Original Medicare + Medigap vs. Medicare Advantage – Which is Right for You?

You mentioned the ability during open enrollment to switch between traditional Medicare + supplement and Medicare Advantage without regard to any pre-existing conditions. What about rating the policy for higher cost if you are switching and have some health issues? Can insurance companies do this to switchers between supplement plans and Advantage Plans?
As an example, what if one selects a low-cost Advantage plan for the first few years of Medicare when presumably more healthy, and then later switch to a combination traditional with Supplement Plan? Would the future cost of the traditional + supplement combo at say age 70, be more than if selected at age 65, due to the insurers ability to experience rate the change for any new health conditions?
Thanks!

Last year when I went to an insurance broker, I switched from Medigap plan N to MA PPO plan. She said if I wanted to switch back to a Medigap plan I only had one year to do it, otherwise I would have to stay with an MA plan. I could then switch between MA plans, but not switch back to Medigap. Does anyone have any thoughts or info on this?

Bill Y., What you have stated is exactly what I have been told. You can switch back, but 1st year only without medical underwriting. You can apply to switch back during any open enrollment, but might not be accepted due to your health. Also, a handful of states override that and do not allow underwriting so best to know what your state rules are.

When Tom said, “Important to remember is that you can switch plans each year without regard to preexisting conditions to reflect your needs for the coming year,” I read this as you can switch MA plans from year to year, not that you can switch from MA to Medigap from year to year without regard to preexisting conditions. He may want to clarify that.

Does anyone know what states do not allow the underwriting ? Also what kind of questions are asked if you do have to go through that ?

We checked with Tom and when it comes to the tricky questions that come up going back and forth to original Medicare most of the answers will revolve around state in which they reside. So you really need to ask questions from your broker or insurer to make sure you make the right decision. With the complexity of regulations in different states, it is hard to generalize.

Here is what Medicare.gov says you CAN DO during the Oct 15- Dec Open Enrollment period (It doesnt address underwriting issues):
Change from Original Medicare to a Medicare Advantage Plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
Join a Medicare Prescription Drug Plan.
Switch from one Medicare drug plan to another Medicare drug plan.
Drop your Medicare prescription drug coverage completely.

Also, during the Medicare Advantage open enrollment period Jan 1- March 31 you can change your Medicare Advantage plan or go back to original Medicare.

See https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

Hello All:

The underwriting needs to be clarified for everyone. I just read Plan N, from my AARP United Healthcare, just purchased from my broker. I am not yet 65--two weeks to go, but clearly for those who switch after the first six months of coverage, the application has questions that have to be answered.. They will underwrite you if you switch after the Open Enrollment period.

You can feel free to switch but the premiums may go up and more than once a year possibly, once you are enrolled. Check the history of rate increases with your broker how often and by what percentage. Of course your condition and as stated before, the state you live in may play a part in the premiums.

I did not see any states that prohibit underwriting by the insurance companies, but I did see states that prohibit doctors from charging Medicare Part B Excess charges (15% above what Medicare allows). These states are Pennsylvania, Ohio, Vermont, Connecticut, Massachusetts, New York, Rhode Island, and Minnesota.

Massachusetts, Wisconsin and Minnesota have their own versions of Medicare Supplemental insurance.

Perhaps of interest, here's an article regarding underwriting and the types of conditions checked.
https://boomerbenefits.com/medigap-underwriting/

Editor Comment: Thanks Peder, this is very helpful!

In another thread, I recently posted about the issues we encountered (these were resolved in our favor) being initially refused by our Medicare Advantage program for triple-bypass surgery after my heart attack because I was out-of-state the the rep deemed it "not an emergency". After that experience, we chose to move back to standard Medigap and will stay there until we decide that traveling will no longer be part of our activity.

Also note that even some Medigap policies may not provide coverage out-of-country. That includes cruises. Pay careful attention to what travel coverage is provided for Medigap.

Boomer Benefits is great. When something goes wrong, they are there for you, even with coding issues in your doctor's office. They get so many awards for their customer service.

More good information here including some state specific exceptions:
https://boomerbenefits.com/medicare-supplement-guaranteed-issue/

Buyer Beware....

Medicare Advantage Plans are 100% private insurance unlike traditional Medicare. The number one goal is not your healthcare....it is to make as much profit as they can. MA is great for people that are healthy. If and when you get really sick, watch out. You are much better off with traditional Medicare + a Medigap policy to cover the remaining 20% Medicare does not cover. Do your research. They are pushing MA Plans because of profit.

Mayo clinic does not accept and Advantage plan the last time I checked

Brent, I don’t agree with your comment. I belonged to Kaiser Permanente, an HMO, for over 30 years when I lived on the east coast. There was never a situation when I didn’t get care I needed because Kaiser wanted to make more money. I gave it up only when I moved to the Midwest where Kaiser isn’t available. An MA may be the best choice for many people. MA plans can cover things such as dental, vision, and hearing benefits that are not available under original Medicare Parts A and B with a Medigap plan. Congress is allowing MAs to provide other additional things such as house ramps. For people with lower retirement incomes who don’t travel much, an MA plan may make much needed benefits available and save money. There are many reasons why an MA plan may be the best option for some people. I worked for SSA for 39 years & now volunteer to help people learn about their Medicare options.

Jean:

The world of insurance was very different 30 years ago. Each year restrictions are placed on patient care. The sicker a person may be, the less the options for the patient, and the ones available may be expensive. I, too, volunteer to help people know their Medicare options and I suspect that where one lives plays a big part. In fact, I just went through this myself as I turn 65 in less than two weeks. I chose a Medi-gap supplement to Medicare Parts A & B.

The options that an MA will allow for care in the dental arena is something I am very familiar with as I work three days a week for an oral surgeon and just yesterday I had a patient whose maximum yearly benefit for dental was $1200.00, no crowns, root canals, fillings or anything other than strictly preventative care was covered. Each year the insurance companies try to save money. MA's as I have recently stated, require pre-authorization now for any procedures that need to be performed. If they do not think they are necessary, then either you will have to pay for them out of pocket, or just not have the procedure. One does not need to be a world traveler to suddenly not be covered by MA/HMOs. You can merely cross the state line--one must check that every person who provides services is in the HMO /PPO network, from an Emergency Room doctor to a surgeon to an anesthesiologist and even the lab and x-ray facility. I live near a Johns Hopkins major hospital and I can tell you not all the doctors participate with certain plans so check, check, check. Even a prescription within an HMO can require a pre-authorization. By the way, all insurance companies say that pre-authorization does not guarantee payment of benefits. So even then, be cautious.

Steve: As for the Mayo Clinic, the one in Rochester Minnesota does accept Medicare assignment. The ones in Jacksonville, Florida and Scottsville/Phoenix do not accept Medicare FOR OUT OF STATE RESIDENTS, if you are a resident of those states you may be covered. Mayo is experimenting to see how this policy will affect their bottom line. Medicare Advantage HMOs require pre-authorization (Good Luck) to be covered at MAYO, so you may or may not be covered. You cannot be seen even if you want to pay out of pocket which was a surprise upon investigation of the MAYO website.

Mayo Clinic does accept Medicare Advantage (MA) plans under some circumstances. See the information from Mayo’s current website below. Connecticut and New York never allow medical underwriting in order to switch from MA plans to Medigap plans at any time, regardless of how long you’ve been in MA plans. This can be done during any annual open enrollment period and at certain other prescribed times. I guess that’s one of the benefits of the higher taxes often paid in those states.

https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/medicare/more-on-medicare

I have Medicare and Medigap AARP Plan F in NC. During the open enrollment period, can I move to Medigap Plan G without medical underwriting? I am afraid that since Plan F will soon no longer be eligible as an option, that as the years pass that those in the plan will age into more need for medical care and cause a larger increase in premiums than it would have if younger, healthier participants were also being added to the group.

Sheila,

You can contact Danielle at Boomer Benefits and she can answer this for you definitively. The concerns you have for Plan F are well founded. Once they no longer accept new members as of January 1, 2020, they will most likely have sicker people in the plan. The rates already have increased and will again. Plan G is just like plan F EXCEPT you would be responsible for the calendar year deductible ($185.00) for Medicare Part B. Once that is met then Plan G is just like Plan F. Part G will be the new guaranteed issue for those newly signing up for Medicare.

As a new Medicare recipient, I originally signed up for Part G-Mutual of Omaha, but then within two weeks I decided for Part N (AARP United Healthcare),and changed. Why? Because Plan G (which will be guaranteed issue, meaning they will have to accept everyone regardless of health history during certain open periods) will be flooded with those who would have gone to Plan F and Plan G rates are already beginning to rise. For those who are was fairly healthy this would be a good choice. Plan N is 30% less than Plan G and has nearly the same coverage with a few caveats.

With Plan N, I must pay the Part B deductible ($185.00), and also up to a $20.00 copay per doctors office visit as well as a $50.00 copay if I go to the emergency room. If I were to be admitted to the hospital, then the $50.00 copay is waived. I also must make sure that all parties involved in my care accept Medicare assignment as payment in full or I will have to pay any excess charges-which is 15% more than Medicare allows. Plan N does not cover those. All else is covered just like plan G. Medicare premiums will likely raise to $144.00 in 2020. The history of rate increases is much more reasonable with Plan N since it is not guaranteed issue. I asked for a history of rate increases on both Plan G and Plan N. Be sure to check what other options you might have in your state. Some states have a high deductible Plan F. I live in the District of Columbia and that is not offered here.

Congress wants Seniors to be conscious of costs as they found that those who had Plan F went to see the doctor more(because everything was covered), than those on plans who paid more out of pocket. In years to come Medi-gap plans that pay for most everything will no longer be offered.

One most interesting comment endorsing Original Medicare and a Medigap plan as the best coverage because the MAPD plans were Insurance company plans and profit driven and thus a lower or inferior plan.
True insurance companies are in business to make a profit and they do so under the watchful eye of CMS. All MAPD PLANS must cover what Original Medicare covers, no exceptions. MAPD plans have there roots in the idea that they can get better results and keep costs under control with a little management of fraud , Waste and Abuse.
In my opinion the cost must be considered. 12 x 134+241+77 x20 years plus interest =$141,024 as opposed to
$32,160... the difference , $108,864, is what can be used to offset any deductibles, copays or Co insurance. Or increase ones disposable income over 20 years. My comparison is based on Current Connecticut plans and prices and a 1% interest rate. It might vary from state to state but you get my point.
Certainly Original Medicare and a Medigap plan have distinct advantages but not so enough to draw a line in the sand.

Tom Cretella, thanks so much for your further analysis from a professional agent’s standpoint. When it comes right down to it, Medicare and its rules can primarily be examined only on an objective basis. It’s not like whether someone does or doesn’t like certain aspects of a retirement state, or a particular retirement community. Those are subjective analyses, while all forms of Medicare are controlled by law and the explicit terms of the policy (albeit variable from state-to-state and county-to-county) and should be judged almost exclusively by objective criteria, usually best provided by an industry professional like yourself. I feel we see too many personal opinions on this blog about Medicare and Medicare Advantage (MA), without backup citation or web links. That is why it is so important for all of us to EVERY YEAR seek professional advice during any open enrollment period for Medicare. Medicare sales agents do not charge for this advice, and are paid the same amount for each policy sold, so have no financial incentive to steer a customer towards on policy or another. The agent’s duty is to help the customer select the best policy (whether Medigap or Medicare Advantage) for the particular needs and situation of each individual customer.

Tom, I have one question for clarification about your post. Is the $141,024 figure for Medigap over time, and the $32,160 for Medicare Advantage over the same period of time, using the assumptions in Connecticut you mentioned? Or is it the other way around? I couldn’t quite tell. Thanks again for your assistance and professional knowledge.

For me, the big takeaway from this article is that the Open Enrollment Period is a time to stop and re-evaluate our Medicare coverages. Make sure we have the right plan and change it if our needs have changed or something better has come along. Not unlike the Zero Based Budgeting idea - nothing is sacred and everything should be re-evaluated.
Thanks Tom for this article, it really helped clarify a lot of things.

The best thing everyone should do, whether new to Medicare or during open enrollment, is to locate your local SHIP or SHINE organization to sit with a volunteer counselor to get unbiased information. These counselors are all certified and receive continuing education: www.seniorsresourceguide.com/directories/National/SHIP/
They are very familiar with all the guaranteed issue rights for their state. They are also familiar with all the assistance programs for low to moderate income clients. They are not paid and are not tied to any insurance company. They can give you print outs to review in case you want to think about your choices.

Drug plans and drug formularies change every year. Even if you are on a Medicare Advantage plan, you should always check your drug coverage for the new year.

Remember not all insurance agents sell all insurance products and they do get paid to sell. If you join a Medicare Advantage program, the agent gets an initial payment and then gets a residual payment every month you stay on that plan.

Once you know what you want to enroll in, then you can enroll on-line or you can work with an insurance agent.

There have have been several recommendations for contacting SHIP volunteers for advice regarding Medicare advice. My experience was that they were not familiar with how TriCare operates as the secondary for Medicare for military retirees who turn 65. I contact two different SHIP counselors, and both admitted they didn’t know what the details were in this regard, or if another medigap or Medicare advantage policy was better or worse than TriCare. I realize this information only applies to a relatively small portion of the TR community, but for those it applies to, you are likely better off contacting the local TriCare office.

This has been a useful discussion as it forced me to go back and look at all of the information that I received when I turned 65. With regard to Tricare-for-Life (TFL), which is what military retirees get when they hit 65: TFL works as a Medigap policy for military retirees and includes coverage for medications. It covers many of the copayments and the like. It does require that people use providers that accept medicare who have not opted out of Medicare. Some, but not all, military bases will take care of TFL participants.

It’s unfortunate that some people here are extremely negative about MA plans when they may be the best option for some people. I had Kaiser Permanente Mid-Atlantic until 6 years ago. It’s been rated very highly by its members for many years. Their services improved continuously, and Kaiser added more and more specialists to their staff. In over 30 years, I was never denied seeing a specialist. Before I left Baltimore 6 years ago, several hospitals already had floors devoted to Kaiser patients. There is a clinic in my small Wisconsin hometown that has 5 MA options. People LOVE the doctor there & trust him to direct their care rather than go on their own to outside specialists. Patients are sent to a nearby community hospital, but are also sent to the highly-regarded University of Wisconsin Hospital in Madison when needed. Jennifer, $1,200 for dental care is still better than $0. It’s unfair to make blanket statements against MA plans when a high percentage of people are happy with MA plans. People should look at the options available in their local area when deciding between original Medicare A & B versus an MA plan.

I would really like Tom to answer Clyde's question as I was confused as well....was anyone else??
Here's Clyde's question:
Tom, I have one question for clarification about your post. Is the $141,024 figure for Medigap over time, and the $32,160 for Medicare Advantage over the same period of time, using the assumptions in Connecticut you mentioned? Or is it the other way around? I couldn’t quite tell. Thanks again for your assistance and professional knowledge.

by Clyde — September 14, 2019

I just can't see the value of adding a supplement...if I understand correctly...with AARPUnitedHealthcare I have AARP Medicare Complete HMO. I am not charged extra monthly...just the $134, right, that comes out of my social security? so, there's no charge to see my primary and only $25 copay for a specialist. My out of pocket maximum is $4900.00 so... then anything else would be covered. I compare that to a supplement which is an additional $198 or so a month PLUS the drug plan...I just don't get it! What am I missing??

My father-in-law, who passed away earlier this year at age 93, spent the last 10 years in assisted living here in Texas. He was enrolled in a UnitedHealth MA plan. His doctor actually came to see him regularly at the assisted living facility. I thought that this was great as he was wheelchair bound and it was difficult getting him to dental and vision appointments. He was unable to travel outside the local area so the MA plan was great and I don't believe many doctors with traditional Medicare patients would come to them as his doctor did. Something to consider for later in life.

We have had Humana PPO MA plan for a year now, this whole thread has me investigating whether to stay with it or take the one time opportunity to go back to my old AARP Medigap plan. I keep looking at the cost differences and MA wins hands down. As far as in-network coverage goes, there seems to be plenty of providers, both here in Indiana and in Florida, where we spend a couple months in the winter.
Why would I want to spend $150+ a month (x 2 for spouse) for Medigap and a plan D when I can get the coverage for $15/month through the MA plan?

Hi Jean:

A $1200.00 maximum for dental coverage per year is fine if you have perfect teeth and just need x-rays every two years and a cleaning every six months. Even a filling or two may be covered, if needed. I was merely stating that people should look at their maximums that the insurance will pay. This would not cover crowns, and root canals or extractions. We see a LOT of broken teeth in our office. If a tooth has been filled, it can become weak over time and crack and break. It is very expensive to replace. Dentures are now a thing of the past and an implant with a crown over it is the way many people go now days. This is not covered by most dental plans and people need to be aware of it.

If you do not go far and you can find a doctor in your MA plan in most of the locations you travel, then go for it. Again, I found out in my own journey that was not what I wanted due to the portability issue. Even if you do find a doctor in your network with an MA, they will still have to pre-authorize your treatment and that can take time. This is not an issue with Medi-gap insurance. In an emergency, or if "time is of the essence" I do not want to have to be pre-authorized for treatment which could open me up to financial risk if it is not done properly, or at all.

Brenda, you appear to have a United HealthCare Medicare Advantage plan through AARP. It also appears that your plan has a $0 monthly premium, which is why you don’t pay anything on a continuing monthly basis. Your annual maximum out of pocket (MOOP) costs are $4900 for covered services, which is just about everything you would medically need; the MOOP cap doesn’t apply to drugs, but many MA plans have solid drug coverage. Regular Medigap does not generally have an annual out of pocket maximum limit on costs for participants. An HMO means you must use providers and hospitals within a network, although those networks are usually quite extensive for most plans. With permission, out of network care can be available, and emergency services, and often urgent care, are always covered by MA plans anywhere in the US. Everyone enrolled in Medicare pays that $134 monthly cost, usually deducted from Social Security, but paid directly to Medicare for those not receiving Social Security. You technically do have a “suppplement,” but your supplement is your Medicare Advantage plan, used by nearly 40% of Medicare recipients. The rest of recipients usually select Medigap, which has traditionally been known as a “supplement” plan. The terminology can get a bit confusing.

Yes, I would still like to have Tom indicate which type of Medicare plan his projected lifetime costs are attached to.

Brenda - I don't think you're missing anything. Or we're both fools! I have a no-cost AARP HMO plan as well. I even ran it by the Medicare specialist at my insurance broker and he didn't see anything wrong with it. As long as you are happy with the doctors and hospitals within the HMO, your drugs are covered, and you're not a big traveler, you should be OK. Any premiums not paid can accrue towards the costs you may have later. My MOOP is $3600, for what reason I don't know. Perhaps it's a function of age and location. Even the one Tier One drug prescription I have is free by mail for a 90 day supply. Hard to beat that.

I recently had occasion to visit my ophthalmologist to prepare for cataract surgery. They wanted to do a test which they said many insurance companies would not cover. I told them to go ahead and do the test and submit the bill to my Humana PPO Medicare Advantage Plan (for which I pay nothing). Humana covered it. I'm extremely pleased with the coverage. And I did not need a referral to see the ophthalmologist.

I would like to say that when you choose a Medicare Supplement it would be wise to ask yourself what would be the best plan if you became ill with a rare disease. Shortly after signing up for Medicare, I was diagnosed with a rare cancer that is best treated out of state at one of 3 hospitals in the USA. Thank God, I had signed up for plan F, otherwise, I would be bankrupt or dead. Assuming you are going to stay healthy defeats the purpose of insurance.

Maimi, I do agree with you. A friend of mine was diagnosed with ovarian cancer, and she told me she would be out on the street were it not for her insurance. I agree that people need to think long and hard about what might happen in the future and not assume that the cheaper plan is the way to go. As we all know, life can turn on a dime. My hub and I both retired "healthy" at 66 and 67, no meds. to speak of. Several years later we were both diagnosed with potentially catastrophic diseases and were grateful that we had Plan F Medigap.

https://www.cbsnews.com/video/how-am-i-gonna-pay-this-man-left-with-650000-in-bills-after-back-surgery/#x

This person has insurance!!

Regulations on insurance have been loosened during the last two years which sets up a buyer-beware situation. It is now possible to buy policies that cover almost nothing. A number of years ago my father was sold a policy that supposedly was a "medigap" policy specific to cancer. What a scam! His existing policies fully covered him for all that this supposed policy claimed to cover.

After reading the comments and talking to many over 65 I am of the opinion that Medicare is currently being dismantled. The movement to PRIVATIZE it is initially appealing with low/zero premiums to lure us in or perks to mislead us but giving control over to the big insurance companies is risky and unwise. Some of the marketing practices are truly unethical. Companies like UnitedHealth Care, Anthem Blue Cross are benefiting in most cases. When we are healthy and young we want the cheaper plans. However these private companies really make out since Medicare pays them very healthy premiums to cover us. It also means sick folks are staying with traditional Medicare and draining the bank. Thus the balance of Medicare subscribers is shifting because of this and hurting it. Again the big companies are making out. My understanding from my agent here in CT is that the premium they are paid is $1000 monthly. Anthem didn't even pay put $1000 for me the last 2 years. Furthermore I am of the opinion some of the marketing could even be considered elder abuse preying on the elderly. I fear for the future when I probably will need care and Medicare as we know it will not be available, or not available at these prices. Another question is will I loose my ability to switch during open enrollment in the years to come due to a pre existing condition or change in rules.
Shouldn't we be working to strenthen and improve Medicare for those of us over 65?

Janet, if you stay in Connecticut, you should have no difficulty changing from Medicare Advantage to original Medicare Supplement. CT and NY are the only states that prohibit underwriting for any pre-existing conditions when changing from MA to Medicare Supplement. At any age.

Thank you Clyde, you certainly have a wealth of information you are sharing on this site.
I do plan on staying and feel confident if the decision is up to CT that ability won't change. Despite the high cost of living here we do have an equally high quality of life. Historically we have been very progressive with our laws regarding insurance, especially health. I wish the other states would join us and NY to allow seniors to move each year without penalties.I do worry about the health of Medicare with the Advantage plans attracting mostly young healthy folks among the usual concerns we all have.

https://www.pbs.org/newshour/economy/making-sense/private-insurers-are-improperly-rejecting-medicare-drug-claims-watchdog-finds

Private insurers are improperly rejecting Medicare drug claims, watchdog finds

The NPR article JoannL mentions is about Part D Medicare drug plans. These must be purchased in addition to original Medicare supplement plans if you want drug coverage. Many Medicare Advantage plans have drug coverage already built-in to the plan. However, if you have chosen a MA plan without drug coverage, you must buy Part D if you do want drug coverage.

OK, so we are curious. How many of you are considering changing plans during the Medicare Open Enrollment period which starts next week? I have thought about changing from a high deductible Plan F to a Medicare Advantage (Plan C), but am told it might not make much difference. Also, my Plan D (prescriptions) is very cheap but some of the immunizations (Shingles in particular) I have had much bigger payments required than my wife's.

I'm not changing from MA. For the limited needs I have at 66, with my current doctor and preferred hospital included in the HMO, and a max OOP of $3600 (which I feel is certainly reasonable considering the cost of any hospital visit) I think I would be silly to change especially at zero plan premium. Of course I still need to pay for Part B, but everyone does.

My "medigap" ins is part of my post retirement plan, although I do pay quite a bit for it. Would not change since I could not go back to it if I didn't like the alternative. Then plan isn't great as far as what is covered but the drug part is outstanding and would be a huge savings should I ever need one of those new, super expensive meds. Hubby is just stating and signed up for a plan F.

I selected Plan G, as my first choice. I just started with Medicare Sept 1, 2019. In late August, I re-reviewed the plans and looked at long term costs and changed to Plan N. I am healthy now with no medications. *Plan F will have only older and sicker plan participants as they close down the plan to new members on December 31. I could have chosen Plan F but I realized the premiums will go up dramatically and have already started to do so. Plan G is now the Guaranteed issue and looks very appealing except for the Medicare Part B deductible --the coverage is nearly identical to Plan F. However, the premiums were 30% more than what I am paying for Plan N. I will have to pay a possible co-pay ( up to $20.00) when I visit a doctor or emergency room ($50.00) however, they are minimal and I would only go to a participating Medicare physician so Plan N in every other aspect is identical to Plan G. Being a former nurse, I am careful and I rarely need to see a doctor. I have seen patients who come to the doctor for things that are unnecessary just because they know the insurance will cover it. I vow not to be like that. Thankfully I know the difference.

It appears that our lawmakers will want us all to go towards Medicare Advantage Plans in the future. If they become more flexible, I will look into them in years to come. If one has the money, then go for Plan F if you can, and or Plan G. My income is limited to one person. My plan D Drug plan is $14.00 per month and I only bought it to avoid future penalties if I ever needed a tier 3-5 drug. I am trying to eat well and exercise do not smoke and socialize on a regular basis. I am praying to God that will help me.

I'm not changing. I'm in traditional Medicare. I'm retired military, so TriCare covers Medigap and drug coverage. That allows the
flexibility of being able to go to any doctor who accepts Medicare, and I don't have to worry about who I can see when traveling. We're also moving to another state, so I don't have to be concerned about whether the network for an MA plan will be in our new location. Like Peder said, I still have to pay for Plan B, but everyone does.

I was having a conversation with my dental hygienist yesterday (which is a trick in itself when you are having your teeth cleaned), and she told me that BCBS plans allow switching from MA to Medigap without underwriting. Investigating.

Like Partegas, retired military Hubby and I have part A and B Medicare and other retiree employment health insurance but no drug plan. After twelve years of increasing medications and costs, a military hospital friend suggested signing up for Tricare For Life. No premiums for our drug coverage as well as coverage for deductible in first few doctor visits at the beginning of new year. There is a fee of $7 (soon to be $10) for 90 day supply of most medications sent to your address. So happy to have Tricare For Life.

I have been on MA since I became eligible for Medicare five years ago and have been very satisfied with it; my costs have been negligible.. I am currently on an MA HMO plan in Palm Beach County, FL. I will stay with MA, but since we live in Connecticut part of the year, I will consider a PPO rather than an HMO for 2020, so I will be covered in both states (and all others) in-network. The monthly premium will still be $0 on either plan. A reminder that MA plans cover emergencies in any state at in-network cost, and usually cover urgent care in any state as in-network.

Apparently the problems occur with MA plans if you need cancer treatment. They can require co-pays and pre-authorizations. Many people carry extra cancer insurance under MA plans. The out of pocket limits also can be erroneous. Check with your broker.

Jennifer, Your comment "It appears that our lawmakers will want us all to go towards Medicare Advantage Plans in the future." is enough to scare me away from ever considering a MA plan! LOL. Couple that with your observation about MA plans and coverage of cancer treatment and, well, it's very concerning. Why would the govt want seniors on plans that dont cover cancer when cancers are mostly diseases of older age and new treatments are extending lives significantly many with many fewer side effects than traditional chemo but are very expensive ?

Jennifer, it is not helpful to say that “Apparently, the problems occur with MA plans if you need cancer treatment.” If you don’t know for sure, please don’t post assertions like this. Of course MA plans cover cancer treatment. One’s plan may not allow you to go to M.D. Anderson or Sloane-Kettering, but there are excellent alternatives available in network. My plan allows me to go to the University of Miami Sylvester Comprehensive Center, one of only two NCI-designated (the nation’s highest rating) cancer centers in Florida. Plus, the highly-rated Cleveland Clinic Hospital-Florida is also available in my network, as well as several other excellent hospitals/cancer centers. And, yes, co-pays are usually required as they are for almost all Medicare plans. On what factual evidence are you saying “many people” on MA carry extra cancer insurance? And out of pocket maximums can be “erroneous?” What does that mean in terms of actual citable evidence of it? Then “it appears that our lawmakers will want us all to go towards MA plans in the future.” Which lawmakers and how many? This kind of major generalization is also not helpful..

You can see that jean understood your comment about MA plans to mean they “don’t cover cancer.” I’m simply saying we all need to do at least a modicum of research about Medicare plans before we post here, lest incorrect or unclear information about plans may be considered as fact. This Medicare topic is designed to be helpful to readers, and posting sweeping statements that aren’t necessarily researched or factual can be confusing at best. Jennifer, I do fully agree with your recommendation to see your Medicare broker or agent. And check them out, too. Some may not be very scrupulous.

I work at a large, not-for-profit rehabilitation hospital that takes care of people who have had strokes, brain injuries, spinal cord injuries, multiple trauma, etc. I can share with you that one of the biggest frustrations I and my colleagues have is getting approval from MA plans for treatment. Many of them refuse to send their beneficiaries for intensive treatment following an accident or injury, instead relegating them to cheaper nursing homes. I tell all of my family to stick with traditional Medicare. MA plans are great for the every day things, but not when something catastrophic happens.

Does anyone have actual experience with MA and cancer treatment costs? I am considering MA plan with a max year out of pocket at $2800 when I turn 65 next year. I can find nothing in the materials that would indicate that cancer treatment would not still be under the max year out of pocket and standard co-pays. Absence of this issue, I would save a lot going with MA.

Dear All:

I am not saying that MA plans do not cover cancer treatments. They do require pre-authorization in many cases, and that can take precious time. I am a former nurse and I have dealt with insurance most of my career and when I was active in surgical nursing. I also live in Washington, DC, and I keep up with the trends. It does not take much research to see, or with the help of a broker as well, that MA plans seem like a good deal but can change on a dime. I stated in a post that even I would consider an MA if they become more flexible and give better coverage. I use a well known broker and pay him nothing. His job is also to keep seniors up to date. Pre-authorizations are imperative for MA treatment and if they are not done properly you are at risk financially. Read the stories that those have written while on a MA plan--they are not all as easy as Clyde would have it seem.

Jean, in this country, insurance rarely covers things that seniors really need like vision, dental and hearing, for example. They may cover cancer, but you will also have to pay co-pays and Clyde, no not all plans require co-pays. You have to do your research.

I have repeatedly stated that the government wants us all to have more skin in the game as it were. That is why they are discontinuing Medi-gap Plan F on December 31. They do not want us to visit the doctor for every little sniffle--which I have seen happen- when the insurance covers everything. They want us to have to pay something to the doctors and hospitals so that we will think about it before we see our physicians. Most surgical procedures are done on an outpatient basis which can cost more than if one is admitted as an inpatient as well.

Thank you to everyone sharing on this topic. All the information is helpful but confirming that MA plans are basically for healthy people who need little care. As I stated earlier I am fortunate to have more options here in CT. Being well now at 67 and for 2020 I will be taking an MA plan with out of network benefits. If I had any serious problems I would stick to a traditional plan and supplemental as the agents in my area recommend. CT does not allow discrimination against pre existing conditions so I will change if needed in 2021 Unfortunately I know many who have had serious cancer diagnoses and learned that being able to go to New York or Boston is important, hence my decision to pay extra for out of network benefits.
Clearly our Republican politicians have aggressively moved to privatization of Medicare and it is downright scary. Changes do need to happen to strengthen Medicare but putting it in the hands of insurance companies focused on profit is a short term solution that can easily hurt us in time.

Janet:

I could not agree with you more. The government wants to get out of administering Medicare insurance and they want all of us one day to go to Medicare Advantage plans run by insurance companies. Soon the "Cadillac polices" like Medi-gap Part F and later Plan G where everything is covered nearly 100% will disappear if this continues. President Trump made a speech recently and he clearly was pushing for the MA plans where OOP was capped as well as the maximum benefits. That means Seniors with limited income would have to pick up the difference. This is not fair nor the way it should be.

It is also an important point that many states have different plans, you simply have to check. What is available in Connecticut may not be available in Colorado for example. Some people will and do simply move out of their MA service area so they can choose a better plan, simply because they cannot qualify for a Medi-gap plan or even another MA plan due to underwriting in their current state. It should not have to be so hard to get insurance. I can see how frustrating it can be.

Another concern for me is that insurances companies are using marketing techniques that I see as questionable.The current MA plans may be unavailable as we know them now once the Medicare is weakened and dismantled by privatization. I have a $100 Walmart gift card from Anthem I was issued for this year 's allowed over the counter approved products. It feels like a ploy and I fear lures the vulnerable who have little money, do not understand the scope of their plans but trust Medicare and the government to follow through on the agreement to provide quality healthcare after age 65. After all we did pay for it.
I do however hardily agree with Clyde who is obviously knowledgeable, well informed and helpful to many. Blanket statements without facts are not necessarily correct and we need to be careful how we present our opinions on this site. In CT we are "still" protected by Medicare laws to some degree even if we move to MA plans. It's hard to believe cancer treatments would not be paid by an MA plan yet paid by traditional Medicare when this is a federal program.
Not all cancer treatments are paid for by Medicare, "Cadillac" private insurance plans or MA plans. It's a tough place to be for a patient and their loved ones. Sad but true we are in a healthcare crisis in this country on many if not all levels. We all need to do our homework and help each other where we can. Thanks to everyone for participating in this discussion.

If you are age 65 in 2019 you will still be able to buy Plan F later on (2020 and later) but may need to meet underwriting qualifications. See link below.

It really makes me wonder if there are these large groups of people who have Plan F that have to go to the doctor for every little sniffle. I for one, hate going to the doctor and would never go if I didn't have to. It is usually a depressing office, ugly exam room and waste of my time if I can just go and buy some cold meds. People have to be bored out of their minds to go to the doctor for no reason!

I do have Plan F and for future health expenses that I hope never occur. Hub has Plan F too and has had medical issues that Plan F has paid all costs except our eye doc for a typical eye exam.

https://medicare.com/medicare-supplement/is-medicare-supplement-plan-f-going-away/

Looks as if Part B is going up from $185 to $197 in 2020.
https://www.medicarefaq.com/faqs/medicare-changes-2020/

There is one thing I hope we can all agree on: it is good to work with a knowledgeable, qualified insurance agent when selecting a Medicare plan. If you’re completely satisfied with what you have now, then maybe you can feel comfortable just letting it roll over and continue for the next year without consulting an agent, but be sure to be aware of any annual changes to your plan. Medigap plans work well for many people, while Medicare Advantage plans are better for others. Although I consider myself to be a progressive and find the profit motive of some insurance companies to be disturbing, MA plans were designed in part to encourage insured people to better utilize their plans in a way that doesn’t allow overuse, and usually is less costly. Such plans call for the user to work to understand how to pick a plan and how best to use it. Medigap plans almost always have more geographical and provider coverage, but don’t have annual out of pocket limits, which can occasionally make a massive financial difference.

It’s good for us to have a give-and-take discussion here on this site in order to make us more-informed consumers. But some thoughts, ideas and information here sometimes don’t provide a complete picture. They’re more opinions, but that’s, in part, why this site exists. It’s a good idea to further check out thoroughly what you read in order to find the best solution for your particular situation.

Thanks Clyde, I think your comment is very well put. The give-and-take discussions on this site are very helpful, but as you state in your first sentence it is important to work with a well qualified insurance agent when selecting an insurance plan. I sent this blog article as link to my younger sister in a Pre Happy Birthday note today as she will soon turn 65. She is a well-educated, well-traveled business woman who knows her history, geography, and people skills, but her response to my email was "What ?! I thought Medicare was free" . So there are those who do need to speak with professionals who can help sort things out.

From the Office of Inspector General U.S. Department of Health and Human Services concerning denial of payments and services under Medicare Advantage plans:https://oig.hhs.gov/oei/reports/oei-09-16-00410.pdf

Editor Comment: Thanks Mike, this was really helpful! Does anyone have any personal experience being denied?

I'd like to know how it's going out there with all of you now that open enrollment has begun. Have you switched and if so, from what to what and why.
I'm with AARPUnitedHeathcare complete HMO. I just got an email from them: see below...Personally, I do not trust this. It's not just them..it's even the government..they want too much information about us...they make it sound like it's for our own good...but it's not (in my opinion) because it gives them more control over us.

Because you use FollowMyHealth, we can make this process easier for you.

Here’s how it works!
We provide you with a Personal Code that lets you share your current prescriptions and doctors securely with our partner, eHealth.
Using your personal code, eHealth’s website shows you Medicare plans that may cover those doctors and prescriptions at the lowest cost.
eHealth uses this information to help you find a Medicare plan that best fits your needs.

NOTE: eHealth is an insurance agency not affiliated with the government.

You have three ways to review your plan options using your personal code:
Visit your personal code URL.
Call eHealth’s Helpline for FollowMyHealth at and give your personal code to one of eHealth’s licensed insurance agents.
Enter your code manually at eHealth’s non-government website

Brenda;
Trust your gut. Personally ,I wouldn't answer any of that either. Seems like they know too much about all of us already. This is public too!

Just waking this thread to inquire if anyone has changed from Medigap to Part C/MA or vice versa.
Would be interest in hearing any reasons. Thanks.

I have plan F and so thankful that I do. Two weeks after I turned 65 and my enrollment kicked in, I was diagnosed with a rare cancer. There is not one oncologist in my state that specializes in this cancer. I had to go out of state for treatment and plan F covered all the medical expenses. The idea that people are over using medical services does not make sense. If you catch a disease early, it is far less costly and it saves lives. I was busy with work and ignored symptoms until the cancer was pretty advanced. Before Medicare, I had a junk high deductible plan through work and it only covered 80% of expenses, not including co-pays. The expense of taking time out of work, coupled with the cost of going to the doctor, made me soldier through the symptoms, hoping they would go away. When I was finally diagnosed, it meant surgery, chemo for a year and radiation. So, it makes no sense to discourage seniors from going to the doctor under plan F. It is this kind of faulty logic that drives the cost of health insurance up.

Maimi:

I hate that law makers are trying to discourage Seniors from going to the doctor by paying more out of pocket costs. It is the wave of the future, however. As a nurse, I did see the system overused and it makes perfect sense that if you have to pay something for it. you will think twice. Plan F is the equivalent of Universal Healthcare, I qualify for it, but I just do not want the increased premiums. Plan N covered all of my costs for my recent hospital stay (four nights in ICU and one night in Cardiac Care), I just had to make sure that all the doctors who saw me accepted Medicare assignment and they all did. A $20.00 copay(under Plan N) would not stop me from seeing the doctor if I needed too nor would a $50.00 copay at the Emergency Room. Since I was admitted to the hospital that was waved. I pay 30% less for Plan N than I would pay for Plan F.

The health care I had in the working world before I was old enough for Medicare is what would have stopped me, as I did not want increased and unexpected costs. Thus I hope every American gets some kind of basic benefit in the future no matter what their age.

So, my plan F is 197./ month. For me, well worth the few extra dollars per month. Wondering what others pay that is worth the monthly savings? Jennifer, so many seniors are on a fixed low income and those copays and deductibles are very much a deterrent from seeking appropriate medical care, which saves lives and lowers the cost to medicare.

I , too, am on a fixed income and supplement it with a part-time job three days a week. As a nurse I did not ever have a situation where we were offered a pension. I do have my 401K. I pay $84.00 for Plan N and that with the deductible for Plan B and a couple of co-pays maybe four times a year, I am ahead of Plan F per annum. To me $84.00 plus the Part B deductible is certainly more affordable than $197. Those who have Plan F will have also pay much higher premiums because if one turns 65 after Dec 31, 2019, Plan F is not available. The people in Plan F will be isolated with potentially older and sicker enrollees since no new younger people will be allowed to enroll and Plan F pays for the deductible. The premiums already are higher than Plan G. Essentially one must do what is best for them and I respect that.

The plans will also have different prices in different states. In OH for 2019, my plan F through AARP has been $123.45 (my Plan D is $53.40 & I've added a dental plan for $38 or so from Metlife). When I was playing with spreadsheets and trying to find the right place to retire, I considered real estate taxes, state income taxes, utility costs, home and hurricane insurance, HOA fees etc. I hadn't realized that Medicare costs could also vary widely.

I am finding fewer doctors accept the Medicare Advantage plans as the private insurance companies are harder to deal with!
Ask you healthcare provider before making a switch!