- Thread starter
- #31
Should You Ditch Your Medicare Advantage Plan?
- Thread starter somarco
- Start date
MedicareWAA
Guru
- 627
I absolutely disagree.
MAPD plans aren't trash, and Medigap isn't perfect. It depends on the person. In many parts of the country, a Plan N or Plan G is $225+ a month when starting Medicare B. That's a minimum $2,700 - $3,000 annual out of pocket cost … plus a Part D plan with typically less generous drug coverage … plus a dental plan with typically less dental coverage.
The typical person SAVES a lot of money in an Advantage plan in many parts of the country, and their benefits are extremely generous as compared to group insurance (which is always managed care).
The only thing you get with a supplement is the hypothetical benefit of being able to go to a place like MD Anderson or Mayo, and that your provider won't need to fight an insurance company on a hypothetical prior authorization that would hypothetically never be approved by a MA plan.
Some people really want the peace of mind that comes from that sort of maximum freedom, and the hypothetical benefit of that privilege ever mattering much. Medigap is a wonderful match for those people. Some people don't care enough to pay $3,000 - $4,000 a year for it (supp + D + dental) knowing they're unlikely to use that much care every single year. They don't attach a $3,000 value to the peace of mind.
Then, at least a third of retirees are lower middle class but not full Medicaid and cannot afford (or it would be too hard to afford) a supplement. Almost every city in America has multiple health systems that will extend a discounted out of pocket schedule for people earning 200% to 400% of the federal poverty level, effectively improving the patient's MA benefits. I've seen people here claim that is unusual. It is NOT unusual, and there is also typically no asset test. The discounts are a form of charity care and a function of keeping their non profit status, and the overwhelming majority of American health systems are "officially" non-profit.
I'm writing this long post because it drives me nuts that there are lazy or misinformed or financially conflicted agents who try to shoe horn everyone into product category A or B. There is no "best" plan option for an unknown person. Every person is like a snowflake or a fingerprint, and we are not the client.
Objectively lay out the FACTS and let the client tell you how they feel about their options.
End rant.
MedicareWAA
Guru
- 627
See my post above. You're just as ignorant when you insist that Medigap is the best option for most people with Medicare. It's not so simple and straightforward.
- Thread starter
- #34
How many policyholders, Don?
3,000 . . . 6,000 . . . 10,000?
And NO complaints?
No one ever had treatment delayed/denied due to prior authorization?
Your policyholders (I won't say clients because I don't think you have any) have NEVER encountered an OON provider/claim?
No one ever had large OOP claims they could not pay?
You must be deaf . . . or maybe you don't have voicemail or listen to your messages . . . or maybe your policyholders with Obamaphones don't have your number . . .
Again, ZERO credibility on this forum.
3,000 . . . 6,000 . . . 10,000?
And NO complaints?
No one ever had treatment delayed/denied due to prior authorization?
Your policyholders (I won't say clients because I don't think you have any) have NEVER encountered an OON provider/claim?
No one ever had large OOP claims they could not pay?
You must be deaf . . . or maybe you don't have voicemail or listen to your messages . . . or maybe your policyholders with Obamaphones don't have your number . . .
Again, ZERO credibility on this forum.
It can seem like a good idea for access issues until someone has a major event. Part B expenses with no cap can devastate a household. Cancer treatment is a big expense and so common these days, I would never suggest that a client go with only original Medicare with no cap on out of pocket costs. Could look at MSA options in their areas, which at least allow access to all Medicare-participating providers. We are working with one that is an Employer Group MSA and if the group signs off to offer it, any former employee no matter how long ago is eligible for the plan. Great option for those who don't like networks or managed care.If you're tempted to ditch your Medicare Advantage plan, you're not alone. Here's when it's a good idea and how to go about it.
While Advantage Plans seem like a good alternative, a substantial number of older Americans who sign up for them don't stick with them. In fact, among those who signed up between 2011 and 2022, around half left their plans within five years.
Many are opting out of their Advantage Plan during open enrollment, either by switching to a different Part C plan or by returning to traditional Medicare instead. Advantage plans are less likely to attract beneficiaries over the long term, the study warns that such plans will likely have less incentive to cater to participants with chronic conditions.
Instead, most people who disenrolled did so because of difficulty accessing care as well as concerns about the quality of their care.
Should You Ditch Your Medicare Advantage Plan? Most People Do
If you're tempted to ditch your Medicare Advantage plan, you're not alone. Here's when it's a good idea and how to go about it.www.kiplinger.com
I am a type I diabetic who wears an insulin pump and CGM and I meet a $6000 out-of-pocket maximum every year. A $0 premium MAPD in my state does NOT make sense for me, as premiums would be less than copays/coinsurance on MA plans every year. Your 3 scenarios are a good start to discussions but it isn't about what's happening today, it's about what risk someone is willing to take on. Insurance is all about risk transfer and we choose what we feel like is best for our situation based on how averse we are to risk.
- 1,742
No, but you certainly do.
I'll be glad when you make a decision.
- 31,477
I'm 72 and I pay $156 a month for Plan F.
Where do you see anybody new to Medicare Part B paying $225 a month for N or G?
