Anybody Love, or Hate, your Medicare Advantage plan??

Looking for pluses and minuses ....

Many thanks for any input! this is making me (more) nuts


Plans can vary by State.  I like my plan; but, since it is through my retirement system, it would not help you.  Please PM if you would like specific information anyway.  Some resources to consider:  

When you sign-up for Medicare, Medicare will send you a book each year that details offerings of Medicare programs serving your area.  Information can be daunting but it will help you zoom in on the features you want.  

Major pharmacy chains like Walgreens have a service (mostly focused on drug coverage) that will help you select the plan that best covers your needs.  

Each State has a SHIP office staffed by trained navigators who will sit down with you (they likely do virtual meetings now), review all the options, and help you select the best plan for your needs and budget.  

AARP has a good article in their current Bulletin which explains the advantages and disadvantages of original Medicare vs Supplement Plans vs Medicare Advantage, listing broad characteristics, pluses, and minuses of each.  Not surprisingly, since they sell supplement plans, they do not recommend Medicare Advantage plans for everyone.   

Your local library, senior center/organization, even your current/former HR office can be a good source of information on plans available where you live.  If you have a retirement system, they may offer one or more plans for less than you would pay on the outside.  Mine also offers some benefits not available in some of the plans they offer directly to individual customers.


Thanks for your response, Joan.  I'll look at that AARP info.

Additional musing: 

We have been "on" Medicare for several years, but only now starting to pay for supplement/Medigap ourselves (up to now, former employer has been covering it).  (Some of) the Advantage plans are sooo much less expensive, while covering more "stuff" than regular Medicare, that i can't help wondering what the catch is. 

Also,  it may not be that easy, or even possible, to change back from Advantage to "regular."  Apparently, the regular Medicare Supplement/Medigap plans can charge extra or deny coverage altogether at that point, depending on age/health.  Seems too risky to me, unless everybody loves their Advantage plans, so that there would be no reason to switch back....


Plans change every year.  That is what the annual transfer period is for.  Since I have never had a Medigap policy, I wouldn't know about any penalties in switching from Medicare Advantage back to to Medigap.  Your local SHIP office should know. The primary difference between Medicare and Medigap as far as I know is that most, if not all, Medicare Advantage programs require that you go in network to receive your medical care while Medigap policies let you see any doctor who accepts Medicare.  Going in network can sometimes save money because fees can be controlled by the insurance company providing the coverage. 


Check deductibles.  I seem to think that advantage plans charge deductibles for each occurrence/visit while regular Medicare plus Supplement charges one, usually larger, yearly deductible (from the Medicare portion).

I am unimpressed with free eye and hearing tests as they don't usually cover eyeglasses,  hearing aids or other additional charges.

It's a pain to research all these various possibilities.


Deductibles or co-pays?  A co-pay is the portion of the bill which the policy holder is responsible for paying.  This can be as little as $5 or $10 dollars a visit.  A deductible is amount you have to pay before the policy coverage takes over.  Policies can vary considerably which is why you need to look at premiums, covered items, deductibles, co-pays, and maximum payment responsibility per year when deciding which policy works best for you financially.


mrmaplewood says:  "It's a pain to research all these various possibilities."

Amen to that!!  Even with a 1/4" thick book from the previous employer's retirement system, it's hard to find direct comparisons.  Seems as though there would be a chart somewhere....

We had a deadline of 10/23 (from previous employer), so just went ahead with Medigap with slight changes from this year's.  It's simpler, because one sign-up covers Medigap and drugs for both spouses, but probably expensive

"Wait till next year," when i swear to do research earlier on!

Thanks to all for responses!  It's easy to love MOL, even from Wisconsin. : )


We are in the AARP Medicare advantage hmo 2 plan through United Healthcare. Includes our doctors who are all Summit Medical Group. Minimal co pays, no deductible, access to St. Barnabas. No monthly premium except what gets deducted from my social security.

Modest out of pocket on some drugs. Many drugs are $2 a prescription.

Am researching if we want to shift to Summit Medical's new plan called Clover.

Will post our decision.

Why does this have to be so COMPLICATED?


rcarter31 said:

We are in the AARP Medicare advantage hmo 2 plan through United Healthcare. Includes our doctors who are all Summit Medical Group. Minimal co pays, no deductible, access to St. Barnabas. No monthly premium except what gets deducted from my social security.

Modest out of pocket on some drugs. Many drugs are $2 a prescription.

Am researching if we want to shift to Summit Medical's new plan called Clover.

Will post our decision.

Why does this have to be so COMPLICATED?

 Is there coverage when you are "out of area"?  I know that United Healthcare has networks in much of the country.  (We are still pre-Medicare and on my husband's employer provided Oxford/United Healthcare PPO but starting to study up on Medicare options since I have less than two years to that birthday.)


sac said:

 Is there coverage when you are "out of area"?  I know that United Healthcare has networks in much of the country.  (We are still pre-Medicare and on my husband's employer provided Oxford/United Healthcare PPO but starting to study up on Medicare options since I have less than two years to that birthday.)

 They have something called Passport that supposedly covers you in other states.  We didn't find them flexible or easy to deal with on it and it got into our addresses and screwed up some stuff after a month on The Gulf Coast.


mjc said:

Thanks for your response, Joan.  I'll look at that AARP info.

Additional musing: 

We have been "on" Medicare for several years, but only now starting to pay for supplement/Medigap ourselves (up to now, former employer has been covering it).  (Some of) the Advantage plans are sooo much less expensive, while covering more "stuff" than regular Medicare, that i can't help wondering what the catch is. 

Also,  it may not be that easy, or even possible, to change back from Advantage to "regular."  Apparently, the regular Medicare Supplement/Medigap plans can charge extra or deny coverage altogether at that point, depending on age/health.  Seems too risky to me, unless everybody loves their Advantage plans, so that there would be no reason to switch back....

 Hi MJC,

I'm Nancy Schwartz and a Maplewood-based Medicare professional (independent consultant and broker). I'm so glad a friend mentioned this discussion to me, so I can add my perspective. To set the stage, I am licensed in most states and credentialed out the wazoo, plus have worked with hundreds of folks to help them enroll in or replace either a 1)Medicare Supplement+ Prescription Drug Policy; or 2) Medicare Advantage. 

First of all, please feel free to send me any Medicare questions via @SmartMedicare.com  MY email is nancy@smartmedicare.com   Please include your name, age, and question. Note that if I answer your question, I'll post the Q&A on my Facebook page (anonymously) so others can learn as well.


mjc said:

Looking for pluses and minuses ....

Many thanks for any input! this is making me (more) nuts

 @mjc, there is no "best" Medicare coverage -- it's an absolutely individualized match based on one's health care wants and needs, medical provider preferences, and budget. 

What are your priorities? Or to put it another way, what are you uncertain about in your current Medicare coverage approach? Please let me know.


joan_crystal said:

Plans can vary by State.  I like my plan; but, since it is through my retirement system, it would not help you.  Please PM if you would like specific information anyway.  Some resources to consider:  

When you sign-up for Medicare, Medicare will send you a book each year that details offerings of Medicare programs serving your area.  Information can be daunting but it will help you zoom in on the features you want.  

Major pharmacy chains like Walgreens have a service (mostly focused on drug coverage) that will help you select the plan that best covers your needs.  

Each State has a SHIP office staffed by trained navigators who will sit down with you (they likely do virtual meetings now), review all the options, and help you select the best plan for your needs and budget.  

AARP has a good article in their current Bulletin which explains the advantages and disadvantages of original Medicare vs Supplement Plans vs Medicare Advantage, listing broad characteristics, pluses, and minuses of each.  Not surprisingly, since they sell supplement plans, they do not recommend Medicare Advantage plans for everyone.   

Your local library, senior center/organization, even your current/former HR office can be a good source of information on plans available where you live.  If you have a retirement system, they may offer one or more plans for less than you would pay on the outside.  Mine also offers some benefits not available in some of the plans they offer directly to individual customers.

 @joan, great input.  But folks, AARP is just a marketing partner with United Healthcare for its Medicare plans. AARP has no other involvement other than getting paid for every policy sold. Keep that in mind. They've done a great job of spinning their brand as an advocate for seniors - they do very little on that front. 

BTW, they market UHC's Medicare Supplement, Prescription Drug and Medicare Advantage policies. But the

Because the Medicare system is so complex (i.e., it's NOT YOU), it's all too easy to make mistakes that result bar some of the healthcare you need or result in lifelong financial penalities. Put frankly, the system is a mess. But you can get great coverage, if you know how.

That's why there are a few folks like me who guide people to find the best coverage at the right price. People I work with tell me they are so reassured by and confident in the Medicare coverage we put in place .


rcarter31 said:

 They have something called Passport that supposedly covers you in other states.  We didn't find them flexible or easy to deal with on it and it got into our addresses and screwed up some stuff after a month on The Gulf Coast.

 @rcarter31, if you're enrolled in a Medicare Supplement + Prescription Drug Policy, you can see any doctor (who accepts medicare) anywhere in the U.S., without a referral, and be admitted to any hospital in the US.

Those on Medicare Advantage plans—even PPOs—typically have to use their coverage WITHIN THEIR HOME COUNTY, except for very short-term ER or Urgent Care help. That means someone local isn't covered for a second opinion or treatment (in 95% of cases) at Sloan Kettering if they have cancer, etc.

Passport is a weak and deceptive program. 


nancys60 said:

rcarter31 said:

 They have something called Passport that supposedly covers you in other states.  We didn't find them flexible or easy to deal with on it and it got into our addresses and screwed up some stuff after a month on The Gulf Coast.

 @rcarter31, if you're enrolled in a Medicare Supplement + Prescription Drug Policy, you can see any doctor (who accepts medicare) anywhere in the U.S., without a referral, and be admitted to any hospital in the US.

Those on Medicare Advantage plans—even PPOs—typically have to use their coverage WITHIN THEIR HOME COUNTY, except for very short-term ER or Urgent Care help. That means someone local isn't covered for a second opinion or treatment (in 95% of cases) at Sloan Kettering if they have cancer, etc.

Passport is a weak and deceptive program. 

 Sounds about right


rcarter31 said:

 Sounds about right

 Wish I could say otherwise about Medicare Advantage(MA) policies in general, but generally, if you have budget enough to support the up front costs (higher premium) of a Medicare Supplement (vs. the pay as you go dings, which typically end up costing more/year of MA) I always recommend that.


nancys60 said:

 @joan, great input.  But folks, AARP is just a marketing partner with United Healthcare for its Medicare plans. AARP has no other involvement other than getting paid for every policy sold. Keep that in mind. They've done a great job of spinning their brand as an advocate for seniors - they do very little on that front. 

BTW, they market UHC's Medicare Supplement, Prescription Drug and Medicare Advantage policies. But the

Because the Medicare system is so complex (i.e., it's NOT YOU), it's all too easy to make mistakes that result bar some of the healthcare you need or result in lifelong financial penalities. Put frankly, the system is a mess. But you can get great coverage, if you know how.

That's why there are a few folks like me who guide people to find the best coverage at the right price. People I work with tell me they are so reassured by and confident in the Medicare coverage we put in place .

 Just one more clarification - Aetna owns CVS so CVS sells only Aetna policies  So you don't have the benefit of someone assessing all options for you -- they will guide you only into the plans of the insurance company they represent.


mjc said:

Looking for pluses and minuses ....

Many thanks for any input! this is making me (more) nuts

Please pm me. I  am a certified Medicare advisor in the State Health Insurance Program and can go through this in detail with  you.


Rufus, that's very kind!  but (1) i'm in Wisconsin now and (2) we had a 10/23 sign-up deadline (from previous employer), so done is done for this year.  As noted above, i swear to look into it in a more thorough and timely way next year = "wait till next year" right?

SHIP is a great thing!   Good for you!


Best wishes. Stay well. Stay healthy.




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