Medicare Advantage?

[wanderingback]

Does anyone know about Medicare Advantage? My mom is asking as she has an option to go to Medicare Advantage. On a physician board I'm on someone recently asked and everyone said no, don't do it. But I didn't read the whole post and don't think there were any specific resources/articles about why people were saying that. She's retired from the school system and has Medicare and Blue Cross Blue Shield. She said some of her friends have been happy with Medicare Advantage. She's 70,  generally healthy, but has normal "old people" problems like hyperlipidemia (no diabetes or other major chronic medical problems). 

So should I tell her not to switch? If so, can anyone point to a specific article as to why?

Thank you!

[chilerellanos]

I know a lot of our local hospitals don’t accept it because it’s really hard to get approvals.

[niq]

I put my mom on Medicare Advantage and it mostly worked for us. I found the benefit structure of traditional Medicare very confusing -- various benefits have limits, etc. The MA plans felt more like an actual health insurance plan.

Washington state has some sort of phone support for plan shopping, which we used to get some advice. One year, they helped us find a new plan with the same insurer that ended up being better.

Mom had type 1 diabetes and lots of prescriptions, but no surgeries or other very expensive medical needs.

I did make sure that all of her regular hospitals & PCP accepted MA plans before we switched.

EDIT Mom had limited finances, so the standard advice to do A+B+D+supplement wasn't really an option. If your mom can afford it I think that makes the most sense, but like awkwardpenguin says it depends a ton on where she lives.

[EvieEthelGarland]

Nov 13, 2024 14:31:08 GMT -5 niq said:

I put my mom on Medicare Advantage and it mostly worked for us. I found the benefit structure of traditional Medicare very confusing -- various benefits have limits, etc. The MA plans felt more like an actual health insurance plan.

Washington state has some sort of phone support for plan shopping, which we used to get some advice. One year, they helped us find a new plan with the same insurer that ended up being better.

Mom had type 1 diabetes and lots of prescriptions, but no surgeries or other very expensive medical needs.

I did make sure that all of her regular hospitals & PCP accepted MA plans before we switched.

Does she use a pump and CGM? Any issues getting those covered?  

[Saudade]

wanderingback, I would not do it. I don't know anyone who has been happy with their Advantage situation. I've linked an article below that seems pretty good at explaining it.

www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

I live and work in a relatively rural area. The city is larger but isolated from the rest of the state, so it draws from a large area. We have two hospital systems. The largest one announced this year that they will no longer be accepting Humana and United Healthcare Advantage plans. That's a large subset of their patients. This is hurting so many of my patients who have received their specialty services at that system and now have to switch to the other system (which has much less in terms of services and # of providers) or travel 3 hours to the next closest area with specialty services.

Another must do is ensure she has Part D, even if she is healthy and not on meds now. It's so problematic and costly to obtain several years down the road when someone has developed a new condition that requires expensive medications.

[wanderingback]

Nov 13, 2024 21:38:30 GMT -5 Saudade said:

wanderingback, I would not do it. I don't know anyone who has been happy with their Advantage situation. I've linked an article below that seems pretty good at explaining it.

www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

I live and work in a relatively rural area. The city is larger but isolated from the rest of the state, so it draws from a large area. We have two hospital systems. The largest one announced this year that they will no longer be accepting Humana and United Healthcare Advantage plans. That's a large subset of their patients. This is hurting so many of my patients who have received their specialty services at that system and now have to switch to the other system (which has much less in terms of services and # of providers) or travel 3 hours to the next closest area with specialty services.

Another must do is ensure she has Part D, even if she is healthy and not on meds now. It's so problematic and costly to obtain several years down the road when someone has developed a new condition that requires expensive medications.

Thank you this is super helpful!

[mofongo]

IME straight Medicare (A,B,D) with a supplement is the best coverage. Saudade shared some good reasons. I get why the advantage plans are attractive, though, and they definitely sell themselves to people. I know it’s not affordable for some people, as the supplemental policies can be costly, though.

[awkwardpenguin]

It depends A LOT on where you live. My mom opted for the Medicare A&B&D&supplement, but it's definitely more expensive than if she was just on Medicare Advantage. She lives in a relatively rural area and sometimes has to travel to the big city for more specialized treatment, and those two areas aren't usually in the same MA "network". If your mom is in an urban area and can get all her care there, she could probably find a Medicare Advantage plan that works for her.

MA is basically universally hated in both the health policy and provider worlds because it is less generous and the way a lot of MA plans generate profits is by cherry picking healthier enrollees. When I worked in the field, it was common for MA plans to hold enrollment events in buildings that were not ADA accessible or required potential enrollees to do stairs so that disabled people couldn't easily attend. It absolutely is bad health policy, but the actual plans sometimes are a good choice for individual enrollees.

[mrsslocombe]

Nov 13, 2024 23:09:18 GMT -5 mofongo said:

IME straight Medicare (A,B,D) with a supplement is the best coverage. Saudade shared some good reasons. I get why the advantage plans are attractive, though, and they definitely sell themselves to people. I know it’s not affordable for some people, as the supplemental policies can be costly, though.

This is my recommendation as well, if she can afford the supplemental. My ILs have supplemental and while it was costly when they were younger and relatively healthy, it was worth it for the final years of my MIL's life when she had a million doctor appts, surgeries, etc. 

Does your mother see doctors all in one health system? And how robust is that system? I'd research if that health system accepts the Medicare Advantage Plans, I know Mt. Sinai only accepts very specific plans. 

[niq]

Nov 13, 2024 19:14:43 GMT -5 EvieEthelGarland said:

Nov 13, 2024 14:31:08 GMT -5 niq said:

I put my mom on Medicare Advantage and it mostly worked for us. I found the benefit structure of traditional Medicare very confusing -- various benefits have limits, etc. The MA plans felt more like an actual health insurance plan.

Washington state has some sort of phone support for plan shopping, which we used to get some advice. One year, they helped us find a new plan with the same insurer that ended up being better.

Mom had type 1 diabetes and lots of prescriptions, but no surgeries or other very expensive medical needs.

I did make sure that all of her regular hospitals & PCP accepted MA plans before we switched.

Does she use a pump and CGM? Any issues getting those covered?  

She qualified for a CGM (which was covered, including the ongoing expenses) but not a pump.

[wanderingback]

Nov 14, 2024 11:31:13 GMT -5 mrsslocombe said:

Nov 13, 2024 23:09:18 GMT -5 mofongo said:

IME straight Medicare (A,B,D) with a supplement is the best coverage. Saudade shared some good reasons. I get why the advantage plans are attractive, though, and they definitely sell themselves to people. I know it’s not affordable for some people, as the supplemental policies can be costly, though.

This is my recommendation as well, if she can afford the supplemental. My ILs have supplemental and while it was costly when they were younger and relatively healthy, it was worth it for the final years of my MIL's life when she had a million doctor appts, surgeries, etc. 

Does your mother see doctors all in one health system? And how robust is that system? I'd research if that health system accepts the Medicare Advantage Plans, I know Mt. Sinai only accepts very specific plans. 

Thank you this is helpful.
My mom doesn’t love in a rural area but it’s not urban either. Her pcp is actually 1.5 hours away in a large city (where her sister and her mother live), so she is up there regularly. But then she has various specialists (eye dr for glaucoma, she still goes to obgyn for mammograms, etc) that are closer to home and not all in the same health system.

So that is a good point re: health system. Since she’s not affiliated with 1 specific one it seems like it’d be a pain to ensure all her doctors accept a new plan.

My mom isn’t rich but as far as I know she can afford her current Medicare plans.

[kitty]

I think in addition to what PP have posted, there is a state dependent factor here too. Most states would require her to go through underwriting if she elected the MA plan and didn’t like it and wanted to switch back to a traditional supplement. If she did develop a health problem during that time she could be denied or face an unaffordable premium. There is a “trial window” which I think is a year where she could switch and have guaranteed access but she would have to keep a close eye on the timing because after that it would be much trickier depending on her location.