Medicare advantage plans

[Snore]

This is my third year using Boomer Benefits as a broker. Why? When providers get a case of the stupids, I call the company and they fight for me. Has worked very well twice! They played me with AARP United.

As to dental and hearing, that coverage is terrible. Who wouldathunk that old folks need hearing aides????

 

[boomer]

That's what we have done for 5 years now, and so far United Health Medicare Advantage is the one he recomends for the past few years.

Rather then use a broker to cover that decision making process, one can choose the Advantage program themselves without a broker. By making the decision ourselves, the broker can't/doesn't tack on the nominal $2.00 a month broker fee, which isn't much at $24 a year per husband or wife - however, once one learns to negotiate the process, one doesn't need the broker, if one checks the box, for automatic re=enrollment every year, or if one chooses to change their Advantage provider.

United Health Medicare Advantage is fine if one chooses to keep their own Doctors. I enrolled in Kaiser myself, right from the start, after using Kaiser for my final two years of ObamaCare. The insurers I used under ObamaCare were Premeira, United and then finally Kaiser, once Kaiser was available in our state, after they bought GroupHealth facilities here in Washington.

When we changed my wife's United Health Medicare Advantage to Kaiser, I handled the switch online without a broker, saving the nominal broker fee. We found out while taking care of my wife's 93 year old mother, United Health Medicare Advantage covers most everything, and recommend United for those who wish to keep their own Doctors. No huge co-pays or unforeseen out of the pocket expenses with United nor Kaiser.

 

[billy backstay]

Thanks Boomer! We are happy to pay 2 bucks a month for an expert who will read all the various policies avaialable every October and advise us on the best choice. Missus BB qualified for Medicare before I, and Connecticare was more cost effective at that time. When I enrolled a few years later United Healthcare was better, and we both went on that. I am not going to try and learn to be an expert on Medicare and take it upon myself to read all the various policy choices and then select one. For the same reason we don't act as our own Doctors, I won't presume to learn how to choose the best Medicare supplement. Both of us had medical events in the past few years approaching $200,000, and all but a token amount was covered by insurance. It's easy to understand now how many otherwise succesful people go bankrupt due to uninsured medical expenses.

 

[No Bargers]

Rather then use a broker to cover that decision making process, one can choose the Advantage program themselves without a broker. By making the decision ourselves, the broker can't/doesn't tack on the nominal $2.00 a month broker fee, which isn't much at $24 a year per husband or wife - however, once one learns to negotiate the process, one doesn't need the broker, if one checks the box, for automatic re=enrollment every year, or if one chooses to change their Advantage provider.

I believe you'll find that most independent brokers collect their fees from the insurance company with no additional charges to the customer, They get compensated by all the companies equally so they should have every incentive to put you in the best plan for you.

From the National Counsel On Aging

 

[tommays]

As has been Said this is a LIFETIME choice so be careful as the Advantage plans do not favor YOU and unlike a plan N or G that is 100% the same Advantage is the WILD WEST of health care coverage variations

There our also PPO advantage plans but in general your picking a relativity small local network that’s not going to allow the best possible choices in the event a serious illness

Personally I went with a plan N and due to my health I was not able to more to a plan G this year as you can be rejected after the initial choice as open enrollment does NOT happen once you get sick UNLESS you had a Qualifying event such as moving to a different state

while there our 20 dollar copays a surprising amount of things such as physical therapy and diagnostics such as a colonoscopy don’t have Copays under Plan N

So with the reverse left shoulder replacement i had it definitely worked out well as there was so many PT visits that would have required copays under and Advantage plan

 

[Point Break]

Well…..remember the brokers ONLY deal with advantage or “Part C” options since traditional Medicare does not pay an incentive to them for placement. Also remember the Pat C plans available to you vary by region as well.

 

[arcpix]

Are they worth it? You see these ads on TV saying you may be eligible for$0 per month.
When I look up plans I'm seeing much higher numbers for out of pocket etc.
It looks just like the reverse mortgage scam to me,but while asking about whether my wife's insurance covered Dental (She has some extensive work to be done) They asked if she had a supplemental plan.... No... "Then it's not covered"
I look at the supplemental plns.... They don't cover it either, except for the charging you $455 for having the plan that doesn't cover you..... I must be missing something.

We joined the Humana advantage plan several years ago and it turned out to be an incredible blessing for us. We selected Humana because all our primary docs were already included. That was the sole reason for the choice.

Two years ago I was diagnosed with Multiple Myeloma. I was referred to a special at another provider by a good friend who is a doc. Turns out that this specialist and the hospital were also part of Humana.

since that diagnosis, I have had multiple scans, more blood work than you can imagine and two surgeries (For other tumors that were discovered in testing for the MM). Our out of pocket has been limited to appx. $2500 for all of this.

maybe another plan would have been lower out of pocket but I can’t imagine that it would be much less.

Anyway, we’ve been happy with it and our daughter, who is with Blue Cross, has agreed. She has told us plenty of horror stories about some of the others who offer advantage plans. Many bad options but some have worked out ok.

 

[Point Break]

We joined the Humana advantage plan several years ago and it turned out to be an incredible blessing for us. We selected Humana because all our primary docs were already included. That was the sole reason for the choice.

Two years ago I was diagnosed with Multiple Myeloma. I was referred to a special at another provider by a good friend who is a doc. Turns out that this specialist and the hospital were also part of Humana.

since that diagnosis, I have had multiple scans, more blood work than you can imagine and two surgeries (For other tumors that were discovered in testing for the MM). Our out of pocket has been limited to appx. $2500 for all of this.

maybe another plan would have been lower out of pocket but I can’t imagine that it would be much less.

Anyway, we’ve been happy with it and our daughter, who is with Blue Cross, has agreed. She has told us plenty of horror stories about some of the others who offer advantage plans. Many bad options but some have worked out ok.

I was also diagnosed with MM about two years ago. Hang in there.

 

[No Bargers]

Well…..remember the brokers ONLY deal with advantage or “Part C” options since traditional Medicare does not pay an incentive to them for placement. Also remember the Pat C plans available to you vary by region as well.

Where we are at the broker got paid for selling the supplemental plans as well. Our broker didn't really care whether we chose an advantage or supplemental plan.
There wasn't a commission on the Part D (drug plan) so we did have to handle that piece.

 

[Point Break]

Where we are at the broker got paid for selling the supplemental plans as well. Our broker didn't really care whether we chose an advantage or supplemental plan.
There wasn't a commission on the Part D (drug plan) so we did have to handle that piece.

Yep, they typically get paid to sell Part C and gap. Most of the time it’s commission incentive based as well….between 1 & 5 %. Mrs PB used one recently when she turned 65 to navigate the mess that is health care insurance in the US. She went with a United Health Care plan. Because of my illness and the ever changing landscape of doctors in the network I remain in Traditional. City of Hope will likely always take Traditional. She is pretty healthy so we’ll see how she likes it in the next year. Interestingly, in checking with several of her providers one does not take Traditional Medicare but does take her advantage plan. What a mess our government and the insurance carriers have made out of the simple task of choosing/getting health care.

 

[Olsonist]

As has been Said this is a LIFETIME choice so be careful as the Advantage plans do not favor YOU and unlike a plan N or G that is 100% the same Advantage is the WILD WEST of health care coverage variations

There our also PPO advantage plans but in general your picking a relativity small local network that’s not going to allow the best possible choices in the event a serious illness

Personally I went with a plan N and due to my health I was not able to more to a plan G this year as you can be rejected after the initial choice as open enrollment does NOT happen once you get sick UNLESS you had a Qualifying event such as moving to a different state

while there our 20 dollar copays a surprising amount of things such as physical therapy and diagnostics such as a colonoscopy don’t have Copays under Plan N

So with the reverse left shoulder replacement i had it definitely worked out well as there was so many PT visits that would have required copays under and Advantage plan

The difference between N and G is about $20/mo.

G has no copays and it also covers something called Extra Charges where a place like Mayo Clinic can charge about 15% above the standard Medicare assignment rate. (You're not getting into the Mayo Clinic on Medicare Advantage.)

N has $20 copays. Both have the $233 annual Part B deductible.

 

[boomer]

No, Medicare Advantage plans are definitely NOT free. You still pay the Part B premium, about $170/mo (usually deducted from your Social Security). But then if anything happens, anything, you pay copays, coinsurance, ... up to a rather large out of pocket max. Moreover everything is always subject to preauthorization by the insurance company and these insurance companies make bank off Medicare Advantage, off of you. BTW, once you go on MA it's very very difficult to switch back to Traditional Medicare. You're fucked for life.

At the complete other end of the spectrum is Traditional Medicare Plan G, maybe $200/mo plus the Part B premium. But then there are no copays, coinsurance, ... other than the $230 Part B yearly deductible. There's no preauthorizations and no referrals either. AARP/UHC has some discounts for vision (EyeMed) and dental (Dentegra) and a health club membership. You'll need a Part D plan which Biden substantially improved this year.

G is more expensive up front $170 + $200 vs $170 but G tightly brackets your Medicare costs. Medicare Advantage seems cheaper up front but with a big exposure in the bad years along with a profit making insurance company fucking you over at every step with preauthorizations, .... Do you really want to spend your out years arguing with insurance companies? As my orthopedic surgeon said, insurance companies are in the business of not providing health care.

You might want to check Marvin Musick on Youtube. Also Stepanie Abt.

https://www.youtube.com/@MedicareSchool

https://www.youtube.com/@AbtInsuranceAgency

My sister the doctor, she and her husband are on G. I'll be going on G as well.

Note that he bases cost on 1-29 quarters and 30-39 quarters. Most retirees have 160+ quarters or 40+ to 50+ years of SSI paid through their employer.

The difference between supplemental plans vs Advantage plans - is Advantage plans require preauthorizations. One rarely has need of a preauthorization for out-of-network coverage. If one needs preauthorization for out-of-network coverage - With Kaiser, in most cases, I simply call my Doctor for out-of-network coverage, and he provides a letter of approval to my out-of-network provider. If he can't provide the approval, I go to the next level and call preauthorization for Western Washington - I've gone one step further and contact the head of preauthorization for Western Washington - and developed a working relationship and now simply call him if I have the need. Quite simple really and easy to do.

One can get low monthly cost with a higher deductible, with the $0 a month or chose from any of the Advantage plans for progressively lower deductibles. Whether it's a $0 or a low end $29.10 a month fee that I pay, all your normal medical needs are covered, plus low cost prescription rates. I've had several visits with my Doctor this year, with $0 copay, as well as my Covid vaccinitions, flu shot, shingles vaccinations for $0 copay. I like getting my blood work done once a year, which requires a $5 copay - $5 is my total out of pocket Kaiser in network copays for the year to date.

Always get preauthorization before attempting to get out of network care. For example, my specialized physical therapy from an out-of-network Doctor of Physical Therapy, I called the head of Kaiser's preauthorization for Western Washington - and put him on a conference call with my Doctor of Physical Therapy and he was approved right away for all patients in Western Washington (which had been a hurdle for him without my intervention), for my weekly, for over two years of Physical Therapy, which is way beyond the care in most cases. I also wanted an out-of-network vascular surgeon, who embraces exercise and diet, for my annual vascular ultra-sound checkups, I simply called my Doctor for authorization. Then called Kaiser's preauthorization and recommended her for our rural county, now she's an approved out-of-network provider for others having need of her specialty. My extra copay is $30 to use this doctor. Extra out of network cost/copay for the year $30.

Why one chooses a insurance, whether Supplemental or Advantage is, these health insurance plans provides an extra level of coverage by helping consumers meet out-of-pocket expenses and other costs not covered by their regular insurance. Supplemental plans serve as secondary payers, filling in coverage gaps and complementing regular insurance. Also note, that Medicare only covers the first 150 days of hospital coverage, all other supplemental plans cover 365 days in the hospital, although coverage that long is very rare. However for $29.10 a month for my Advantage plan, that's inexpensive.





A brief explanation of Advantage Dental plans in the final segment.

 

[veni vidi vici]

We use a broker and he must get his cut from the plan.
He does a very thorough analysis and gives us several options.
Humana PPO , dental is we pay at checkout and file with Humana for reimbursement , up to 2K or thereabouts.
I have VA as backup, recently did a hearing examination as a baseline. The tech recommended that I would benefit from hearing aids. I have not noticed that I have trouble hearing yet so I will be retesting in a year. She said that the hearing aids are state of the science and I think batteries are included, I know they are very expensive so that will be a savings when the time comes.

 

[boomer]

With my wife's broker, and even sat down for discussion with him about my options for my first enrollment. Even after being told all the options from the broker, and getting a list in order of preference. I still went home and wadded through all the pros and cons of each, and the next year did the same for my plan of choice - probably a wee bit too anal, but I have a tendency to analyze, till all the options are explored. I checked the box for automatic enrollment in my Kaiser plan, and presently and in the foreseeable future, have no plans to change my provider, unless my level of care declines, which it hasn't yet - but operate under the "Never say never", modus operandi.

I still have the option of signing up with the VA, and have a choice of my own Doctor on this side of the water, however I like the service Kaiser provides. Even though all my old service buds but one use the VA, I'll hold off going through the hoops to get on board with the VA for now....

Discussing Kaiser with a HMO executive from Scot Tempesta's Facebook page - her feeling is/was, if the USA was to model USA ACA healthcare, she'd look no further then Kaiser for her model.

As PB says, the agent's commission is typically a percentage of the annual plan premium.

For those wishing to become a broker: Can you make money selling Medicare Advantage plans? Or rather, Is Selling Medicare Lucrative? In short, yes. The average Medicare Advantage policy pays around $287 a year in commission if the purchase replaces an existing plan. However, you can get approximately double that - $573 - if you write up a new Medicare Advantage plan for someone who hasn't had one before.

 

[veni vidi vici]

As PB says, the agent's commission is typically a percentage of the annual plan premium.

For those wishing to become a broker: Can you make money selling Medicare Advantage plans? Or rather, Is Selling Medicare Lucrative? In short, yes. The average Medicare Advantage policy pays around $287 a year in commission if the purchase replaces an existing plan. However, you can get approximately double that - $573 - if you write up a new Medicare Advantage plan for someone who hasn't had one before.

Which is why the ads are competitive and relentless.
It can be a very confusing process, like most insurance.
I am happy to pay a premium for the best coverage I can afford with known upper limit on out of pocket expenses. Hospitalization is crazy expensive.

 

[billy backstay]

I believe you'll find that most independent brokers collect their fees from the insurance company with no additional charges to the customer, They get compensated by all the companies equally so they should have every incentive to put you in the best plan for you.

From the National Counsel On Aging

I had forgotten this, and yes they get paid by the insurer, not the insured party.

 

[Olsonist]

Thanks @boomer, I would recommend everyone going through a bunch of the Reverend Marv (luv the Rev) and Stephanie Abt's videos. They're great for getting you up to speed.

My AARP/UHC Plan G is quoted at $124/mo in the SF Bay Area. My twin brother up in Seattle is quoted $203/mo. I'm looking at Aetna Silver Script Smart Rx at $7.70 for Part D. And again, everyone has to pay the $170/mo Part B premium. Roughly $124+$170+$7.70/mo.

For me, the important point for Plan G is the flexibility (no network) and that I don't have to fight with insurance companies at all. If Medicare covers it, Plan G pays it. Plan G is a little more expensive up front with the best coverage available and probably less expensive in the long run. No, Joe Namath is not your friend. Neither is Allison Janney.

BTW, I viscerally hate insurance companies but going through a broker for Medigap plans has its benefits. Occasionally, there is a Medicare mis-coding problem and having a broker deal with it is way easier. Rev Marv, Stephanie Abt and Boomer Benefits are all fine brokers. There are brokers who specialize in UHC as well. But UHC brokers will try to push you into UHC Medicare Advantage.

 

[Blue Crab]

... I called the head of Kaiser's preauthorization for Western Washington - and put him on a conference call with my Doctor of Physical Therapy and he was approved right away for all patients in Western Washington (which had been a hurdle for him without my intervention) ...

"When the people lead, the leaders will follow."

 

[Olsonist]

Switching from Traditional Medicare to Medicare Advantage is easy because the insurance companies want your money. Switching from Medicare Advantage to Traditional Medicare is difficult because they make less and they don't want your risk. You'll generally have to go through medical underwriting and if you forgot to brush your teeth they can say no.

But there is an exception. You can be on Medicare Advantage and switch back to Traditional Medicare during your first ("Trial") year. This is something a broker can help you with but you need to know that it's possible.

Also, some states allow you to switch from one Traditional Medicare Plan to another at any time. Washington State does this. You can be on a lower premium High Deductible Plan G and switch to regular Plan G right before surgery. That's probably why Plan G is more expensive up there than down here.

 

[boomer]

Which is why the ads are competitive and relentless.
It can be a very confusing process, like most insurance.
I am happy to pay a premium for the best coverage I can afford with known upper limit on out of pocket expenses. Hospitalization is crazy expensive.

Why do brokers push Medicare Advantage plans? Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.