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Pitfalls of Medicare Advantage Plans

Likkmee

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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.
Move to Panama,no problem
 
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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.
Move to Panama,no problem

I'm not moving, I hope a lot of you move if Biden gets elected. Don't let the door hit you in the a..
 
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Penelope

Penelope

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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

I'm will to look on a Senior forum but I'm getting my husband a Medigap plan.

the plans offered in MI pay a copay of 20% for DME. I don't trust any Plan C.
 

Grumblenuts

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Thanks, Penelope. I recalled this topic while listening to a review of this crap on the Ralph Nader Radio Hour today. Your instincts are correct. Stick with Medigap or "Medicare Supplement") plans only. Medicare Advantage remains the ripoff it's always been. Those pushing it here are just shysters.
 

healthmyths

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Thanks, Penelope. I recalled this topic while listening to a review of this crap on the Ralph Nader Radio Hour today. Your instincts are correct. Stick with Medigap or "Medicare Supplement") plans only. Medicare Advantage remains the ripoff it's always been. Those pushing it here are just shysters.

Two advantages that Medicare advantage (MA) plans have that I don't think you are aware of.
1) Called a deductible. Traditional Medicare rolls over the first (2021 will be $203. What this means the patient IS responsible for this first $203.
MA plans don't have this. Go to the doctor in January with traditional Medicare you have to pay the first $203... MA plans you don't.
2) I use to live in a very competitive MA Florida and every month my MA sent SS the Part B Medicare deduction of $144/mo. Again to understand:
If I were on traditional Medicare, my SS check would be billed $144/month...but MY MA actually sent the payment to SS so It wasn't deducted!
Right there nearly $2,000 advantage over traditional Medicare.
 

MarathonMike

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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.
Very good info, thanks.
 

justinacolmena

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a popular Humana Medicare Advantage Plan
It's an all-day wait in the waiting room for anything less than a dire emergency, and even for that you aren't going to get a thorough examination before the doctor orders something drastic and unnecessary.
 
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Penelope

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Every month, Medicare pays into Advantage plans an amount that covers the Part A and Part B costs of beneficiaries. If a plan also offers prescription drug coverage, Medicare provides a separate payment.

The amount of the monthly payments depends on two main factors:

  • the healthcare practices in the county where each beneficiary lives, which influences a procedure called the bidding process
  • the health of each beneficiary, which governs how Medicare raises or lowers the rates, in a Medicare Advantage funding: Sources, distribution known as risk adjustment
-----------------------------------------
The premiums you pay are deducted from Medicare and go to private ins.

The premiums you pay to the Medicare Advantage plans go directly to the private ins.

Republicans want to do away with Medicare.
 

JustAGuy1

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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 rule of thumb is that the more you pay in premium the less you pay for care.

  • 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.
Rates are negotiated and they all have max out of pocket.

  • 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
Possible but but never really happens.

  • One may have difficulty getting emergency or urgent care due to rationing.
Nope.

  • The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
Provider directories have ALWAYS been fluid even in the ACA plans.

  • Members have to follow plan rules to get covered care.
ALL plans have "rules".

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.

You can ONLY go back to a Medi Gap plan within a one year period and ONLY if you were in one when you switched to the MAPD. You only get 1 free admittance in the Medi Gaps and that's when you age in. After that you have to underwrtitten.
 

justinacolmena

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the healthcare practices in the county where each beneficiary lives
So what is the best way to torture doctors out of their malpractice, since they enacted tort reform, hold them to account for their billing fraud, punish them for all the murder, mayhem, and malicious disfigurement they commit, and discipline them for all the harm and injustice they cause to their patients?
 

Harry Dresden

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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.
i pay my medicare bill to the CMS address you showed....
 

JustAGuy1

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i pay my medicare bill to the CMS address you showed....

For Part B of course. If you work at least 10 years in the US you pay nothing for Part A. Then you need something to plug the holes in Original Medicare and that prem goes to..............private carriers.
 

Harry Dresden

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For Part B of course. If you work at least 10 years in the US you pay nothing for Part A. Then you need something to plug the holes in Original Medicare and that prem goes to..............private carriers.
yep for me its BC/BS and they plug those holes really well....
 

justinacolmena

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i pay my medicare bill to the CMS address you showed....
20-something girls work as nurses and caregivers to have sex with 65-75-year-old men. You can tell because all the 20-something boys in that district are gay, because they don't have enough money to have sex with the girls their own age.
 
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Penelope

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it is for me....i dont hardly pay anything.....between them and BC/BS i have 0 co-pays and low drug costs....
You must be on Medicare/Medicaid plan.
 
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Penelope

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I don't want you to think Medicare is the answer, but Medicaid is the answer with no health ins plans and of course those rich enough to pay humongous premiums they are going to charge in the future for medigap and advantage plans. PPO plans is a must, and second opinions a must.
 

justinacolmena

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I don't want you to think Medicare is the answer, but Medicaid is the answer with no health ins plans
You get it whether you want it or not at a certain age or if you become disabled.
of course those rich enough to pay humongous premiums they are going to charge in the future for medigap and advantage plans. PPO plans is a must, and second opinions a must.
Oh you're corporate. One doctor didn't screw your life over bad enough and the court wants another doctor to second his professional opinion of a mental illness or insanity diagnosis.
 
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Penelope

Penelope

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You get it whether you want it or not at a certain age or if you become disabled.

Oh you're corporate. One doctor didn't screw your life over bad enough and the court wants another doctor to second his professional opinion of a mental illness or insanity diagnosis.
What are you talking about. I mean cancer to have a second opinion or a grave disease. I know you get medicare, but I think medicaid is the way of the future.
 

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