- Aug 18, 2019
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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!Of the 824 MA plans, there are 506 for profit plans.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.’”
here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:
Medicare Advantage Plans as a physician. Here's how he describes them:
- 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
- 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.
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.
-----------------------------------------------------A Medicare Advantage plan may help you lower health costs not covered by Medicare, but there are definite tradeoffs compared to classic Medicare/Medigap.www.investopedia.com
Just for your information.
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.
Medicare is not going broke in 2026. What the Trustees Report really says, and what it means to you.www.forbes.com
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.
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!
How many free government cell phones are out there? Ten million, twenty million? Who are the biggest Lifeline phone providers?www.freegovernmentcellphones.net
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.