What's new
US Message Board - Political Discussion Forum

Register a free account today to become a member! Once signed in, you'll be able to participate on this site by adding your own topics and posts, as well as connect with other members through your own private inbox!

Pitfalls of Medicare Advantage Plans

JustAGuy1

Diamond Member
Joined
Aug 18, 2019
Messages
9,716
Reaction score
8,591
Points
2,140
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.
Of the 824 MA plans, there are 506 for profit plans.
Now almost ALL of these "for profit" plans are paying federal corporate income taxes which you and anti-capitalists seem to forget.
These federal taxes go to subsidize Medicare which will according to the TRUSTEES of Medicare, Medicare will go broke in
MA Plan Directory | CMS

Those “going broke” headlines are all about Part A Hospital insurance (HI), which accounted for about 40 percent of the program’s $710 billion in spending in 2017. HI mostly is funded by the Medicare tax that is withheld from worker paychecks and paid by the self-employed. And that tax—as well as other smaller sources of revenue-- is not sufficient to pay the bills. It hasn’t been for years.

Medicare Parts B and D are funded very differently, and are at no risk of “going broke.” Unlike Part A, there is no dedicated tax for these programs. Rather, they are funded through a combination of enrollee premiums (which support only about one-quarter of their costs) and general revenues—another way of saying the government borrows most of the money it needs to pay for Medicare.


Another factor FAVORING MAs is some especially in competitive states like Florida which I know as I lived there under my MA plan in Fl for
over 5 years PAY my Part B social security DEDUCTION. What this means is traditional non-MA Medicare requires that the Part B Medicare payment for 2021 of $148.50 per month is deducted from my SS check...ever month...$1,776 in 2021 to be deducted.
Medicare Rate Increases for 2021 | Medicare Cost Projections

MY MA plan in Florida PAID that Part B deduction so my SS check was larger than the traditional Medicare beneficiary.
Do you understand why? Called competition! With 62 distinct plans, Fl is extremely competitive. Hence MAs have to offer more incentives.
To me that additional $1,776 is a great incentive!
So in summary, Medicare CHARGES your SS for Part B... Some MAs in Florida Pay that monthly charge...mine did!
Over 60% of MAs must pay state/federal income taxes...thus reducing the taxes you might have to pay!
Finally, an advantage that traditional Medicare doesn't offer that my MA offered... OTC supplies... Over the counter... toothpaste, headache tablets, vitamins, blood pressure monitor, other equipment in Fl my MA had $50/month I could order! Another $600 I didn't have to spend on
OTC stuff. So just between the SS payment of $1,776/year and the $600/year in OTC... I SAVED nearly $2,300.
Savings using MA.. $2,300, tax revenue paid local/state/federal incalculable. Oh and one more thing. I got a Samsung tablet with which daily I check my blood pressure, blood glucose readings and report to my MA for their monitoring. The other day I had a much lower diastolic reading and I get a call from the monitoring group AND my cardiologist who was called with this abnormal reading.
Medicare doesn't offer that!

What plan are you on?? Only this year was offered a rebate this high on the news. You are helping to defund Medicare which all republicans and tramp wants. Then you will be on all private plans and they can do whatever they want, pre the ACA scene.
Living in Texas my MA is not as competitive as the one I had in Florida because Florida has more older people which I guess you don't understand!

Obviously you know extremely little compared to me regarding Medicare as I've worked with Medicare providers for the last 15 years in processing claims.

You are also obviously against capitalism. Why?
There has never been a system of providing rising levels of living than capitalism.
I mean look what YOU are using today which when I was 20 years old was NEVER possible. Who could send information like we are doing 50 years
ago? NO ONE. What KING in any country or any age would be able to do what you are able to, i.e. with a little pocket device known as a "cell phone"
communicate with the world and for over 10,202,752 for FREE!

But it truly is a waste of time communicating with people like you that are Anti-America, anti-capitalism and most importantly ANTI_LOGIC!
Totally and truly ignorant!

It's like talking to a brick wall with her.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
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.
Of the 824 MA plans, there are 506 for profit plans.
Now almost ALL of these "for profit" plans are paying federal corporate income taxes which you and anti-capitalists seem to forget.
These federal taxes go to subsidize Medicare which will according to the TRUSTEES of Medicare, Medicare will go broke in
MA Plan Directory | CMS

Those “going broke” headlines are all about Part A Hospital insurance (HI), which accounted for about 40 percent of the program’s $710 billion in spending in 2017. HI mostly is funded by the Medicare tax that is withheld from worker paychecks and paid by the self-employed. And that tax—as well as other smaller sources of revenue-- is not sufficient to pay the bills. It hasn’t been for years.

Medicare Parts B and D are funded very differently, and are at no risk of “going broke.” Unlike Part A, there is no dedicated tax for these programs. Rather, they are funded through a combination of enrollee premiums (which support only about one-quarter of their costs) and general revenues—another way of saying the government borrows most of the money it needs to pay for Medicare.


Another factor FAVORING MAs is some especially in competitive states like Florida which I know as I lived there under my MA plan in Fl for
over 5 years PAY my Part B social security DEDUCTION. What this means is traditional non-MA Medicare requires that the Part B Medicare payment for 2021 of $148.50 per month is deducted from my SS check...ever month...$1,776 in 2021 to be deducted.
Medicare Rate Increases for 2021 | Medicare Cost Projections

MY MA plan in Florida PAID that Part B deduction so my SS check was larger than the traditional Medicare beneficiary.
Do you understand why? Called competition! With 62 distinct plans, Fl is extremely competitive. Hence MAs have to offer more incentives.
To me that additional $1,776 is a great incentive!
So in summary, Medicare CHARGES your SS for Part B... Some MAs in Florida Pay that monthly charge...mine did!
Over 60% of MAs must pay state/federal income taxes...thus reducing the taxes you might have to pay!
Finally, an advantage that traditional Medicare doesn't offer that my MA offered... OTC supplies... Over the counter... toothpaste, headache tablets, vitamins, blood pressure monitor, other equipment in Fl my MA had $50/month I could order! Another $600 I didn't have to spend on
OTC stuff. So just between the SS payment of $1,776/year and the $600/year in OTC... I SAVED nearly $2,300.
Savings using MA.. $2,300, tax revenue paid local/state/federal incalculable. Oh and one more thing. I got a Samsung tablet with which daily I check my blood pressure, blood glucose readings and report to my MA for their monitoring. The other day I had a much lower diastolic reading and I get a call from the monitoring group AND my cardiologist who was called with this abnormal reading.
Medicare doesn't offer that!

What plan are you on?? Only this year was offered a rebate this high on the news. You are helping to defund Medicare which all republicans and tramp wants. Then you will be on all private plans and they can do whatever they want, pre the ACA scene.
Living in Texas my MA is not as competitive as the one I had in Florida because Florida has more older people which I guess you don't understand!

Obviously you know extremely little compared to me regarding Medicare as I've worked with Medicare providers for the last 15 years in processing claims.

You are also obviously against capitalism. Why?
There has never been a system of providing rising levels of living than capitalism.
I mean look what YOU are using today which when I was 20 years old was NEVER possible. Who could send information like we are doing 50 years
ago? NO ONE. What KING in any country or any age would be able to do what you are able to, i.e. with a little pocket device known as a "cell phone"
communicate with the world and for over 10,202,752 for FREE!

But it truly is a waste of time communicating with people like you that are Anti-America, anti-capitalism and most importantly ANTI_LOGIC!
Totally and truly ignorant!

You seem to enjoy getting paid for healthcare, I don't. I don't work in the health care industry. They are based on value based healthcare. I bet you pay for highly for OOP max and your copays are high.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
All that proves is we pay too much.
 

healthmyths

Gold Member
Joined
Sep 19, 2011
Messages
23,643
Reaction score
6,256
Points
280
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.
Of the 824 MA plans, there are 506 for profit plans.
Now almost ALL of these "for profit" plans are paying federal corporate income taxes which you and anti-capitalists seem to forget.
These federal taxes go to subsidize Medicare which will according to the TRUSTEES of Medicare, Medicare will go broke in
MA Plan Directory | CMS

Those “going broke” headlines are all about Part A Hospital insurance (HI), which accounted for about 40 percent of the program’s $710 billion in spending in 2017. HI mostly is funded by the Medicare tax that is withheld from worker paychecks and paid by the self-employed. And that tax—as well as other smaller sources of revenue-- is not sufficient to pay the bills. It hasn’t been for years.

Medicare Parts B and D are funded very differently, and are at no risk of “going broke.” Unlike Part A, there is no dedicated tax for these programs. Rather, they are funded through a combination of enrollee premiums (which support only about one-quarter of their costs) and general revenues—another way of saying the government borrows most of the money it needs to pay for Medicare.


Another factor FAVORING MAs is some especially in competitive states like Florida which I know as I lived there under my MA plan in Fl for
over 5 years PAY my Part B social security DEDUCTION. What this means is traditional non-MA Medicare requires that the Part B Medicare payment for 2021 of $148.50 per month is deducted from my SS check...ever month...$1,776 in 2021 to be deducted.
Medicare Rate Increases for 2021 | Medicare Cost Projections

MY MA plan in Florida PAID that Part B deduction so my SS check was larger than the traditional Medicare beneficiary.
Do you understand why? Called competition! With 62 distinct plans, Fl is extremely competitive. Hence MAs have to offer more incentives.
To me that additional $1,776 is a great incentive!
So in summary, Medicare CHARGES your SS for Part B... Some MAs in Florida Pay that monthly charge...mine did!
Over 60% of MAs must pay state/federal income taxes...thus reducing the taxes you might have to pay!
Finally, an advantage that traditional Medicare doesn't offer that my MA offered... OTC supplies... Over the counter... toothpaste, headache tablets, vitamins, blood pressure monitor, other equipment in Fl my MA had $50/month I could order! Another $600 I didn't have to spend on
OTC stuff. So just between the SS payment of $1,776/year and the $600/year in OTC... I SAVED nearly $2,300.
Savings using MA.. $2,300, tax revenue paid local/state/federal incalculable. Oh and one more thing. I got a Samsung tablet with which daily I check my blood pressure, blood glucose readings and report to my MA for their monitoring. The other day I had a much lower diastolic reading and I get a call from the monitoring group AND my cardiologist who was called with this abnormal reading.
Medicare doesn't offer that!

What plan are you on?? Only this year was offered a rebate this high on the news. You are helping to defund Medicare which all republicans and tramp wants. Then you will be on all private plans and they can do whatever they want, pre the ACA scene.
Living in Texas my MA is not as competitive as the one I had in Florida because Florida has more older people which I guess you don't understand!

Obviously you know extremely little compared to me regarding Medicare as I've worked with Medicare providers for the last 15 years in processing claims.

You are also obviously against capitalism. Why?
There has never been a system of providing rising levels of living than capitalism.
I mean look what YOU are using today which when I was 20 years old was NEVER possible. Who could send information like we are doing 50 years
ago? NO ONE. What KING in any country or any age would be able to do what you are able to, i.e. with a little pocket device known as a "cell phone"
communicate with the world and for over 10,202,752 for FREE!

But it truly is a waste of time communicating with people like you that are Anti-America, anti-capitalism and most importantly ANTI_LOGIC!
Totally and truly ignorant!

You seem to enjoy getting paid for healthcare, I don't. I don't work in the health care industry. They are based on value based healthcare. I bet you pay for highly for OOP max and your copays are high.
I was hospitalized for 32 days nearly died. Bill from Hospital was over $320,000. My Medicare Advantage plan paid $60,000. My share...$1,000!
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
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.
Of the 824 MA plans, there are 506 for profit plans.
Now almost ALL of these "for profit" plans are paying federal corporate income taxes which you and anti-capitalists seem to forget.
These federal taxes go to subsidize Medicare which will according to the TRUSTEES of Medicare, Medicare will go broke in
MA Plan Directory | CMS

Those “going broke” headlines are all about Part A Hospital insurance (HI), which accounted for about 40 percent of the program’s $710 billion in spending in 2017. HI mostly is funded by the Medicare tax that is withheld from worker paychecks and paid by the self-employed. And that tax—as well as other smaller sources of revenue-- is not sufficient to pay the bills. It hasn’t been for years.

Medicare Parts B and D are funded very differently, and are at no risk of “going broke.” Unlike Part A, there is no dedicated tax for these programs. Rather, they are funded through a combination of enrollee premiums (which support only about one-quarter of their costs) and general revenues—another way of saying the government borrows most of the money it needs to pay for Medicare.


Another factor FAVORING MAs is some especially in competitive states like Florida which I know as I lived there under my MA plan in Fl for
over 5 years PAY my Part B social security DEDUCTION. What this means is traditional non-MA Medicare requires that the Part B Medicare payment for 2021 of $148.50 per month is deducted from my SS check...ever month...$1,776 in 2021 to be deducted.
Medicare Rate Increases for 2021 | Medicare Cost Projections

MY MA plan in Florida PAID that Part B deduction so my SS check was larger than the traditional Medicare beneficiary.
Do you understand why? Called competition! With 62 distinct plans, Fl is extremely competitive. Hence MAs have to offer more incentives.
To me that additional $1,776 is a great incentive!
So in summary, Medicare CHARGES your SS for Part B... Some MAs in Florida Pay that monthly charge...mine did!
Over 60% of MAs must pay state/federal income taxes...thus reducing the taxes you might have to pay!
Finally, an advantage that traditional Medicare doesn't offer that my MA offered... OTC supplies... Over the counter... toothpaste, headache tablets, vitamins, blood pressure monitor, other equipment in Fl my MA had $50/month I could order! Another $600 I didn't have to spend on
OTC stuff. So just between the SS payment of $1,776/year and the $600/year in OTC... I SAVED nearly $2,300.
Savings using MA.. $2,300, tax revenue paid local/state/federal incalculable. Oh and one more thing. I got a Samsung tablet with which daily I check my blood pressure, blood glucose readings and report to my MA for their monitoring. The other day I had a much lower diastolic reading and I get a call from the monitoring group AND my cardiologist who was called with this abnormal reading.
Medicare doesn't offer that!

What plan are you on?? Only this year was offered a rebate this high on the news. You are helping to defund Medicare which all republicans and tramp wants. Then you will be on all private plans and they can do whatever they want, pre the ACA scene.
Living in Texas my MA is not as competitive as the one I had in Florida because Florida has more older people which I guess you don't understand!

Obviously you know extremely little compared to me regarding Medicare as I've worked with Medicare providers for the last 15 years in processing claims.

You are also obviously against capitalism. Why?
There has never been a system of providing rising levels of living than capitalism.
I mean look what YOU are using today which when I was 20 years old was NEVER possible. Who could send information like we are doing 50 years
ago? NO ONE. What KING in any country or any age would be able to do what you are able to, i.e. with a little pocket device known as a "cell phone"
communicate with the world and for over 10,202,752 for FREE!

But it truly is a waste of time communicating with people like you that are Anti-America, anti-capitalism and most importantly ANTI_LOGIC!
Totally and truly ignorant!

You seem to enjoy getting paid for healthcare, I don't. I don't work in the health care industry. They are based on value based healthcare. I bet you pay for highly for OOP max and your copays are high.
I was hospitalized for 32 days nearly died. Bill from Hospital was over $320,000. My Medicare Advantage plan paid $60,000. My share...$1,000!
What is your OOP max? Did you have covid?
 

Grumblenuts

Gold Member
Joined
Oct 16, 2017
Messages
7,318
Reaction score
1,855
Points
140
I get it , you're illterate. Part B premium does NOT go to a Private Insurance company. Son I do Medicare and ACA all day. There is nothing you can teach me. Premium is not "reimbursement", you do know that right? The context by the way is MAPD plans. If you need more education let me know.`
Notice, three distinct definitions. "Insurance" is only mentioned in the second one. What you do "all day" has made you too close to the trees to see the forest. To the contrary, you really have nothing to offer ("teach") any outside of your little, protective, corporate-speak bubble. Wake up. People are not widgets. No one ever requests such boringly studious and socially inept lessons to begin with, Poindexter. Join the human race.
 

JustAGuy1

Diamond Member
Joined
Aug 18, 2019
Messages
9,716
Reaction score
8,591
Points
2,140
I get it , you're illterate. Part B premium does NOT go to a Private Insurance company. Son I do Medicare and ACA all day. There is nothing you can teach me. Premium is not "reimbursement", you do know that right? The context by the way is MAPD plans. If you need more education let me know.`
Notice, three distinct definitions. "Insurance" is only mentioned in the second one. What you do "all day" has made you too close to the trees to see the forest. To the contrary, you really have nothing to offer ("teach") any outside of your little, protective, corporate-speak bubble. Wake up. People are not widgets. No one ever requests such boringly studious and socially inept lessons to begin with, Poindexter. Join the human race.

LOL,you're an idiot :) The subject of the discussion was "premium" and that it was being paid to "private" insurers. Nothing you can do to change that, Part B "Premium" is paid to CMS. There is nothing you can do to change that either.You poor old man, she brought it up and you don't get to change the context of a discussion you joined late.
 

Grumblenuts

Gold Member
Joined
Oct 16, 2017
Messages
7,318
Reaction score
1,855
Points
140
LOL,you're an idiot :) The subject of the discussion was "premium" and that it was being paid to "private" insurers. Nothing you can do to change that, Part B "Premium" is paid to CMS.
Fine. Have it your way. Try arguing that point with the only one who's actually argued with it.
Your Medicare premiums are paid to a private company. How retarded are you?
Get a room.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion over the past three years alone, but federal officials say they are moving ahead with long-delayed plans to recoup at least part of the money.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.

Getting refunds from the health plans has proved daunting, however. Officials with the Centers for Medicare & Medicaid Services repeatedly have postponed or backed off efforts to crack down on billing abuses and mistakes by the increasingly popular Medicare Advantage health plans offered by private health insurers under contract with Medicare. Today, such plans treat more than 22 million seniors — more than 1 in 3 people on Medicare.

Medicare Advantage Plans Overbill Taxpayers By Billions Annually, Records Show

Medicare Knows About $30 Billion in Overbilling but Refunds Prove Elusive - Medxoom

--------------------------------
Those lobbyists cost money and the ads too. MA plans cost billions of money for taxpayers.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
In July 2019, Kaiser Health News reported that the government had overpaid Medicare Advantage plans by nearly $30 billion in the past three years alone. In addition, as many as 20 whistleblower lawsuits ― the most recent filed late last month by the Justice Department against industry giant Anthem — have accused health plans of ripping off Medicare by exaggerating how sick their patients were.

 

Mac1958

Diamond Member
Joined
Dec 8, 2011
Messages
88,810
Reaction score
33,089
Points
2,280
Location
Opposing Authoritarian Ideological Fundamentalism.
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......

I am concerned about all those attractive TV commercials that appeal to seniors to change to an Advantage program. They promise even eyeglasses and hearing aids and transportation to the doctor's office.

To be fair, some (many?) people seem to like Advantage programs.

I am just afraid to take a chance.

*****

Taking advantage of seniors seems to be a full-time job. I have been getting calls from a recording that says something like: "This is Officer Bob. You did not pay your power bill. Press button 1 to talk with an agent. Otherwise, your power will be turned off in 30 minutes."
Indeed, there are MANY who are all too happy to take advantage of seniors, and if there were a hell, that place would a special room waiting for those people.

But I can tell you that the plans are excellent, as long as you understand how they work. They're essentially like a PPO or an HMO, so you pay as you go, IF you go. So your monthly premium might be $0 or $40, but then you might pay a $30 co-pay when you go to the doctor, or $500 if you go into the hospital. This, as opposed to around $200 to $400 per month for a Medicare Supplement that covers all medical services, and Drug Plan. That's a good choice to have.

You need to be aware of the provider network that an MA plan has, and you need to be aware of the formulary included in the drug portion (the drugs covered and at what price). So it's helpful to have an experienced agent go over that with you. Medicare Supplements, by and large, will have more doctors accepting them.

I was brought in as the financial guy in the room for a Fortune 50 insurer for six years, watching them put MA plans together in my state - county by county, service by service, co-pay by co-pay, premium by premium. I think they're an excellent option, and I think ALL Americans should have them as an option. I put my mother-in-law on a Secure Horizons (United Health Care) Medicare Advantage plan a couple of years ago and she loves it.

My two cents.
 
Last edited:

JustAGuy1

Diamond Member
Joined
Aug 18, 2019
Messages
9,716
Reaction score
8,591
Points
2,140
LOL,you're an idiot :) The subject of the discussion was "premium" and that it was being paid to "private" insurers. Nothing you can do to change that, Part B "Premium" is paid to CMS.
Fine. Have it your way. Try arguing that point with the only one who's actually argued with it.
Your Medicare premiums are paid to a private company. How retarded are you?
Get a room.

I was, you stuck that huge nose of yours where it didn't belong.
 

debbiedowner

Gold Member
Joined
Feb 12, 2017
Messages
10,418
Reaction score
2,158
Points
275
Just catching up on this thread this morning by skipping around and I have to say there are pitfalls in any health insurance plan and justaguy, healthmyths and mac are correct. Don't know how old healthmyths is but I'm 72 been on MA since 65 same company since I work for them and I have saved over $18,000 over the years in separate premium's of a supplement and Part D plan and that is with one year being a very bad year with 2 weeks in the hospital and pic line 6 weeks thereafter and my share of hospital of $96,000 was $1475 and pic line and several ct scans that year I paid a total of $2200 out of pocket, a supplement and part D would have approximately cost me $3000 that year (I smoke) so more. The plan has a $6500 max out of pocket and out of approximately 450 clients have had one in 8 years meet that max and he didn't really pay it but the immunotherapy company he was receiving did. BTW your max is for Medical not drugs. I am on a PPO and most provider's in Florida are in network and more than half the U.S.

I do not sway people either way when talking with them I explain both sides and let them make their decision. Most wealthy and most poor choose an MAPD plan in my area and all coming off a subsidized ACA plan choose MAPD.

MAPD does replace original Medicare A&B although you are still in Medicare program and have to pay part B premium and healthmyths is correct that quite a few plans reimburse your Part B premium or a portion and most have added extra's to offset the competition. The higher star rating, plans are reimbursed more money from the Govt.

I do not advocate Medicare for All but rather lowering the age a bit if an eligible person wants to buy into it. I also advocate going back to underwriting days for individuals under Medicare eligble age but at the same time if one could not qualify for an under 65 plan give them the option to buy into Medicare at any age.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
When they get rid of Medicare and they will, then Medicare Advantage plans will take off and then we will not have Medicare so there goes you

hospital of $96,000 was $1475 ,

That seems strange that all you had to pay was 1475 since your OOP is 6500.
Did you get a discount for working for them?

So your all for underwriting, well they do it for Medicare.
 

debbiedowner

Gold Member
Joined
Feb 12, 2017
Messages
10,418
Reaction score
2,158
Points
275
When they get rid of Medicare and they will, then Medicare Advantage plans will take off and then we will not have Medicare so there goes you

hospital of $96,000 was $1475 ,

That seems strange that all you had to pay was 1475 since your OOP is 6500.
Did you get a discount for working for them?

So your all for underwriting, well they do it for Medicare.

Max out of pocket is the cumulation of co pays and any percentages you may to pay. My plan called for a $295 a day co pay days 1 through 5 after 5 nothing.

They do not underwrite for Medicare they do for a supplement if you don't get one when you are eligible.

Insurance company employee's don't get discounts.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
When they get rid of Medicare and they will, then Medicare Advantage plans will take off and then we will not have Medicare so there goes you

hospital of $96,000 was $1475 ,

That seems strange that all you had to pay was 1475 since your OOP is 6500.
Did you get a discount for working for them?

So your all for underwriting, well they do it for Medicare.

Max out of pocket is the cumulation of co pays and any percentages you may to pay. My plan called for a $295 a day co pay days 1 through 5 after 5 nothing.

They do not underwrite for Medicare they do for a supplement if you don't get one when you are eligible.

Insurance company employee's don't get discounts.

Some plans underwrite for Medical Advantage and they sure will when they dc Medicare which they will in the future.

I read they want to get rid of plan B meds too.

I'm researching for my husband but I think he would be Plan G and a Medicare prescription plan, as he has no issues now just an occ kidney stone.

I don't want Medicare Advantage plans, as they change copays , OOP max, deductibles annually and they sure will when they (republicans) get rid of Medicare, then the prices will really go up.

Then all plans will have underwriting. See now they want everyone to sign up for Part C plans(Medicare Advantage) and then they will slowly do away with the medigap plans and Medicare as we know it.
 
OP
Penelope

Penelope

Diamond Member
Joined
Jul 15, 2014
Messages
53,414
Reaction score
10,023
Points
2,060
The are raising Part B premiums sky high and raise Medigap Premium sky high as they want to force Plan C upon you.

We need Biden in to save us from this tragedy, and pack the court with more Supreme Court justices to save the ACA.
 

Grumblenuts

Gold Member
Joined
Oct 16, 2017
Messages
7,318
Reaction score
1,855
Points
140
Biden won't save us but I'd agree he's not Trump.
I was, you stuck that huge nose of yours where it didn't belong.
Projecting, I see. Here's why I came in.
The Medicare premium part B goes to the private health ins company. The take money away from Medicare.
She's correct. You just didn't get what she was really saying. Get over yourself.
 

debbiedowner

Gold Member
Joined
Feb 12, 2017
Messages
10,418
Reaction score
2,158
Points
275
When they get rid of Medicare and they will, then Medicare Advantage plans will take off and then we will not have Medicare so there goes you

hospital of $96,000 was $1475 ,

That seems strange that all you had to pay was 1475 since your OOP is 6500.
Did you get a discount for working for them?

So your all for underwriting, well they do it for Medicare.

Max out of pocket is the cumulation of co pays and any percentages you may to pay. My plan called for a $295 a day co pay days 1 through 5 after 5 nothing.

They do not underwrite for Medicare they do for a supplement if you don't get one when you are eligible.

Insurance company employee's don't get discounts.

Some plans underwrite for Medical Advantage and they sure will when they dc Medicare which they will in the future.

I read they want to get rid of plan B meds too.

I'm researching for my husband but I think he would be Plan G and a Medicare prescription plan, as he has no issues now just an occ kidney stone.

I don't want Medicare Advantage plans, as they change copays , OOP max, deductibles annually and they sure will when they (republicans) get rid of Medicare, then the prices will really go up.

Then all plans will have underwriting. See now they want everyone to sign up for Part C plans(Medicare Advantage) and then they will slowly do away with the medigap plans and Medicare as we know it.

No plans to my knowledge underwrite for MAPD plans. If you are referring to end stage renal disease they cannot deny any longer beginning in 2021.

Yes, the current administration want to limit some in hospital administered part B drugs.

In your previous post you mentioned one plan in Michigan, there are many. You also mentioned DME and each plan treats this differently to some degree except I know of no plans that make you pay a thing for diabetic supplies because they are covered under Part B regardless if you're on an MAPD.

Yes, many plans change co pay annually.

If you want an agent in Michigan I suggest you go to this forum and ask, there are a couple of very truthful agents here: Senior Insurance Forum
 

USMB Server Goals

Total amount
$201.00
Goal
$350.00

New Topics

Most reactions - Past 7 days

Forum List

Top