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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWhats The Issue On Medicare Advantage Plans.....
a friend of mine is going to be retiring and needs to apply for a Medicare plan and is not sure what to do.
Any advice I can pass on to her?
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PoindexterOglethorpe
(28,493 posts)I have one.
However, your friend needs to research the plans available in her area, because the same company will offer vastly different plans in different places.
I believe there are senior services that will also help someone on this.
Joinfortmill
(21,162 posts)I've had an Advantage plan for 10 years and, I've had some serious medical conditions, including a brain stent. My coverage has been comprehensive and affordable. I stick with national plans like Aetna, Humana, and United Health care. I always choose a PPO. Not an HMO.
Lots of folks really dislike them and I think that is because some of them are not good. So, stick to the plans rated 4 or 5 stars. Best of luck.
PoindexterOglethorpe
(28,493 posts)I am the most annoyingly healthy person out there, especially given my age, 77.
A couple of years ago I fell and broke an arm -- a non displaced hairline fracture, meaning as trivial a break as could be called a break. Two different ER visits, plus another one to my doctor. I paid almost nothing of $6,000 plus of fees.
I can say that when I was doing out patient registration at the local hospital (meaning people who were there for an x-ray, MRI, some other such thing) I learned to hate Blue Cross Blue Shield. They were the absolute worst about denying payment. And for everyone they covered, not just those with their Advantage plan.
av8rdave
(10,656 posts)When you enroll in an advantage plan, you’re entrusting your care to a for-profit health “care” insurance plan. You’re not on Medicare.
All well and good if you stay relatively healthy, and you don’t mind being told what providers you can and cannot see.
Advantage plans were borne of W’s attempt to privatize Medicare. I suspect they’re making a small handful of people a ton of money.
Otto_Harper
(822 posts)Go with actual Government issued Medicare plus a type "G" supplement and a part D prescription plan.
While it may look more expensive, at first, on a monthly basis, consider the following:
I lost my wife a year and a half ago to Cancer+covid, requiring about 3 months total of hospital stays.
I myself was just hospitalized for 3 months, and have ongoing at-home treatments in progress.
Total out of pocket for the two of us, less than $2,000. For everything. Mostly transportation expenses.
Native
(7,359 posts)for us, the difference in premiums between the regular G plan and the high deductible G plan was equal to the amount of the higher deductible. So, if you have a good year, you're saving that money, and when you're not having a good year, you have to meet that higher deductible (which is basically the extra premium you would have paid for the regular G plan).
dwayneb
(1,107 posts)More and more hospitals and providers are starting to stop accepting MA plans.
These plans are great until you get really sick and need expensive procedures and drugs. Then they start throwing up roadblocks and stall to pay, providers hate them.
Traditional Medicare, Part G is the way to go if you can afford it.
Plus - realize once you decide on Part C Medicare Advantage, you cannot change your mind and go over to Traditional supplement without an underwriting review. You are stuck in most cases.
Americanme
(497 posts)
Deuxcents
(26,914 posts)To Lee Memorial as of January 1st. People are trying to find other providers. Blue Cross and Humana are the ones that will not be accepting the insurance.
dalton99a
(94,115 posts)1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage
By: Anna Claire Vollers - October 23, 2024 5:00 am
HUNTSVILLE, Ala. — Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as Medicare’s open enrollment period begins.
Libby, a retired middle school librarian, has what she considers good health insurance through the state employee health plan. Andrew has insurance through his job as a university professor and plans to join Libby’s insurance when he retires next year.
But this year, a few days before open enrollment began, a letter arrived from UnitedHealthcare, informing the Potters that the region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage plan.
The Potters spent the next couple of weeks worried and unsure what to do. It seemed incredible that 14 area hospitals, including the area’s only Level 1 trauma center, could suddenly become much, much more expensive.
...
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https://www.kfyrtv.com/2024/10/29/hospitals-no-longer-accept-humana-medicare-advantage-plans-2025/
Hospitals no longer accept Humana Medicare Advantage plans in 2025
By Elizabeth Shores
Published: Oct. 29, 2024 at 4:35 PM CDT
BISMARCK, N.D. (KFYR) - Hospitals in Bismarck are ending their contracts with Humana Medicare Advantage.
The North Dakota Insurance Department says it’s a growing trend across the U.S., and it encourages those affected to select new plans during the open enrollment period, which is happening now.
We reached out to both Sanford Health and CHI St. Alexius for confirmation.
Sanford confirmed that on Dec. 31, 2024, it will stop accepting this specific plan. Not all Medicare Advantage plans are going to be affected.
Check with your healthcare provider to see which plans are going to be covered in the new year.
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https://www.houstonpublicmedia.org/articles/news/health-science/healthcare/2024/10/28/504274/md-anderson-to-stop-accepting-blue-cross-blue-shield-texas-medicare/
Blue Cross Blue Shield Texas terminates Medicare Advantage agreement with MD Anderson
MD Anderson said it was notified via a letter from BCBSTX earlier this year.
Kyle McClenagan | Posted on October 28, 2024, 3:24 PM (Last Updated: October 29, 2024, 9:54 AM)
Beginning Friday, MD Anderson Cancer Center physicians will no longer be in-network on Blue Cross Blue Shield of Texas (BCBSTX) Medicare Part C Advantage plan coverage or Managed Medicaid services, according to the care provider's website.
An MD Anderson representative said the health care center was notified by BCBSTX earlier this year that it would be ending its Letter of Agreement. Medicare is a federal health insurance program for people 65 and over. Medicaid is a state and federal program that assists in covering medical costs based on income eligibility. Medicare Advantage plans are offered by private insurance companies and offer additional coverage on top of Medicare.
The agreement will officially end on Nov. 1 but MD Anderson will continue to accept Medicare and Medicaid. The termination also does not apply to UT Care Medicare PRO or the Texas A&M 65 Plus Medicare Advantage Plan — which is part of the retirement plans for the University of Texas and Texas A&M University systems.
Medicare Part A, which covers hospital stays, hospice care, skilled nursing facilities and some home health care, will still be accepted by MD Anderson. Medicare Part B, which covers doctor visits, preventive care, screenings and medical supplies will also still be accepted.
...
etc. etc.
buzzycrumbhunger
(1,931 posts)The probability that things won’t be paid for is too high to bother with them. They’re private insurance replacing proper Medicare plans and although they suck you in with promises of things like no copays, a grocery allowance (huh?), and other perks, the fact is that they leave you holding the bag for uncovered bills. Nightmare for our pharmacy. Many don’t even cover vaccines and tell you to bill through Part B.
I consider them worse than the way the ACA plans were farmed out to private insurors instead of just giving us Medicare for All. Why pay 5% of your income to have everything covered when you can pay 20% more to an insurance company? *eyeroll*
dalton99a
(94,115 posts)Texas Cancer Patients May Need New Doctors After Insurance Changes
Published Oct 29, 2024 at 6:26 PM EDT
Updated Oct 30, 2024 at 2:40 PM EDT
...
Chris Fong, a Medicare specialist and the CEO of Smile Insurance Group, said while insurance companies are attempting to save money by reducing the costs of services and adding on steps like prior authorization or referrals, medical centers are also experiencing inflation on medical supplies and doctor salaries.
"Unfortunately, the patients are some of the most affected through these contract negotiations," Fong told Newsweek. "The advice we give to our clients is to look at how they would like their healthcare to operate. If they prefer the flexibility to choose doctors and medical providers with less limitations, they should consider traditional Medicare with a supplement and prescription plan."
Ryan said insurance companies are increasingly using 'network narrowing' as a cost control strategy.
"They're betting that by excluding expensive providers, they can offer lower premiums," Ryan said, adding that they don't always consider the human cost.
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https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
By Casey Ross and Bob Herman
March 13, 2023
An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin woman with a shattered left shoulder and an allergy to pain medicine. In 16.6 days, it estimated, she would be ready to leave her nursing home.
On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone. Meanwhile, medical notes in June 2019 showed Walter’s pain was maxing out the scales and that she could not dress herself, go to the bathroom, or even push a walker without help.
It would take more than a year for a federal judge to conclude the insurer’s decision was “at best, speculative” and that Walter was owed thousands of dollars for more than three weeks of treatment. While she fought the denial, she had to spend down her life savings and enroll in Medicaid just to progress to the point of putting on her shoes, her arm still in a sling.
Health insurance companies have rejected medical claims for as long as they’ve been around. But a STAT investigation found artificial intelligence is now driving their denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare that covers more than 31 million people.
...
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https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
http://web.archive.org/web/20240829155209/https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.
By Reed Abelson
Published April 28, 2022 | Updated Dec. 3, 2022
Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.
The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.
Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers.
Enrollment in Advantage plans has more than doubled over the last decade, and half of Medicare beneficiaries are expected to choose a private insurer over the traditional government program in the next few years.
The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.
...
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https://www.npr.org/sections/shots-health-news/2024/07/25/nx-s1-5050850/california-tries-but-fails-to-fix-a-major-medicare-loophole-for-seniors
California tries but fails to fix a major Medicare loophole for seniors
July 25, 2024 9:19 AM ET
By Kate Wolffe
...
In 2023, Scripps Health, a major San Diego hospital system, stopped accepting Medicare Advantage plans, saying the plans paid less than other insurers for the same treatments, and required doctors to navigate prior authorization protocols that were burdensome and time-consuming.
The move sent seniors in the San Diego region scrambling to sign up for traditional Medicare, supplemented by Medigap plans. The high numbers of people who found Medigap plans unaffordable drew the attention of State Senator Catherine Blakespear, who put forward a Medigap reform bill.
Four states reformed Medigap in the 1990s — Connecticut, Maine, Massachusetts, and New York. The rest, including California, allow Medigap insurers wide leeway in setting prices and issuing denials.
California’s bill would have created a 90-day open enrollment period for Medigap, every single year. That would allow seniors to opt-in or out each year and not be denied — or face exorbitant premiums due to pre-existing conditions.
“Cancer or any chronic illness is very, very expensive, and that's why having supplemental coverage is important,” said Adam Zarrin, a policy analyst for the [Leukemia and Lymphoma] Society. “The second part is about making sure that patients have access to the best health care available.”
Zarrin says leukemia and other blood cancers are more commonly diagnosed in older adults, after age 55.
...
Jit423
(1,568 posts)Increasing competition is the only way to stop the price gouging and cost creep of huge conglomerates run from off-shore and in other countries but owned and operated by some billionaires here in the US. This kind of hidden economy is rampant now and can only be changed with a new House and Senate that will really support reducing the costs to Americans and not the fake RW-tariff-loving-wealthy Trump supporters. Simply put, we need more of our economy owned and run by Americans who care about working Americans and, I'll say it, the poor.
Demsrule86
(71,542 posts)I heard a proponent of original Medicare report that she pays 240 a month for the plan that covers the 20% Medicare doesn't pay...well that would mean 480 a month for hubs and me. And also I would lose my part B giveback which is 175 a month in 25. Then I would need to pay for an expensive pharmacy plan because I am on Eliquis...I can't afford it Original Medicare does not cover vision, hearing or gyms also. I had open heart surgery to replace a bad valve in 23 I was in AFIB and my always low blood pressure was crashing, four cardioversions plus the 3 in the hospital, 3 ablations and countless expensive tests including almost daily Echo's, MRI's and CT scans.
I spent three month in the hospital...mostly in intensive care and owed about $700.00 in out of pocket. I went to UH in Cleveland which is one of the best hospitals for heart issues (Harrington). I could have gone to Cleveland Clinic but preferred UH. On original Medicare I would have needed the lowest cost plan, and a high deductible for the gap coverage. I doubt I would be alive today.
SheltieLover
(80,449 posts)I don't think they offer the one I bought any longer as it covers the entire deductible and all co-pays. Almost all doctors and healthcare facilities accept standard Medicare.
This is not at all the case with Medicare Advantage can appear to be cheaper and include more, but that is not necessarily the case and, if the person ever wants to go back to standard Medicare, they might have to pass a physical to qualify. Many doctors refuse certain Advantage plans and just within the past couple of weeks, there was a news article saying that one Advantage plan provider was leaving 13 million + people without coverage. No idea what will happen to those folks. Medicare Advantage is private insurance, therefore, imho, a scam.
spooky3
(38,632 posts)Medicare covers—how will you know until it’s too late?
SheltieLover
(80,449 posts)Advantage plans are raping the Medicare system because they charge the govt. much more than standard Medicare.
dpibel
(3,941 posts)Original Medicare covers most medically
necessary services and supplies in
hospitals, doctors’ offices, and other
health care facilities. Original Medicare
doesn’t cover some benefits like eye
exams, most dental care, and routine
exams.
Medicare Advantage (Part C)
Plans must cover all medically necessary
services that Original Medicare covers.
Plans may also offer some extra benefits
that Original Medicare doesn’t cover—
like certain vision, hearing, and dental services
As you can verify from the link, that is from medicare.gov.
This seems to be at odds with your assertion.
PA Democrat
(13,428 posts)PRIOR AUTHORIZATION to deny or delay services that original Medicare routinely covers automatically.
by Robert King
It “has turned into a process of basically just stopping people from getting care,” said Rep. Pramila Jayapal (D-Wash.), leader of the House Progressive Caucus.
Jayapal was one of more than three dozen House Democrats who told CMS this month of “a concerning rise in prior authorizations,” accused health insurers of prioritizing “profits over people” and asked for “a robust method of enforcement to rein in this behavior.”
Unlike traditional Medicare, Medicare Advantage plans can employ prior authorization and restrict beneficiaries to certain doctors within their network. Those are among the incentives private insurers have to participate in the program and enrollment has doubled during the last decade.
But Sen. James Lankford (R-Okla.) said some hospitals in his state won’t take Medicare Advantage plans any more. “We can’t do it because we can’t afford the constant chasing from all the denials,” he said.
https://www.politico.com/news/2023/11/24/medicare-advantage-plans-congress-00128353
The American Medical Association is also highly critical of Medicare Advantage Plans abuse of prior authorization procedures:
On top of that, 24% of physicians reported that prior authorization has led to a serious adverse event for a patient in their care. Among the physicians the AMA surveyed, these shares said that prior authorization resulted in a serious or adverse event leading to:
A patient being hospitalized—19%.
A life-threatening event or requiring intervention to prevent permanent impairment or damage—13%.
A patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—7%.
Prior authorization also adds significant costs to the nation’s health system. According to the AMA survey, prior authorization results in worse patient care, squeezes patients and physicians’ pocketbooks and leads to higher overall use of health care resources.
Demsrule86
(71,542 posts)old more affordable plans that are not available today. And still you pay more than I do. I can't afford original Medicare. And more people are on Advantage plans these days you know for that very reason. Many of you have never used Advantage and only report horror stories that may or may not be true. I have not personally heard of anyone here being denied care...my treatment has cost millions you know. The latest ablation was $30,000 and it was same day surgery.
Farmer-Rick
(12,667 posts)A Medicare advantage plan. So, what are you saying? It is taken directly out of your Social Security, so maybe you don't notice it?
Unless you make more than $105,000 the standard monthly premium for 2024 is $174.70 even with a Medicare Advantage plan. You pay for regular Medicare anyway.
You pay $0 for part A, then you pay that $174.70 premium for part B. Then you obviously bought an Advantage plan that you pay more for and that's part C.
Then you need a a drug plan, part D. The national base premium for 2024 is $34.70, but it varies by plan and income.
Also a lot of people have gap insurance that covers services not covered by Medicare and that 20% Medicare won't cover.
But you pay for Medicare even if you have an Advantage plan. It just seems to me you are paying extra for nothing.
I would spend the extra money on a good gap insurance plan or a better drug plan.
Demsrule86
(71,542 posts)money every month...mine is this year 175.00...every month. I suggest you google it. Also, I pay no premium.
moose65
(3,454 posts)Are you saying that you get your part B premium back, and then you don't pay ANYTHING else? Not for a drug plan, or a supplement?
delisen
(7,366 posts)A lot depends on how pro-patient individual providers are and how greedy and ethical the Advantage insurance company is.
dwayneb
(1,107 posts)You have no clue with MA how predatory you particular insurer is; and if good today, whether they will change their tune at some point in the future.
I do know that my providers are always very happy when they realize I am on Traditional with supplement. I an go to any specialist I want no questions asked at any time (assuming that it's a Medicare covered visit or procedure).
delisen
(7,366 posts)Demsrule86
(71,542 posts)PA Democrat
(13,428 posts)Unfortunately, not all Advantage plans are providing the care their patients are entitled to or in a timely fashion. My statement is not based upon "horror stories that may or may not be true." It is based upon DATA contained within numerous studies.
The AMA article I cited above contained data provided by physicians.
The Kaiser Family Foundation analyzed the more than 46 million Prior Authorization requests that Advantage Plans required prior to services being approved in 2022.
Just one in ten (9.9%) prior authorization requests that were denied were appealed in 2022. That represents an increase since 2019, when 7.5% of denied prior authorization requests were appealed. The low rate of appeals may be attributed to enrollees not knowing that they can appeal a denial or finding the appeal process intimidating. A prior KFF survey found that many people who experience denials, including those with Medicare, are confused by their coverage and don’t know how to file an appeal with their plan.
The vast majority of appeals (83.2%) resulted in overturning the initial prior authorization denial. Though a small share of prior authorization denials were appealed, more than 80% of appeals resulted in partially or fully overturning the initial decision in 2022, and in each year between 2019 and 2021. These requests represent medical care that was ordered by a health care provider and ultimately deemed necessary but was potentially delayed because of the additional step of appealing the initial prior authorization decision. Such delays may have negative effects on a person’s health.
Medicare Advantage insurers vary in their use of prior authorization. In 2022, the volume of prior authorization determinations varied across Medicare Advantage insurers, as did the share of requests that were denied, the share of denials that were appealed, and the share of decisions that were overturned upon appeal, meaning people may have different experiences depending on the Medicare Advantage plan in which they enroll.
https://www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/#:~:text=More%20than%2046%20million%20prior%20authorization%20requests%20were,Advantage%20enrollee%2C%20similar%20to%20the%20amount%20in%202019.
dwayneb
(1,107 posts)"... people may have different experiences depending on the Medicare Advantage plan in which they enroll"
thanks for posting those links, we should all be looking at the DATA not anecdotes
PA Democrat
(13,428 posts)offered.
I recently spent more than an hour reviewing the 20 plus pages of changes to my elderly parents' Medicare Advantage Plan. It would be overwhelming to say the least for many older people to determine the full potential impact of the changes on their out of pocket expenses.
Some copays went up some went from a flat amount to a percentage. Healthy food allowance of $150 per quarter was eliminated and the $100 debit card that could be used to cover copays was also cut. The overall impact was higher copays for the same premium with the same out of pocket maximum.
Demsrule86
(71,542 posts)Also have a say in what is covered. They are after all insurance companies. And my sister - law was required to pay the deductible before her broken hip surgery. So spare me. The bottom line is I get more for my money than original and hubs and I can't afford original.
PA Democrat
(13,428 posts)cover the entire 20% of remaining expenses not covered by Medicare A & B. The only out of pocket expense is for the one-time annual $240 deductible. After that, if it an expense that Medicare covers you get no bill. The supplement insurance company has NO say in whether or not to pay and has no prior authorization requirements.
I'm not the enemy here and I'm not trying to diss people who have Advantage Plans, but I do believe it is important that people make informed decisions.
I also am alarmed that Medicare Advantage Plans cost significantly more per enrollee to the taxpayer than traditional Medicare while spending God knows how much of TAXPAYERS' money on corporate profits and advertising rather than on actual medical care.
Report: Medicare Advantage plans cost more, provide less
The Centers for Medicare and Medicaid Services has created a system in which Wall Street actors and insurance conglomerates have increasingly extracted large profits at the expense of Medicare, its patients and taxpayers – according to a new report by the Center for Economic and Policy Research (CEPR) co-authored by a Cornell professor.
Privatized senior care offered by Medicare Advantage insurance plans has led to higher costs for Medicare and is a drain on the Medicare trust fund, according to the report, “Profiting at the Expense of Seniors: The Financialization of Home Health Care,” authored by CEPR co-director Eileen Appelbaum and Rosemary Batt, the Alice Cook Professor of Women and Work in the ILR School. The study also finds that these plans diminish the amount and quality of care provided to patients.“The evidence shows that the Medicare Advantage plans cost much more than the traditional Medicare plans because they use many financial tactics to increase their profits,” said Appelbaum, an economist; Batt and Appelbaum are longtime collaborators. In 2020 alone, large MA insurance plans received an estimated $12 billion in overpayments, according to the Medicare Payment Advisory Commission.
Patients and care workers pay the costs. On the surface, Medicare Advantage plans appeal to seniors because, unlike traditional Medicare, they may include coverage for dental and vision or provide other benefits not available in traditional Medicare. But “there are hidden costs that people often fail to see,” Appelbaum said. “Medicare Advantage plans limit which providers and facilities a patient can use. They often require pre-authorizations for treatment, and denial rates are high for services that seniors are entitled to.”
https://news.cornell.edu/stories/2023/11/report-medicare-advantage-plans-cost-more-provide-less
I do believe that there should be more affordable options, but I don't agree with turning over a large chunk of the Medicare trust fund over to for-profit companies that are insufficiently regulated and are engaged in some fraudulent practices.
The Medicare Advantage Influence Machine
New court filings and lobbying reports reveal an industry drive to tamp down critics — and retain billions of dollars in overcharges.
https://kffhealthnews.org/news/article/medicare-advantage-cms-overcharges-lobbying-unitedhealth-
lawsuit/
Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated
Questionable diagnoses of HIV and other maladies triggered extra Medicare Advantage payments; ‘It’s anatomically impossible’
https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d?msockid=0bee55de187c65e1014040fa19aa642e
Skittles
(171,704 posts)and they are WELL ON THEIR WAY
of COURSE they make it "enticing" for people, but that doesn't mean it doesn't completely STINK
Joinfortmill
(21,162 posts)
RobinA
(10,478 posts)plenty. Tell your friend to talk to someone who knows the business and isn't reimbursed by it.
Farmer-Rick
(12,667 posts)For something you are required to pay for anyway?
Even with a Medicare Advantage plan part C, you still pay for regular Medicare. I know because I tried to get out of paying Medicare when I turned 65 and just use my own health insurance. It didn't work.
They take the money right out of your Social Security.
I would use the extra money on gap insurance, a better drug plan or vision and dental insurance. But throwing more money at a private plan that's supposed to provide the same thing as Medicare is a waste of money.
MichMan
(17,150 posts)You pay for traditional Medicare Parts A & B with no additional premium for Part C.
Farmer-Rick
(12,667 posts)"The average monthly premium for Medicare Advantage (MA) plans, also known as Medicare Part C, in 2024 is projected to be $18.50."
https://www.medicare.gov/basics/costs
So, yeah, most people pay more for a Medicare Advantage plan.
Part A is free for 65 year old Americans who paid Medicare taxes. You pay for part B. Yeah, a distinction without a difference since an average American can't get out of paying it.
I have Medicare but I have to force myself to use it since I pay over $2,000 a year for it. While I have healthcare insurance that is free with my retirement plan.
MichMan
(17,150 posts)Majority have zero premiums; those that do average out with all the ones that don't for $18.50.
Mine cost me $19.98 a month because I chose to have enhanced dental coverage. But I also get $105 per quarter in an OTC debit card. So my premium for MA is actually a negative $15 per month.
radius777
(3,921 posts)much better than original Medicare as it includes Rx coverage (ie, part D) for no additional cost, along with dental and vision. It's an HMO, but has a huge network. They've never had an issue getting anything covered. Not sure what others are talking about. But they/we live in the NY metro area, and there are many good MA plans available. Just made sure to go over all of the plan details to ensure no surprises. Medicare's own online site makes it easy.
Demsrule86
(71,542 posts)You need to consider talking to someone.
Demsrule86
(71,542 posts)the exception. But I made sure to choose a plan that had it...I couldn't afford even a crappy original policy. I have a great Advantage plan.
Farmer-Rick
(12,667 posts)Even if you have a part C Advantage plan. It's taken directly out of your social security. I know. I tried to avoid paying it and it wasn't allowed.
Everyone, even those with a Part C Advantage Plan pays for part B....which is what everyone thinks of as Medicare.
Jacson6
(2,013 posts)I had a friend that signed up for one. He had a heart attack and ended up in a out of network hospital. He received a $100k hospital bill that was not covered. You take your risks with these plans. If he had plain old medicare he would of been liable for 20% after the Medicare deduction.
dpibel
(3,941 posts)About half of medicare beneficiaries are on advantage. That's millions of people.
I have said many times on these threads, and will say it again here:
If it's such a scam, why are there not many people on every one of these threads recounting their individual, personal, first-hand savaging by advantage?
It's always some variation of "A man, a big man, who came up to me with tears in his eyes..."
dwayneb
(1,107 posts)It's not bad at all until you get sick.
That's when they will throw you under the bus. Refusal to pay, stalling, forcing you to use procedures that are not as good, limiting the specialists you can see.
There is a reason why so many hospitals are starting to refuse MA.
https://www.beckershospitalreview.com/finance/15-health-systems-dropping-medicare-advantage-plans-2024.html
dpibel
(3,941 posts)OK. It's not a scam. It's just terrible coverage?
If that's the case, the question remains: Where are the many millions of people who have been damaged?
On this very website, with a demographic that skews elderly, where are the many people telling their stories about how Medicare Advantage ripped them off?
You'd think in the many many many "Watch out for Advantage" threads that appear here every year, there'd be at least on person who'd step up and say, "That's me. I needed care and it was denied me."
But there's not.
dwayneb
(1,107 posts)They are on Medicare Advantage. They have to truck all over town to get her to the specialists she needs because only a few are accepted in her system. Me? I can go anywhere I want, no questions asked. That's a huge problem when you are in your late 80's like they are. She was also forced to go through alternative less effective treatments for her arthritis and osteoporosis when her doctor knew were not the right course of treatment but she had no choice - MA wouldn't pay.
There are several posts in here describing other specific downsides but obviously people don't like to give our personal information.
Here is a good report from NBC and NPR with a number of different anecdotes.
https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012
https://www.npr.org/2024/01/07/1223353604/older-americans-say-they-feel-trapped-in-medicare-advantage-plans
What really proved the point to me was that UHC which provides my Traditional Supplement sent one of their salesmen to my house trying to convince us to switch to Medicare Advantage. Told us how much his elderly mother "loves it".
That tells you something right there. UHC knows which side their bread is buttered on. I tried to get this sleazy salesman to tell me how much Medicare gives UHC for each MA customer, but he wouldn't. I think it's around $15,000 a year. Once you start getting expenses up to that level, that when they start stalling and twisting and turning in their efforts to deny payments or to force you to get alternate less effective procedures like my neighbor.
dalton99a
(94,115 posts)for each customer
There are plenty of people making $100K+ from selling MA plans
mahina
(20,645 posts)Thanks heaps.
Demsrule86
(71,542 posts)away from home. However emergency care is covered no matter what.
Tweedy
(1,284 posts)And prescription plan with community rating.
Medicare advantage plans cost the government more without giving seniors additional value. These plans spend a ton of money on advertising. The commercials are misleading. The plans replace traditional Medicare and put the senior back in the private insurance marketplace.
Conversely, a Medicare supplement plan is a supplement to traditional Medicare. Such plans stay with you and allow you to go to any doctor you want without referral unless your friend chooses an hmo or ppo supplement plan. Community rating keeps the monthly price rational as your friend ages.
Imho
WVGIRL
(43 posts)Tell your friend to sign up for regular medicare and get one of the supplemental plans offered BY THE GOVERNMENT. Do not get a plan C because that is Medicare advantage which is managed care by and insurance company. they only make money by denying service to people. I have Plan G. If you get straight medicare and stay away from anything that says MEDICARE ADVANTAGE, you can go to any doctor and they will not haggle with you over what they will cover. Medicare advantage is neither medicare OR an advantage. It is just you are paying a middle man. During Bush era they let insurance companies demand and get a piece of the pie because of strong lobbying.
dpibel
(3,941 posts)Please point me to even one of these.
Medicare supplement plans are, and always have been, private insurance.
I swear to god. These bogeyman threads can just devolve into crazy screaming matches.
karynnj
(60,965 posts)Using the plan definition to determine how much. For all currently available plans for new people, the plan will not pay the Medicare deductible. Plan G pays all the other remaining charges. Other plans pay less but have far lower premiums. For example, after the deductible is paid, plan N will charge $20 for doctor's visits, $50 for an ER visit etc.
The difference is the Medigap plan does not require pre-approval or independently considered whether something is covered. Anything traditional Medicare covers is then sent to the Medigap plan and is covered.
Demsrule86
(71,542 posts)MA plans must offer a benefit “package” that is at least equal to traditional Medicare's and covers everything Medicare covers (except hospice care). Mine doe cover hospice care.
karynnj
(60,965 posts)and restriction of providers. Not to mention, some hospitals have rejected many of the MA plans. This may not matter as much in a major metropolitan area, but it is a big deal in other areas. I live in Burlington, VT. UVM Medical center is excellent and virtually all specialists in the area practice out of UVM connected practices. There are MA plans where UVM is out of network ... and some plans will no longer provide plans in VT next year.
Demsrule86
(71,542 posts)MichMan
(17,150 posts)Demsrule86
(71,542 posts)Biophilic
(6,552 posts)You have to use doctors etc who are associated with whatever insurance company you sign up with. Just watched a friend drive her mother all over the place getting specialists lined up. She’s a nurse. She was exhausted. I worked in geriatric rehab. Don’t know how many times I watched people sent home because their Medicare advantage refused to continue with treatment even though it was doctor recommended. I never saw that happen with straight Medicare. I have straight Medicare and it has done very well for me over the last 14 years. The bottom line is that Medicare is not trying to make money off you, but Medicare Advantage is.
dpibel
(3,941 posts)If that's actually what you have, you're rolling the dice far more than anyone on Advantage.
Unless, of course, you can easily pony up 20% of a million or two when you have a major hospitalization.
dwayneb
(1,107 posts)Even Trump and his billionaire buddies probably have a high end Traditional Supplement plan.
dpibel
(3,941 posts)As written, the post I responded to appears to say the poster has just Medicare.
And that's a mighty big gamble.
Demsrule86
(71,542 posts)My care has cost millions. I now need a hysterectomy...a gift from the right to life doctor who almost killed me in Georgia...the infection caused damage and I have a prolapse as a result which would be covered anyway but mine is more urgent because it lays on the bladder which affects my kidneys. I am approved.
Biophilic
(6,552 posts)My experience has been different and was frustrating when I saw patients not getting full treatment. I also have a couple of younger friends attempting to help parents deal with finding specialists etc and heard their frustrations.
Demsrule86
(71,542 posts)I live in Cleveland and we have three wonderful hospitals...Cleveland Clinic, University Hospital and Metro Health. I am very lucky. My Advantage plan was great. I owed less than an $1000.00 out of pocket for three years of care. Original is simple too costly for me when you have to have Medigap, no giveback and a decent pharmacy plan.
Demsrule86
(71,542 posts)hospital in 23 during open heart surgery mostly in intensive care. I have had numerous ablations and cardioversions...to keep me out of AFIB. The latest one cost over 30,000 dollars I paid a $40 deductible. I have an average of 2 echo's every month for over a year. I have an advantage plan and it has been great.
Gaugamela
(3,511 posts)receiving Medicare funds. This was George W. Bush’s Medicare “fix”, designed to slowly bleed Medicare dry in order to kill it off.
Medicare Advantage entices those entering the eligibility pool (thus cherry picking the younger and healthier participants) with inexpensive plans that sometimes offer extras like vision and dental, but as the participants get older the companies jack up prices (lemon dropping). Advantage plans can change year to year, unlike Medicare where the benefits are designated by Congress. And the Advantage plan benefits are only available in a local service area, whereas Medicare will cover costs anywhere in the country. Also, the private companies are notorious for denying treatment.
Unfortunately, not everyone can afford a Medicare Supplement plan (these are legitimate plans which cover costs that traditional Medicare doesn’t), and so the Advantage plans become the fallback.
I have the Plan G supplement, and my cost is $165 per month, in addition to the Medicare Part B premium which is currently $174.70 per month. Part B premiums are determined by income. https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
former9thward
(33,424 posts)Medicare Advantage came in under Clinton. MA is regular Medicare -- it is part C of the Medicare program. MA plans have far more benefits than regular Medicare. They have vision, dental and hearing. Medicare does not cover any of that.
Gaugamela
(3,511 posts)Medicare Part C because that’s what the insurance lobbyists wanted, but it effectively takes the insured out of the Medicare system. The insured is opting to use their Medicare money for private insurance. As what you said about vision, dental etc., you’re repeating what I said. But all the downsides of MA that I listed are correct.
former9thward
(33,424 posts)Response to former9thward (Reply #36)
Gaugamela This message was self-deleted by its author.
Silent Type
(12,412 posts)Gaugamela
(3,511 posts)Silent Type
(12,412 posts)think it’s right or best for them.
IMO, taking something that half (over 30 million) of Medicare beneficiaries voluntarily chose — until the government makes original Medicare meet their needs — would be wrong.
I’m on original Medicare, but I foresee being forced into MA to get rid of MediGap, Part D, and get $2000 or so in useful benefits like dental.
Instead of griping about MA, Howsabout we get on government to do something. Until then, I’m supporting MA by voting for Democrats who will consider everyone’s needs.
Gaugamela
(3,511 posts)MA is setting up Medicare for failure, as designed. The only way out, as I see it, is Medicare for All.
Silent Type
(12,412 posts)upon private insurance like MA, you think we’d do it. In my IMO, that’s what it will take until we get big majorities in Congress.
The ACA is based upon private insurers. Half Medicare beneficiaries choose these plans. All MediGap and Drug plans are privately insured.
I don’t see us getting MFA without it. So, we can remain pure and end up debating this in 25 years with no progress, or we can be willing to do what it takes to make a major change.
Understand, I’m not saying this would be better than a single government payer. I’m saying it has little chance of won’t passing otherwise.
Since I don’t believe MFA will pass otherwise, I’d be for allowing private insurers to bid for patients under arrangements like in ACA where they have to spend a high percentage of income on care and government provides quality reports that help beneficiaries choose AND switch plans if they aren’t satisfied, etc.
Gaugamela
(3,511 posts)but nonetheless I will advocate for it, and try to expose poison pill legislation designed by the right to achieve their goals by stealth. And you never know, sometimes social attitudes can change very quickly, and policy can follow. All positive change starts on the progressive fringe and slowly filters into the popular mindset.
Demsrule86
(71,542 posts)health care. They couldn't afford both. Original Medicare is costly.
Gaugamela
(3,511 posts)Demsrule86
(71,542 posts)And it has done that. Unless you are grandfathered with older plans, original Medicare is not affordable.
Gaugamela
(3,511 posts)to the private sector. The private sector routinely overcharges Medicare and are slowly milking it dry.
Medicare should have a zero dollar bottom tier for those who can’t afford it. People pay into it their whole working life, and should be able to receive it at 65 regardless of their circumstances. Otherwise they’re simply subsidizing those better off than themselves.
Demsrule86
(71,542 posts)Gaugamela
(3,511 posts)moose65
(3,454 posts)MA is vastly different. They essentially bribe people by tossing them a few bones like some dental coverage or (I’ve heard) things like gift cards almost.
MA plans are paid a set amount per year by the government. They are not fee-for-service like regular Medicare. The endless ads are excruciatingly bad. They have been overpaid for years.
former9thward
(33,424 posts)It is part of the Medicare program just as Part A and Part B are. You may not like that but its true.
moose65
(3,454 posts)It is a ripoff. It takes money from the Medicare trust fund and gives it straight to private insurance companies, who then rip people off for profit.
Demsrule86
(71,542 posts)deal with prescription plans and medigap with original- and there are out of pocket expenses too.
moose65
(3,454 posts)If MA is the "same" as traditional Medicare, then why aren't its benefits available to everyone, as traditional Medicare is?
MA is just a way to make us fight with each other. MA throws its clients a few bones every year, so that you will defend your own MA plan.
Just another way to divide us so we don't see who is ripping us off.
Demsrule86
(71,542 posts)can get Advantage and save money. It really isn't anyone's business.
questionseverything
(11,836 posts)And will toss you back into the government pool when you cost too much….and then we all have to pay for advantage customers
It’s everyone’s business
Skittles
(171,704 posts)they've ripped off taxpayers for BILLIONS - the ENTIRE GOAL of "Advantage" is to GET RID OF MEDICARE so YES IT IS "EVERYONE'S BUSINESS"
dalton99a
(94,115 posts)beyond routine outpatient visits and simple ailments
It is an open secret that people who sell Advantage plans would not buy them for themselves or family
“When we did focus groups with brokers, many said they are paid more to put people into Medicare Advantage plans, sometimes much more,” Jacobson said. But “if they were going into Medicare tomorrow, most of them said they would choose to be in traditional Medicare.” These brokers do not get any commission for helping someone enroll in original Medicare. Likewise, they said most Part D prescription plans don’t offer commissions; for those that do, the rate is low. As for Medigap policies, an agent might get some money for signing people up, but agents say it’s not as much as what they get for a Medicare Advantage enrollment.
https://www.aarp.org/health/medicare-insurance/info-2023/will-original-medicare-survive-medicare-advantage.html
Voltaire2
(15,377 posts)you can be denied coverage for pre-existing conditions by medigap plans if you decide to switch back to actual Medicare. Every year you can change MA plans, but you may be locked in to MA.
The MA plans can disappear entirely or enshittify every year. The medigap plans all provide basically identical coverage within their category, so cost is basically the only variable.
dwayneb
(1,107 posts)We started out at around $220 for person per month. But I project that at 85 it will be closer to $400 a month. It's because the initial discount sunsets, and there is an increase for the class every year.
No matter what you do you are screwed in this country because $$$ flowing to the billionaires are always considered more important than the people.
Voltaire2
(15,377 posts)At this point I’m just trying to avoid the fatbergs in the sewer pipe of life in the disunited states.
Deuxcents
(26,914 posts)With “free” this n “free” that n once you’re in, it may not be possible to get back into Original Medicare without medical exams, if at all. If it’s too good to be true..you know how the saying goes. If you’ve put your life’s earnings into a wonderful benefit called Medicare, don’t give it away to insurance companies.
former9thward
(33,424 posts)Link where you can't get back into regular Medicare. You can't because it is not true. Regular Medicare is administered by a corporation. Why are you not mentioning that?
Gaugamela
(3,511 posts)may add more on top of that.
Jmb 4 Harris-Walz
(1,117 posts)because you were enrolled in a Medicare approved alternative (Medicare Advantage). What you might actually have trouble enrolling in is a Medi-gap supplemental plan (not Original Medicare). The medi-gab insurers are the ones you need to worry about. Also, if you switch from MA to Original Medicare don’t forget to enroll in Part D for prescriptions.
Gaugamela
(3,511 posts)dwayneb
(1,107 posts)No one can afford to go on Part B only, which only pays 80%. Any big surgery could easily stick you with tens of thousands of dollars in bills.
So you have to get a supplement and if you were on MA, their underwriting will probably force you to pay a LOT more in premiums, or you might be rejected outright.
Deuxcents
(26,914 posts)The CMS is not a corporation. So glad you are pleased with your healthcare decisions, Former9thward
splunge63
(159 posts)lol
good God, there's an ocean of mis-information on this subject
former9thward
(33,424 posts)https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs
former9thward
(33,424 posts)https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs
splunge63
(159 posts)then pray you don't get seriously sick. what a scam
blue neen
(12,465 posts)The scam starts right there.
former9thward
(33,424 posts)How is a scam?
dpibel
(3,941 posts)FFS. Americans live and die with bean counters making medical decisions.
Is there some magic that happens at 65? "I useta be subject to bean counting. Now I'm free!!!!"
RobinA
(10,478 posts)bean counters just like Medicare Advantage and any other insurance product. I can't understand where this nonsense about Medicare approving everything came from. It just isn't true.
splunge63
(159 posts)MA turndowns v Medicare turndowns. not in the same universe
stopdiggin
(15,463 posts)That Medicare supplement ALSO are quite expensive - go up ever year (take a look at the charts) - and also have sizable deductibles and some 'uncovered' restrictions.
The solution is obviously to make Medicare comparitively affordable. Currently, for many consumers, that remains not the case.
Jmb 4 Harris-Walz
(1,117 posts)Medicare Advantage draws people in with eye, hearing, dental care benefits. They also give freebies that people like but they can change these whenever they like.
Kamala has stated a desire to improve Medicare by adding eye and hearing benefits, if that happens, Medicare Advantage loses even more of its draw.
Do yourself a solid and go with what most everyone in this thread suggests!
dalton99a
(94,115 posts)Many people have based their decisions on those wellness benefits (and the free lunch provided by the very nice salesperson) and are now trapped
former9thward
(33,424 posts)Or spoke to a salesperson. I looked over everything and chose MA. Have not regretted it.
dpibel
(3,941 posts)How about the fact that Advantage plans cost from nothing to a few tens of dollars.
Medicare Supplements (in my state) run $200 to $300 a month.
Those of you who have that kind of money lying around can pontificate all you want. Those who are living on Social Security and a bit more? They may have a hard time ponying that up.
Jmb 4 Harris-Walz
(1,117 posts)RobinA
(10,478 posts)that you can afford the gap insurance. I also found that Part D prices can be much higher than Medicare Advantage.
dwayneb
(1,107 posts)Sadly in this country your health care is only as good as what you can afford.
For many people the only alternative is Medicare Advantage simply because they cannot afford the premiums of a traditional Supplement plus Part D.
I pay about $200 for the supplement and about $55 for the Part D monthly and SO is about the same. But this amount will go up over time.
dwayneb
(1,107 posts)Many people simply don't have the income to pay the Supplement premiums plus Part D.
Plan for at least $250 a month per person.
Of course the Medicare Advantage folks will likely pay through the nose at some point, when their MA plan decides not to pay. Or, they will simply have to forego medical treatments that they really need.
The insurers get a stipend each year for every MA client, I heard that it was around $15,000. So once they have shelled out that much in a year, that's when you will start to see them stalling and doing everything in their power to not pay for your procedures.
Not that Traditional Medicare is perfect either. Doesn't cover dental, eye care, long term care.
In the USA you are pretty much screwed when you get old.
milestogo
(23,082 posts)and figure out what else you will need covered. Get on the phone and talk it through with an agent.
There are loads of different plans and they vary from state to state. Don't listen to broad brush generalizations. Know what you need and keep shopping till you find it.
OAITW r.2.0
(32,133 posts)I've had specialist visits, outpatient surgical procedures, Cat Scans, and other visits....Nothing out of packet, so far. 71+ and counting.
Jmb 4 Harris-Walz
(1,117 posts)medi-gap policy and Part D? Just curious, no need to reply if you’d rather not.
OAITW r.2.0
(32,133 posts)If there is a better, government sponsored option, I'd seriously consider it.
dpibel
(3,941 posts)For that money, you could get a medigap plan.
Paying that much for an advantage plan is, I think, ill-advised.
Sibelius Fan
(24,808 posts)Medicare Advantage makes sense with them.
I have never had issues with something not being covered. That includes hospital stays that ran over $50,000 - my copay was $0.
OMGWTF
(5,131 posts)I think it's a fking crime that they are allowed to use the word "Medicare" in their name. It's private insurance and they have no problem telling you "No" whereas traditional Medicare plans may cost more you are covered and can go see any doc you want. There is a small deductible every year. I've been on it for four years and have had surgery and many doctor visits but have never seen a bill. Get the Part D drug coverage too. It's cheap.
MichMan
(17,150 posts)Medicare Advantage is not Medicare. It is an insurance company boondoggle and is costing taxpayers tens of millions so insurance companies can make a profit. Reporting indicates that these insurance companies deny 18-25% of all claims submitted. It’s probably fine if you don’t have to use it, but beware if you get sick.
Figarosmom
(11,979 posts)Advantage only covers a little bit of it before the patient ends up getting kicked out before they are able to care for themselves again. That I know from my physical therapist daughter who has fought with the insurance for patients. Advantage is private insurance not Medicare. It is cheaper and sometimes free if you are low income. But it's pretty expensive if you're not low income.
Silent Type
(12,412 posts)the patient is well enough to go home. The “advantage” to original Medicare is that you would argue with facility and maybe doctor to get more days, rather than the MA. In any event, you are own your own quickly.
That’s not to say MA is better, but they cover the same number of days as Medicare, even if asking questions for continuing to pay.
Here’s coverage rules under original Medicare.
https://www.medicare.gov/coverage/inpatient-rehabilitation-care
IMO, MA or original Medicare comes down to whether one can afford to pay for MediGap and drug plans and forgo some limited dental and other benefits.
The networks are a pain, but I’m not much on obsessing over which doc is best. If you are, that’s a consideration.
dwayneb
(1,107 posts)Not sure about Medicare Advantage.
Point is - in this country you are screwed regardless unless you have $$$$.
eallen
(2,983 posts)Medicare Advantage plans often are cheaper up front, but limit your service providers and require pre-approval when you're faced with a major medical issue. As others have pointed out, they are provided by private insurers.
The alternative is traditional Medicare, parts A and B, which are fulfilled by the government. Along with a Medigap policy, since parts A and B leave significant copays. There are different Medigap plans, with plan G being one of the more comprehensive. But that will cost, and if all you can afford is a less expensive Medigap, keep your fingers crossed that it works out when you need it.
The choices get complex, quickly. And insurance salesmen will tempt you with their Medigap policies. They get paid to do that. They won't be around when the insurer says you don't really need something your physician is convinced you need.
dwayneb
(1,107 posts)Maybe that's what you meant. I had a salesman come to our house and spend 2 hours trying to convince us we needed a Medicare Advantage plan and to drop our Plan G supplement. About how much his aging mother loves it lol.
Funny thing is - this Advantage salesman was from UHC also, the same company that has our Plan G. So that tells you which plan earns them more money doesn't it? There is a reason why they run Advantage ads for two months every year.
Wifes husband
(720 posts)If you are eligible, I recommend Medicare A and B, with Blue Cross. No problems at all. Bills are just paid.
elocs
(24,486 posts)I've been satisfied with it and because I also have Medicaid, I have dual care coverage--what medicare does not pay for, Medicaid does.
dwayneb
(1,107 posts)In the USA your health care is only as good as you can afford. Unless you have money, you are screwed when you get old. Our system sucks. And if Trump gets elected, it is going to get far, far worse.
He and his billionaire friends can pay for their treatment out of pocket, why would they give a shit about people like us out in the heartland?
elocs
(24,486 posts)Last edited Sun Nov 3, 2024, 08:17 AM - Edit history (1)
I haven't had so much as a cold in 16 years now and even then I still went to work. I pay nothing for my insurance and get $164/month which I use to buy food (along with SNAP benefits I pay nothing each month for food). I am not in good shape by accident because I have never drank or smoke and weigh what I did 54 years ago, exercise regularly for decades (since I switched to the carnivore diet a year ago after 3 years keto I have increased my muscle mass which is important for the elderly I am up to doing 100 push-ups-in a row, not a set) so I'm doing my bit to stay healthy.
I'm just stressed out for another couple of days and then hopefully joyously happy or seriously depressed.
Emile
(42,284 posts)The more people on private Advantage plans the more expensive Medicare gets.
dalton99a
(94,115 posts)'Nuf said
haele
(15,396 posts)My mom has Medicare, Tricare, and a Medicare Advantage (MA) HMO. The HMO is through the large primary hospital in her city, so while they may change up her plan on her, it's more like her old employer's medical insurance - only with a smaller network.
She's pretty happy with all three as she doesn't travel and her medical costs tend to seem in the same range as medical costs in the 1980's were. But then again, she also has Tricare that covers her part D.
The decision needs to be made with several considerations in mind:
Do you live in a large Metro area with a range of medical facilities that allows you a wider range of in network service choices? MA might be a decent choice, especially if the insurance is with a large hospital system that specializes in geriatrics, or cancer, or is also a teaching hospital.
If you live in a hospital system desert, Medicare part G supplemental might be a better choice.
Do you travel a lot? Do you have decent retirement, or are you struggling?
If you go with an Advantage plan, you need to keep on it. Medicare is required to put out public announcements as well as sending you letters and emails well in advance when they change their policy. If something is denied, they will inform you immediately.
According to mom, even though her MA plan is with the Hospital, her doctor's office is the one they tell if something is denied or not a available, and she gets official notification through her EOB letter at the end of the month. It depends on the plan.
Good luck. But keep in mind, your friends best option is to check her local health care facilities and find out what they accept before making her choice.
Haele
lindysalsagal
(22,910 posts)claims or servicing all hospitals. Medicare is safer.
Just remember that when they need lots of slick TV commercials, there's a reason. It's crap.
dwayneb
(1,107 posts)Yes you will be able to get the Medicare B portion of "traditional" but that only cover 80%. Obviously that's a huge problem if you have a $200,000 heart surgery and you are stuck with a bill for $40,000.
It's the supplement insurers that will force an underwriting review and will surely charge you more or may even reject you entirely for their coverage.
dalton99a
(94,115 posts)outside the initial enrollment window
unless you have a guaranteed-issue rights letter from your current insurer
Without such a letter, expect instant rejection or crazy sky high premiums if your health history is less than perfect
MineralMan
(151,267 posts)However, for people who are generally healthy, they can be a very good option. I have one, and it has worked very well for me, since I don't have any major health concerns. Very convenient, and the $0 copay medications I take are also helpful.
If major health concerns are an issue, though, many people will do better with traditional Medicare and a supplement. However, monthly costs will be higher overall. You can change plans each year, so there is that, as well.
CrispyQ
(40,969 posts)I'm not sure Kaiser doctors accept Medicare patients outside of their Advantage plan. ??? At any rate, there's so much variety from area to area that she really needs to research what's best for her. She should reach out to seniors in her area, maybe through social media sites like Nextdoor & ask what they like/dislike about their providers.
LZ1234
(270 posts)My financial guy told me to stick with traditional Medicare, apparently once you get out of Medicare and go into Advantage, it's not a given you can get back in. I remember him saying that traditional was more expensive but provided better hospital coverage and not subject to changes the same way Advantage is.
I was also reading recently on another post a couple weeks ago that Medicare Advantage was terminating some people's coverage. I would welcome some confirmation on this on whether this is true or not.
travelingthrulife
(5,179 posts)they do not reimburse costs well enough for the facility to survive. If I wanted to keep access to my excellent medical facility and my doctor I had to switch to regular Medicare, as did my husband.
Regular Medicare has been fine except they have nada for eyes, teeth and no prescription coverage (they, unfortunately, use private insurers for that part, and they pretty much suck).
dalton99a
(94,115 posts)The money she's spent on what they refused to pay far exceeds the cost of a supplement & Part D. I've seen the bills and denial letters. They refused to pay for her last hospital stay (they said the hospital shouldn't have admitted her for acute kidney failure). And before that they kicked her out of stroke rehab much earlier than regular Medicare and her daughter had to temporarily move in with her. Her doctors are disgusted. Appeals are useless. She is afraid to travel because of her network. The thing is she could easily afford a supplement at that time but now no insurer will accept her because of her preexisting conditions.
Emile
(42,284 posts)Starting January 1, 2025, many Medicare Advantage beneficiaries will face notable changes that may leave you with gaps in your coverage or increase your expenses.
Insurance carriers have stated that Medicare Advantage plans may have less coverage than before.
Response to travelingthrulife (Reply #118)
Emile This message was self-deleted by its author.
Lonestarblue
(13,479 posts)With Advantage plans, insurance company employees make the decisions on what healthcare you’re allowed to have and how it affects their profits.
With original Medicare, you and your doctor make your healthcare decisions. Medicare includes a Part A and Part B to cover hospital care, physician visits, and tests. Most people do not pay a premium for Part A since the taxes paid into Medicare are assumed to cover this expense. You will pay a Part B premium. In addition, Medicare does not cover longer-term hospital stays and some other costs. A Medigap or Medicare supplement insurance policy will cover what Medicare does not, though some things are not included such as home care or cosmetic surgery. A Part D drug insurance policy helps cover the cost of drugs. The best site for learning about Medicare is meducare.gov.
Medicare Advantage plans rolls all this coverage into one private insurance policy. Medical care is not directed by the government, other than what they will pay, for these plans. Insurance companies determine your medical treatments. They will seem cheaper because they include eye and dental exams until you get really sick, at which point you may or may not get the best treatment, especially if it is something like a costly cancer treatment.
Skittles
(171,704 posts)also, the entire purpose of "Advantage" is to eventually get rid of Medicare and turn it ALL over to private insurance
Ms. Toad
(38,635 posts)Last edited Fri Nov 1, 2024, 08:03 PM - Edit history (1)
The system is set up so that Medicare Advantage has an annual enrollment period every single year - and you can take advantage of it any year you choose to.
Traditional Medicare (Medicare + a Medigap plan) is something you can choose only on your initial entry into Medicare (age 65, for most; later if you or your spouse have a qualifying employee plan. I'm only aware of one state, Illinois, which guarantees at least one MA plan that can transition to a Medigap plan later on).
If you decide your Medicare Advantage plan isn't working for you, in most states (1) they can refuse to issue you a Medigap plan and (2) if they choose to issue you one, they can charge whatever they feel like charging - the favorable rates available at age 65 will not be available to you.
Medicare covers virtually everything eligible for coverage, without the need to pre-authorize treatment. If your doctor orders it, it is generally deemed medically necessary. There are a handful of exceptions - we have run into one of them. AND - if Medicare deems that a treatment you have been provided required pre-authorization, unlike MA plans - the medical provider will be required to eat the costs. (My spouse had eyelid and eyebrow lifts because they had gotten bad enough to limit her vision. That was recently added to the pre-authorization list. Her doctor apparently did not get pre-authorization so it was initially paid, then denied. They appealed the denial. The denial was confirmed, but as part of that decision was a direction to her doctor that my spouse did not have to pay a penny.) But - generally - if your doctor orders an MRI, you get one. If your doctor orders a CT scan, you get one. No wait for pre-authorization.
Medicare Advantage is required to cover the same stuff, BUT they are allowed to put hoops in place for you to jump through. A pre-authorization is routine, and covered procedures are often denied (with the hope that you won't appeal). Ultimate they should be covered. But many people don't bother to appeal (or their doctors won't assist them). That's not a bug, it is a design feature - it is the way MA plans were supposed to save the government money and let them offer you "free" stuff.
Medicare allows you to go to virtually every doctor or hospital in the country - and with no additional copay for being out of network.
Medicare Advantage generally has a limited network of doctors - so that even within your local area you can't see any doctor you want to see - and there are probably no network doctors in other states (so if you're a snow bird, you may be out of luck when you fly off to Florida for the winter).
Medicare has a fixed 20% copay, after a small (This year around $250) deductible. You can purchase a Medigap plan that covers all but the $250 deductible. My Medigap plan costs around $100/month. So my total costs for covered treatments for the year are fixed about $3540. I have separate dental coverage for about $228/year. I currently have vision insurance for about $108/year (I will be dropping that this year, since my spouse had cataract surgery and no longer needs expensive glasses). My drug plan has a $0 premium. So, aside from costs for prescriptions and excess costs on dental or vision - both of which will also apply to MA plans, my total spend on medical stuff (no matter how much I need, no matter where I need it) is around $3876.
Medicare Advantage plans are all over the place. You have the fixed premium cost for Medicare - around $2100. On top of that you have whatever premium your MA plan charges - an average in Ohio of $186/year. So minimum annual cost is $2286. Medicare Advantage plans permit high out of pocket caps: According to Kaiser Family Foundation - the average max out-of-pocket across all plans, weighted by enrollment, is $4,882 for in-network services and $8,707, bringing the total (aside from prescriptions and excess costs on dental or vision) to between $7168-$10,993.
So in a year you are diagnosed with cancer, need a transplant, are hospitalized more than once, etc., under traditional Medicare with a plan G supplement/Medigap plan you will be paying around $3876 - but under Medicare Advantage you will likely be paying $7168-$10,993. As a one time deal that may be manageable. But once you have a catastrophic health condition (COPD, cancer, a transplant, and a myriad of other things), you will likely spend that much each and every year. That is both why so many at age 65 find an MA plan so attractive (a premium as low as $0, and no significant expenses) AND why you aren't allowed to switch to a Medigap plan later on (in order to remain affordable without the government subsidy MA plans get, the plans have to include the full range of health statuses from 65 to death so the healthy people subsidize the sicker ones).
Just as an aside - MA plans are capitation plans. They receive a per person payment from the government (of around $12,000) each year. They way they make money is by denying services, putting up barriers to treatment, and limiting their networks. Anything left from that $12,000 goes into their pocket - so they have a financial motivation to limit your care and/or make it so difficult you will give up. In addition, MA plans can receive a higher capitation rate if their patient population is sicker - and MA plans have been routinely upgrading patient conditions to bump up their capitation rate. They've been caught - which is part of the trigger for higher rates, lower services, and fewer plans this year.
Personally - I would never have a MA plan. As we age, our health care needs tend to grow. What may look attractive to a relatively healthy 65 year old may not look so great at 90. I have personal experence with catastrophic health conditions. My daughter has a $200,000 a year condition. She struggles with her work insurance, because she has to pay not only the premiums but the total out-of-pocket max each and every year. Those caps are intended as once every several years expenditures - not as an annual spend. But as we need more health care, it can easily become an annual expense. I've got two cancers - fortunately both were relatively low cost, but the second requires costly monitoring every year for the rest of my life. There are no guarantees we will remain healthy enough for a Medicare Advantage plan to be a good choice - and once we are sick enough, chances are very high that we will be denied entry into the plan that caps annual expenses at far lower (a Medigap plan), since you have a one-time-only option to get into that system.
A good resource, once they get to comparing costs, is their state's SHIIP program. They can provide unbiased information about Medicare and the insurance (MA or Medigap) plans available in that state. (They are not licensed agents, and do not sell insurance.)
dalton99a
(94,115 posts)Last edited Sat Nov 2, 2024, 11:49 AM - Edit history (1)
https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-rate-announcement
mahina
(20,645 posts)dpibel
(3,941 posts)That's pretty amazing.
Here's a Forbes article that says the average monthly cost of Advantage in Ohio is thirty bucks, give a take a couple. https://www.forbes.com/health/medicare/medicare-advantage-in-ohio/
I realize I question you at my peril, as you do come to these celebrations well-armed.
But it did catch my eye that you pay $100 for your MediGap vs the Ohio average of $186 for Advantage. I think something's off here.
Ms. Toad
(38,635 posts)The $186 is average per year cost for MA, per kaiser family foundation.
Look at the total annual costs I've cited for each. MA is cheaper in you have no expenses beyond the premium. If you have health care costs for any significant medical condition, total costs (premium + shared medical costs) will be higher and largely unpredictable under MA.
Not to be an editor or anything, despite being an editor: I got confused when you quoted your monthly cost for MediGap and gave the $186 for MA without specifying monthly or annually.
As I said, I know you always come prepared.
Ms. Toad
(38,635 posts)I wasn't trying to be cagey - my spouse was just anxious to head out and I didn't have time to double check whether I designated the payment period for each number.
dpibel
(3,941 posts)that you were trying to be cagey.
Desert grandma
(1,076 posts)is IF your Medical Advantage plan will no longer be offering the plan in your state the next year. THEN, you can go back to original Medicare and get into a Medigap Supplemental plan without going through underwriting. The Medigap plan must accept you without regard to pre-existing conditions. Medigap supplemental plans offer various coverages. We also have the plan G, as it covers what original medicare does not, and also covers the extra fees a place like the Mayo Clinic charges. The only charge we pay is the Medicare Part B deductible. Medigap policies are rated in various ways: attained age, issue age, and community rated. The best one is "issue age rated". It does not increase yearly except if medical inflation in your region increases dramatically. Age attained increases every year on your birthday as you age. Community rated charges everyone in the community the same premium, and it can increase but not like the age attained policies. My Medigap Supplemental has increased MAYBE about $10 a month since I first got it 10 years ago. Most policies offered in a state are "Age attained", and therefore usually end up being the most expensive. There are usually only 1 or 2 at the most that are "Issue age" policies. AARP is the only community rated plan in our state. Medicare is a complicated program and Medicare Advantage Programs can be helpful to those that feel they cannot afford the cost of a Medigap supplement policy or need the dental and vision they might offer. As others have said however, they can end up being the most expensive and difficult to access the care you need. Since my hubby is a 100 % disabled veteran, I have Champ VA which covers my prescription drugs. We have our own dental and vision plans through the state of NM, the employer I retired from.
markie
(24,017 posts)I choose BCBS Plan F when I had to make the choice years ago.... have not been disappointed (except pretty expensive premiums every year)
now to decide about Plan D (drug coverage) as I do not use any prescription drugs, but concerned for the future??