Medicare ? Advantage plan or supplement. What do you have ?

[DW]

To put Medicare funding into context, the Affordable Care Act cut Medicare spending by $865 billion. This administration had nothing to do with it.

In contrast, the Congressional Budget Office (CBO) previously estimated that full repeal of the ACA would increase Medicare spending by $802 billion from 2016 to 2025.

If the terms of the ACA are modified instead of repealed, one can call a reduced reduction in spending as an increase in spending; or one can call it a cut; all depending on partisan spin. Confusing? Yes, but let’s not be confused about the cuts established in the ACA.

[bassin08]

We should not fund Medicade using Medicare money and we will be fine.

[Lundman1!]

I went on Medicare about a year ago. I researched the Advantage Plans and getting a regular supplemental plan. I didn't see any advantage to the Advantage Plan, which some providers really seem to push. I want to know what my costs are up-front. I elected Plan F, which in my case is ~$105.00 per month. Plan F will no longer be offered after either 2020 or 2021 (I can't remember which), UNLESS you are already on it.

[YATYAS]

Originally Posted by bassin08

We should not fund Medicade using Medicare money and we will be fine.

We should not allow someone who paid less than $30,000 over their lifetime receive $50,000 in benifits for a single hospital trip.

[Bosshogg]

Originally Posted by eriksat1

You might just have to wait and see what our president does to Medicare. The talk is he is trying to cut it big time.

“Trump’s 10-year budget unveiled Monday calls for more than $845 billion in reductions for Medicare, aiming to cut “waste, fraud and abuse” in the federal program that gives insurance to older Americans. It’s part of a broader proposed belt-tightening effort after deficits soared during the president’s first two years in office, in part due to massive tax cuts for the wealthy. “

Look into what President Trump is cutting, it is nonsense items. For example, if you visit a doctor's office that is associated with a hospital, they are reimbursed at a higher amount than an independent doctor's office. Trump isn't cutting any services, just the nonsense. Watch out for those click-bait headlines, they always mislead.

OP - Went through this in 2017. My best advice is when or if you use the Internet to research out Medicare gap plans, never and I mean under no circumstance, enter your phone number or email address. If you do, you will regret this for the next year or so.

When coming into this, it is overwhelming and you end up mystified over all the terms used to describe plans. What I did was I used the AARP's web site to research United Healthcare information, they provided details without having to enter your personal information. Even then it was confusing. Then I discovered a representative from United Healthcare would come to your home and go over everything with you. That is what my wife and I did and because of that, we learned a lot and if we have a question we can call the "man".

As mentioned, what is available to you is based on the state you live in (yet another issue Trump is trying to correct). In a nutshell, you have two choices;

Advantage plan (like an HMO)
GAP plan (PPO, they use letters like Plan F)

If you plan on traveling, you will likely be better covered with a gap plan.

I live in Michigan and went with Plan F through United Healthcare. I have no out of pocket costs. If it is covered by Medicare, then my Plan F picks up what Medicare does not pay.

As far as costs, Medicare part A is free if you qualify for Medicare. Part B will cost you depending on how you set up your retirement income. I stay under $170K AGI per year so I pay 135.50 per month and my wife's is the same amount. Plan F is around $318 per month for both of us.

I hope this information saves you from what I went through.

Originally Posted by DW

The best plan depends on your health condition. One should evaluate the best plan based on your medical needs.

Be honest with yourself.
I said I'm in "good health", and my wife and kids laughed.

[Anonymouse]

All Anonymouse can tell you without adding political OPINIONS is what has happened to him and his wife since both became disabled.
First, a little back-story digression.....

Mrs. Anonymouse had sudden and catastrophic kidney failure in 2004 and a transplant in 2005.
Her "Gold Cadillac" State of Wisconsin (UW) insurance plan, through work, quit at $500,000.
All that right-wing natter about "overpaid" public workers is BOOLLSHEEET!!!
She was making $25,000/year at a University property management job the private sector pays over $60,000/year for.
Supposedly the good benefits made up some of the difference, but they didn't, not when it came to crunch time.

By the time it was all over, our out-of-pocket was somewhere in the $625,000-$650,000 range & we had to sell off a YUGE chunk of the rental real estate we had invested in for old age, to pay those bills off.
That is how NOT having a Universal Healthcare system, like every other civilized nation, can bankrupt a person.
Anonymouse was a paper millionaire at the time, with maybe $800,000 in actual equity.
By the time Mrs. was all taken care of, we were down to 2 pieces of mortgaged rental property and our home.

Then, a year later, out of nowhere, Anonymouse went and died from a "widow-maker" heart attack.
Previously, Anonymouse had been really sick a total of 3 times - all the flu - in his entire life.
Being her sole caregiver after the transplant, Anonymouse had to quit working and thus had no insurance.
The heart attack ended up costing us out-of-pocket, $142,000.

There went one of the 2 remaining rental real estate properties and a home equity loan of $33,000 on our already paid-for house.
But Anonymouse was more fortunate than most - he still had 1 piece of rental property (slightly leveraged at $40,000) and a small loan on the personal residence.

You can make comments about not buying insurance or any of a million reasons why this might have been avoided but when YOU have to deal with a loved one in a coma for a few months and then take care of them in recovery 24/7 for another year - in addition to raising 2 children - YOU can maybe catch Anonymouse's ear for all of 5 seconds before he punches you in the snout for not minding your own business.

Anonymouse did all the right things, he went to school and started his own construction business, he deprived himself and family for decades to invest in real estate for their futures, making wise investments and not wasting money on needless luxuries like new cars or a fancy house (1,400 sq.ft. ranch).
But in just 2 years, almost all of that was wiped away - really through no fault of his own making, other than not spending tens of thousands on ADDITIONAL private insurance policies that would have short-circuited his investments completely.
Most peeps take it for granted that your work heathcare plan will take care of most of the terrible things that befall you - until it doesn't, and then it's too late.

Anyhoo, fast forward a bit and by 2013 Anonymouse and the Mrs. are both on Medicare & Social Security Disability Income.
Since it's inception the Mrs was enrolled in Part D for drugs and Medicare paid 80% of everything else.
Anonymouse finally went on Medicare in 2013, along with part D for meds.
It worked pretty well until last year when the Mrs ended up hospitalized (4) times for short periods and has now gone into chronic slow rejection of her allograft, for who knows until when, when it finally gives up the ghost entirely.
That point being, eventually she's going to need yet another transplant, costing hundreds of thousands of dollars & this time we aren't millionaires anymore.
(Sold off the last rental property last year and paid off the home equity loan.)

So this year, during Open Enrollment in October, we decided to be good citizens and pay extra for one of those Medicare "extra" plans.
Short POLITICAL digression - If we are going to have affordable Universal Healthcare, EVERYONE, healthy and unhealthy alike, MUST participate. no skating because you are young and don't NEED a lot of healthcare right now.
Sooner or later, you WILL need it, and it's your DUTY to have participated even when you didn't - just like the peeps participating when they don't need it and you DO !!!

United Healthcare Advantage Open costs more in monthly premiums and is supposed to help with hospital costs, but the out-of-pocket co-pays are higher than they would be on straight Medicare with part D.
($15 for a doctor visit and $50 for a specialist visit.)
Typically all the doctor visits were around $20-$30 with straight Medicare and write-downs.
The drug tier co-pays are also higher than they were on the Part D plan we used to have through the same United Healthcare Part D underwriter.

A side note, Medicare Supplement plans and Medicare Advantage plans are NOT the same thing.
This is CRITICAL to know and several reps Anonymouse spoke with either lied or didn't bother explaining that, which is sort of how we settled on United Heathcare Advantage Open - they were VERY forthcoming about the differences.

Also CRITICAL to note is that when you join a Medicare Advantage plan, you are WITHDRAWN from actual Medicare and are then covered by an entirely "for-profit" PRIVATE healthcare underwriter - though you can go back to straight Medicare without a penalty any time you wish.
This probably explains the higher co-pays and stuff - they ARE out to make a profit off your misery, afterall.
They get paid on multiple ends - by you, by Medicare for handling your claims, and they cut side deals with big pharma on meds & get discounts from providers for everything else.
Whatever they can chisel out from all sources is theirs to keep, and pad their profits.

The idea for us being, instead of the almost $7,000 in out-of-pocket we paid for hospital stays last year, even after Medicare and the write-downs by the hospital, we won't be hit so hard again if the Mrs is hospitalized again in the future.
Seems like a fair trade off, if the Advantage plan delivers what they promised, and IF she needs to be hospitalized at all again - which is the whole point in buying "insurance" to begin with.
Somewhat higher co-pays against less out-of-pocket for hospitalizations.
YMMV (Your Mileage Might Vary).

[JMKC]

Originally Posted by Lundman1!

I went on Medicare about a year ago. I researched the Advantage Plans and getting a regular supplemental plan. I didn't see any advantage to the Advantage Plan, which some providers really seem to push. I want to know what my costs are up-front. I elected Plan F, which in my case is ~$105.00 per month. Plan F will no longer be offered after either 2020 or 2021 (I can't remember which), UNLESS you are already on it.

You made a great move, from experience.

[hawg]

What is Plan F. It's too low $'s to be a supplement isn't it? It must still be a glorified Advantage plan? The $160 more I spoke about was with prescription plan included which is not a part of Blue Cross Basic. An Advantage plan, in Mn at least, is just allowing an independent insurance company to manage your medicare that add a few whistles and bell incentives like a few routine co pay situations. They are "managed plans".

[DW]

This is a correction to misstatements

“... Also CRITICAL to note is that when you join a Medicare Advantage plan, you are WITHDRAWN from actual Medicare and are then covered by an entirely "for-profit" PRIVATE healthcare underwriter - though you can go back to straight Medicare without a penalty any time you wish.
This probably explains the higher co-pays and stuff - they ARE out to make a profit off your misery, afterall.
They get paid on multiple ends - by you, by Medicare for handling your claims, and they cut side deals with big pharma on meds & get discounts from providers for everything else.
Whatever they can chisel out from all sources is theirs to keep, and pad their profits...”

Last I checked the health insurance industry earn an average slim 4% margin which is unfair to portray as greedy. I suspect that is a bargain when the same service is provided directly by the Feds.

It is true that Medicare Adavantage insurance companies assume Medicare responsibility from the Feds, as was intended. Congress created the Advantage plans to lower Federal costs and risk while improving patient service.

Not only do Advantage plans reduce the Fed costs, but generally reduce patient costs, and in my case by a LOT! Most Medicare doctor deductibles are 20%. My copays are $10 to $50 depending.

If you think the Feds do it better, count the number of Doctors who will accept Medicare only covered patients. Not many!