Pitfalls of Medicare Advantage Plans

Penelope

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
 

Mac1958

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
Medicare Advantage Plans are essentially like the PPO or HMO plans people have through their jobs. Many of them have a $0 monthly premium, so it's more "pay as you go, if you go". And they include the Prescription Drug Plan and other benefits, like health club memberships.

Medicare Supplement Plans cover everything but cost much more and you have to add the drug plan. So you're paying $200 to $300 per month whether you need it or not, but you have better coverage when you need it.

So it's a choice that seniors have, in terms of their budget and their health. This is what I think we should all be covered by, with some tweaks. Solid foundational coverage by the base Medicare plan, combined with market choice, competition and innovation. We should all have this. They would also be portable, and take a massive cost monkey off the backs of American employers.
 
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Penelope

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Being on Medicare is not what its cracked up to be.
 

RightNorLeft

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.

I have several friends on Advantage plans and most have no issues, I believe it greatly depends on which one you choose. Those that have zero copays or monthly premiums are not going to cover those that have copays and small monthly premiums.

From my understanding from more than just a couple that have it...Freedom is the best in florida, no copay and no premiums, you are restricted to certain practioners but those that have it seem to really like it.
 

TheParser

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
 

dblack

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."
You should be tickled pink then, because the state is hell bent on taking over health care the US. It's just getting too hard to run a war without it.
 

debbiedowner

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
The article is very misleading. First if you're in a skilled nursing facility whether on an under 65 plan, original Medicare, MAPD when you have either reached a certain point or have shown no improvement you're going to be kicked out. On original Medicare they also have to report progress. If you're there past day 100 that is when you pay 100%.

Diabetic supplies are covered regardless of MAPD under Part B of Medicare and are free.

If you're not in your first 12 months of MAPD and decide to go back to original Medicare there are going to be health questions and medical underwriting and you can be denied.

I don't know anywhere in Florida that care is rationed.

Those are just a couple things wrong with this article.
 

debbiedowner

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
Those young people if they bring up Medicare Advantage plans on a cold call you did not request are very much breaking the law and need to be reported.
 

debbiedowner

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
One or the other is not a perfect fit for everyone when I decided in 2013 on Medicare Advantage I weighed how much a supplement would cost and Part D premium's in a year vs the max out of pocket of the plan and at that time just about even except for co pays I would have paid. The most in any one year I have paid out of pocket in 8 years is $2300
 

TheParser

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
Those young people if they bring up Medicare Advantage plans on a cold call you did not request are very much breaking the law and need to be reported.
Oh, no! I would never report someone for that.

They have to earn a living.

At least they are not robbing or sucker punching people on the street.

Besides, the enrollment period will soon be over and the calls will cease.



Have a nice day!
 

debbiedowner

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
One or the other is not a perfect fit for everyone when I decided in 2013 on Medicare Advantage I weighed how much a supplement would cost and Part D premium's in a year vs the max out of pocket of the plan and at that time just about even except for co pays I would have paid. The most in any one year I have paid out of pocket in 8 years is $2300. I have saved in premium's of supplement and part D approximately $24,000 over the years.
 

debbiedowner

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
Those young people if they bring up Medicare Advantage plans on a cold call you did not request are very much breaking the law and need to be reported.
Oh, no! I would never report someone for that.

They have to earn a living.

At least they are not robbing or sucker punching people on the street.

Besides, the enrollment period will soon be over and the calls will cease.



Have a nice day!
Then the fraud continues in the business. CMS has rules to combat fraud and if one doesn't want to report an illegal call then let's not report the crooked doctor for Medicare fraud.

Many of those calls come from off shore call centers.

Many of those caller's (not all) are making double what you're making a year, maybe more.

Many of those caller's are getting senior's to change plans by misrepresenting plan information.

On and on......
 
OP
Penelope

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
The article is very misleading. First if you're in a skilled nursing facility whether on an under 65 plan, original Medicare, MAPD when you have either reached a certain point or have shown no improvement you're going to be kicked out. On original Medicare they also have to report progress. If you're there past day 100 that is when you pay 100%.

Diabetic supplies are covered regardless of MAPD under Part B of Medicare and are free.

If you're not in your first 12 months of MAPD and decide to go back to original Medicare there are going to be health questions and medical underwriting and you can be denied.

I don't know anywhere in Florida that care is rationed.

Those are just a couple things wrong with this article.
Or you stay in a nursing
Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
The article is very misleading. First if you're in a skilled nursing facility whether on an under 65 plan, original Medicare, MAPD when you have either reached a certain point or have shown no improvement you're going to be kicked out. On original Medicare they also have to report progress. If you're there past day 100 that is when you pay 100%.

Diabetic supplies are covered regardless of MAPD under Part B of Medicare and are free.

If you're not in your first 12 months of MAPD and decide to go back to original Medicare there are going to be health questions and medical underwriting and you can be denied.

I don't know anywhere in Florida that care is rationed.

Those are just a couple things wrong with this article.
home if you self pay or go on Medicaid.

Those are just a couple things wrong with this article.
What else is wrong with the article?
 

Admiral Rockwell Tory

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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
Those young people if they bring up Medicare Advantage plans on a cold call you did not request are very much breaking the law and need to be reported.
Medicare Advantage is government program. The "do not call list" does not apply. You are probably one of those morons who probably think recruiters can't call young people to join the military. I deal with those libtards every day!
 

Redcurtain

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Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
President Donald Trump has continued to fulfill his promise to lower health insurance premiums by lowering the Affordable Care Act (ACA) exchange premiums for the third year in a row.
 
OP
Penelope

Penelope

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Joined
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Messages
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Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
I'm with you no Medicare Advantage for us. Only Medigap for us.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
49,006
Reaction score
7,281
Points
1,860
Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
President Donald Trump has continued to fulfill his promise to lower health insurance premiums by lowering the Affordable Care Act (ACA) exchange premiums for the third year in a row.
The ACA is only for those who are under 65.

So why is he taking the ACA away?
 

Redcurtain

Diamond Member
Joined
Apr 2, 2020
Messages
3,738
Reaction score
3,635
Points
1,908
Pitfalls of Medicare Advantage Plans

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

Snip


here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Ambulance—$300
  • Hospital stay—$175 per day for the first 10 days
  • Diabetes supplies—up to 20% copay
  • Diagnostic radiology—up to $125 copay
  • Lab Services—up to $100 copay
  • Outpatient x-rays—up to $100 copay
  • Therapeutic radiology—$35 or up to 20% copay depending on the service
  • Renal dialysis—20% of the cost
Medicare Advantage Plans as a physician. Here's how he describes them:

  • Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
  • Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.11
  • One may have difficulty getting emergency or urgent care due to rationing.
  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
  • Members have to follow plan rules to get covered care.
  • There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
  • It can be difficult to get care away from home.
  • The extra benefits offered can turn out to be less than promised.
  • Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
Snip

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare.3 At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap can may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.8

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

-----------------------------------------------------
Just for your information.
President Donald Trump has continued to fulfill his promise to lower health insurance premiums by lowering the Affordable Care Act (ACA) exchange premiums for the third year in a row.
The ACA is only for those who are under 65.
If they have more money grandma has more money
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
49,006
Reaction score
7,281
Points
1,860
Like many other people in their golden years ("golden"? Yeah, right!), I have been getting at least a dozen calls on my (landline) phone asking me to join a Medicare Advantage plan. I am always courteous and tell them thanks but I'm not interested. Then hang up. I realize that the callers are young people who no doubt earn a pittance for making these calls.

So far, I am very grateful to original Medicare and am downright afraid to switch to an Advantage plan.

I thank President Johnson for initiating Medicare. If it is considered a form of "socialism," then I salute "socialism."

*****

When it comes healthcare, I am a bleeding heart. Being ill reminds us how vulnerable we human beings are. I fully support the best healthcare system possible for everyone -- even for undocumented immigrants. I do NOT want health workers to be government workers, such as cops or post office workers or TSA workers. I want health workers to stay part of the private economy. That ensures better patient care and accountability.
Those young people if they bring up Medicare Advantage plans on a cold call you did not request are very much breaking the law and need to be reported.
Medicare Advantage is government program. The "do not call list" does not apply. You are probably one of those morons who probably think recruiters can't call young people to join the military. I deal with those libtards every day!
MA plans are private healthcare, they take money away from Medicare.
 

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