Advantage Plans (private medicare) verses Medicare the gov't plan.

[Penelope]

KEY TAKEAWAYS​

• A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription) and other benefits.
• All Medicare Advantage providers must accept Medicare-eligible enrollees.
• Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses.
• Medicare Advantage customers can switch back to Original Medicare during an annual enrollment period.
• Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers.

Pitfalls of Medicare Advantage Plans

A Medicare Advantage plan may help you lower non-covered health costs, but there are definite tradeoffs compared to classic Medicare/Medigap.

www.investopedia.com

Most Medicare advantage plans have the donut hole.
Most Medicare advantage plans have 20% payment for DME and drugs you can get under Medicare for free.
You need to belong to a network. OON cost you more money.

If you want to switch back to Medicare and medigap supplement plan a supplement plan can deny you.

Once many people sign up for MA plans lost will be Medicare, which the republicans want.

It will be privatized medicines and watch them jake the prices up and changes to private Medicare.

 

[Dekster]

KEY TAKEAWAYS​

• A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription) and other benefits.
• All Medicare Advantage providers must accept Medicare-eligible enrollees.
• Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses.
• Medicare Advantage customers can switch back to Original Medicare during an annual enrollment period.
• Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers.

Pitfalls of Medicare Advantage Plans

A Medicare Advantage plan may help you lower non-covered health costs, but there are definite tradeoffs compared to classic Medicare/Medigap.

www.investopedia.com

Most Medicare advantage plans have the donut hole.
Most Medicare advantage plans have 20% payment for DME and drugs you can get under Medicare for free.
You need to belong to a network. OON cost you more money.

If you want to switch back to Medicare and medigap supplement plan a supplement plan can deny you.

Once many people sign up for MA plans lost will be Medicare, which the republicans want.

It will be privatized medicines and watch them jake the prices up and changes to private Medicare.

I was under the impression that once you took out an advantage plan you were already perma-banned from returning to traditional medicare. Seems to me that was how it was when we looked into it for my grandmother. She ended up being worse off when Medicare D was created than before because that made her ineligible for a prescription assistance program being run by a local non-profit that worked with getting low-income uninsured people prescriptions through the manufacturers at little to no costs. Her doc was insistent on keeping her on some high dollar cholesterol meds that were not covered by any Medicare D plans she could find so she basically lived in the doughnut hole most of the year. Once Medicare D came along she was no longer "uninsured" for that program's purposes.

 

[debbiedowner]

I was under the impression that once you took out an advantage plan you were already perma-banned from returning to traditional medicare. Seems to me that was how it was when we looked into it for my grandmother. She ended up being worse off when Medicare D was created than before because that made her ineligible for a prescription assistance program being run by a local non-profit that worked with getting low-income uninsured people prescriptions through the manufacturers at little to no costs. Her doc was insistent on keeping her on some high dollar cholesterol meds that were not covered by any Medicare D plans she could find so she basically lived in the doughnut hole most of the year. Once Medicare D came along she was no longer "uninsured" for that program's purposes.

CMS says if you are a first timer in an MAPD plan you have, so to speak a 12 month free look and anytime in that time period can switch back to original Medicare and almost all insurance companies in that time period have to guarantee you a Medicare supplement, after that time period yes you can be turned down for a supplement.

Patient drug assistant programs all work different, some will say if you have Part D you cannot receive any assistance and then there are some who don't care and will continue assistance.

 

[Dekster]

CMS says if you are a first timer in an MAPD plan you have, so to speak a 12 month free look and anytime in that time period can switch back to original Medicare and almost all insurance companies in that time period have to guarantee you a Medicare supplement, after that time period yes you can be turned down for a supplement.

Patient drug assistant programs all work different, some will say if you have Part D you cannot receive any assistance and then there are some who don't care and will continue assistance.

I always thought it was ridiculous that she couldn't get coverage for some name-brand prescriptions yet what she (as in mostly me) paid for them still counted against her to throw her into that idiotic doughnut hole. I am glad they have at least effectively done away with that for seniors. She is dead now so not a problem I've had to deal with since.

 

[debbiedowner]

I always thought it was ridiculous that she couldn't get coverage for some name-brand prescriptions yet what she (as in mostly me) paid for them still counted against her to throw her into that idiotic doughnut hole. I am glad they have at least effectively done away with that for seniors. She is dead now so not a problem I've had to deal with since.

If a drug is not covered under the plan it can't possibly send you to the donut hole because the insurance company is not paying anything towards that drug nor you a co pay.

 

[Dekster]

If a drug is not covered under the plan it can't possibly send you to the donut hole because the insurance company is not paying anything towards that drug nor you a co pay.

I said she couldn't get coverage. I did not say that there was no circumstance under which the drug would be covered. I cannot recall of it was a tier 3 or specialty tier under her plan, but he doctor refused to switch her to another medication and wouldn't help her try to get an exception for it.

 

[Penelope]

I was under the impression that once you took out an advantage plan you were already perma-banned from returning to traditional medicare. Seems to me that was how it was when we looked into it for my grandmother. She ended up being worse off when Medicare D was created than before because that made her ineligible for a prescription assistance program being run by a local non-profit that worked with getting low-income uninsured people prescriptions through the manufacturers at little to no costs. Her doc was insistent on keeping her on some high dollar cholesterol meds that were not covered by any Medicare D plans she could find so she basically lived in the doughnut hole most of the year. Once Medicare D came along she was no longer "uninsured" for that program's purposes.

If you're not in a trial period the supplement can do underwriting on you and possibly deny you.

They are pretty fussy in advantage plans and if you drug in not found in the formulary you are not getting it. Also, you belong to a network so you have to go to a dr. on their network or is you're OON you get to pay more.

Supplement plans you can go anyway in the 50 states and to a doctor of your choosing, even a specialist.

 

[debbiedowner]

We all know you don't like Medicare Advantage plans. All plans cover you anywhere in the U.S. for emergencies regardless and many have networks all over the U.S.

When it boils down to a supplement plan almost costs you nothing out of pocket I don't think most people look at their premium for Part B, supplement and Part D which will be in 2022:

Most will pay $170.10 per month for Part B = $2041.20
Medicare supplement depending what state and what plan on an average will cost you approximately $2400 for 2022.

Let's use the national average for Part D which is approximately $33 x12 + $396 next year.

Grand total for Part B, supplement and Part D 2022 = $4441.20 for 2022

Most Medicare Advantage plans, yes you are still paying Part B premium of 2041.2, many plans no premium and max out of pocket anywhere from around $2000 to $6500. So all in all it does not really matter which way you go. Exception HMO's because most don't have coverage outside your immediate service area.

 

[Greenbeard]

We all know you don't like Medicare Advantage plans. All plans cover you anywhere in the U.S. for emergencies regardless and many have networks all over the U.S.

Medicare Advantage plans are okay, such as they are. Their biggest problems are:

1) They're obviously marketed to old people, many of whom don't necessarily have the cognitive wherewithal to shop for these kinds of products. And there are so many options that some degree of choice paralysis sets in anyway and even a savvy shopper (which, again, may be asking a lot here!) would not necessarily be able to tease out which option best meets their needs and preferences.

Why Aren’t More People Comparison Shopping for Health Plans? (Published 2021)

Most Medicare beneficiaries don’t compare plans during open enrollment season, and may be paying more, or accepting more restrictions, than they should.

www.nytimes.com

2) One of the selling points of letting these private plans compete with traditional Medicare is that this is supposed to save us money. That has not been the case.

Back when the private plans were being vastly overpaid the ACA stepped in to offer some correction, to the point that now they're hovering around just "somewhat overpaid." But they've never actually been as cheap as or cheaper than simply enrolling all old folks into traditional Medicare.

3) On a somewhat related point, the private sellers game the system. Pretty extensively, by the look of it. Which again drives up spending on the private plans.

Why Medicare Advantage Plans Are Being Overpaid By $200 Billion And What To Do About It


The dark side of privatizing Medicare!

 

[debbiedowner]

Medicare Advantage plans are okay, such as they are. Their biggest problems are:

1) They're obviously marketed to old people, many of whom don't necessarily have the cognitive wherewithal to shop for these kinds of products. And there are so many options that some degree of choice paralysis sets in anyway and even a savvy shopper (which, again, may be asking a lot here!) would not necessarily be able to tease out which option best meets their needs and preferences.

Why Aren’t More People Comparison Shopping for Health Plans? (Published 2021)

Most Medicare beneficiaries don’t compare plans during open enrollment season, and may be paying more, or accepting more restrictions, than they should.

www.nytimes.com

2) One of the selling points of letting these private plans compete with traditional Medicare is that this is supposed to save us money. That has not been the case.

Back when the private plans were being vastly overpaid the ACA stepped in to offer some correction, to the point that now they're hovering around just "somewhat overpaid." But they've never actually been as cheap as or cheaper than simply enrolling all old folks into traditional Medicare.

3) On a somewhat related point, the private sellers game the system. Pretty extensively, by the look of it. Which again drives up spending on the private plans.

Why Medicare Advantage Plans Are Being Overpaid By $200 Billion And What To Do About It

The dark side of privatizing Medicare!

You're right it does cost CMS about 13% more than traditional Medicare.

It's only marketed to someone on Medicare Part A & B.

I also agree there are many crooked insurance agents out there that take advantage of many senior's. The honest agent would ask if there is someone in the family that can sit in and listen to his/her pitch.