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Seniors with Medicare, is Mayo worth the hassle?

Visiting Mayo Clinic | Last Active: Sep 23 11:47am | Replies (42)

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@flrvingbob

Facts.... Traditional Medicare "supplemental" plan coverage is all the same regardless of provider or the "sexy name" they apply to them. "Medigap" plans are dictated by CMS and simply put "if medicare covers it, the supplemental plan covers it. Deductibles are based on criterial set by CMS. There is no "grandfather" plans, just the plan you signed up for that was available from CMS at your time of eligibility.

Plan F (no longer available) had no Part B deductible. Plan F is no longer an option. Plans G and N are now the most popular and both have high deductible options for those who are are disciplined enough to before need "self fund" the short fall.

If there was a discernable difference between insurance companies providing medigap plans its rates. Some start all low and gradually ramp up year over year....its the get you in the door plan. Others have higher initial rates but their historical year over year increases average lower and ultimately over time end up less expensive. Again, all medigap policies provide the same "CMS Dictated" coverage. Ask you broker to provide you a 10 or 20 year history of rate increases of all providers you are considering. The math doesn't lie...brokers do.

As to the "never change my senior gold plan"... unless you wish to have to go through a rating process with another provider, you can never leave the plan you have.

The entire "I am about to hit 65...Mcdicare" exercise is a decision that cannot be taken lightly. Your decisions are pretty much cast for the rest of your life.....so chose wisely. While "advantage plans" may look very attractive (Joe Nemeth driving you to bingo, get money back for "stuff" and more), advantage plans are not Medicare and shouldn't even be allowed to use the Medicare name. They are private insurance plans in which the government (ie CMS) pays for someone else, at a lower cost to CMS to provide your health care...you are not on Medicare.

Advantage plan providers can and do change the terms and conditions of their plans every year, up to and including removal of certain coverages that the bean counters may deem to be excess exposure... Insurance companies for the most part are "for profit" entities and regardless of some of the short comings and slightly higher cost for traditional Medicare, Advantage Plans are only for the advantage of the insurance company, not your health. Yes, there are some (few) reasonably good Advantage Plans out there but they are few and can change course at any time.

As I noted early on, this is a "once in a lifetime" decision so you must take the time to sort it out, as daunting as it is and get it right. Oh, brokers make more money selling Advantage Plans than traditional medigap plans. Some insurers (big brand) bonus their agents for pushing their medigap plans while there may be more "cost effect" option available. You have the right to ask the questions..... Is the agent paid more to sell one plan over another? Is the agent on a quota system with their firm?.....I could go on but suffice to say the field is by no means "level".

Different states have differing laws governing how you are rated (there are three types of "groupings" that can determine your rates. Also rates and availability can change literally by the Zip Code you live in...

Sorry for the long missive. I spent 6 months investigating my "65" medical transition. As a business owner with large numbers of employees across many states, I had to deal with the nuances of every flavor of insurance and how to best equitably provide for my employee without breaking the bank. I found dealing with my own Medicare transition in some cases more daunting due to the "once and done" nature as well as the exaggerated and false claims by agents, providers and insurers. Too much media and marketing setting false expectations of "everything is covered and it's cheap" was a common theme

One piece of anecdotal data... I queried nearly 100 "Smart" people I knew were of Medicare age and all but 7 were on traditional Medicare....there's a message in there somewhere.....

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Replies to "Facts.... Traditional Medicare "supplemental" plan coverage is all the same regardless of provider or the "sexy..."

You are right. People must consider carefully when they sign up for Medicare. It is not where one wants to save money, because one does not get healthier with age.
The most important differences for me between traditional Medicare and the Advantage plans is CHOICE OF DOCTOR and being able to self refer.
I have a Medigap Plan F which is no longer available (but if you had it you got to keep it=grandfathered in). I got it in 2009. I had started to research plans a little, but went with this plan because my brother was so happy with his and I could take it with me from Minnesota to Florida where I was retiring, and it offered some international coverage.

Regarding premiums, I asked the sales Rep how much it typically increased each year and he said 10%. Fortunaately with the passage of the ACA (Obamacare), those increases became more modest.
For those not familiar with the ACA (Obamacare): Under the Affordable Care Act (ACA), insurance companies are required to spend a significant portion of the premiums they collect on medical care and health care quality improvement. This is known as the Medical Loss Ratio (MLR). Specifically, insurers must spend at least 80% of premiums on medical care for individual and small group plans, and at least 85% for large group plans.
If insurance companies fail to meet these requirements, they must provide rebates to policyholders. For example, in 2019, insurance companies returned $1.37 billion in rebates to policyholders.
This applies to all insurance companies. My BCBS now limits increases so I see no rebate, but if one has insurnce from employer, the company may keep the rebate and the employee will not see it.