Insurance at 65

We're beginning to look at the extra coverage one needs after qualifying for Medicare.  So many questions, so many options, and what's Clover - never heard of it before, but now it knows me (couple of mailings).  How did you choose? What did you do?   Thanks!

I went with the advantage plan equivalent to the health insurance I already had, same doctors/hospitals, drug rider, very similar benefits.  Paper work was handled by my employer immediately prior to retirement so no break in coverage.

joan_crystal said:

I went with the advantage plan equivalent to the health insurance I already had, same doctors/hospitals, drug rider, very similar benefits.  Paper work was handled by my employer immediately prior to retirement so no break in coverage.

This is what I did too, before my retirement in 2011.

There are various "Medigap" policies available, offered by different insurers. Policies are designated by letters (e.g., Plan N, Plan F, etc.). You can find charts online that compare the features of each. 

Important note: Plans are exactly the same from one insurer to the next, but may differ significantly in cost. For example, Plan N may cost X dollars if you buy it through Horizon but Y dollars if you buy it via United Health Care. So, first decide on the plan you want and then compare the cost from company to company.

Another important note: Plans N and F are very, very similar, but Plan F (the often-called Cadillac plan) is generally much more expensive. For many people (including me), Plan N is fine.

Are the plans really the same or do they offer the same coverage though from different sets of providers?

Steve said:

Are the plans really the same or do they offer the same coverage though from different sets of providers?

The plans are the same. If Dr. Smith accepts Medicare + Plan N, s/he will accept it whether submitted in conjunction with Horizon or United Healthcare or whatever company. 

[One caution: Someone once told me that if a provider does not normally deal with a particular Medigap insurer, it may be more of a hassle getting claims paid, even though they must ultimately be paid under the plan. I don't know if this is true or not, because my main provider (Summit Medical Group) does deal with my Medigap insurer (Horizon Blue Cross). But it never hurts to ask.]

Important: Note that there is difference between traditional Medicare/Medigap and Medicare Advantage plans (I believe that's what they're called). Medicare Advantage plans do differ in coverage, cost, and providers as far as I know. (I've never had one.) Other posters may want to comment about those plans...

@soorlady:  If you choose to go with "original" Medicare coupled with a supplemental (medigap) plan, don't forget you will need a Prescription plan as well (also known as Part D).  There are many different ones available.

I have heard good things about Medicare Advantage plans from someone I know who also (still) works for a doctor's office and is therefore also conversant with insurance issues from that perspective.  The idea of starting with the Advantage plan related to prior employer-based plan sounds like a good one.  (Filing that away for when I need it in a few years ... not as many as I'd like.)

When I recently went through this, I called the Union County Division on Aging.  I was directed to the State SHIP program http://www.state.nj.us/humanservices/doas/services/ship/  I called, and it was very helpful in that the Rep was very knowledgeable, answered the list of questions I prepared, and it helped me in my decision making process.  I ultimately went through AARP---(who also has independent insurance counselors ,who don't try to steer you to one plan or another) UnitedHealthcare Plan F---which is pretty inclusive and has a prescription plan.  This plan has no deductible. I considered the Advantage plan, but I felt the high deductible was not for me.

Plan F is indeed the Cadillac plan, although as I noted earlier Plan N is nearly the same as lower cost.

The Part D drug plans are separate. In other words, you can get your Medigap insurance through United Healthcare (or other provider) and your Part D drug plan through a different provider. There is a website you can use to compare drug plans. It's very useful, because it enables you to enter the actual drugs you take and set various filter options.

calliope said:

When I recently went through this, I called the Union County Division on Aging.  I was directed to the State SHIP program http://www.state.nj.us/humanservices/doas/services/ship/  I called, and it was very helpful in that the Rep was very knowledgeable, answered the list of questions I prepared, and it helped me in my decision making process.  I ultimately went through AARP---(who also has independent insurance counselors ,who don't try to steer you to one plan or another) UnitedHealthcare Plan F---which is pretty inclusive and has a prescription plan.  This plan has no deductible. I considered the Advantage plan, but I felt the high deductible was not for me.

We also have United Healthcare as our Medicare supplement. It's expensive but has seemed worth it and the company has been pleasant to deal with on the relatively few occasions that there have been questions. The prescription plans are not as good in our experience; they disallow almost any non-generic drug and have preferred tiers, though I am told that for heavy-duty drugs for serious illnesses they aren't as bad as they are for regular daily prescriptions. What I like about our  Medicare supplement plan is that we can go to any health care provider who accepts Medicare, rather than being part of a more limited network, which I think is the case with the other (Advantage?) kind of plans.

I have a NJ friend who swears by the Medicare Supplement Plan F.  He was scheduled for heart surgery but his NYC hospital was closed by Hurricane Sandy so he was able to go to Cleveland Clinic for the surgery.  He has several chronic conditions so his recovery was complicated and he was hospitalized for some time.  Later, in Florida for the winter, he spent additional time in a hospital.  It was all covered by his Medicare Supplement Plan F.  

The Medicare Advantage plans offered by Horizon Blue Cross Blue Shield are all HMO's with a limited list of hospitals and docs in NJ with cost sharing.  While they would cover emergency care outside of NJ, you would lose the option of care in NYC.  In my friend's case, I know at a minimum his share of the FL care would have been expensive--and, likely much of it contested by Horizon.  (Horizon used to offer some Medicare Advantage plans that included the option of HMO preferred providers or more cost sharing with out-of-network providers, but they moved to strict HMO in 2015).

Bottom line, I've concluded that a Medicare Advantage plan can be a good deal, but our NJ plans aren't that flexible and the cost sharing can add up.  For some, a Medicare Supplement Plan (commonly called Medi-gap.  Think old-fashioned fee for service model) may be more appropriate.  There are a range of plans and prices (F and N being the most comprehensive and expensive).  For some reason the booklet the government sends lists the Medicare Advantage plans and prices available in NJ, but doesn't include the same information for Supplement Plans offered in NJ.  

Not every advantage plan is strictly an HMO.  The advantage plan I have (not Horizon) recently switched from HMO to POS which means I can now use any provider who will accept my insurance.