MidAtlantic

I am looking at Aetna and Humana plans right now and the copay for Primary Doctor is $5 and for Specialist $35 on both policies. That is way less than 20%. Both policies are at zero additional cost to the traditional medicare premium and include good prescription drug coverage.

civilservant

I'm not speaking for all plans, since there are literally hundreds... although the there is also likely to be additional co-insurance on there too, not just the co-pays.

However they are still Medicare Advantage plans.... so are inherently worse than traditional Medicare.

In my humble opinion, A/B do it far better than letting insurance companies get involved and mess up the whole thing. But hey, I'm pro-single payer, and that's for another thread, so....

Nutmegger

lansbury

Big draw back to that, at least where I am, a lot of primary care doctors will not take patients who only have basic medicare. My doctors office has a list of four medicare advantage plans they accept, and do not take basic medicare.

retman

I have just enrolled in Medicare at 65. Here is my take having "studied" MEDICARE for several months so as to fully understand the options and various nuances.

1. I suggest you work with a broker experienced with Medicare enrollment. It will cost you nothing. The broker is paid a commission by the insurance company you sign up with.
2. Whether you choose Medicare Original plus a Medicare Supplement or Medicare Advantage there is a standard cost you will pay of $135.50 monthly. If you receive SS benefits it will be deducted before you receive your benefits.
3. Medicare Advantage provides health coverage (hospitals and doctors) plus drug prescription. It is possible that the premium might be as low as zero or up to typically $50 pm. There is a deductible to pay which could be as high as $6,400 approx or possibly lower depending on the Advantage plan selected.
4. Choosing Medicare Original leaves you exposed with no cap for 20% costs whatever that might be without buying a Medicare Supplement plan to cover these costs. Therefore you should consider a Medigap / Supplement plan to cover deductibles and costs not covered by the Medicare Original plan. THE GOOD THING ABOUT MEDICARE ORIGINAL YOU CAN CHOOSE ANY DOCTOR PROVIDED THEY ACCEPT MEDICARE ASSIGNMENT, which 97% of doctors across the USA do.

This is what I chose with monthly costs: I live in North Carolina. This information is freely available online via the Medicare.gov website. Costs are variable by state. There are various Medicare Supplements Plans with varying premiums. Most applicants will choose Plan G, or Plan N. Plan F covers everything, however the higher monthly premium typically exceeds the $185 Part B deductible that Plan G does not cover. That is the only difference between Plan G and F. So why bother with Plan F, makes no sense.


Medicare Original premium $ 135.50
Medicare Supplement Plan G $100.00 (Mutual of Omaha)
Part D - Drug Plan $17.20 (AETNA)

Total costs pm $252.70.

My only annual costs that I will have to bear is $185 for Part B annual deductible. That's it... Nothing more.
Final recommendation: Use the services of an experienced broker in Medicare enrollment.

lansbury

I believe there are some plans which cover the donut hole. I don't know much about them as my meds don't get me anywhere near that problem

Giantaxe

The unfortunate thing about high deductible Medicare Advantage plans is that they aren't considered high deductible in the eyes of the IRS. So no ability to contribute to an HSA in conjunction with them. Of course, if you already have lots of money in an HSA, you can use it for your Medicare premiums and deductibles.

Rete

Sorry, NM .... I didn't read your post before posting myself. But I see that the OP hasn't replied to either of us.

sid nv

Thanks to all for the points raised and suggestions. I don't have time now to address these, but I am following up the issues raised.
I am going to attempt to post a link to the plan I am looking at below - don't know if this be successful as I new to this - however, for anyone reading this thread looking for a Medicare Plan, this will not be much use as it is specific to a small area located in Nevada:

https://www.seniorcareplus.com/plans...-to-see-plans/

sid nv

Checked with our doctor's office, and they accept either Original Medicare, or Medicare Advantage. It does seem odd that your PCP will not accept Original Medicare.

sid nv

Thank you, excellent summary.

Re. contacting a broker, I generally prefer to avoid Agents, aka. Salespeople. However in this case I might have to concede defeat. Anyone who can navigate the Medicare Maze has to be worth their salt.

I have now come across the alphabet soup of Supplement Plans. It looks like Plan F will be discontinued in 2020, presumably for the reason you outline.

sid nv

We are age 65+, so eligible for Medicare.

Re. COBRA, it looks like state law takes precedence over Federal law, so in my state Nevada small companies may have an obligation.

vespucci

Note that this may be your only chance to automatically enrol in a Supplement plan; if you enrol in an Advantage plan and want to switch to Medigap later you may have to be free from certain pre-existing conditions to be accepted. (This is from my own experience with one insurer; I do not know if it applies to all insurance companies and plans).

retman

Plan F is being discontinued as the Government wants everyone to pay something, hence Plan G with its deductible of $185 becomes the best default. I think you need to view Agents in this situation a little differently in that you know you want medical healthcare coverage, so it's not as if you are being sold something you were unaware of. And if you choose to buy a Supplement Plan, realistically your choice is either Plan F or perhaps N. The coverage provided by each plan sold by an insurance company is exactly the same. The difference is the premium charged by the insurance for that plan can differ. There is no need to pay more for a particular plan to insurance company A than Insurance company B. I recommend selecting a company that is financially sound: AM Best ratings. Plus often insurance companies offer discounts from published rates for example two persons in a household over aged 60 even if only one is signing up for a supplement plan. This is where the knowledge of an experienced broker can help.

sid nv

Thank you. Another twist that I was unaware of. It does indeed looks like we could lose guaranteed issue protection if we do not sign up for Medigap now, with the possible exception of a 1-year trial period on an Advantage plan. Also, Medigap protections vary by state. For anyone else pondering this stuff,informative article by Kaiser link below. The map in this article showing Medigap purchasers by state has CA percentage as "N/A", so I guess they do things differently in CA.
https://www.kff.org/medicare/issue-b...across-states/