Advice on Medicare Advantage vs Medigap

[catherine]

Arghhh.. I hate this stuff.

DH turns 65 in a couple of weeks. I'm already on Medicare but since I rarely go to the doctor (maybe less than 10 times over the past 15 years) and have no chronic conditions, other than osteopenia, I chose the cheap option: Just the basic A&B.

But DH has a few medical conditions and 4 regular prescriptions (all available in generic form) so I definitely want to shore up his coverage.

My instinct is to go with Medicare Advantage over MediGap/Medicare Supplemental. He has two doctors that he definitely wants to stick with and there's one Advantage plan I found that has both in its network.

Any reason why I should choose MediGap instead?

[Sad Eyed Lady]

I have no answer because I am mulling over those options myself right now. I get so confused with all this stuff. I too am leaning toward an advantage plan because they seem more conclusive, some have dental and vision as well as the drug plan. I called one of the advantage companies yesterday because I had just received the new booklet in the mail and he said they would not have any answers until next Monday as to pricing and coverage area. Good luck! I hope someone with more knowledge will share on this post.

[pinkytoe]

This might be a good question for the city data.com retirement forum. I have to start thinking about this stuff too...

[Teacher Terry]

I have friends on the advantage plan. They say many doctors aren’t taking regular Medicare but everyone takes the advantage plans.

[Rogar]

Probably worth verifying, but I understand that under the advantage plans if you want to see a specialist you need a referral from you designated primary care doctor. With medigap you can see a specialist of choice and at your discretion as long as they accept medicare and do not need a referral.

I have had questions about whether you are in an advantage plan and develop medical problems, whether you can switch into a comprehensive medigap policy during open enrollment?

[Teacher Terry]

Locally that’s not true for us Roger. In fact here you can see whoever you want no referrals needed. But I am sure every place is different.

[Rogar]

Locally that’s not true for us Roger. In fact here you can see whoever you want no referrals needed. But I am sure every place is different.

I don't know that all advantage plans are the same either?

[Teacher Terry]

My guess would be that they are not the same.

[Sad Eyed Lady]

No, they are not all the same. The booklet I was looking at yesterday listed some as needing a referral for a specialist, some not. Some offer drug plans, some not. All different.

[Gardnr]

Mom always had a gap plan. She was on SS only and she knew exactly what her healthcare would cost-just her premium. And all expenses were paid by it. That said, she died in 2007. Her premium was $168 and she liked the peace of mind it offered her. She had 2 total joints and a triple bypass with that plan over 15 years.

Don't forget about plan D. There is an accumulating penalty if you don't have it.

[Teacher Terry]

Here with a advantage plan it covers everything

[Rogar]

I was getting confused and had to look it up. This is what Investopedia says. I have read that many start out in an Advantage plan and then shift into a Medigap when more health issues develop.

Cost: Medigap coverage usually has a higher monthly premium, but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget.

Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.

Lifestyle: Medicare Advantage plans often only operate with a certain region. If you’re a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently: Some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states; Advantage plans generally do not.

[Teacher Terry]

Our local advantage plans don’t work in the way you describe so people should check carefully in their own area so they get the right plan for themselves.

[iris lilies]

Mom always had a gap plan. She was on SS only and she knew exactly what her healthcare would cost-just her premium. And all expenses were paid by it. That said, she died in 2007. Her premium was $168 and she liked the peace of mind it offered her. She had 2 total joints and a triple bypass with that plan over 15 years.

Don't forget about plan D. There is an accumulating penalty if you don't have it.

yes, Plan D! Thank you. I knew there was one I needed to keep an eye on.

I plan to use a local i surance broker who specializes in Medicare.