite what others may tell you, a supplement does not have to be terribly expensive.  Most people have Plan F and generally it's the worst value.  Depending on where you live Plan G and especially Plan N will be a better choice.  And don't discount the high deductible plan f.  While you do have to pay the share of cost it is limited to $2,200 and usually can be bought for under $35 per month.  I have a number of clients on that plan and I will use it myself once I turn 65 in a year.
> 
> ...



with an f-plan in ny at 3300 a person we use a high deductible f-plan and pay 1100 a year but save 2k . not only that but our supplement cover my 480 dollar gym membership through silver sneakers . it is the best value for us . we usually spend 300-400 in unreimbursed stuff a year out of the 2k we save .


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## mathjak107 (Oct 28, 2017)

You  need to evaluate these four criteria - 


your *health*
your   need/desire for *doctor/provider   flexibility*
your *ability to pay* Medigap (and Part D) *premiums*
*carrier   reliability* (especially true   for Advantage and some Part D plans)
If you have a lot of chronic  health issues or foresee serious issues - and can afford it - then a *Medigap G or F* - provides the most flexible,  worry-free, and trouble-free choice. You can see _any_ provider anywhere in the country who  accepts Medicare, no gatekeepers on treatment approval, no provider networks.  Bills go to Medicare and your Medigap. 

_Generally, with a Medigap  F/G, your Medicare-approved expenses will be paid 100%. For the  most part, medical expenses are pretty much limited to Medigap premium _(and Part D premium and copays if  you take medication). 

There are less expensive  (premium) cost-sharing Medigap plans available, as well, but often these prove  to be a false economy when managing chronic illness or worse. Copays and  hospital deductibles can eat up any premium savings in short order.

If  you are reasonably healthy and can afford some premium and the very low 20% not  paid by Medicare the few times you doctor - then a *high-deductible Medigap  F*, which, again, provides the most _provider flexibility_ and _caps your annual max out-of-pocket  (your 20%) at $2,180_, _worst  case scenario, all at one-half  to one-third the cost of a regular Medigap F_. Bills go to Medicare and  your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2200 or so .  Thereafter, the Medigap pays 100%. 

If you're healthy, over a  period of years, you'll probably be much further ahead financially with an hd-F. 

If you are cost-conscious, then an *Advantage* (aka Medicare health plan) (if you're  healthy - or, even if you're sick - depending on plan) can be an appropriate  choice, as it bundles docs and drugs, for a low or zero premium. Pay close  attention to: 


copays   and max out-of-pockets, especially if you're sick or anticipate health   issues.
restricted   networks - an issue if you need specialty care or if you travel a lot.
drug   formulary (tiers and copays).
For the chronically ill, annual Advantage  copays could exceed twice the cost of a Medigap F, as max out-of-pockets can be  set at $5-$7k, or more. 

If  you travel a lot or snowbird, _unless_ it is a PPO with out-of-network  coverage, Advantage is _not_ an appropriate choice.

If you choose *Advantage*, know that you are  divorcing yourself from Medicare and putting the decisions for treatments,  benefits, and payment in the hands of the PRIVATE (this means _for-profit_) Advantage  insurer. Some are good actors, others are not. Common bad behaviors by MA's are  denials of mandated Medicare benefits, onerous oversight on long-term therapies  and preapprovals, etc., slow pays, denials they've received the provider claims,  customer-service run-around, and more. 

*Check with network providers  and providers' billing people on ease of use, timely payment, preapprovals,  insistence on use of generic drugs, verify with the provider that  provider is, in fact, in that network - insurance reps and websites often are  wrong - and talk to people you know who have the same plan.*

Unless you are in a guaranteed issue state, know that once past the  Initial Open Enrollment, you will not be able to switch to  a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another  Advantage plan during Annual Open  Enrollment.

So, choose carefully, because there may not be a do-over if you decide later you prefer a  Medigap.


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## GreenSky (Oct 28, 2017)

Very nice review of Medicare supplements.  A couple of minor issues but really more of opinion vs accuracy. 

The bottom line is to meet with at least one INDEPENDENT insurance agent to discuss options.  Those people who do this themselves or based upon posts on an internet forum can make incorrect decisions.  Listening to friends really can lead one astray.

I've been working with Medicare beneficiaries since the early 90's and see many people regret their decision.  Please use an agent that can show you all the options. 

Rick


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## mathjak107 (Oct 28, 2017)

GreenSky said:


> Very nice review of Medicare supplements.  A couple of minor issues but really more of opinion vs accuracy.
> 
> The bottom line is to meet with at least one INDEPENDENT insurance agent to discuss options.  Those people who do this themselves or based upon posts on an internet forum can make incorrect decisions.  Listening to friends really can lead one astray.
> 
> ...




friends of ours learned the hard way about the differences between a for profit insurance company with their advantage plan vs a not for profit program like medicare .

they have cancer in one side of the pituitary gland . the doctors wanted it removed . the insurer will only pay for the cancerous side  and wants them to wait for the other side until it is cancerous too.  medicare in the surgeons opinion never gave a patient a hard time clearing out both sides so as to avoid more surgery .

but that is typical with advantage plans . things can all to easy turn in to negations and you stand a tiny chance of winning


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## StarSong (Oct 28, 2017)

Mathjak: Thank you for explaining this in such comprehensible terms.  I now have a good starting points to continue my research.


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## sunnyac (Nov 3, 2017)

This forum has been very helpful!  I'll be eligible for Medicare Jan 2018 and am researching Medicare now and not considering MA as I travel/snowbird.  Can anyone pls clarify -- do you have to undergo health underwriting when changing plans within Medigap; i.e., changing from hi-F to G or N?  Thx!


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## mathjak107 (Nov 3, 2017)

sunnyac said:


> This forum has been very helpful!  I'll be eligible for Medicare Jan 2018 and am researching Medicare now and not considering MA as I travel/snowbird.  Can anyone pls clarify -- do you have to undergo health underwriting when changing plans within Medigap; i.e., changing from hi-F to G or N?  Thx!




that is decided on a state level . in ny no , but other states possibly


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## GreenSky (Nov 3, 2017)

Generally you must qualify medically to change from one Medicare supplement to another.  And by using a plan with typically better value (G, N or Hi-F) you could run the risk of paying more in a year than with Plan F.  But one needs to look at LIKELY issues and a time frame longer than one year.

I'm partial to Plan N or Hi-F for most people.  Others like the convenience of not writing small checks.  Everyone is different.  PLEASE use an independent agent rather than spending months researching a relatively simple product.

Rick


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## sunnyac (Nov 3, 2017)

Thank you for ur replies.  I live in NJ.  Most of the mail I am receiving is directly from a Medicare provider.  I did receive a note from one broker and have an appt next week.  I like to be informed about a topic prior to meeting so I may be over-thinking but its just in my nature.  But u all are very informative and much appreciated!


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## chrisgjim (Nov 3, 2017)

sunnyac said:


> This forum has been very helpful!  I'll be eligible for Medicare Jan 2018 and am researching Medicare now and not considering MA as I travel/snowbird.  Can anyone pls clarify -- do you have to undergo health underwriting when changing plans within Medigap; i.e., changing from hi-F to G or N?  Thx!



Right now you are in your open enrollment period so no company will ask you any questions.  After your open enrollment period ends, if you decide that you want to change plans you will need to go through medical underwriting, unless you are in a state that will allow you to change plans once per year.  Now, never buy a plan and expect to keep the same plan for the rest of your life.  Every company will raise rates and after 3-4 yrs there will be other companies that will give you a better rate.


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## mathjak107 (Dec 14, 2017)

StarSong said:


> Mathjak: Thank you for explaining this in such comprehensible terms.  I now have a good starting points to continue my research.




keep in mind that on paper medicare and advantage plans are supposed to  cover the same things but in practice they do not .

the reason is because the for profit advantage plans can  make a judgement call on something ,to save money and refuse to pay .  by having an advantage plan you have no idea if medicare which is not for profit would pay  as you don't have it so they only thing you can do is go by what your advantage plan pays .

in the case of my friend with the  pituitary gland cancer , the advantage plan denied removing both halves .   they would only pay for the cancerous side not the other side which did not look healthy .

because she does not have medicare they can't argue the fact they are not paying  for what medicare would . 

the surgeon said medicare always pays for both halves to be removed  but that is not considered evidence that medicare would have covered it so she can't argue it based on the fact medicare would cover it but they aren't . .

so while in theory they are supposed to pay for the same treatment , don't believe for a second that is always true . you have no way of knowing what medicare would have done in your situation if you don't have it but have an advantage plan.

it is very easy to claim in the advertising that advantage plans have to cover what medicare does , but the out for them is without having medicare you don't know what medicare would pay for in your exact path  of treatment .


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## dpwspringer (Dec 14, 2017)

mathjak107 said:


> keep in mind that on paper medicare and advantage plans are supposed to  cover the same things but in practice they do not .
> 
> the reason is because the for profit advantage plans can  make a judgement call on something ,to save money and refuse to pay .  by having an advantage plan you have no idea if medicare which is not for profit would pay  as you don't have it so they only thing you can do is go by what your advantage plan pays .
> 
> ...


I've heard this same argument about advantage plans before and I think your explanation/example is one of the best I've seen.


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## MJC-56 (Dec 20, 2017)

Sunnyac  if you are a snowbird the last thing you want is a Medicare Advantage plan.  Medicare Advantage Plans are local coverage and change every year.  Medigap plans are accepted by every doctor and hospital that accepts Medicare and they never change.  Check this out:  https://medigapseminars.org/medicare-for-snowbirds-and-rvers/   and this  https://medigapseminars.org/new-to-medicare/


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## Buckeye (Dec 21, 2017)

NOTE TO OP  I've had traditional Medicare + Plan F forever.  It is the best value for me, but what I value may be different than what you value.  So please do not let other folks tell you they know what is best for you.  You have to do your own homework, decide what is of value to you, and then do the math.  (Mathjak107 gives an excellent overview). 

As an FYI, I've been licensed to sell Medicare supplements and Advantage plans, and what I found is that most agents will steer you to the product that pays them the highest commissions.   Just sayin'


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## GreenSky (Dec 21, 2017)

Hoot N Annie said:


> NOTE TO OP  I've had traditional Medicare + Plan F forever.  It is the best value for me, but what I value may be different than what you value.  So please do not let other folks tell you they know what is best for you.  You have to do your own homework, decide what is of value to you, and then do the math.  (Mathjak107 gives an excellent overview).
> 
> As an FYI, I've been licensed to sell Medicare supplements and Advantage plans, and what I found is that most agents will steer you to the product that pays them the highest commissions.   Just sayin'



I tend to agree that most agents don't know what they're talking about.  Not sure if your statement of highest commission is necessarily true but most agents don't understand value and simply sell "you will never get a bill."

While Plan F does cover all the out of pocket for Medicare, generally Plan G will save $400+ per year against the policyholder paying the Medicare deductible of $183.  I call that better value than handing an insurance company $400+ to save you $183.

That being said, some people would rather not get a bill and the net savings of over $200 (generally it's closer to $300-400) is not worth it for them.

As far as commission, I find that both Advantage and Supplements wind up paying about the same over the course of years.  This may not be true in all areas.

Rick


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## mathjak107 (Dec 21, 2017)

here in nyc we don't even have a  G-PLAN  offered . we took a high deductible f-plan and so far made out great  because of the savings .


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## GreenSky (Dec 21, 2017)

I too like the High-F and will be what I will buy 11 months from now.  However, Plan G is available in NY but maybe not from all companies.  Just as Hi-F is not available from all.

Not all plans choices are the best value in all areas.  Generally speaking Plan N is the "go-to" plan in CA as Plan G doesn't save much over Plan F.  In Nevada, Plan G is usually $500-600 lower than F.

It's very rare than anyone can make a case for Plan F once they speak with an independent agent that actually understands Medicare supplements.  Also, since commissions are generally based upon premium by recommending other plans with lower premiums the agent is also earning less.

Rick


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## Aunt Bea (Dec 21, 2017)

A question about Medigap premiums.

In my area the premiums for plan F run from a high of $408.72/month to a low of $193.00/month.  

If the programs are identical does paying a higher price do anything to increase the value to the consumer.  For example do some companies haggle less over approving claims or do some companies pay benefits more quickly, make the claim process easier, etc...


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## GreenSky (Dec 21, 2017)

Aunt Bea said:


> A question about Medigap premiums.
> 
> In my area the premiums for plan F run from a high of $408.72/month to a low of $193.00/month.
> 
> If the programs are identical does paying a higher price do anything to increase the value to the consumer.  For example do some companies haggle less over approving claims or do some companies pay benefits more quickly, make the claim process easier, etc...



All plans of the same letter provide exactly the same benefits.  And no company is better or worse than any others regarding payment of claims.  And aside from billing issues, it should be rare to ever have to contact your company.

It pays to talk with an independent agent to see what plans choices are best for you.

Rick


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## Ken N Tx (Dec 21, 2017)

Aunt Bea said:


> A question about Medigap premiums.
> 
> In my area the premiums for plan F run from a high of $408.72/month to a low of $193.00/month.
> 
> If the programs are identical does paying a higher price do anything to increase the value to the consumer.  For example do some companies haggle less over approving claims or do some companies pay benefits more quickly, make the claim process easier, etc...



My Medigap (Plan F) started out lower and increases yearly with age..


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## MJC-56 (Dec 21, 2017)

Ken N Tx said:


> My Medigap (Plan F) started out lower and increases yearly with age..



That's true for most states, like TX.  However, the rate of increase is different with each company.  if you are experiencing rate increases of 9% or more you should shop your coverage.
You can change plans at any time as long as you qualify medically.


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## mathjak107 (Dec 21, 2017)

each state has different rules . most states do have under writing as well as increases are age based . ny where i am charges more for policies but we have no underwriting and no aged based increases and we can switch  at enrollment any time .


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## GreenSky (Dec 22, 2017)

mathjak107 said:


> each state has different rules . most states do have under writing as well as increases are age based . ny where i am charges more for policies but we have no underwriting and no aged based increases and we can switch  at enrollment any time .



I just chose a zip code at random and looks like (in that zip) one would pay an extra $360 in premium for Plan F vs Plan G.  In other words, to have an insurance company pay the $183 deductible the premium increases by $360.  And I used the lowest cost plan for that zipcode.  

Rick


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## mathjak107 (Dec 22, 2017)

yep , if a g-plan is available there is a big difference for not having the insurer right those deductible checks . i pay 93 bucks a month for a high deductible f-plan . it is 2k cheaper  than an f-plan but it has a 2k deductible . we average 400-500 between my wife and i so it is a big savings .

but wait , there is more:   out of the 93 i pay , silver sneakers pays the 40 bucks a month i was paying for my gym membership . it is a freakin amazing deal


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