Posted 10/14/2019 4:15 PM (GMT -7)
The most comprehensive medical coverage is traditional Medicare and a Medicare Supplement Plan either G or F. This gives you either the Medicare deductible of $189.00 per year or $0. F (no deductible) goes away next year and only those already on it will be able to continue. The premium is higher than an advantage plan, but not by much. I think the biggest plus is that you are not restricted to an insurance company network and you do not need referrals to specialists.
Supplement Plans can restrict coverage except at three times. First, when eligible for Medicare, when coming off an approved employer sponsored plan, or when permanently moving from one Medicare administrative region to another. Any of us with PCa will not get a supplement plan unless we are in one of these three situations.
Advantage plans can not restrict coverage eligibility because they have restricted provider networks and they have significant deductibles, co-pays and out of pocket limits. So anyone can choose the Advantage plan but not everyone can get a supplement plan.
As far as the drug coverage, the Advantage plan and the Part D Drug plan should, for the most part, follow the same rules. Formularies for common generics may be cheaper in the Advantage plan, but not for the tier three and four drugs.
Advantage plan benefits will vary by state. The best are in Florida and Arizona due to senior demand. In other states the coverage can be substandard. Due to the state demographics and premium costs, approximately 35% of Medicare eligible seniors have opted out of Medicare in favor of the Advantage plans. An interesting side-note and factual-not political, is that the PPACA (Obamacare) first draft eliminated the Advantage plan as a way to get commercial insurance companies out. Then Florida Senator Bill Nelson threatened to withhold his support so a special deal was struck that would only allow Advantage plans to be sold in Florida. Of course this was patently unconstitutional and the PPACA was re-written to allow Advantage plans to continue. Recently the current administration has moved to improve Advantage plan benefits as they are very popular and get the government off the hook for claims.
In our financial planning practice we counsel people regarding health insurance. basically, my advice for people with a known serious condition, such as PCa, is to use a supplement plan. This fixes out of pocket expenses at a lower level and provides access to any specialist in the USA. For the very healthy prevention oriented person in retirement friendly state an Advantage plan is a great consideration.