Switching from Advantage Plan (which left my area, creating a qualifying event) to Original Medicare. Here's Why [View all]

Here's my story: I joined an Advantage Plan when I became eligible for Medicare about 10 years ago. My experience with the coverage and services has been positive until recently when it began to cost me significant out of pocket expenses, which was quite a surprise. In the past they even covered a 100% of a very expensive brain aneurysm procedure including endovascular coilling with two stents. This brain procedure was a ONE TIME EVENT, so hold that thought.

Fast forward three years and I developed an eye disease called neurovascular age related mascular degeneration or 'Wet AMD'. This condition is chronic, and it seems that CHRONIC may be an operative word in how Advantage Plans cover conditions.

Wet AMD requires eye injections every few weeks. They are expenisve. My eye injection costs approximately $2,000 for each injection. The Advantage plan I had covered about 80% of the cost, about what regular Medicare covers. I had to pick up the remainder, which was approximately $400 per injection, which is about $3200 a year.

The short story is that $3200 seems to be the cut off point where Advantage plans no longer have an advantage. That is, the cost of original Medicare, a drug plan, and a Medigap plan will cost me all in, including the $185 Medicare deduction, premiums, and copays approximately $3,000 a year. And that is approximately what I am paying in co-pays to the Advantage plan. If I get this disease in my other eye, which may well happen, my out of pocket costs with the Advantage plan doubles, but my preimiums, etc. with regular Medicare with a Medigap plan will likely remains stable or only increase slightly, and becomes a far better financial option than an Advantage plan.

So, the moral of my story is that it appears that Advantage plans lose their advantage when a chronic condition like mine rears it's ugly head. My condition of approximately 8 injections per year will cost over a five year period about $80k (2,000x8=16,000x 5=80,000) And that is where the rubber meets the road, so to speak. If you have a chronic condition that is expensive to treat as mine is, you might want to consider regular Medicare with a Medigap plan. It may save you a lot of money in the long run.