Yves here. I am normally not keen about videos with no transcripts, but this one is short and suitable for sharing, with good graphics and animations. Plus is it by our sometimes comrade in arms Eileen Appelbaum. Here Applebaum gives a short discussion of how Medicare Advantage plans are set up to foster over-pricing and under-care relative to the composition of patients.
The video also says not-for-profit Medicare Advantage plans can deliver good outcomes. Even if so, the tradeoff is being locked into a network.
Originally published by the Institute of New Economic Thinking
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Thank you for this Yves. I have been considering leaving the advantage plan I have and returning to the traditional medicare. Any information in the coming year will help greatly in deciding how to go about this and determining facts about health care plans to balance the pluses and minuses of either system.
My understanding is that once you sign up for Medicare Advantage, you can’t go back to standard Medicare, unless the Medicare Advantage plan you’re on dumps you or goes out of business. It’s just another reason to avoid Medicare Advantage.
Yes you can. My partner went to the social security office, took a number, sat through the long wait and went back to traditional Medicare. He had been on Medicare originally, then was talked into switching to an Advantage plan. Perhaps that made a difference, but it’s worth a try.
It’s complicated and both answers are effectively wrong — because the important missing part of the question is, “When can you switch from Medicare Advantage to Original Medicare and have guaranteed issue rights for a Medicare supplement (“Medigap”) plan. In general, it’s like this:
If your current Medicare Advantage (MA) plan terminates coverage: You can return to Original fee-for-service Medicare with guaranteed issue rights for Medigap, if you apply within 123 days of the termination of MA plan.
If you move outside your MA plan service area: You must apply within 63 days of moving in order to have guaranteed issue rights.
If joined an MA plan when you were first eligible for Medicare: You can switch to Original Medicare and have guaranteed issue rights for Medigap during your first 12 months in the Medicare Advantage plan. The same applies if you switch from a Medigap policy to an MA plan for the first time since becoming eligible for Medicare, and leave the MA plan within the first 12 months.
In most other cases, Medigap insurers don’t have to issue policies and may apply medical underwriting provisions — setting premium levels based on health and preexisting conditions.
These are bare basics and there are exceptions, including variations in state laws. The very best advice is to contact a SHIP counselor.
Let me alter that last paragraph to add: Actually, the very, very best advice is to select Original Medicare and the very best Medigap policy you can afford the moment you become eligible for Medicare.
Yes. Consider the Medigap Plan as catastrophic medical insurance that will keep you out of personal bankruptcy, not just add-on coverage.
Discussing coverage with a specialist who has YOUR interest/situation as the premier incentive is essential. The words you read in any Plan contract don’t always mean what you think they do.
As Lambert has said, Medicare requires you to be impossibly prescient with your coverage selections. An impossible task.
A couple of other points:
1) You should consider a high deductible MediGap plan. The cost savings compared to the standard deductible are considerable and generally outweigh the extra cost of the standard deductible plan, even in years with large medical expenses. Standard Medicare covers a LOT.
2) I moved from one state to another and ended up having to keep the Medigap policy from the state I used to live in. So far it has not turned out to be a problem.
Agree 1000 percent
My parents made this mistake and switched to regular Medicare with gap insurance
Medicare Advantage is a lie
It should be renamed Medicare Disadvantage
uncle doug,
thanks so much! That’s a very helpful comment.
You can change from Medicare (dis)Advantage Plan to Traditional Medicare during the open enrollment period, between October 15 – December 8 every year. Be aware, that other than CT, NY and MA, you will not be able to get Medigap, a.k.a. Medicare Supplemental insurance, only PDP (Part D) insurance.
I’m not sure this is correct. There may be underwriting involved if reapplying for medigap plans if switching back.
Yes. Unless the switch takes place in the context of one of the sets of circumstance when/where the beneficiary has guaranteed issue rights, insurers may employ medical underwriting to determine whether to issue a policy and/or set premium levels.
We just went through this process for my wife. She was on a MA plan that was cancelled by her clinic. We were able to get her on a supplement only because Blue Shield of CA offered that option for those people without underwriting. Otherwise even if you try to switch from one medigap plan to another or go from a MA plan to a supplemental plan you will be underwritten, which means if you have a preexisting condition you won’t get to switch.
Thank to all of you for your helpful comments and input.
I paid no attention to medicare advantage because as is I never got a doctor bill. I have a fairly expensive medicare supplement, but even tho I’m low income and live on SS, I could afford the supplement and have not had worry 1. I’m 87.
Thanks for this post.
The deceptive (imo) advertising for Medicare Part C is very often confused, deliberately, in people’s minds with the older Medicare medigap supplemental plan Medicare Plan C.
These are 2 entirely different programs. People have heard for decades about the supplemental Plan C, the Medigap policy to cover what Parts A and B do not cover.
https://www.medicarefaq.com/medicare-supplements/plan-c/
And yes, Medicare is trying to push new enrollees into Medcare Advantage plans that are essentially HMOs.
Traditional Medicare is also slowly chipping away at the older medigap plans like F and C, eliminating the better ones for new enrollees. Existing enrollees are grandfathered in to those better plans.
There are still many medigap plans, like G and H and others. Not quite as good as F and C, but pretty good.
Medigap plans are still run by the same insurance crooks and are quite expensive. They don’t cover drugs (Part D) which you have get separately. Between the insurance (a big part of FIRE) companies and the crooked hospitals we’re really screwed. It’s best to lead a healthy life using exercise, healthy eating and living and avoid going to the doctor.
You’re more screwed by hospitals if you have Medicare Advantage, however.
I have been on Medicare Advantage for several years. I have very little use for traditional medicine and rarely go to regular doctors. I asked about switching to original Medicare last year and was told that I could do it during the end-of-year period or switch during the first three months of the year.
Because the Advantage plan gives me free gym membership and I don’t have to pay for a drug plan (although I no longer take chemical pharmaceuticals). If traditional Medicare gave me free Silver Sneakers membership, I would probably switch even if I had to pay for a drug plan that I might not ever need just because I dislike insurance companies and I see that they intend to get rid of original Medicare.