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Medicare Advantage Insurance

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  • Medicare Advantage Insurance

    Does anyone on this site have a Medicare Advantage plan and if so, how does it pay for dialysis? I have Medicare primary and a Supplement as secondary and it pays 100 %, but is very expensive each month. Just checking to see if any other options. Thanks

  • #2
    The math on this one provides the answer. Any Medicare Advantage Plan will be subject to the 20% that Medicare does not cover directly to your deductible and your annual out of pocket max. If the out of pocket max for the MA plan exceeds the annual premium for your Medicare Supplement plan, stick with the Supplement plan. This assumes that you have wisely chosen a Medicare Supplement plan that has $0 annual out of pocket max and $0 annual deductible. If you have a Medicare Supplement plant with deductible and out of pocket max you will have to add these amounts to the annual premium to then compare to the out of pocket max for the Medicare Advantage Plan.

    I am paying $2725/year in Medicare Supplement premium and I have no out of pocket. An appropriate MA plan has an out of pocket max of $4100 and a monthly premium of $11. If I switch to the MA plan my total cost increase will be $4100 + $132 = $4323 - $2725 = $1598 - a bad deal for me. The monthly amount unpaid by Medicare for dialysis treatments, labs and nephrologist approaches $700 or $8400/year. This is the amount you would pay out of pocket without any coverage beyond Original Medicare. That out of pocket amount can skyrocket with a hospitalization, fistullogram, out patient surgeries, etc. MA plans can have annual out of pocket charges approaching $6500.

    Until my Medicare Supplement Plan annual premium cost reaches $4323, I'd be a fool to enroll in any MA plan. Additionally, the underwriting restrictions for most Supplement plans would bar me from re-enrolling in the plan that has covered me since 2018 when I was 63 years old and an ESRD patient since July 2012 and previously covered by an employer's group plan and Medicare.
    Last edited by stumpr54; 02-01-2021, 06:13 PM.

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