Linkfan92

Linkfan92 t1_ixbebqw wrote

Reply to Hidden audits reveal millions in overcharges by Medicare Advantage plans by rustyseapants

Used to be licensed in all Medicare related products... Quick (VERY generalized) rundown for those interested:

You may hear medicare referred to in "parts":

Part A: Inpatient Coverage

Part B: Outpatient Coverage

Part C: Medicare Advantage

Part D: Prescription Drug Coverage (PDP)

Part A+B is "Original Medicare".

You also have medicare Supplements or "gap" coverage.

There's three primary flavors that you can pick from the above options:

  1. Original Medicare: Part A+B (+D)
  2. Original Medicare + Supplement (+D)
  3. Medicare Advantage (generally has built-in D)

Option 1) Original Medicare (+drug plan)

OG medicare is great because it has immense flexibility in who you can see. Most doctors accept it. Take a trip across the country? You can still likely find a covered doctor if you need one.

Strongly suggest you purchase a PDP for drug coverage. Even if you don't need a pdp, there's a PERMANENT penalty increase if you later end up needing to sign up for one... The longer you didn't have a pdp, the higher the penalty.

Biggest downside is a 20% coinsurance for outpatient services. This 20% coinsurance has NO ANNUAL LIMIT. E.g., you get cancer and have chemo treatments that come out to $100k (like my mom), you pay $20,000 of it.

Option 2) Original Medicare + Supplement (+drug plan)

Same as original medicare, but you get a supplement plan to help cover that pesky 20% coinsurance.

Supplements come in various plan coverage options dictated by the gov. Plan A, Plan B, Plan G, etc.

Plan G is the current "top tier" choice.

If you're risk averse and can afford it, I'd go with a plan G supplement + Original Medicare + a PDP any day.

(My opinion. Not legal advice.)

Two major downsides to Supplements:

  1. Affordability. Monthly cost can be high. You're paying up front for amazing coverage, but the cost can be hundreds a month. You'll also likely want to purchase a pdp (sold separately), for drug coverage, which costs extra. You also get charged more if you have certain medical conditions.

  2. Eligibility. Not everyone can get a supplement plan. You have to pass medical underwriting to qualify. Rules depends on the private carrier you're purchasing from. However, When you first begin your Medicare Part B, you have a 6 month window to sign up for a supplement and AUTOMATICALLY qualify and NOT be charged more for preexisting conditions. So, if you're diabetic and about to start medicare Part A and B, definitely make sure you consider purchasing a supplement... You might not get another chance.

Option 3) Medicare Advantage

Medicare Advantage (part C) replaces your original medicare (part A and B). So, you get your coverage through the advantage plan instead of the gov.

All Advantage plans are different. So the following is generalized.

Positives:

  • Vast majority qualify for one.

  • Most advantage plans don't cost anything extra.

  • Most include pdp coverage (saving you money)

  • They come with Max Out of Pocket (MOOP) that limits your annual expenses. I've seen quite a few where the max out of pocket is LESS than the annual premiums for the best supplement in the geographic area... e.g. why pay $3k a year for a supplement when your advantage plan caps your expenses at $2,500?

  • Advantage plans may include dental/vision. (Original Medicare doesn't cover dental/vision.)

  • May include other benefits: Meals on wheels, silver sneakers gym membership, etc.

Dis-advantages (no pun intended)

  • Most are HMO style that require prior authorization for specialists. Can be very clunky to get the care you're wanting. Really depends on the carrier and how the particular plan is structured.

  • Advantage plans are geographically based. Unlike supplements that you can go anywhere in the US with, don't expect an advantage plan to offer good coverage if you go on vacation to another state.

  • Coverage can change year-to-year. Just because the advantage plan is good this year doesn't mean it will be next year. (You do have an "open enrollment" each year to change to a different one though).

Side note: Advantage plans are geographically based. They tend to completely suck in rural areas and are much better in dense, elderly populated zones (Florida).

Edit: Not legal advice. Also, it's been a few years, totally open to making corrections to the above.

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