Medicare + Part D + Medigap...or Medicare Advantage? - AgingCare.com

Medicare + Part D + Medigap...or Medicare Advantage?

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There are plenty of insurance brokers who have been blowing up my phone since the beginning of the year, but quite frankly, I trust the advice of the people on this board above some stranger out for profit.


I will be eligible for Medicare in December but understand I can apply in September. The health issues I have are issues I have to live with: fibromyalgia, high blood pressure, arthritis and stress from caring for bedridden hubby I see my PCP once a year, have a few cursory blood tests and that’s it. I haven’t been in the hospital for 6 years and that was elective surgery. Been 9-1-1-ed once, 10 years ago. I take a total of 2 meds that cost me $6.00, granted that’s with drug coverage.


For years and years I’ve dutifully written out checks for ridiculous amounts of money for health insurance I never use. We are in a terrific money crunch now. I added up hubby’s supplemental and drug costs and it’s over $200 a month. Plus we still pay a good buck for what Part D doesn’t cover.


Medicare Advantage holds a real appeal for me right now. People have said it’s great until you want to use it and then you pay through the nose with co-pays. But, I don’t use it! If I go for my yearly physical, what I’d have to pay would still be less than what the monthly fees for Medicare +Supplemental would be. To me, it’s like flushing money down the toilet. Money we need to use for other things...like food. I had a regular plan with CareSource a few years ago and wound up paying 1/2 the costs of my physical, x-rays, and blood tests anyway. Can’t be worse than that!


Help, help! Counting on you guys! Thanks!

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Istucany, hubby has Medicare, AARP, (which I think is United Healthcare). He has dental and eye through his union.

Jacobsonbob, his finger looked very bad. We have seen the Urgent Care doctor before and I trust him. I believe he got to see the specialist sooner because he did go by ambulance. I also think the doctor thought I would take him home and not go to the ER because I complained about the long wait time the last time I was there. Remember this was a table saw accident and the doctor thought nerves and tendons were damaged.

This is from my cell phone I hope it gets through ok.
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Reply to MaryKathleen
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Ah: You;re welcome!
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Reply to Llamalover47
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I was rereading my post,
I realized that I wasn't clear. It sounded like I haven't had any health issues. That is not true. I meant the insurance companies have paid off with no problem.

Ahmijoy one major illness can cost thousands. My husband cut his finger badly on a table saw recently. We went to urgent care. The doctor said he needed a hand surgeon and insisted be go by ambulance to the hospital about 1/2 mile away. It cost $1,400. Just for ambulance. Insurance covered all. Haven't seen anything from urgent care , ER or doctor.
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lstuscany Jul 28, 2018
Hello Mary,

Hope me you’ve been well. You were one of the first people to respond to me when I signed up some months ago.

With your reference to the urgent care, cut finger, ambulance and specialist. What insurance was the primary. Medicare then a secondary?
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As Llamalover47 says, use an agent.

I went to the Medicare site when it was time for me to carry insurance and it even states there, get an agent.

You don't pay the agent - they earn small commissions. An Advantage Plan will cost you more money and still has limits. My DH had a "oldie but goodie" plan that is no longer offered so we kept it. No limits on it back then.

I opted for a policy that I pay the deductible because it saved me more than the deductible in paying the premiums. A good agent will give you the time to figure it all out - have a calculator and pen & paper handy. It took me a few minutes to see that paying the deductible out of pocket really did save me money over the premiums.

I never met my agent - talk to friends and family, that's how I found my agent. He has me call him every November to see if there is a better plan for me. He's changed my insurance companies twice and my drug plan twice. Since I take no drugs, I can always get the cheapest plan he can find. Same with the Health Insurance, I've never been hospitalized for anything.
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Reply to RayLinStephens
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Ahmijoy Jul 28, 2018
Thanks, Raylin. I can’t quite pull the trigger on the Advantage plans. I do understand what everyone is saying. It’s a gamble, and with the way my life has gone over the past decade, it’s a guarantee I’d lose.

I did get a letter from a local agent and I will call him when I become eligible in September. I remember my mother also used an insurance agent and her plan was always changing, but her insurance premiums didn’t seem to cause her hardship. I may even have this agent look over hubby’s supplemental and drug plan.

thanks again!
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You would be wise to use a qualified insurance agent when you sign up for Medicare Supplemental as it can be difficult to understand which plan letter to sign up for, assuming you're going purchase Medicare Supplemental. What also comes into the decision in your own health history.
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Ahmijoy Jul 28, 2018
Thanks! I am going to use an agent. I realize it’s just the intelligent thing to do.
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Issues with Plan C--the Advantage Plan-- (1) you typically can't get a Medigap or Plan F if you decide some day to switch to Original Medicare. That caveat could leave great financial liability as you would have to pay the 20% that Original Medicare doesn't pay for (Plan F pays for what isn't covered by Original Medicare---and for expensive health issues that is important), (2) they have limited physician/lab/extended care networks (whereas Original Medicare allows to you go to any doctor, lab or facility that accepts Medicare---there are no "door-keepers to seeing specialists either (make sure you check out your local physician network with any Advantage Plan) and (3) some extended care facilities (i.e., ALF, nursing homes, etc. will not accept Advantage Plan members---this is frightening). Don't choose which Medicare Plan based on how healthy you are because you never know what might happen in the future!
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Reply to Spankiedoodle
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Ahmijoy Jul 28, 2018
You’re absolutely right. My current physician is listed as accepting the Advantage plan I was looking at,

Like I wrote before, it’s the proverbial crapshoot. I’m sure not planning on “going down”, but with the stresses of caregiving, who knows.

Thanks fir taking the the time !to reply
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I wish I could offer some good advice. I have heard that Advantage plans are not good. I have no experience. I was such an innocent. When I was eligible for Medicare, I didn't even know I had to get it. I just happened into the Social Security Office for another matter. That was in May, I turned 65 in June, this was 19 years ago. Just pure luck on my part. So, I went with Medicare and my regular insurance which is GEHA (Government Employees Health Association). I also get their dental program. I have never had a problem other than a couple of blood tests that weren't covered. My daughter who is on Medical, went with Kaiser. She likes it, but a lot of people don't. I do pay a lot, but since it is a PPO. I can go to any doctor without a referral. To me that alone is worth the money. As one doctor told me. "Dear, you are golden, you can go anywhere." Too, I don't have to wait for my family doctor to give me a referral. If I ever get really down on my finances, I will switch to a HMO, but as long as I am the least bit able I will stay where I am. I have no co-pay when I go to the doctor.
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CTTN55 Jul 28, 2018
"I do pay a lot, "

What is a lot? Thanks!
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Good timing for this subject! I turn 65 in November, so can call the 1st of August to sign up..... for what, I am with everyone else in the "unsure boat".
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I had no idea what Medicare was all about when I spent two years taking care of my parents. I (they) never got a medical bill during those years, which included multiple trips to the ER, cancer surgery, pneumonia, re-hab, and hospice care with skilled nursing.

When I turned 65, I decided it was worth it to have the kind of coverage they had. I figure I'll probably be too frail some day, as were my parents, and my caregiver(s) would have one less headache without having to worry about Medicare. I also figured I might end up with a chronic condition (who knows what the future holds?) that requires multiple hospitalizations -and I don't want to be fretting about whether to get needed medical attention because of money worries.

So I opted for Original Medicare, parts A & B, and a supplemental (Medigap) plan. I chose supplemental (Medigap) Plan F (which is just like Medigap Plan G - only G has a small deductible and F has no co-pay or deductible). I chose United Healthcare as the underwriter - through AARP - for my Plan F supplement. Every healthcare provider I've been to immediately recognizes my coverage (Plan F is the most popular medigap plan) and knows the bill will be paid for. They never ask for copay S or deductibles (or full payment) upfront.

I opted against Medicare Advantage plans because their networks, copay, deductibles, etc, change too frequently.

For Part D prescription coverage, I kept my retiree benefit plan, as it's certified under Medicare. I still pay co-pays for several drugs. Without that retiree coverage, I'd probably have to evaluate Part D plans every year to find the least expensive in terms of the particular drugs I take.

Always plan with the future in mind, knowing health issues tend to get worse as we age. A more inexpensive plan now may not work in the future and the "open window" to get the best insurance for future needs will be closed by then.

Just my thoughts. Good luck!
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Myownlife Jul 25, 2018
Good info, Jake, thanks! My coworker who is like an older sister advised me on the same, but with the G. Up until now, I have been very healthy, last hospitalization was for the birth of my last child over 30 years ago :), few medications which are inexpensive, but who knows what the future may hold.

I do not want to be insurance poor, but also do not want to have a surprise emergency that takes a chunk out of my savings, either.
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Contact your local Council on Aging and see if there is a SHINE (Serving the Health Insurance Needs of Everyone) program.  They have people trained to review what your insurance needs are and what plans might best fit those needs.  It is a free service.
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LMueller Jul 26, 2018
Yes, Ellen is right! SHINE provides free Medicare workshops in held in various locations. See if you can find one near you. There are also similar workshops sometimes hosted by your local area, held in libraries or other venues. You can try to ask or check your local office or paper for such events. They are also free services. Even consulting an agent should not cost you. On the other hand, you can also check online (aside from here) for similar situations and resources. If you got interested in Medicare Supplement plans and ensure your future healthcare expenses with it, you can try seeking more information, request quotes and be contacted by a licensed agent, at no cost at freemedsuppquotes.
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