Medicare Advantage vs Medicare Supplement insurance; Medicaid
I just spoke to a very knowledgeable insurance agent (an “insurance advocate”).
He explained to me some of the most important differences between Medicare Advantage and Medicare Supplement (“Medigap”) plans.
For many of us, health insurance is one of our biggest expenses. Those who travel a lot, or move between U.S. states during the winter and summer, should pay a lot of attention to the type of insurance coverage they get, and where it applies. What is available and where it can be used, depends a lot on the location of your official residence, as well as the type of insurance you get. Some areas, including the rural areas where you can buy or lease a relatively cheap official residence (I was once offered a trailer in the middle of nowhere for $5000, whose site rental was $50/month, though that was a couple decades ago), something some of you who travel a great deal might do for legal reasons, do not have Medicare Advantage plans available, but Medicare Supplement plans are available everywhere in the U.S.
Ordinarily, if you can get a Medicare Advantage plan in your geographic area, it is much cheaper than a Medicare Supplement plan, and is likely to cover extra things like Dental & Vision, and maybe other things like buying a certain amount of healthy groceries and/or non-prescription drugs.
Both might or might not cover gym memberships. I think the best of the bunch is the Silver Sneakers program which insurance companies like BlueCross/CareFirst might cover - because you can go to almost any gym, including some very expensive ones. United Health Care’s Renew Active program doesn’t cover as many gyms - and in my geographic area, United Health Care Advantage plans don’t cover Renew Active in any event. But that varies a lot area-to-area. Other aspects of many different gym programs were discussed in another thread,
https://forum.projectvanlife.com/t/11k-nationwide-gyms-showers
But a Medicare Supplement programs is much better for people who travel a lot within the U.S. In particular, you can go to the 95% of doctors, who accept Medicare, anywhere in the U.S… In contrast, Medicare Advantage plans usually only cover care received in some counties in one state, and in most cases, only cover in-network doctors and other medical practitioners - though they may partially cover other doctors. (Except emergency care.)
Also Medicare Supplement plans include drugs administered by a doctor, whereas Advantage plans do not. For certain medical conditions, such drugs can be very expensive.
Ordinarily, you can’t switch from an Advantage plan to a Supplement plan staring 6 months after your Medicare starts without paying major fees, nor can you switch Supplement plans without paying such fees. You can switch Advantage plans once/quarter, without penalty – so if your medical costs are low now, and you don’t travel a lot, they might make much better economic sense. But if you move, you can switch between any two plans that you are eligible for- with no questions about pre-existing conditions.
He says a lot of people move after they develop an expensive condition, precisely so they can switch between plans.
Some of you may also be on Medicaid, because of certain medical conditions, or because of low income (and depending on other parameters and your state of official residence, on your assets.) That’s very important, because you may be able to sign up for a “dual-eligible” (Medicare/Medicaid) Advantage plan much cheaper than for a normal Advantage plan.
Medicare Advantage plans differ a lot, company-to-company, and plan-to-plan. Medicare Supplement plans of a given letter designation (e.g., a Medicare Supplement type G plan) have IDENTICAL coverage, for a given letter designation, even though they have different premium costs. There are various sites where you can see most all the Medicare Advantage and Supplement plans that apply to you - but even the government sites don’t list them all. E.g., in my state, Maryland, many of the Advantage plans aren’t listed on the U.S. government site, including some of the CareFirst (Blue Cross) plans, like their dual eligible plan. United Health Care plans are sometimes a bit cheaper, though I think fewer doctors are in-network for them, but not for dual eligible plans if you have 100% Medicaid coverage.
If you were on Medicaid, you can’t be discontinued from it at present because of the Medical State of Emergency created by Covid-19, even when you turn 65. (I’m not sure if that is true in all states! Medicaid rules vary a lot, state to state.) That was originally supposed to expire 12/31/21 (I think), but has so far been extended until 7/31/22 - and may keep being extended for a while. But many people say it probably can’t continue forever, because it costs too much.
Some people deliberately kept their income down (e.g., delayed pension and Social Security withdrawals didn’t take a pension or limited IRA withdrawals) so they qualified. I’m not sure how the state of emergency affects people whose income does go beyond certain limits. Ordinarily the end of the State of Emergency will discontinue coverage for people over 65 (if you qualified only due to low income), but I’m not sure if that applies during the Medical State of Emergency. But I’m pretty sure the 100% coverage is income limited even now.
(BTW, If you have certain medical conditions you can have or keep Medicaid regardless of income and assets, and that was true even before the Covid Medical State of Emergency.)
If you qualify for Medicaid with 100% coverage, Medicare Part B and a prescription drug plan are completely covered by the federal government. In addition, if you sign up for a Dual Eligible Medicaid/Medicare Advantage plan, you don’t have to pay anything for most prescription drugs, or much of anything else.
But Medicaid IS a state-administered program. Out of state travel limits or eliminates coverage (except prescription drug coverage in some cases.) Plus, with those income limits, you can’t travel as much, or do as many things, as many of you would like to.
Also - when the Covid Medical State of Emergency ends, all states will be required to re-examine the qualification of everyone on Medicaid. It is expected that many people will lose Medicaid because they don’t file the paperwork that might have to be done to keep it, and because the Medicaid offices will effectively have to redo decades of work, so will inevitably make mistakes. Many Medicaid offices around the U.S. have been hiring and training a lot of new people to try to deal with this expected deluge of re-qualifications.
One last thing: Some of you want a job you can work on-line, so you can work while you travel. Apparently many insurance agents and insurance advocates can do that.