Medicare Advantage Plans--good or a waste of money

My parents have had AARP United Healthcare for years. My father passed away in February but both he and my mom had many prescriptions and their monthly premiums were $330 a month each. I’m going to be 66 this year but still working full time so I’ll be watching this thread for more advice.

Same for my parents. My mom passed away in 2019 and I moved my dad down near me in an assisted living facility. He has the AARP UHC plan plus a RX plan and cost for both is around $370 or so per month. This year, he has been to the ER by ambulance 4-5 times, had a pacemaker installed with 2 days in the hospital, and a few other visits and I have never gotten a bill for anything. In the 2 years since I have managed his finances, I have never received not one bill for anything other than his prescriptions. The RX plan does not pay all, but some of them.

Bennett
 
Same for my parents. My mom passed away in 2019 and I moved my dad down near me in an assisted living facility. He has the AARP UHC plan plus a RX plan and cost for both is around $370 or so per month. This year, he has been to the ER by ambulance 4-5 times, had a pacemaker installed with 2 days in the hospital, and a few other visits and I have never gotten a bill for anything. In the 2 years since I have managed his finances, I have never received not one bill for anything other than his prescriptions. The RX plan does not pay all, but some of them.

Bennett
I also took over paying my parents bills years ago and my father was in 2 different hospitals, 3 different stays including ICU and then rehab and hospice. AARP UHC paid for all and extends rehab coverage out to 100 days.
 
My mom also had the basic Medicare and the AARP supplemental insurance until she passed in 2019. I think her premium was around $240 a month plus whatever was deducted from her SS. One of the big reasons I researched & signed her up for this was because she had a few health issues that required a stay in a rehab facility. Medicare only covers 21 days I believe and then it gets costly, like about $1k + a day! The AARP covered 180 days I believe PLUS her copay for the 21 days as I think it was only covered 80% through medicare. In addition, she procured prescription coverage as well. As far as prescriptions go, the copay cost will vary by drugstore. Do a little research on that. After a year or so I found out if my mom moved her scripts from Rite-Aid to Stop & Shop pharmacy across the street they went down to almost nothing saving her hundreds a month. In addition, if you have a sickly parent there is something (at least in NY) called community medicaide. It differs from traditional medicaide in that they can own a home & have retirement money etc and if qualified, they pay for everything. PM me if you want anymore info/guidance in that.
 
My mom also had the basic Medicare and the AARP supplemental insurance until she passed in 2019. I think her premium was around $240 a month plus whatever was deducted from her SS. One of the big reasons I researched & signed her up for this was because she had a few health issues that required a stay in a rehab facility. Medicare only covers 21 days I believe and then it gets costly, like about $1k + a day! The AARP covered 180 days I believe PLUS her copay for the 21 days as I think it was only covered 80% through medicare. In addition, she procured prescription coverage as well. As far as prescriptions go, the copay cost will vary by drugstore. Do a little research on that. After a year or so I found out if my mom moved her scripts from Rite-Aid to Stop & Shop pharmacy across the street they went down to almost nothing saving her hundreds a month. In addition, if you have a sickly parent there is something (at least in NY) called community medicaide. It differs from traditional medicaide in that they can own a home & have retirement money etc and if qualified, they pay for everything. PM me if you want anymore info/guidance in that.
I think the AARP UHC covered out to 100 days when my dad was in rehab in December of last year. My parents never had much and outlived what they did have saved. They own a co-op and lived on SSI with me and my siblings paying many of their bills but they still had too much income for Medicaid. I was able to get them on Community Medicaid by applying separately and putting the excess in a Pooled Trust which we can spend down on living expenses. BTW the income limit for a single household like my mom is $1,150/mo. Her SSI benefit is $1,650.
 
One thing to look carefully at is coverage out of your area of residence. Many Advantage plans will not provide coverage outside of your approved doctor/network or if they do it is quite a bump in cost. Remember the steak knives are not free.
 
One thing to look carefully at is coverage out of your area of residence. Many Advantage plans will not provide coverage outside of your approved doctor/network or if they do it is quite a bump in cost. Remember the steak knives are not free.
Most cover care when you travel outside of your service area and have an emergency with no penalty price wise. This may be a Medicare requirement. It is important to look for a plan that includes well respected hospitals and physicians. This gives consumers choice which we all appreciate. Good hospitals and doctors have choice as well and want to do business with plans that treat them well as it expands their opportunities to serve more patients.
 
I work in the MA/ACA/CMS space, for a large Michigan health plan (they are my companies parent). My mom is 83 and lives exclusively off of her SS monthly check, so I see it from her side as well. She's been in and out of the ER/Hospital many times over the past 3 years. Medicare plus her supplemental have covered everything, less copays. Our family has been happy with the level of care she receives for the most part. I think she pays $200 a month for her supplemental.

Depending on the state you live in the state will administer or they will put it out to bid to health plans. I work for the latter.

Based on what I have learned I do educate my friends/colleagues/family to be prepared, you may need supplemental insurance and Medicare is NOT free. Also, spend an hour with an elderly law attorney to learn, educate yourself, it's money well spent. We were trying to get my late dad's senior living facility paid for (he had dementia) without much luck. After talking to an elderly attorney we got it all paid for except $90/month.

I now max out on my HSA and will look at other options to set funds aside.
 
Last edited:
Most cover care when you travel outside of your service area and have an emergency with no penalty price wise. This may be a Medicare requirement. It is important to look for a plan that includes well respected hospitals and physicians. This gives consumers choice which we all appreciate. Good hospitals and doctors have choice as well and want to do business with plans that treat them well as it expands their opportunities to serve more patients.
Correct, it's called OOA - Out of Area and payment of the claims is called ITS.
 
I work in the MA/ACA/CMS space, for a large health plan (they are my companies parent). My mom is 83 and lives exclusively off of her SS monthly check, so I see it from her side as well. She's been in and out of the ER/Hospital many times over the past 3 years. Medicare plus her supplemental have covered everything, less copays. Our family has been happy with the level of care she receives for the most part. I think she pays $200 a month for her supplemental.

Depending on the state you live in the state will administer or they will put it out to bid to health plans. I work for the latter.

Based on what I have learned I do educate my friends/colleagues/family to be prepared, you WILL need supplemental insurance and Medicare is NOT free. Also, spend an hour with an elderly law attorney to learn, educate yourself, it's money well spent. I now max out on my HSA and will look at other options to set funds aside.
Only if you have traditional Medicare will you need a supplemental insurance policy for part B services. If you are enrolled in an Advantage Plan you do not need supplemental as the Advantage Plan covers all medically necessary conditions that Medicare covers, including the part B services, copays, etc. that folks buy supplemental coverage for. Drugs are also covered so you do not a part D plan. Many Advantage Plans do this for no added premium to the enrollees other than the money that is deducted from their monthly social security checks. Frequently, companies add dental, hearing aid coverage and gym memberships as well. Vision can be included for an extra monthly charge. If you live in a market with good hospitals and physicians, Advantage Plans can save you lots of money every month. We never thought twice about selecting one over traditional Medicare and have been in the same plan for 11 years.
 
Well we got her signed up with a plan through Humana. It fits all the boxes we needed to be checked--good local coverage, ER coverage when we're out of area, drugs, etc. $26/month. I figure she's worth that much.

Thanks to all of you for the information you provided. It helped me ask the questions I needed to ask and now I feel a lot more comfortable about a product that a week ago I had ZERO knowledge of.

My hat's off to all of you who answered on here and sent me PM's.
 
Enrollment closes tonight but in the event someone is still deciding or comes across this later I'll net out a few key points with Medicare Advantage:
  • Over 40% of Medicare Recipients are enrolled through a Medicare Advantage Plan
  • People enroll in Medicare Advantage either because they can get a broader set of benefits through a Med Advantage plan or because they would rather deal with Blue Cross, Aetna, Cigna, etc. than the Federal Government.
  • Med Advantage plans are required to cover AT LEAST the same benefits as traditional medicare, but the health plans networks and out of pocket costs (deductible, co-pay, in network and out of network out of pocket) may vary.
  • Just like you would if you were shopping for standard health insurance, contact the heath plan you are considering and check and see if your providers (doctors, therapists, etc.) AND facilities (hospitals, labs, etc.) are in network
  • CRITICAL - Contact the health plan and ask for their Med Advantage formulary - this is the list of covered drugs, and how they are covered (how they pay). Be sure to check the dosage, quantity, and form (pill, liquid, injection etc.) to match how they pay for the drugs that you take.
  • CMS (Center for Medicare and Medicaid Services) is the federal governing body for Medicare and Medicare Advantage plans. They have a Star rating system that is rigorous and specifically designed to let enrollees compare the quality of plans. This isn't just Yelp opinions, the Star rating program evaluates Med Advantage plans across a number of criteria ranging from customer service to health outcomes to evaluate plans and provide information to inform consumers. The Star ratings also play into the compensation that health plans receive.
  • I would recommend going directly to the CMS website to research, and going directly to the individual health plans in your state to ask questions, rather than going through navigators. I'm not knocking the navigators, but you will usually get more accurate answers going right to the source.
  • You are enrolling for the plan year, but can change plans at the end of the year. If you don't like your choice after a year, you can switch back to traditional Medicare, or switch to another private health plan
  • Health plans move in and out of the market. If you can see the enrollment volume it will give you a sense for their stability in the market. It is hard for plans with small enrollment to stay profitable, because they still have all the admin costs along with all of the compliance burden, but don't have the membership across which to spread those costs. Plans with larger enrollment tend to be more stable.
 

Forum statistics

Threads
112,950
Messages
1,422,861
Members
60,932
Latest member
juliediane
Back
Top