I got traditional Medicare with a good Plan G supplement. For the most part, it's been great. I haven't been challenged about whether I really need a test or treatment, and I don't have to get a referral to see a specialist.
I've been on Medicare for over 20 years (since I went on disability). I initially signed up for a Medicare Advantage plan, and then quickly discovered there no doctors I wanted to see who took Medicare Advantage plans. So I switched to straight Medicare and paid the 20% copay for many years, preferring that to seeing HMO doctors. And then last February I tried (second attempt) to get a Medicare Supplement plan to pick up the 20% copay and to my surprise quickly qualified, also a plan G. This was unusually fortuitous in that I unexpectedly ended up in the hospital for 2 weeks and needing a couple of surgeries/procedures the following month, after no hospitalizations or anything for years and years. And it's all covered now at 100%, no questions asked.
When she had covid, they didn't let her have Paxlovid until day 5. Another time, they denied her the RSV test although she had the symptoms. She wants to get off Advantage and onto traditional Medicare, but it is exceedingly difficult to do so.
Exactly - these are some of the pitfalls with Medicare "Advantage" plans. However, it's not difficult to switch to original or traditional Medicare - that part is very easy to do, though you might have to wait for the open enrollment period to do this - I'm not sure about whether you can only do this during the open enrollment period.
What can be difficult is qualifying for a Medicare Supplement (also called Medigap) plan. From the Medicare.gov website:
- The best time to get a policy is during your Medigap Open Enrollment Period.It’s the 6-month period that starts the month you turn 65 and you first have both Medicare Part A and Part B. During this time, you can buy any Medigap policy sold in your state, even if you have health problems.
If you’re under 65, you may not be able to buy a Medigap policy, or you may have to pay more.
You can apply to enroll in a Medigap (Supplement) plan at any time - you don't have to wait for open enrollment. However, if this is done after the 6-month period referenced above when you first qualify for Medicare, your policy has to be underwritten. Being underwritten means you can be denied for pre-existing conditions, and you have to answer a series of questions about your health. So getting accepted all depends on one's health and the company providing the policy. I had initially applied for a Supplement plan about 4 years ago and was denied because of a Moh's surgery for basal cell cancer (skin cancer) - the best kind of cancer to get, it doesn't metastasize or kill you etc. And yet the company considered it cancer "surgery". Okay - I re-applied last January and this time the questions had changed and Moh's surgery no longer was a deal breaker, and they gave me a policy. And it was more affordable than I had anticipated - $100 a month.
I recommend using United Medicare Advisors (unitedmedicareadvisors.com) for applying for such a policy - I had a very knowledgeable agent, she was extremely helpful and even recommended I apply with the company which had the cheapest premium, to my surprise. She explained why they were better than some of the companies with more expensive policies (more financially stable among other things).
