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    Medicare Advantage vs Medigap

    I have been on SSDI for 18 months and am 56 years old T4 paraplegic. Soon I will be on Medicare and will need to choose between Medicare Advantage and Medigap as a supplement to Medicare. Was wondering which of these you find is the best and pros/cons of them.

  2. #2
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    Go to the AARP site. There is good information there about relative merits of plans, but any way you slice it it is very complicate, with many "what ifs" build in. Since it is impossible to answer the "what ifs", our choice is a bit of a guessing game.

    https://www.aarp.org/health/health-i...tcmp=AE-HP-LL1

    In addition, all states have a helpline where someone will attempt to help you sort out your information and what fits you best.

  3. #3
    Personally I would never get a Medicare Advantage Plan.

    They purport to save you money or offer other benefits above and beyond traditional medicare, but they can only do so by providing inferior services or coverage. Many providers do not accept these plans.

  4. #4
    Quote Originally Posted by funklab View Post
    Personally I would never get a Medicare Advantage Plan.

    They purport to save you money or offer other benefits above and beyond traditional medicare, but they can only do so by providing inferior services or coverage. Many providers do not accept these plans.
    I believe they are called "Medicare Advantage" plans because once you switch to them you realize the advantage that traditional medicare has over these private plans...

  5. #5
    Senior Member Oddity's Avatar
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    I can't get Medigap in Virginia. Only available for 65 and over population. I choose an Advamtage plan for one important reason: stop loss.

    Its saved me over $8,000 this year alone. The 20% co-pay traditional Medicare has can be enormous.

    My annual max OOP with the Advantage plan is $2,500. My Medicare 2019 20% OOP would have been ~$8,000, and nothing really big happened. Traditional has no max. It costs you what it costs, with Zero stop loss. My Advantage OOP for 2019 was only ~$650. Heaven forbid you have to be hospitalized on traditional Medicare. 20% of a huge number is still a big number.

    Benefits for me actually got better. No doctor changes required. Dental, drugs, vision, mental, chiropractic, etc all included for same I was paying traditional. E.g. A (bladder control) drug I'd been wanting to try was not covered by Part D and was $600 a month. Advantage Plan: $35 monthly copay for same drug.

    Ive yet to encounter a situation where Advantage plan has not worked in my Advantage. (2 years and counting). They even covered my latest wheelchair much better. (Just a few hundred for a chair and smart drive instead of a thousand.)

    Only thing I don't like is needing to get referrals sent for all my specialists but that took like 20min and the referral authorization lasts 12 months.

    All that said, Medicare + Gap is better, IMO, but it more than doubles the monthly premiums and isn't available in every state for folks on Medicare under 65. Advantage is no more premiums, unless you want to upgrade, which is another benefit: buying better coverage if you want better coverage. Traditional Medicare is take it or leave it.

    My .02
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  6. #6
    Doesn’t traditional part A cover 100% of hospital costs?

  7. #7
    Quote Originally Posted by funklab View Post
    Doesn’t traditional part A cover 100% of hospital costs?
    No. 80%. And B is what pays for outpatient physician visits, PT, OT, etc.

    If you go with Medicare Advantage, you are really going with an HMO. Physician and hospital choice may be non-existent or very limited. Be sure to look at their DME coverage too...it may be less than traditional Medicare.

    If you go with a Medigap plan, be sure it is one that also includes Medicare Part D (medication coverage); otherwise you will have to also chose and pay for a D plan. That is a Medicare requirement.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #8
    Senior Member Oddity's Avatar
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    I have a good advantage because the company running my plan also runs 100% of the hospitals in my region and ~75% of the group practices and other facilities. Every doctor I've ever gone to is a member of their network. Most are affiliated business wise too.

    There aren't any Advantage plans with worse coverage than Medicare, even for DME, between Anthem, Humana, Sentara and United, that I can find.

    I thought by law they had to be at least as good.


    Quote Originally Posted by SCI-Nurse View Post
    No. 80%. And B is what pays for outpatient physician visits, PT, OT, etc.

    If you go with Medicare Advantage, you are really going with an HMO. Physician and hospital choice may be non-existent or very limited. Be sure to look at their DME coverage too...it may be less than traditional Medicare.

    If you go with a Medigap plan, be sure it is one that also includes Medicare Part D (medication coverage); otherwise you will have to also chose and pay for a D plan. That is a Medicare requirement.

    (KLD)
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  9. #9
    Senior Member Oddity's Avatar
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    Quote Originally Posted by funklab View Post
    Doesn?t traditional part A cover 100% of hospital costs?
    Depends on length of stay and state insurance regulations. For short stays, yes. There is always a deductible (2019 ~$1,500 per "spell of illness"/admittance for a condition. Admissions for multiple issues means multiple $1,500 deductibles. Once for each diagnosis code being treated, per admission, essentially.) Long stays get up around $300-$400 per day co-pay. More in some states. It's not a flat 20% co-pay for Part A like it is for part B, but even some out patient part B services (chemo, radiation, outpatient surgeries, etc) still can be HUGE bills. My Dad racked up nearly $50k in Medicare copays over just a couple years recently.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  10. #10
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    Quote Originally Posted by Oddity View Post
    Depends on length of stay and state insurance regulations. For short stays, yes. There is always a deductible (2019 ~$1,500 per "spell of illness"/admittance for a condition. Admissions for multiple issues means multiple $1,500 deductibles. Once for each diagnosis code being treated, per admission, essentially.) Long stays get up around $300-$400 per day co-pay. More in some states. It's not a flat 20% co-pay for Part A like it is for part B, but even some out patient part B services (chemo, radiation, outpatient surgeries, etc) still can be HUGE bills. My Dad racked up nearly $50k in Medicare copays over just a couple years recently.
    Wow.

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