Prepping for Retirement

Medicare Advantage is for profit. While they may seem to offer a lot of perks they are notorious for denying diagnostic tests. Even if in the end they cover them the drs office has to go back and forth with them causing lots of delays. You will also have less choice of drs and hospitals because nobody wants to have to deal with all the back and forth needed to get approvals and delayed payments. Current health does not guarantee future good health. It is difficult to change because when you initially sign up for Medicare and the MediGap you get a special rate for the medigap and later on they are allowed to charge you more and depending on the state they can charge you more for pre existing conditions or your age.

Wow, my experience has been the complete opposite. I have Kaiser Senior Advantage, which is Medicare + the Advantage plan through Kaiser. The transition from regular Kaiser was seamless and my coverage continues to be virtually 100%, with no having to try to get things approved, ever.

I guess I can’t speak for other Advantage plans. But if you have access to Kaiser, I highly recommend it.

To the best of my knowledge, if you give up original Medicare you cannot go back.

Medicare Advantage is not one health plan. I read that this year the average Medicare beneficiary has access to 43 Advantage plans. Some of these, like Kaiser, are non-profit. Most of them are HMOs but some are PPOs. If you don't like managed care or don't want to see a primary care doctor to get referrals to a specialist, you shouldn't get an Advantage plan.

Meeting with an agent is a great plan. They can explain the different options in your area and sign you up. They are paid by Medicare or by insurance companies, so there is no cost to you. A good agent should ask about your current health issues and medications to provide good recommendations. There is not one answer for everyone.

I wanted to keep my wonderful primary care doctor and have access to specialists within the large academic hospital system she works in. The agent recommended an Advantage plan which allows me to see physicians within that network. I pay only for Medicare B and D and have a zero premium with my plan. If you get "regular Medicare" you will need to pay for a supplement plan to cover the 20% that regular Medicare doesn't cover. My plan gives me access to all the gyms in my area for free, so that's a big savings for me also.

we have both had very good luck with united healthcare medicare supplement insurance and prescription plans.. not an advantage program. and we have had lots of expensive healthcare the last few years.. and it is easier to have that if you are traveling in the states or have a second home somewhere.

if your income is high in retirement, you will have to pay more for the supplement.. and it is based on income two yrs ago. so there is lag.. if you take out a lot of money to do a project, your rates will increase.. then they can go back down.

try to not change too much too fast in retirement. it takes a bit to adjust. my biggest thing was having dh understand I don't make lunch or breakfast for him. I do mostly do dinner. and we try to do independent activities --not locked at the hip.

My only advice is to try to get a PPO rather than a HMO, if possible. Over here, many big medical groups are not taking Medicare Advantage HMO plans anymore. Lot of people were/are scrambling to find new health providers.

I am not under Medicare, but earlier this year I had to almost look for a new doctor when my insurance company and the medical group could not reach an agreement. There was already a set date for when my insurance would no longer be accepted, which was 2 weeks before my appointment! I seriously debated keeping the appointment and paying out of pocket. Luckily, an agreement was finally reached. This made me decide that at the next open enrollment, I am picking a PPO. It may be more expensive, but it gives me more options.

My mom has United Healthcare PPO as her supplemental insurance. She has had no issues with it, and she can see a lot of doctors with no referral. Sorry for the long post! Good luck! I understand this is a complex decision to make.

I do not have to have referrals and I have a Medicare Advantage plan. My primary may give me a referral if I see her and she thinks maybe I need a specialist. However, if I think I need to see and ENT for sinus issues, I can just pick up the phone and make an appointment with them.

When you see an agent, you will find out about the plans available in your area. If you have a lot of excellent HMOs in your area, you will have good Advantage plans through those same HMOs. In some parts of the US, HMOs are not as common or not as high quality.

Here is the official information on switching from an Advantage Plan to regular Medicare. In the open enrollment period, you can switch from an Advantage plan to traditional Medicare (and buy the supplement and drug plan) or switch from traditional Medicare to an Advantage plan. You can also switch from one Advantage plan to another. There are also special enrollment periods if you move or change coverage.

We have Highmark Advantage Plans and have been very satisfied.  

I went with a higher priced supplement plan offered through my teachers retirement. I live in a different state, and had 2 choices. The advantage plan, United Healthcare is not accepted by the major medical system in my area. Plus I have no deductible or copays and can essentially see any doctor that takes Medicare. Happy with my choice. Goes into effect on 11/1/24

Me too.  The only issue I’ve had is with the dental part. A specialist wouldn’t see me because he doesn’t take an HMO. So I may need to talk to the local consultant that I saw when I was picking plans. I also think at some point my  dentist is not going to take Medicaid or Medicare. The only reason she takes the one I have now is because it’s Highmark, which is also a Blue Cross Blue Shield product 

My parents are both on a Medicare advantage plan and have never had a single issue with coverage or seeing PCP or specialists. Both had the Aetna advantage plan.

When you first apply for Medicare, you are not subject to underwriting; therefore, if you have any chronic health issues, this is the time to AVOID advantage plans and stick with a traditional Medicare plan. Switching later can be VERY expensive as your health issues will be a determining factor in whether you are even accepted AND how much you will pay if you are. It can be VERY expensive to switch.

Another factor to consider: where you live. We live in NM; not a lot of healthcare options here. We want to be able to travel for healthcare options...and with many Advantage plans, you are tied to a certain medical system which is limiting. My husband regularly travels to the Mayo Clinic in AZ for pancreatic cancer screening; he could not do so with an Advantage plan. If I get cancer, I want to be able to go to a top cancer hospital; not the little oncology practice here in my hometown. Things like this make me hesitant to take an Advantage plan.

Hubby took a traditional plan when it was his time to sign up; I will do the same when it is mine.