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Old 10-08-2023, 10:17 AM
 
533 posts, read 479,288 times
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I wouldn't waste your trial right to see if Advantage works for you, but rather, save it for when you might want to switch Medigaps if you live in a state that doesn't have a birthday or similar rule.

 
Old 10-08-2023, 11:32 AM
 
37,315 posts, read 59,832,630 times
Reputation: 25341
Quote:
Originally Posted by KaraG View Post
I'm confused about the costs of Advantage plans. I see them referred to as free or $0 premium, yet my mom pays for hers. Do some people get them free?
Understand this—
Someone who signs up for Advantage plan has signed away his/her right to traditional Medicare A/B and any Supplemental Medigap plan

That person has become a CLIENT of the insurance company sponsoring the Advantage plan

Medicare then PAYS the insurance company a flat fee to cover services that person may require in the coming year(s)——a FLAT FEE—fixed amount of $$
If the client is paying a monthly premium plus deductible then that is in addition to the FLAT FEE Medicare pays

The insurance company LOSES MONEY if it pays out MORE than it takes in for that person’s insurance
The insurance company does not want to lose money—
It becomes a gatekeeper over services that the person and the person’s doctor might consider necessary—
Even mandatory—to address health needs of the insured

There is no gatekeeper to Medicare clients like there is in Advantage plans

In Advantage plans—the Advantage is to the insurance company vs the individual really
Some people pay no monthly charges depending on their area and the plan/company they go with and some people do—and for some people that is their only option because they can’t afford to risk costs that might come if they had Traditional Medicare A/B but couldn’t afford a decent supplemental plan….My sister is one of those—
So far she has been pretty lucky with her Advantage plan in getting the specialists she needs to see
But because of her income and her location she doesn’t have as many choices as others

Sometimes it depends on the ongoing-RX that person might need because Advantage plans usually include RX coverage vs a separate Plan D required with traditional Medicare
 
Old 10-08-2023, 11:45 AM
 
Location: USA
9,113 posts, read 6,155,520 times
Reputation: 29884
https://www.city-data.com/forum/65738169-post44.html

I've asked the moderator to make this a sticky.
 
Old 10-08-2023, 10:21 PM
 
Location: Wisconsin
25,576 posts, read 56,455,902 times
Reputation: 23371
Quote:
Originally Posted by Lillie767 View Post
https://www.city-data.com/forum/65738169-post44.html

I've asked the moderator to make this a sticky.
Good idea. We can now add Oklahoma and Kentucky to that list thanks to SCG who posted this today on another thread:
Quote:
Originally Posted by SCGamecock View Post
Oklahoma implemented a Medigap "birthday rule" on 9/1/2023 that allows switching to another plan with equal or lesser benefits without underwriting.

Source: https://content.govdelivery.com/acco...letins/3706aeb

Kentucky gets a Medigap birthday rule in January 2024, but it is only for switching to the same letter plan at a different company.

https://www.healthinsurance.org/medicare/kentucky/
 
Old 10-09-2023, 09:15 AM
 
Location: Bellevue
3,037 posts, read 3,304,919 times
Reputation: 2896
Quote:
Originally Posted by KaraG View Post
I'm confused about the costs of Advantage plans. I see them referred to as free or $0 premium, yet my mom pays for hers. Do some people get them free?
Depends on the Plan & if you never use the service to see a doctor.

You still may have to pay $164 monthly Part B fee. Some plans may refund this money. Someone on Medicaid may qualify for this.

About 60% of plan participants do get their Plan with $0 premium.

UHC/AARP may have largest network of doctors. But depending on the plan may pay $3000-$4000 Max Out Of Pocket. Different plans will have different deductible, co-pay.

In the Prescription part may pay something depending on the medication.

JD Power & Medicare have ratings for the Plan. Some may be no better than the other. May be easier to weed out the worst plans. Finding the best plan may depend where you live so you have decent choice of doctors. You may find in a "good year" only pay plan premium. But in a "bad year" pay MOOP.

Last edited by GWoodle; 10-09-2023 at 09:31 AM..
 
Old 10-09-2023, 10:54 AM
 
9,848 posts, read 7,712,566 times
Reputation: 24480
Quote:
Originally Posted by GWoodle View Post
Depends on the Plan & if you never use the service to see a doctor.

You still may have to pay $164 monthly Part B fee. Some plans may refund this money. Someone on Medicaid may qualify for this.

About 60% of plan participants do get their Plan with $0 premium.

UHC/AARP may have largest network of doctors. But depending on the plan may pay $3000-$4000 Max Out Of Pocket. Different plans will have different deductible, co-pay.

In the Prescription part may pay something depending on the medication.

JD Power & Medicare have ratings for the Plan. Some may be no better than the other. May be easier to weed out the worst plans. Finding the best plan may depend where you live so you have decent choice of doctors. You may find in a "good year" only pay plan premium. But in a "bad year" pay MOOP.
My mom's premium comes out of her Social Security check every month, she does have the UHC/AARP and uses it.

That's what I was just wondering, does having the payment automatically come out of your SS check seem like a free plan to some people. And the people I know who don't have the deduction for their advantage plan had Medicaid before age 65.

I'm not switching from regular Medicare, just trying to see how things really work.
 
Old 10-09-2023, 11:03 AM
 
50,717 posts, read 36,411,320 times
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Quote:
Originally Posted by KaraG View Post
My mom's premium comes out of her Social Security check every month, she does have the UHC/AARP and uses it.

That's what I was just wondering, does having the payment automatically come out of your SS check seem like a free plan to some people. And the people I know who don't have the deduction for their advantage plan had Medicaid before age 65.

I'm not switching from regular Medicare, just trying to see how things really work.
My mom had zero premium with Advantage.
 
Old 10-09-2023, 11:49 AM
 
3,217 posts, read 2,425,895 times
Reputation: 6328
Quote:
Originally Posted by Ariadne22 View Post
This is absolutely not true. The ability to switch is state specific.
I never said that you were guaranteed or not underwritten or any other terms for the Supplemental plans only that you can switch if unsatisfied at the next open enrollment (or it looks like anytime during that first year). There are other conditions you can switch such as moving, your doctor is no longer taking Advantage plans etc., but yes, if you are trying to switch because you were suddenly diagnosed with some condition you may not be able to get a Supplemental or might be under some restrictions.

This is for switching with no underwriting https://www.medicarefaq.com/faqs/swi...re-supplement/

Can You Switch from Medicare Advantage to Medigap Without Underwriting?

The only time you may switch from a Medicare Advantage to Medigap without underwriting is if you have a Special Enrollment Period that grants you guaranteed issue rights. This means that you will be able to enroll in the plan of your choice with no health questions. Thus, you cannot be denied coverage for any reason.

Some of the most common Special Enrollment Periods to switch from Medicare Advantage to Medigap without underwriting health questions are called trial rights.

Trial Right 1: You join a Medicare Advantage Plan when you first become eligible for Medicare at age 65 and wish to switch to Medicare Supplement within the first year.
Trial Right 2: You disenrolled from a Medigap policy to enroll in a Medicare Advantage plan for the first time, and within the first 12 months of being on the Medicare Advantage plan, you wish to switch back to your original Medigap plan.
These two trial right situations are commonly overlooked by Medicare enrollees because they are unaware the rules exist. If you wish to switch from a Medicare Advantage plan to a Medicare Supplement plan, working with a knowledgeable licensed agent is the best way to ensure you do not miss out on enrollment opportunities such as trial rights.

Can You Switch from Medicare Advantage to Medigap Without Underwriting?
The only time you may switch from a Medicare Advantage to Medigap without underwriting is if you have a Special Enrollment Period that grants you guaranteed issue rights. This means that you will be able to enroll in the plan of your choice with no health questions. Thus, you cannot be denied coverage for any reason.

Some of the most common Special Enrollment Periods to switch from Medicare Advantage to Medigap without underwriting health questions are called trial rights.

Trial Right 1: You join a Medicare Advantage Plan when you first become eligible for Medicare at age 65 and wish to switch to Medicare Supplement within the first year.
Trial Right 2: You disenrolled from a Medigap policy to enroll in a Medicare Advantage plan for the first time, and within the first 12 months of being on the Medicare Advantage plan, you wish to switch back to your original Medigap plan.
These two trial right situations are commonly overlooked by Medicare enrollees because they are unaware the rules exist. If you wish to switch from a Medicare Advantage plan to a Medicare Supplement plan, working with a knowledgeable licensed agent is the best way to ensure you do not miss out on enrollment opportunities such as trial rights.

Last edited by NorthofHere; 10-09-2023 at 12:13 PM..
 
Old 10-09-2023, 11:53 AM
 
3,217 posts, read 2,425,895 times
Reputation: 6328
Quote:
Originally Posted by ocnjgirl View Post
My mom had zero premium with Advantage.
Are you sure that Part B is not taken out of her social security? Some Advantage plans don't charge extra but you still pay the Part B.
 
Old 10-09-2023, 01:01 PM
 
50,717 posts, read 36,411,320 times
Reputation: 76529
Quote:
Originally Posted by NorthofHere View Post
Are you sure that Part B is not taken out of her social security? Some Advantage plans don't charge extra but you still pay the Part B.
I can't remember, I'm sorry. She had that plan 15 years ago or more now.
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