OT: Medicare Advantage Plans

[Sheriff Buford]

Ok... I guess I'm becoming an ole' geezer! I have started researching the Medicare debacle. I see advertisements saying their Advantage plan is better than anybody else's. I trust you folks immensely. Tell me what plan you use and the plusses and minuses of your plan. Thanks for everything!

I also remember seeing here years back that when you go on Medicare, they require yo to do another sleep test. Is that true?

Sheriff

[LSAT]

I have had the AARP United Health Care Plan for 10 years. Obviously we have been happy with it or we wold have switched. The Plan has Co Pays for most items. Plans vary by state.....We currently pay $10 for primary care visits..$35 for Specialists....There is a dental benefit and an eye care benefit. DME supplies costs 20% of the negotiated rate...Most RX are free for Generic Drugs... Using the Advantage Plan eliminates the need for a Medicare Supplement and a Drug Plan. The advantage Plan uses our Part B benefit plus costs us $27 mo each.

[Pugsy]

I also remember seeing here years back that when you go on Medicare, they require yo to do another sleep test. Is that true?

NOT true. But it does depend on the type of sleep study done to get you the diagnosis. Medicare will require records and if the sleep study doesn't meet the diagnostic criteria then they will want a new study. Most sleep studies done within the last 10 years or so will meet that criteria..even a home study unless it was a pulse ox on the finger only study. So in most cases Medicare will NOT require a new sleep study. They don't want to pay for anything unless they just have to. It all depends on the level of criteria used on the old sleep study and if you still have access to that report.

Medicare Advantage plans vary by state and county sometimes so my plan information would be useless for you unless you were my neighbor....hey, the house down the road from me is up for rent...wanna move?

You have to look closely at the plans available where you live...some are local or state and some are national like the Plan that LSAT uses through AARP. There are pros and cons with all of them.
Be very careful....with some plans a cpap machine is no longer a purchase item but instead a perpetual rental thing. Big PITA. Costly PITA. This can change every year.
Masks and other stuff...still purchase and all you owe is the 20% of the Medicare approved amount.

You can save a lot of money using a advantage plan if you are basically health and willing to take a bit of a risk that you won't ever be in a situation where you will have big out of pocket items (like a hospital stay).
You give up your Medicare coverage with the advantage plan and the money that comes out of your social security check for medicare goes to the insurance company and not the government. That company then becomes your insurer and for the most part they normally follow Medicare's usual guidelines for approving stuff and how they pay...your portion for part B stuff is normally 20% of the Medicare approved amounts and they normally go by the fee schedule that medicare sets for goods and services. When it comes to cpap stuff...the machine and the perpetual rental thing is the biggest drawback. They don't all do it but a good many do and they can change each year if they wish.

Oh...all those perks that Joe Willie is hyping....look closely because there are always little hidden caveats in small print.
Deductibles and maximum allowance kind of things. They really aren't that good of a deal. Yeah...they pay for dental after a 35 deductible up to maybe 200 total per year...or for eyeglasses..yeah after a deductible up to maybe 250 a year...that sort of thing.
So you have to look hard at what they actually will pay and they all vary.

But you can save money with them as long as you accept a little risk in turn for having either zero monthly added cost (remember they are already getting the money coming out of your social security check).
The biggest negative...what it would cost you in the event of a hospital stay...that's where they get you.
Little doctor copays...and specialist co pays...we can handle.
Yesterday I had to see a specialist...hand problem so orthopedic...45 co pay....got a joint injection which I haven't yet got the bill for but probably 20% of some allowed amount...last time I got one in my shoulder it was around 20 bucks my portion.
When I go see my PCP...$5 a visit this year...last year it was no co pay. Who knows what it will be next year.
I pay nothing each month for my advantage plan...it's sort of a HMO kind of plan as I have a network to stay in which is fine with me as all of my doctors are within my network. If something should happen when I go to Vegas to see the daughter...there is a provision for that kind of stuff.
It also includes medications...got my pain pills and blood pressure pills a couple of days ago...a months worth...$6 total. That was nice because my old advantage plan had my pain pills on a different tier level and cost me 36 a month.

So you have to do a lot of research...what each covers and doesn't and what your potential out of pocket might be as well as medication schedules.

[chunkyfrog]

Advantage plans are heavily advertised.
They are run by private companies--FOR PROFIT.
The money has to come from somewhere.
I am suspicious of what they DON'T say.
Very suspicious . . .

[Pugsy]

Advantage plans are heavily advertised.
They are run by private companies--FOR PROFIT.
The money has to come from somewhere.
I am suspicious of what they DON'T say.
Very suspicious . . .

Of course they are for profit. It's the good old American way....Those regular Medigap policies...the alphabet plans...guess who owns them...private insurance companies and they are in it for the profit as well. They charge you premiums monthly so that they can pay the part that straight Medicare doesn't pay for health costs. They are banking on people paying premiums each month and they don't have to pay out as much as they take in with the monthly premiums. They are no different at all than the private companies who sell Advantage plans.
Those alphabet plans...they have limitations and exclusions as well...they all do.
People have to educate themselves on the pros and cons of going either way.
They have to take the time to read the fine print on all of them and then decide what works best for them.

You have a regular Medigap supplement don't you? Did you ever stop to think that whomever it is with...it's a private company...they all are or are underwritten by a private company.

[chunkyfrog]

The restrictions of advantage plans are not easily discovered--until it is too late.
Providers and procedures are limited in many places.
If I could be sure not to lose key items--CGM, effective, safe insulin in pens.
My tremor is worsening, so these things are a MUST.
I could not even write on my grandson's birthday cake.

[LSAT]

The restrictions of advantage plans are not easily discovered--until it is too late.
Providers and procedures are limited in many places.
If I could be sure not to lose key items--CGM, effective, safe insulin in pens.
My tremor is worsening, so these things are a MUST.
I could not even write on my grandson's birthday cake.

Do you have one of these plans?..If not, don't comment on something you know nothing about.

[chunkyfrog]

The restrictions of advantage plans are not easily discovered--until it is too late.
Providers and procedures are limited in many places.
If I could be sure not to lose key items--CGM, effective, safe insulin in pens.
My tremor is worsening, so these things are a MUST.
I could not even write on my grandson's birthday cake.

Do you have one of these plans?..If not, don't comment on something you know nothing about.

Since changing over would be permanent, with no changing back, I need more information.
To do so uninformed, could be disastrous.
I have heard of such limitations causing harm.

[LSAT]

The restrictions of advantage plans are not easily discovered--until it is too late.
Providers and procedures are limited in many places.
If I could be sure not to lose key items--CGM, effective, safe insulin in pens.
My tremor is worsening, so these things are a MUST.
I could not even write on my grandson's birthday cake.

Do you have one of these plans?..If not, don't comment on something you know nothing about.

Since changing over would be permanent, with no changing back, I need more information.
To do so uninformed, could be disastrous.
I have heard of such limitations causing harm.

You are allowed to change back each year
https://www.medicare.gov/sign-up-change ... ntage-plan

[Pugsy]

Since changing over would be permanent, with no changing back, I need more information.
To do so uninformed, could be disastrous.
I have heard of such limitations causing harm.

I don't know who you are getting your information from but it's totally wrong. You can opt in or out of Medicare every fall during open enrollment and in some situations even after that.
Medicare does allow it...we just last year was in a situation with my mom where her advantage plan hadn't renewed their contract with her preferred doctor/hospital network by the end of open enrollment and it was still in negotiation. My insurance agent showed me in the rules where Medicare would allow her to opt back in to Medicare if we needed to up until March 1. Luckily the hospital group and the plan came to an agreement and they stayed in network the first of Feb.

Yes...some advantage plans work like HMOs...some work like PPOs...some have no restrictions at all.
Everything is well explained in the coverage book though.
That's why I tell people to do their homework. It's not that hard.

So you can opt in or out of Medicare as often as you want to within the open enrollment time frame and under special circumstances can even do an appeal and change after open enrollment ended.
You can change advantage plans every year if you want to...during the open enrollment period...that's what it's there for. People do it all the time. In 11 years I have had 4 different advantage plans.

[chunkyfrog]

To change from advantage back to a supplement, I would face UNDERWRITING.
This may not be the case everywhere, but in good ole Nebraska, it is.
With diabetes, OSA, and a history of CANCER, the bean counters have a party--in Hawaii!
I would likely have to go on Medicaid.
Local stories are grim.

[Pugsy]

To change from advantage back to a supplement, I would face UNDERWRITING.
This may not be the case everywhere, but in good ole Nebraska, it is.
With diabetes, OSA, and a history of CANCER, the bean counters have a party--in Hawaii!
I would likely have to go on Medicaid.
Local stories are grim.

Hmmmm....In Missouri there are supplements that don't do any underwriting at all during open enrollment.
It is entirely possible that in Nebraska they do...obviously I have no way to check it out.
The only thing that monkeys up things is the end stage kidney failure question...that will put up a red flag but it is also a flag on changing to an advantage plan.

And you are past the 5 year mark....which should account for something.

When is the last time you checked on any questions as to medical history on a supplement?

Do you want to change to an advantage plan? If you don't...then don't but maybe not be so quick to tell people they are crap when they aren't.

[chunkyfrog]

I spoke with a SHIIP rep earlier today on the phone.
In my case, an advantage plan would be more costly than what I have now.
Of course, YMMV. (Your mileage may vary.)
People without costly medical needs can do very well with an advantage plan.
Insurance is always a gamble--but the "house" has all the numbers.

[Sheriff Buford]

Thanks for yall's response. Good discussion. I'm trying to educate myself each day. Geez.... what a nightmare. I learned yesterday that Plan G would pay for the deductibles and if I signed up for the the plan G six months before the month I turn 65, my pre=existing conditions would not be a factor. Also...,. the info I was looking over stated to stay away from the Advantage plans.... so I will look closer at the Advantage plans.

- where does Medicare cover the cpap costs?

Sheriff

[NoOnesPerfect]

CPAP is covered under Part B, which seems a bit weird to me.

You can’t sign up 6 months prior - the sign up period is 3 months prior, plus the month you turn 65, plus another 3 months. You can sign up any time during that period and not have to worry about pre existing condition status.