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  • Helping parents choose Medicare plan

    Hello all,

    My parents are approaching age 65 in the next few months, and they will be retiring and going from their employer provided insurance plan to Medicare. As their dutiful physician son, I want to help them wade through their Medicare options.

    I figure some other folks have had to help their parents make similar decisions. What resources would you recommend? I've purchased the two copies of Medicare for Dummies book which my father and I are reading. My parents are both relatively healthy. Any thoughts on straight Medicare versus Medicare Advantage plans?

    Any help/advice/recommendations is greatly appreciated.


  • #2
    Do they travel much ?

    If they travel a lot or spend a lot of time in different areas would get a standard plan with secondary and D.

    If they have a lot of complicated issues, same as above.

    Otherwise would look into local Medicare Advantage plans which is popular in their area, which wrap the secondary and d into one package.

    If you dont like them , pick one that pays doctors poorly.

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    • #3
      Strongly suggest regular with supplement plan. Not advantage

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      • #4
        ADVANTAGE limits choice of doctors, drugs, etc
        BEST is straight medicare with supplemental and drug

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        • #5
          In my experience, advantage plans are generally awful. Our office takes them but they deny so much and require tons of prior auth. They delay start of cancer treatment. I've had them tell me they have 15 business days to decide if radiation is authorized. Then I have to do a peer to peer after they deny a treatment plan (regular) medicare would have authorized without prior auth.

          Worse when I want to refer to another specialist it can be challenging to find someone who takes the plan and the offices that do often have long waits to get an appointment.

          Get regular with supplement.

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          • #6
            With Medicare (A&B), drugs(D) and a supplement you can go to virtually any doctor or physician in the USA. No requirement for a referral or any authorization. If it is covered by Medicare, the supplement pays the 20% for A&B. Automatic and a legal requirement.
            Drug coverage (Part D) is separate. Line up their medications and you will get all plans available and the out of pocket costs. One specific medication and pharmacy you use will determine your best choice.

            With Advantage, you will be limited to physicians in your county. You need a specialist not in your county? Good luck a ton of red tape. You can also have very limited choices of specialists locally. What is available and when is not an advantage. They also are more aggressive in areas like physical therapy. More disturbing than a root canal on vacation. It’s only a problem when you have a problem. Restrictions galore, primarily where, when and which physician.

            Also, they have guaranteed acceptance during the grace period for a supplement plan. Once they get out, they may never get back in.
            Plan F & G supplement plans fit most needs. On G, you pay the deductible($203).
            The SNF is a potential need. Good to have.
            If you get a good plan, don’t leave it until you have better coverage in place.
            https://www.medicare.gov/supplements...digap-policies

            The Medicare dot gov site has all the info and tools you need. Prices too.The gem of the Medicare program is actually the government phone service. 800-Medicare. No stupid question, no salesman, just guidance or answers. Fast and courteous.

            Get them accounts set up and its easy to shop.

            You probably won’t find a problem with Advantage until it’s a real problem without coverage. Even in the hospital or facility, you coverage may be administered differently. You are not going through Medicare. It’s cheaper for a reason.

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            • #7
              I will be picking a plan in about a year for myself. I plan on regular Medicare with a supplement.

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              • #8
                Another vote for straight Medicare A&B, part D, and a supplemental insurance policy.

                Medicare advantage plans may cost less in premiums, but you get what you pay for — they often deny medically reasonable services that straight Medicare covers.

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                • #9
                  I believe Plan F is no longer available for new enrollment, so Plan G is the next best choice if you want to minimize out of pocket costs and don’t mind paying a higher premium.

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                  • #10
                    Originally posted by Hatton View Post
                    I will be picking a plan in about a year for myself. I plan on regular Medicare with a supplement.
                    More decisions, which plan. A through K. The coverages are different, but each insurance company has the same coverage if they offer the plan.

                    Supplement also involves choices.
                    If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that:
                    • Begins 3 months before the month you turn 65
                    • Includes the month you turn 65
                    • Ends 3 months after the month you turn 65
                    Step 1:
                    Medigap policies are standardized, and in most states are named by letters, Plans A-N. Compare the benefits each plan helps pay for and choose a plan that covers what you need.

                    https://www.medicare.gov/medigap-sup...g=en&year=2021


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                    • #11
                      Originally posted by Tim View Post

                      More decisions, which plan. A through K. The coverages are different, but each insurance company has the same coverage if they offer the plan.

                      Supplement also involves choices.
                      If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that:
                      • Begins 3 months before the month you turn 65
                      • Includes the month you turn 65
                      • Ends 3 months after the month you turn 65
                      Step 1:
                      Medigap policies are standardized, and in most states are named by letters, Plans A-N. Compare the benefits each plan helps pay for and choose a plan that covers what you need.

                      https://www.medicare.gov/medigap-sup...g=en&year=2021

                      Yeah I am familiar with this. I helped my ex husband pick his plan and more recently a neighbor.

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                      • #12
                        Originally posted by Hatton View Post

                        Yeah I am familiar with this. I helped my ex husband pick his plan and more recently a neighbor.
                        That was awfully nice of you.

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                        • #13
                          Originally posted by Hatton View Post

                          Yeah I am familiar with this. I helped my ex husband pick his plan and more recently a neighbor.
                          I figured you would be! A zombie apocalypse policy, if it existed, I would assume you decided on self insuring.
                          Some are unaware of the previous conditions guarantees for supplement policies is extremely limited. It is limited to the initial period. Not signing up at 65 is one of the landmines. Preexisting conditions is another. Deductibles is another. The personal responsibility for the 20% is another. When I hear "Medicare for All" I cringe. The premiums and deductibles and preexisting conditions will disrupt the supplemental insurance market and there will still be people uninsured. It is not free and 20% responsibility will be a problem for many.

                          The "best" part is that all insurance companies coverage is exactly the same for each contract type. Choose that and the best price and the consumer is fine.

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                          • #14
                            Originally posted by Curious George View Post
                            I believe Plan F is no longer available for new enrollment, so Plan G is the next best choice if you want to minimize out of pocket costs and don’t mind paying a higher premium.
                            That is correct for the OP's parents.

                            A small clarification for those unaware. Plan F was/is no longer available for new Medicare enrollees starting 1/1/2020. Anyone enrolled in Medicare as of 12/31/2019 can still enroll in Medicare Supplement Plan F. This would require medical underwriting except in CT, NY and WA that mandate unlimited open enrollment with guaranteed issue.

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                            • #15
                              You also need to think about vision, dental and hearing (where applicable). Medicare does not cover (nor does Medigap).

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