# Medicare Advantage and Medicare Supplement Plans (Medigap)



## GreenSky

There were a couple of questions about these products in another thread so I thought this subject deserved a thread of its own.

Medicare Advantage Plans replace Original Medicare with a private insurance policy.  The benefits must be at least on par with Medicare but copays, coinsurance and other "rules" are based upon the insurance company's plan.  As an example, Medicare requires a one-time deductible for in-patient services billed by the hospital with an annual deductible and 20% coinsurance for all other covered benefits.  A Medicare Advantage plan could charge as little as zero to many hundreds of dollars a day for the same hospitalization.  However, most MA plans includes the Part D drug plan.

As far as premium payment, Medicare pays most if not all the premium for these plans.  They generally come in either of two "flavors"; HMO and PPO.  The HMO plans are the most restrictive usually requiring referrals for most non-primary services. The network can be quite restrictive.  PPO plans will allow for self-referral into a much larger network and usually (at a higher cost) allow the member to go out of network.

Original Medicare has a deductible for Part A (Hospitalization) that is charged for every admission per benefit period of 60 days.  Part B has an annual deductible and then covered charges are paid at 80% of the allowable.  To protect oneself from these charges a Medicare Supplement can be purchased.  There are 10 standardized plans but the most popular are F, G and N. All supplements of the same letter are identical regardless of the insurance company.  The only difference is the premium.  Don't let anyone tell you their company is the best.  They are all the same.

Plan F covers 100% of your costs.  Plan G is the same as Plan F except it does not pay the Part B deductible ($183 for 2017).  Plan N does not pay the deductible, requires a copay of up to but never more than $20 for office visits (treatment does not raise the cost and various services such as physical therapy, chemo, etc. are not office visits), and up to $50 for emergency room visits that don't result in admission.

Plan N do not pay excess charges.  This is when a doctor will not accept the assignment of your claim.  The provider still must do all the billing but payments go to the patient.  It is then up to the doctor to bill the patient and hope the bill is paid.  For all this work the doctor winds up with 9.25% more than he/she would receive if assignment was accepted.  It's not worth the trouble and 96% of all physicians accept assignment.  I've helped hundreds with their Medicare supplement plans and not one has ever told me their doctor did not accept assignment.  It's truly a non issue.

I hope this brief description and comparison helps.  I'm always available to talk without obligation nor a sales pitch.  I promise!

Rick
insure(at)greenskyins(dot)com


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## mathjak107

we have a high deductible f-plan . it is perfect for us . it cost 2k less and has a 2k deductible . most of our non medicare covered claims are about 400 a year so we save 1600 a year as opposed to just taking a full f-plan .

not only do we save 1600 a year but they pay for our gym directly through silver sneakers saving another 480.00 a year in membership .  that makes the high deductible f-plan a real value .


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## GreenSky

mathjak107 said:


> we have a high deductible f-plan . it is perfect for us . it cost 2k less and has a 2k deductible . most of our non medicare covered claims are about 400 a year so we save 1600 a year as opposed to just taking a full f-plan .
> 
> not only do we save 1600 a year but they pay for our gym directly through silver sneakers saving another 480.00 a year in membership .  that makes the high deductible f-plan a real value .



I completely agree.  I'll have Medicare in 2 years and that's the plan I will use.  So many people are afraid of the $2,000 out of pocket despite generally saving between $1,000-$1,500 annually in premium.

Rick


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## QuickSilver

Maybe give this a look..

http://wendellpotter.com/2013/04/medicare-advantage-or-disadvantage/


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## Bill4x4

I plan to retire later this year and looking at the Medigap plans vs. the Advantage plans for my zip code the advantage plans have a lower monthly cost with equal or better coverage than Medigap with part D. Am I missing something? If not then why would anyone want the Medigap plans?


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## GreenSky

Bill4x4 said:


> I plan to retire later this year and looking at the Medigap plans vs. the Advantage plans for my zip code the advantage plans have a lower monthly cost with equal or better coverage than Medigap with part D. Am I missing something? If not then why would anyone want the Medigap plans?


'

1)  Not everyone has access to Medicare Advantage; 
2)  The coverage for MA always is at least as good as Medicare (although copays and deductibles can vary);
3)  All Medicare Advantage plans are network based meaning you may not be able to see the doctor of your choice.  I'm not talking about primary care doctors but rather specialists.  If the specialist you want to see is not in network you cannot see that doctor unless you pay 100% of the cost.

Neither MA nor Medicare+Medigap fits everyone.  You have to decide what's best for you, both now and in the future.  There is no doubt that MA plans restrict your freedom of choice.  And it's usually the case that MA will save the most premium dollars although can be the most expensive (both financially and out of pocket costs) in the event of illness.

Find an independent agent to help you with your choices.  And if you don't feel good about that agent, find another.

Rick


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## QuickSilver

Bill4x4 said:


> I plan to retire later this year and looking at the Medigap plans vs. the Advantage plans for my zip code the advantage plans have a lower monthly cost with equal or better coverage than Medigap with part D. Am I missing something? If not then why would anyone want the Medigap plans?



Yes..  A Medicare Advantage plan is an HMO...  This means the insurance company can deny procedures and hospitalizations.. They can dictate which doctors you can see and which hospitals you may go to..

I will advise sticking to Traditional Medicare with a Plan F or Plan G supplement and a Part D based on your medication needs.


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## GreenSky

QuickSilver said:


> Yes..  A Medicare Advantage plan is an HMO...  This means the insurance company can deny procedures and hospitalizations.. They can dictate which doctors you can see and which hospitals you may go to..
> 
> I will advise sticking to Traditional Medicare with a Plan F or Plan G supplement and a Part D based on your medication needs.



Actually, MA plans include both PPO and HMO in many areas. 

Plan F is going away and will be even less of a value in the future.  I agree with Plan G but am partial to Plan N.

Rick


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## Butterfly

My Advantage plan is an HMO, but the HO pool is huge and encompasses most of the specialists in Albuquerque, that is to say most of our specialists take my plan.  I have no deductible and my doctor visits are $5, with specialists being more.  I think they are $50 now.  BUT, when I had my hips replaced, I only paid that $50 once, at the first visit to the orthopedic surgeon.  The rest of the visits were considered ongoing care and I didn't have to pay again.  Now when I dislocated my shoulder I had to pay the $50 again to the orthopedic group, but that was a different issue.  When I initially dislocated the shoulder, I had to pay $65 to the ER, but that was all; no additional for ER docs or X-rays or all the morphine and assorted drugs (thank God for painkillers!!!) I got so they could put the shoulder back in its socket.

With my hips, I paid $0 out of pocket for all the pre-surgery stuff, x-rays, lab stuff, and all that.  I paid $0 to the anesthesiologist.  I DID pay the hospital the medicare deductible for the couple of days I was in there for each hip, which was a total of about $900.  That was ALL I paid.   My plan picks up the hospital charges 100% after day 3.  I would have paid more than that in premiums if I had a Medigap policy.  I have a $3,400 maximum out of pocket yearly; I haven't come anywhere near that, even in the year when I had the hips done.

My plan is affiliated with the largest hospital here and is administered by them.  I wouldn't change.  I've gotten great care for very little out of pocket cost.  I pay nothing additional for the Advantage plan, just the regular Medicare premium.


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## maunymuray

Hi Rick, 

Maybe you can help me understand, and shed light for others. I wAs advised to switch to a Plan F from an Advantage plan. I did, feeling relievd I was “fully” covered (as per an agent, and reading material). To my surprise, this is not always the case. I went for a phhysical once, and was billed for my blood panel. I recently had hernia repair, woke up with a support belt for my recovery, and I received a bill for this belt, not from the hospital, but from a third party suplier I never heard off. I refuse to pay, and am now being threatened with legal action, or a collection agency. So, is this the Plan F everyone is raving about? I feel duped, and everyone needs to know about this. Of course, the surgery was over 50K, and had I had a lesser plan I would incure a much greater expense than a $40 bill for a support belt. My concern is that in other circumstances I could wake up with a charge much higher than this. My question is, what can I do, and is there another plan that truly covers it all? BTW, I am still contacting, and awaiting answers from all parties involved, but no one has been able (?) to help me, so far...


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## mathjak107

there is a lot more to this . the first question is did you have a high deductible f-plan ? the second question is did the doctors assigned to you or lab  agree to take just what medicare pays them . they may not be accepting medicare. in which case you owe anything above the agreed medicare prices just like an advantage plan .

the labs and doctors have to be part of medicare . if not you pay anything over the medicare agreed prices . was anything considered preexisting in your state when you switched plans ? did medicare cover the belt ? if they don't you get nothing paid by a supplement .remember supplements only pay the difference on what medicare covers . if medicare paid nothing you get nothing from the supplement .medicare must cover the expense first .


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## Butterfly

maunymuray said:


> Hi Rick,
> 
> Maybe you can help me understand, and shed light for others. I wAs advised to switch to a Plan F from an Advantage plan. I did, feeling relievd I was “fully” covered (as per an agent, and reading material). To my surprise, this is not always the case. I went for a phhysical once, and was billed for my blood panel. I recently had hernia repair, woke up with a support belt for my recovery, and I received a bill for this belt, not from the hospital, but from a third party suplier I never heard off. I refuse to pay, and am now being threatened with legal action, or a collection agency. So, is this the Plan F everyone is raving about? I feel duped, and everyone needs to know about this. Of course, the surgery was over 50K, and had I had a lesser plan I would incure a much greater expense than a $40 bill for a support belt. My concern is that in other circumstances I could wake up with a charge much higher than this. My question is, what can I do, and is there another plan that truly covers it all? BTW, I am still contacting, and awaiting answers from all parties involved, but no one has been able (?) to help me, so far...



The support belt may be considered by Medicare to be "durable medical equipment," which Medicare in many, if not most, cases does not cover.


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## mathjak107

Butterfly said:


> The support belt may be considered by Medicare to be "durable medical equipment," which Medicare in many, if not most, cases does not cover.


i think the poster thinks the supplement is supposed to cover everything  -period . but that is not how supplements work .they only pay for what medicare covers .if it is something medicare won't pay for a supplement pays nothing . it must be a medicare covered event


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## terry123

I have a Humana Medicare Advantage Plan that is a ppo plan with a drug plan.  Love it as all of my meds are free. I get a 90 day mail order supply and if I need short term meds I use Walgreens.  My pcp, specialists and hospitals are in network. They do the silver sneakers gym and offer a $50.00 health and wellness program each quarter where you can order over the counter things you need.  I would never have a HMO plan as they are too restrictive requiring referrals, etc.  This PPO plan works for me but its offered only in certain areas. I just ordered the 2019 information to see if there are any changes that might affect me.  I hope to keep it so I won't have to buy a supplement and go back to regular Medicare.


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## mathjak107

we use a humana high deductible f-plan and medicare. for the monthly premium i pay the fact it includes silver sneakers and pays for my gym has 1/2 the premium  i pay going for what i would pay for the gym .

be careful with that ppo advantage plan. they can be dangerous if you end up with a non participating doctor or lab  .

 If you go to a preferred provider, they may pay as an example up to  85% of the doctor's charges and if you go to a non-participating provider they  pay up to 65%, but that's not the whole story.

 The preferred providers have already agreed to be reimbursed a certain price from humana , but the non-participating providers haven't, so they can charge you anything they want. humana will only pay 65% of the UCR (usual, customary, & reasonable) charges. For example, a surgeon or an anesthesiologist charges $2,000, but the contracted price with humana  knocks it down to $1,000. humana pays $850 (85%) and your copayment is $150. However, if the surgeon or anesthesiologist is a non-participating provider and he charges the same $2,000,humana  will only pay $650, which is 65% of the $1,000 UCR. You are then responsible for paying not only the $350 difference between humans payment and the UCR, but also the other $1,000 that the anesthesiologist billed.

So the bottom line is that your copay with the  provider " doctor is $150, but you're copay for the non provider doctor is $1,350. So you see, just because humana will reimburse you for any doctor you see, the amount you have to pay can be quite different.


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## terry123

As I said before I only use in network providers.  Once when my pcp asked another doctor for a consult I told him to remember that I am only going to see a provider in my network.  In fact I had a new neuro guy come in and introduced himself and I promptly told him that if he was not a network provider not to come in.  He laughed and assured me he was and said he understood.  I don't care what anybody thinks, it is my health involved and I know there are qualified providers in my network and I will only use them.


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## mathjak107

you would be amazed how many get stung by this because they think they can see any doctor because it is a ppo . it never hurts  to keep reminding everyone.you may be aware but few are aware how it works . that is until the bills come in from seeing a non participating provider .


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## mathjak107

Bill4x4 said:


> I plan to retire later this year and looking at the Medigap plans vs. the Advantage plans for my zip code the advantage plans have a lower monthly cost with equal or better coverage than Medigap with part D. Am I missing something? If not then why would anyone want the Medigap plans?



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 $2,180. 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 haven't done so, as yet, strongly recommend you read this: Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?

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.

also read my warning above on advantage ppo's .*


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## ROBIN48

In my case plan f-n will cost me from 1600 a month to 1300 a month. Yes I said a month. This my be due to my chronic disability.I have congested heart failure.


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## mathjak107

if you have health issues, you should join a plan when you’re first eligible, during your Medigap Open Enrollment Period. This is the period when you have guaranteed-issue rights, and Medigap insurers can’t deny you coverage, require medical underwriting, or charge you a higher premium if you have health problems.

you must be trying to switch plans not first join otherwise they can't count prexisiting .


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## Harold Hayden

I have an advantage plan, which is currently $134 @ month. Out of pocket expenses have been running about $400 annually, so a total of approximately $2,000 @ year.
My wife has medigap plans, with premiums in the $300 @ month range. Her out of pocket expenses have also been running about $400 annually or about $4,000 @ year.

We have discussed having her switch to an advantage plan, but have never pulled the trigger. Largely due to my retirement included a healthcare reimbursement clause. It covers mine, but comes up a bit short on hers. The end sum is affordable, so why not. 

My opinion, is that any health care plan is a shot in the dark. You can save money up front and take a chance on future health problems costing more... or spending money up front on the potential of future health problems that may not come into play. Gaze into the crystal ball and make a choice.


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## mathjak107

there is more to it than money . advantage plans are gate keeper to your treatment and procedures and not everything just flies through unfortunately. nothing is ever a problem until it is a problem .

we have a friend who learned there is a difference to late .

they had pituitary gland cancer and the doctors wanted it out .

her advantage plan said they would only authorize the cancerous side but not the side that was in bad shape at this point .

her doctors thought that was insane . medicare ALWAYS PAYS  for the removal of both halves .

but  the advantage plans know you can't prove in your case what not for profit medicare would cover so they can pretty much deny anything they like and you can't prove other wise . it was a big learning curve for them about the difference between a  for profit insurer and not for profit medicare  as a gate keeper to your health


i wish the price was the only difference .


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## Butterfly

My plan is owned and operated by the largest (and not for profit) healthcare system in New Mexico.  It covers thousands and thousands of seniors here.  Most of the seniors here are on this plan and no one I know has ever had any problem at all with it.  My sister had all kinds of trouble getting her care covered by another plan (a nationally known one).  She has multiple medical issues and I had an ongoing battle with them over her care.  I finally got her to switch to the one I am on and we have had zero problems with it and she gets better care and better hospitals.  We each pay about $20 a month for the plan and are extremely pleased with it.


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## mathjak107

what plan is that ?


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## Butterfly

mathjak107 said:


> what plan is that ?



It is the Presbyterian Senior Care plan and is tied to our Presbyterian Hospital system and our Presbyterian Healthcare Group of physicians and medical professionals.

It is a local plan available in two counties in New Mexico where the hospitals and care group are.


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## mathjak107

how does it work if you travel?


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## Butterfly

Butterfly said:


> It is the Presbyterian Senior Care plan and is tied to our Presbyterian Hospital system and our Presbyterian Healthcare Group of physicians and medical professionals.
> 
> It is a local plan available in two counties in New Mexico where the hospitals and care group are.



The plan says it covers urgent or emergency services anywhere in the world.  Neither I, nor anyone I know personally, have had any personal experience with this benefit.  This isn't a big worry for me because I really don't travel much anymore -- primarily because I can't afford it, but also because I don't particularly feel the inclination to do so.  I did an awful lot of travelling in my younger days.


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## GreenSky

Sorry for the late reply.  I've been SO busy helping my clients with the annual election period.

Like all Medicare Supplements, Plan F (which I almost never recommend due to cost vs. G or N) only pays for services authorized by Medicare.  If Medicare doesn't cover the service neither will your supplement.

Some here keep pointing out how wonder their HMO is.  That's great unless you want to choose your own doctors, hospitals, etc.  In many areas (ie. Los Angeles) many great doctors are available.  But if you want to see a doctor out of network you're going to pay yourself.

So I agree that a Medicare supplement is always the best choice if money is not an object.  In fact, I'd much rather go with a high deductible plan f (HDF) which kicks in to pay your out of pocket after a $2,300 deductible.  Keep in mind Medicare will still pay their share so unless you have a hospitalization or something like chemo you won't spend much.  And the premium generally is $40-50 monthly.  Must better access to care than any Medicare Advantage and generally the out of pocket in most areas is lower.

Hope that helps a bit.  

Rick


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## Ryan

GreenSky said:


> Sorry for the late reply.  I've been SO busy helping my clients with the annual election period.
> 
> Like all Medicare Supplements, Plan F (which I almost never recommend due to cost vs. G or N) only pays for services authorized by Medicare.  If Medicare doesn't cover the service neither will your supplement.
> 
> Some here keep pointing out how wonder their HMO is.  That's great unless you want to choose your own doctors, hospitals, etc.  In many areas (ie. Los Angeles) many great doctors are available.  But if you want to see a doctor out of network you're going to pay yourself.
> 
> So I agree that a Medicare supplement is always the best choice if money is not an object.  In fact, I'd much rather go with a high deductible plan f (HDF) which kicks in to pay your out of pocket after a $2,300 deductible.  Keep in mind Medicare will still pay their share so unless you have a hospitalization or something like chemo you won't spend much.  And the premium generally is $40-50 monthly.  Must better access to care than any Medicare Advantage and generally the out of pocket in most areas is lower.
> 
> Hope that helps a bit.
> 
> Rick



Hi Rick,

Some comments on Medicare Supplemental Plan F.

My understanding is that Plan F is going to be discontinued for new enrollments as of 12/31/2019.  If you already have that plan by that date, you can keep it and will be grandfathered in.

That being the case, what do you think of this analysis.

Since there will be no new enrollees in Plan F after 12/31/19, the pool of people already enrolled will have an increasing average age since younger people will not be added.  So the premiums for this plan will probably increase sharply after that date.  Perhaps another good reason not to enroll in Plan F now.

Also, if you do sign up for Plan F, and the premiums start to rise, you may not be able to switch to another supplemental plan if you develop a serious health condition and be stuck with Plan F and the rapidly rising premiums.

That being the case, it seems to me that Plan F is probably not a good choice even now based on what we already know about the near future of that plan.

This same logic may or may not apply to the high deductible Plan F as I am not sure if that is also being discontinued or not.  Do you know?

And even if the high deductible plan is being discontinued, it might still make sense now in some cases for those who want a lowe(r) premium plan and can self insure up to the deductible.

Thoughts?


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## GreenSky

Ryan said:


> Hi Rick,
> 
> Some comments on Medicare Supplemental Plan F.
> 
> My understanding is that Plan F is going to be discontinued for new enrollments as of 12/31/2019.  If you already have that plan by that date, you can keep it and will be grandfathered in.
> 
> That being the case, what do you think of this analysis.
> 
> Since there will be no new enrollees in Plan F after 12/31/19, the pool of people already enrolled will have an increasing average age since younger people will not be added.  So the premiums for this plan will probably increase sharply after that date.  Perhaps another good reason not to enroll in Plan F now.
> 
> Also, if you do sign up for Plan F, and the premiums start to rise, you may not be able to switch to another supplemental plan if you develop a serious health condition and be stuck with Plan F and the rapidly rising premiums.
> 
> That being the case, it seems to me that Plan F is probably not a good choice even now based on what we already know about the near future of that plan.
> 
> This same logic may or may not apply to the high deductible Plan F as I am not sure if that is also being discontinued or not.  Do you know?
> 
> And even if the high deductible plan is being discontinued, it might still make sense now in some cases for those who want a lowe(r) premium plan and can self insure up to the deductible.
> 
> Thoughts?



You are "almost" correct.  Plan F will be closed to those who get their Medicare after next year but it's still open to "older people".

But your analysis is exactly correct.  Without new people enrolling the prices will have to continue to skyrocked.  HDF won't be as big an issue since enrollees tend to be pretty healthy.  HDG will be available to new enrollees.

Lastly, I have almost never seen where Plan F makes financial sense as companies charge more to cover the deductible than the actual cost of the deductible.  I took a look a few years ago and 78% of my clients were in Plan N.

Rick


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## Ryan

If someone becomes eligible for Medicare in 12/2019 and enrolls in Medicare for the first time on or after 1/1/2020, can they enroll in HDG?


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## GreenSky

Ryan said:


> If someone becomes eligible for Medicare in 12/2019 and enrolls in Medicare for the first time on or after 1/1/2020, can they enroll in HDG?



By then the HDG should be available so the answer is yes.

Rick


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## Trade

I have traditional Medicare with a BCBS PPO plan as secondary. 

I love it. 

It's expensive but my coverage is almost as good as Canadians get from their system for free. 

I would not touch a Medicare Advantage Plan with a 10 foot pole.


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## GreenSky

Trade said:


> I have traditional Medicare with a BCBS PPO plan as secondary.
> 
> I love it.
> 
> It's expensive but my coverage is almost as good as Canadians get from their system for free.
> 
> I would not touch a Medicare Advantage Plan with a 10 foot pole.



Just to clarily, the Canadians don't get medical care for free.  It's buried in taxes.

If you don't like Medicare Advantage, you would hate single payer like Canada.

Rick


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## Trade

GreenSky said:


> Just to clarily, the Canadians don't get medical care for free.  It's buried in taxes.
> 
> If you don't like Medicare Advantage, you would hate single payer like Canada.
> 
> Rick



I seem to remember discussing this with you before. Please correct me if I am wrong, but I seem to remember that you are a Medicare advantage sales person. Am I that correct? 

As for how I would feel about Canadian health care I would appreciate it if in the future you would not be so presumptuous as to attempt to speak for me. 

Thanks in advance.


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## GreenSky

Trade said:


> I seem to remember discussing this with you before. Please correct me if I am wrong, but I seem to remember that you are a Medicare advantage sales person. Am I that correct?
> 
> As for how I would feel about Canadian health care I would appreciate it if in the future you would not be so presumptuous as to attempt to speak for me.
> 
> Thanks in advance.



I've sold hundreds of Medicare advantage plans and even more supplements.

As far as speaking for you, I did not.  I tried to liken long waits and lack of service from Canada to the same with MA plans.

You're welcome in advance.

Rick


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## Trade

GreenSky said:


> I've sold hundreds of Medicare advantage plans and even more supplements.



Then with all due respect I would submit that you are biased towards Medicare Advantage Plans due to the fact that you sell them for a living. 

As for the Canadian Health Care System there are several Canadians that are members here and again with all due respect I would submit that they are in a much better position than you are to speak to it's effectiveness and efficiency.


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## Ryan

Trade said:


> I have traditional Medicare with a BCBS PPO plan as secondary.
> 
> I love it.
> 
> It's expensive but my coverage is almost as good as Canadians get from their system for free.
> 
> I would not touch a Medicare Advantage Plan with a 10 foot pole.



A few questions.

1. What is a BCBS PPO plan?

2. Is a BCBS PPO plan better than Medicare supplemental Plan G or F?  If so, specifically why?

3. How are the costs of a BCBS PPO compared to Medicare G or F?

4. Can you state the specific reason(s) why you would not get a Medicare Advantage plan?

Thank you.


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## Ryan

GreenSky said:


> By then the HDG should be available so the answer is yes.
> 
> Rick



Thank you.  It's one of the options I would consider.  Is there any useful information about it available online yet?


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## Trade

Ryan said:


> A few questions.
> 
> 1. What is a BCBS PPO plan?
> 
> 2. Is a BCBS PPO plan better than Medicare supplemental Plan G or F?  If so, specifically why?
> 
> 3. How are the costs of a BCBS PPO compared to Medicare G or F?
> 
> 4. Can you state the specific reason(s) why you would not get a Medicare Advantage plan?
> 
> Thank you.



My BSBS PPO plan is the plan I had as an employee of the state of Florida. When I retired I was given the option of keeping it at considerably higher cost than when I was an employee. It's not available on the general market. When I became Medicare eligible it became my secondary coverage at a reduced cost as it now only picks up what Medicare doesn't pay. However it also includes prescription drug coverage. The cost to me is $388 a month each for my wife and I. That's high, but it is not subject to increases with age as other supplementals are. 

If I were to go to a medicare advantage plan I would be subjected to a limited network of providers. I don't like that idea at all. In addition I would have significantly higher prescription drug costs as my wifes epilepsy medication is one of those Tier 4 drugs. Right now I get a three months supply for a $100 co-pay. There is no Medicare Advantage Plan that would come even close to that. Another reason I stick with it is that if I ever drop my BCBS PPO I can not go back to it. It's gone forever.


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## Ryan

Thanks for that info Trade.

That IS a high premium!  My parents live in one of the most expensive insurance areas in the country and have supplemental Plan G.  One is 97 and the other 89.  I believe their premium is $273.50 a month each.  Of course it does not include Part D, but fortunately so far their medications are not very expensive (my father used to get his from the VA but now finds he can get better prices from the private market).  I have never seen a single penny out of pocket charge they have had to pay for doctors or hospitalization in spite of many years of both and they never have to file any claims or do any paperwork at all.  The premium is the only cost they have in addition to the drugs.

PS: I like your song reference.  I dig that song. nthego:


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## Trade

Ryan said:


> PS: I like your song reference.  I dig that song. nthego:


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## MeAgain

Two of my senior cousins were here for a visit and they ask me about supplemental plans.
  So I brought them here where you people have went over the plans told them all the great benefits about this site. So at least one should be joining soon once she has time.
   I told her if retires next year it would be helpful also to find out about her 401K plan. I think the majority should go towards paying off or down her home.


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## GreenSky

MeAgain said:


> Two of my senior cousins were here for a visit and they ask me about supplemental plans.
> So I brought them here where you people have went over the plans told them all the great benefits about this site. So at least one should be joining soon once she has time.
> I told her if retires next year it would be helpful also to find out about her 401K plan. I think the majority should go towards paying off or down her home.



Every penny out of a 401K is taxable. Taking out a bunch to pay off what is likely a low interest rate on a mortgage might not be the best advice. 

Rick


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## Butterfly

MeAgain said:


> Two of my senior cousins were here for a visit and they ask me about supplemental plans.
> So I brought them here where you people have went over the plans told them all the great benefits about this site. So at least one should be joining soon once she has time.
> I told her if retires next year it would be helpful also to find out about her 401K plan. I think the majority should go towards paying off or down her home.



IMHO, someone who is trying to decide about medicare supplements/advantage plans should seek professional advice about which is better for their particular situation because there is no one size fits all answer.  It's a big decision and one needs professional advice, NOT the advice of folks on some online forum (tho we do have a couple of professionals here).  I believe the answer for each person includes looking at their medical situation, where they live, and of course their financial status.  

ALSO, about the 401K, I believe one should definitely get professional financial and tax advice before using the proceeds of an IRA in a large chunk to do anything.  There can be substantial tax consequences, as I understand it.


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## Aunt Bea

Butterfly said:


> IMHO, someone who is trying to decide about medicare supplements/advantage plans should seek professional advice about which is better for their particular situation because there is no one size fits all answer. It's a big decision and one needs professional advice, NOT the advice of folks on some online forum (tho we do have a couple of professionals here). I believe the answer for each person includes looking at their medical situation, where they live, and of course their financial status.
> 
> ALSO, about the 401K, I believe one should definitely get professional financial and tax advice before using the proceeds of an IRA in a large chunk to do anything. There can be substantial tax consequences, as I understand it.



Great advice!


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## mathjak107

not only is the 401k or ira taxable unless it is a roth but taking a large sum can rigger all kinds of nasties  like getting your medicare premium increased or social security taxed  if it is not . you can lose an aca subsidy too .

you can be bumped in to a higher tax bracket too .

can you imagine taking something with a decent rate of return despite some temporary dips , getting whacked with taxes and the nasties  above just to pay off a low interest rate mortgage ????


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