OT... YouTube 'Medicare School'

[Grumpy48]

There are likely other channels on YouTube that explain Medicare and insurance options, but I found the videos on this particular channel very well presented and may be of help to those coming onto Medicare or already enrolled in the decision making for an Advantage plan or a supplement, as well as a drug plan. Note that the presenter does work for an insurance company and he does mention this occasionally. I don't believe this biases his presentations, but you may have a different opinion.

https://www.youtube.com/@MedicareSchool

[CPAP-A-MUST]

I’ve watched his videos and learned a lot. So much so I am in the middle of making a major change in my Medicare supplemental plan. My neighbor referred me to their Medicare insurance people and boy oh boy what a GREAT experience. Will be saving $872/year going from a Plan F to a Plan G. The Plan G is the same as Plan F except for the Part B deductible which isn’t that much.

[ChicagoGranny]

I might need to watch some of those videos. I have a Medicare Advantage plan. The premiums are zero. There is a dental benefit included that pays fully for two cleanings per year and has some decent dental work benefits. My gym membership is fully paid for. Also, I get $125 per quarter to cover OTC health, and the category of products included is broad. It pays 100% of an annual eye exam plus $300 toward eyeglasses.

How does the insurance company do this? Da gubmint is paying (overpaying) them handsomely. Medicare pays more per patient for Advantage Plan members than it does for Medicare participants. You can find a 60 Minutes segment about this ripoff.

[Sheriff Buford]

I might need to watch some of those videos. I have a Medicare Advantage plan. The premiums are zero. There is a dental benefit included that pays fully for two cleanings per year and has some decent dental work benefits. My gym membership is fully paid for. Also, I get $125 per quarter to cover OTC health, and the category of products included is broad. It pays 100% of an annual eye exam plus $300 toward eyeglasses.

How does the insurance company do this? Da gubmint is paying (overpaying) them handsomely. Medicare pays more per patient for Advantage Plan members than it does for Medicare participants. You can find a 60 Minutes segment about this rip off.

It's a big business. The Medicare Advantage plan companies are for profit and get paid handsomely for each participant. That's how they can pay for those annoying commercials on TV. They also pay people to put up card tables and the local supermarket to sign up new members.
Before signing up, make sure you see if a local hospital takes the advantage plan policy. The man next door to me has to see a cardiologist and has to travel 60 miles to the closest doctor that takes the plan he' on. He says he's stuck because he doesn't like the doctor, but doesn't have a choice. I have found the Advantage plans are ok until you get sick. That's when you have to go t6o the hospitals that take the plan, deal with referrals, etc....

Sheriff

[SleepGeek]

Medicare pays more per patient for Advantage Plan members than it does for Medicare participants. You can find a 60 Minutes segment about this ripoff.

link please ?

[chunkyfrog]

. . .
link please ?

Broken record.

[CPAP-A-MUST]

With advantage plans look closely at what you Part A out-of-pocket is. My husband has an advantage plan with the maximum out-of-pocket of $8K…Plan G is zero for Part A and Part B is the annual deductible $230 or so.

[Janknitz]

. . .
link please ?

Broken record.

Sleep Geek is right with respect to the fact that Medicare pays more to Advantage Plans than to traditional Medicare. The reason is that Advantage plans are "capitated"--in other words, they pay per "life" or "head" every month, regardless of need, while traditional Medicare pays out a set fee based on the diagnostic code, so the higher acuity, the higher the Medicare coverage (a modified sort of fee for service). The theory behind this is that ultimately if most people are on an Advantage plan it will save money for Medicare because Advantage plans have a great incentive to prevent complications and maintain health. Medicare keeps sweetening the incentives for Advantage plans to get more people to sign up (delivered meals after hospitalization, gym memberships, dental care). Therefore, once more people are stuck on Advantage plans, Medicare can gradually cut back on payment per capita.

Great theory, lousy execution. I live in an area where a large self-contained HMO has approximately 80% of the Medicare market (they've sucked up so much of the market, it's nearly impossible to get a Medicare doctor outside of this HMO). They do OK for some things, but as people age (this is the population I work with) they are really getting the short shaft. They consider dementia to be a "social issue, not a medical one" and basically abandon the care of elderly people who have multiple diagnoses. They try very hard NOT to pay for skilled nursing care when it's absolutely warranted (even when it turns out to be penny-wise and pound-foolish for them). Medicare has rules about coverage and what they must cover, but they get away with totally ignoring these rules, aided and abetted by "quality improvement organizations" (agencies to appeal their Medicare decisions) that work in lockstep with them. And when appeals are necessary, people are generally in crisis and not up for a fight--they take total advantage of that. They treat people like numbers and practice cookie cutter medicine. Their primary doctors are harried because they are expected to spend no more than 12 minutes per patient. Even the good ones have their hands tied when certain treatments would be best but aren't "the protocol" of this HMO. It takes vigorous advocacy, especially for elderly people. My youngest daughter has some physical disabilities, and I had to appeal many times because they tried not to pay for things they were contractually obligated to provide. It's always about the bottom line with them.

As for "The Medicare Advantage plan companies are for profit", some are TECHNICALLY non-profit. They do rake in the money, but they are good about investing in infrastructure and equipment, salaries are the best around. I just wish they would put some of that money into training a little more humanity in to their system.

I'm not complaining about the people. Most are great--there have been some really bad apples, but that's in every system. And I get that they need to keep their jobs, so they must toe the line. But their systems turn you into a number and I hate that. I'm sick to death of them checking off their boxes instead of paying attention to the person in front of them.

[ChicagoGranny]

I have found the Advantage plans are ok until you get sick. That's when you have to go t6o the hospitals that take the plan, deal with referrals, etc....

I've heard that. Fortunately for us, the three area hospitals and their clinics are in-network as are my other doctors. Gramps had a specialty procedure at an out-of-network provider, and we were prepared to pay the out-of-network charges. Surprise! When the EOB came, our insurance carrier declared the claim in-network because they had no one in their network who did that procedure. We didn't even have to ask!

With advantage plans look closely at what you Part A out-of-pocket is. My husband has an advantage plan with the maximum out-of-pocket of $8K…Plan G is zero for Part A and Part B is the annual deductible $230 or so.

Good point. We started out with a $7000 maximum annual out-of-pocket per person. Should both of us get bad chronic illnesses, we could afford it. We just told the kids it would come out of their inheritance. The insurance carrier continues to lower the maximum annual out-of-pocket. It's now down to $3500. Easy peasy. Thank you, just charge it to the taxpayers and the national debt!

Therefore, once more people are stuck on Advantage plans, Medicare can gradually cut back on payment per capita.

I don't subscribe to this idea. Congress is heavily lobbied by the insurance companies and will not let Medicare do this. Crooks abound!

[chunkyfrog]

So many variables are linked to where you live.

[booksfan]

I have found the Advantage plans are ok until you get sick. That's when you have to go t6o the hospitals that take the plan, deal with referrals, etc....

I've heard that. Fortunately for us, the three area hospitals and their clinics are in-network as are my other doctors. Gramps had a specialty procedure at an out-of-network provider, and we were prepared to pay the out-of-network charges. Surprise! When the EOB came, our insurance carrier declared the claim in-network because they had no one in their network who did that procedure. We didn't even have to ask!

Hubby had to have eye surgery this summer (not cataract). Surgeon was in-network, but the out-patient surgery center and the hospital he used as an alternative were not (we have multiple hospitals in our area). His Medicare Advantage plan approved a prior authorization and then paid as if it were in-network. I was afraid we would have to start the process over again with another surgeon but have to ask BEFORE making the initial appointment where they operate...and, realistically, who thinks of doing that?!

[ChicagoGranny]

then paid as if it were in-network

Well, there you go! You got the results you wanted.

I'm not promoting Advantage plans. Everyone has to study their particular situation and the plans available. A broker who sells multiple lines can help. But, people need not rule out Advantage plans without investigating.

[bwexler]

I have been on Advantage plans for 13 years and have had several significant out of pocket expenses, Totaling close to one third of what my Medigap premiums likely would have been.

[ChicagoGranny]

I have been on Advantage plans for 13 years and have had several significant out of pocket expenses, Totaling close to one third of what my Medigap premiums likely would have been.

If they were only one-third of what your Medigap premiums would have been, why do you consider them significant? Maybe the significance was the nice amount of money you saved with Advantage vs. Medigap?

[bwexler]

If they were only one-third of what your Medigap premiums would have been, why do you consider them significant? Maybe the significance was the nice amount of money you saved with Advantage vs. Medigap?

The total is over $9,000. I consider that significant.
I agree the premium savings was MORE significant. That is why I am still on an Advantage plan.

Prior to Medicare I was uninsured for over 40 years.
When I had cancer my cost was $35,000. I was still ahead compared to paying insurance premiums for 40 years and seldom meeting the typical $1,000 deductible.