OT:::::Medicare Advantage plans "are taking over Medicare and they are taking advantage of elderly patients,"

Well......my Humana plan (zero premium) is paying for some dental work I was unfortunate to need to the tune of a little over 2400 bucks. My copay....zero.

My meds are zero copay for the most part.
I have one special med that is really costly retail like over 500 a month and I pay 47. It will last me 3 or 4 months.

Paid nothing out of pocket with my recent bout with parotitis and vertigo and 3 office visits for it.
One of the meds for my vertigo was a grand total of $0.67....yep less than a buck.

My worst ever year in terms of out of pocket costs with an advantage plan had me paying a little over 700 bucks.
That was the worst and that's when I broke my wrist and had to have pins put in it. Surgery big time.
Most years I rarely had out of pocket costs more than 100 bucks.

I am WAYYYYYYY ahead and a happy camper.
I got Medicare prior to age 65....medicare supplements cost those of us like me well over 300 a month.
Do the math....duh.

SleepGeek wrote: ↑

Wed Dec 20, 2023 8:44 pm

Ever notice those who claim to be "way ahead" or "be happy" never volunteer what MA plan they are using?

And IMHO IF you travel an HMO type plan is not the one to have.
Of course I don't like an HMO even when not traveling.

Didn't know that mentioning the plan was needed but here ya go since it seems important to you...Humana Gold Plus...from someone who has been "very happy" on their MA plan. So many things covered that I did not have covered with previous insurance plans. What they have covered this year is more than I've paid out for the Medicare required premiums. (There is no premium cost for the Humana plan; just the required Medicare premium for I believe it's Part B.)

For my me and my husband, our Humana Gold Plus (HMO) Medicare Advantage plan fits our lifestyle (little travel), our health needs, and our pocketbook. It's an HMO, so need network medical, but so did the last plan I had, and the one before that, so nothing new or inconvenient for me. Also, this Humana Gold Plus HMO Medicare Advantage plan does not require referrals.

SleepGeek wrote: ↑

Wed Dec 20, 2023 8:44 pm

lazarus wrote: ↑

Wed Dec 20, 2023 7:53 pm

Seems like a relatively balanced overview/comparison?

Ever notice those who claim to be "way ahead" or "be happy" never volunteer what MA plan they are using?

I am about to start my fourth year with Alignment Health Plan in San Diego County.
One reason not to mention the MA plan name is they offer different benefits in different counties/states, and deferent plans for individuals with different needs. On a national or international forum like this, naming the company is almost meaningless without so much more detail, no one would be able to follow it anyway. It would be like saying I bought a Ford or a Toyota without mentioning the model or trim or year.

If I were on straight Medicare I would have a 20% copay plus a $224-$240 deductible.
If I had a Medigap supplement plan I would have a $200+ monthly premium.

My out of pocket for items I chose to pay cash for rather than hassle insurance has been ~$13000, or an average of $1,000 per year.
The premiums on Medigap would have been more than $1200 plus $224 deductible per year.

This has probably been mentioned before but......
Medicare Advantage plans are great for SOME people, not so much for others.
First and foremost I am willing to pay for the right to go to the doctors I choose, based on my needs and convenience: A pulmonologist, a retinal surgeon, electrophysiologist, vascular surgeon, ophthalmologist, ENT, PCP, Gastroenterologist, dermatologist, etc

I went down the managed health care road many years ago, and was sadly distressed when my PCP and his partners decided to abandon the HMO that I'd been using for years leaving me high and dry.
So, I took charge of selecting doctors myself based on recommendations, reliability and competence , rather than letting the "insurance company" determine where I could go.

Have I saved money or lost money by using traditional Medicare and a G supplement, I don't know. But being satisfied that my health care needs were being met to MY satisfaction is far more important to ME than the financial aspect.

I understand that some people, because of finances, have to relinquish the freedom to make their own choices of care givers.

Traditional Medicare suits me just fine.

dataq1 wrote: ↑

Thu Dec 21, 2023 3:26 pm

First and foremost I am willing to pay for the right to go to the doctors I choose

Nearly all the doctors, hospitals, and dentists in my area accept my MA plan. No referral is required. Gym benefit, vision, dental and $125/quarter for OTC. Even toothpaste is covered!

That fine for you and in your zip code, some of us are not as fortunate.

dataq1 wrote: ↑

Thu Dec 21, 2023 6:08 pm

dataq1

Read the subject line in your comment. I'm staying in context.

ChicagoGranny wrote: ↑

Thu Dec 21, 2023 5:30 pm

Nearly all the doctors, hospitals, and dentists in my area accept my MA plan. No referral is required. Gym benefit, vision, dental and $125/quarter for OTC. Even toothpaste is covered!

That’s fine for you and in your zip code, some of us are not as fortunate.

bwexler wrote: ↑

Thu Dec 21, 2023 2:41 pm

One reason not to mention the MA plan name is they offer different benefits in different counties/states, and deferent plans for individuals with different needs.

BINGO. Which is why it's important to share those details with the reader.

IF you read here much you will also notice that those who don't want to go to another Dr to meet insurance requirements -then elect to Pay-Out-Of-Pocket are on unknown MA HMO plans.

IF the reader is wanting the same deal how will they ever find it?

dataq1 wrote: ↑

Thu Dec 21, 2023 6:48 pm

ChicagoGranny wrote: ↑

Thu Dec 21, 2023 5:30 pm

Nearly all the doctors, hospitals, and dentists in my area accept my MA plan. No referral is required. Gym benefit, vision, dental and $125/quarter for OTC. Even toothpaste is covered!

That’s fine for you and in your zip code, some of us are not as fortunate.

Indeed, my brother (Anthem Advantage in Northcentral PA) has to travel 95 miles one-way to see his MA electroguy.

From above: "and deferent plans for individuals with different needs"

Yea, he didn't know that he would need an electrophysiologist Until after Dec 7 2022, to late to see about any alternate plans

ChicagoGranny wrote: ↑

Thu Dec 21, 2023 5:30 pm

dataq1 wrote: ↑

Thu Dec 21, 2023 3:26 pm

First and foremost I am willing to pay for the right to go to the doctors I choose

Nearly all the doctors, hospitals, and dentists in my area accept my MA plan. No referral is required. Gym benefit, vision, dental and $125/quarter for OTC. Even toothpaste is covered!

Same foir me as Granny. I have never wanted to go to a specific PCP, specialist, dentist, etcetera that was not in my network. No referrals needed either, even through it's an HMO. My husband and I each get $100 a quarter for OTC from a catalog, and $50 a month each on a card that can used in stores for groceries, medical-related stuff, and even to pay utility bills. And it rolls over from month to month if it's not completely used up each month. Also that free gym membership thing Granny mentioned. So related to the OP topic, for me and my husband, MA is not taking advantage of us; just the opposite.

dataq1 wrote: ↑

Thu Dec 21, 2023 3:26 pm

This has probably been mentioned before but......
Medicare Advantage plans are great for SOME people, not so much for others.
First and foremost I am willing to pay for the right to go to the doctors I choose, based on my needs and convenience: A pulmonologist, a retinal surgeon, electrophysiologist, vascular surgeon, ophthalmologist, ENT, PCP, Gastroenterologist, dermatologist, etc

I went down the managed health care road many years ago, and was sadly distressed when my PCP and his partners decided to abandon the HMO that I'd been using for years leaving me high and dry.
So, I took charge of selecting doctors myself based on recommendations, reliability and competence , rather than letting the "insurance company" determine where I could go.

Have I saved money or lost money by using traditional Medicare and a G supplement, I don't know. But being satisfied that my health care needs were being met to MY satisfaction is far more important to ME than the financial aspect.

I understand that some people, because of finances, have to relinquish the freedom to make their own choices of care givers.

Traditional Medicare suits me just fine.

I’m the same way, I want the choice to go where I want to go. The Medicare advantage plans seems more like updated or more a modern version of HMOs where you must stay within a network of doctors.

I was the financial caretaker for my parents and my mother in law for several years before their deaths. They were all in the 80s-90s. Every year I would have to explain over and over why they might not do well on the Medicare Advantage programs that they saw on TV relentlessly.
The message that they got from the TV ads was "healthcare is free, free, free !" All through Oct and November all they remembered was FREE, and occasionally they even caught the "we may even send you money".
So as the dutiful son, I checked it out and made the calls. Now they were living in a big city, with several hospitals. As it turned out each hospital was associated with a different Advantage plan. And when I found a plan that their favorite hospital participated in, it turned out that their doctor(s) were either not in that plan or did not have privileges at "their" hospital.
For three years running I probably was on the phone each fall checking and crosschecking for hours and hours and hours with various insurance companies or insurance brokers trying to get the freebies (as I called them)

When I stop and consider the time and effort that I ,as a reasonably smart 45 year old, I came to the realization that expecting an 83 year old to do this every year on their own was verging into elder abuse. That was really driven home when I, in going over my Dad's doctor bills (original Medicare) found that the doctor's billing service had made a mistake. After talking with the billing service, then the doctor's office, then the billing service again to straighten out a 25 dollar overcharge, my Dad flew into a rage and said to me " just pay the f'ing bill my time is too short to be wasting it with this crap.

Now, I'm not necessarily accusing that insurance companies do this on purpose (denying treatment, changing reimbursement schedules, or switching up network providers" to make more money, but it sure seems abusive to elderly folks who don't have someone to go to bat for them.

LordAlmightyLord137 wrote: ↑

Thu Dec 21, 2023 11:11 pm

After talking with the billing service, then the doctor's office, then the billing service again to straighten out a 25 dollar overcharge, my Dad flew into a rage and said to me " just pay the f'ing bill my time is too short to be wasting it with this crap.

He's right, you know? I have a friend who will go to customer service to get a two-dollar refund on an overcharged item in a buggy of $200 worth of groceries.

Your HMO may not cover the best procedures:

Given all the freebee available on some Advantage, it's got to make you wonder how these are paid for. (freebee example: groceries mentioned earlier, gym memberships etc).

Assuming that the government medicare (original or traditional medicare) is administered efficiently and effectively , how is it that Advantage programs can offer the same care AND groceries etc for the same premimum (currently 165.00/month).

So, under the Advantage plans, the government sends 165/month of your SS benefits to a commercial insurer... hereupon that commercial insurer is providing you with same or better healthcare coverage AND groceries. That really doesn't make sense - either the government medicare plan is gouging people and making a profit OR the commercial insurance is not really providing the same or better healthcare coverage.

Ever notice that Traditional Medicare doesn't seem to spend $ on advertising, but commercial Advantage insurers sure do. Literally thousands of TV ads in the fall. The commercial insurer pays for all of that. Where does that money come from - out of your 165/month. If it is spent on advertising, it can't be available for your health care.