- Aug 24, 2015
- Reaction score
- Second World
Move to Panama,no problemPitfalls 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.