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Honored Contributor
Posts: 39,574
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage

[ Edited ]

@Moonchilde wrote:

@software, something "new" for me now is having to worry about whether Medicare covers something or not and making a point of asking if/when I have a doubt, because IMO most doctors' offices don't care - if Medicare pays, great, but if Medicare doesn't pay, you or I will still pay, so they don't care enough to check unless you make a point of asking. It's not going to happen a lot, and I don't ask about everything, but I do get annoyed that I have to worry about it 😟


@Moonchilde

 

Maybe I can help with this ..... Here's the most simplistic description I can come up with ... 

 

Think of Traditional Medicare as similar to a PPO.    You can go to any doctor that accepts Medicare payment.  You will need to select a Medicare Supplement (Part B) to cover doctors and labwork etc.   You very likely will also have to select a Part D which is for prescriptions.

 

Think of Medicare Advantage as similar to an HMO (think Kaiser for this comparison).   You will be in a network of doctors.   If you go to a doctor outside the network, you will pay more out of pocket. Prescription coverage is usually included, but not always.

 

Basically, if you have health issues and want to keep the doctors you have, Traditional Medicare is your best bet.  

 

However, if you are pretty healthy and see an MD rarely, other than for an annual checkup, and aren't attached to the MDs you have, the Advantage plans might be your best bet.  

 

HTH

Honored Contributor
Posts: 18,504
Registered: ‎05-23-2010

Re: Getting switched with little warning into Medicare Advantage

[ Edited ]

Thank you, @Tinkrbl44, but I know all of that. I'm already on Medicare. But good info for others :-)

 

My point was that there are things one takes for granted are covered by their health insurance under a working person's insurance that Medicare *doesn't* cover, may/may not cover, or may cover less frequently than a regular employed person's policy - and sometimes it pays to check up front, because although it *should* be a given that the office will be proactive about it, they aren't always.

 

Example - I recently had facial skin lesions removed under Medicare. Under BXBS I would never have needed to give it a thought. But for these particular lesions, Medicare often refuses to pay for it as not medically necessary unless certain criteria are met.

 

If I hadn't done my homework, and didn't ask what the fee would be worst case scenario of not covered, I could have been out several hundred dollars just assuming Medicare would pay and depending on how it was submitted. As it was, forewarned is forearmed, and I made sure they got the extenuating info they needed, so the dictor told me he was sure it would be covered.

 

Situations like this wouldn't be frequent, but they exist under Medicare.

Life without Mexican food is no life at all
Esteemed Contributor
Posts: 6,473
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage


@nomless wrote:

@hopi wrote:

Insurance companies are ripping people off and a letter that is not sent certified and explaining what they have done should not be acceptable.  There is so much fraud out in the public with older people it is frightening.  


 

You might not like what the insurance company did and debate can be had whether the practice is acceptable, but equating it to fraud is inaccurate.  The insurance company did not engage in fraudulent behavior. The insured party was notified.


When you say you notified someone in court by mail the judge will ask to see that it was sent certified.

Honored Contributor
Posts: 39,574
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage


@hopi wrote:

@nomless wrote:

@hopi wrote:

Insurance companies are ripping people off and a letter that is not sent certified and explaining what they have done should not be acceptable.  There is so much fraud out in the public with older people it is frightening.  


 

You might not like what the insurance company did and debate can be had whether the practice is acceptable, but equating it to fraud is inaccurate.  The insurance company did not engage in fraudulent behavior. The insured party was notified.


When you say you notified someone in court by mail the judge will ask to see that it was sent certified.


@hopi

 

I believe if they send you 3 notices via mail and none of them are returned as Undeliverable, it's assumed you just ignored your mail.

Esteemed Contributor
Posts: 5,660
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage

[ Edited ]

The person mentioned in this article had already enrolled in traditional Medicare.  Why did no one in whatever govt agency handle these things notice when she was switched to Medicare Advantage by her former insurance company when she had already enrolled in traditional Medicare?

 

When you get close to your age for Medicare enrollment you are flooded and I Do mean flooded with marketing material.  Every day for months I got 3-4 solicitation letters a day.  The woman in the story had already made her choice and enrolled in traditional Medicare.  She had no reason to pay any attention to these solicitations.

Esteemed Contributor
Posts: 7,709
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage


@KathyPet wrote:

The person mentioned in this article had already enrolled in traditional Medicare.  Why did no one in whatever govt agency handle these things notice when she was switched to Medicare Advantage by her former insurance company when she had already enrolled in traditional Medicare?

 

When you get close to your age for Medicare enrollment you are flooded and I Do mean flooded with marketing material.  Every day for months I got 3-4 solicitation letters a day.  The woman in the story had already made her choice and enrolled in traditional Medicare.  She had no reason to pay any attention to these solicitations.


 

It was a notification from her insurance company that she ignored.  What needs to be clarified is if she notified BCBS that she no longer wanted to be insured by them when she signed up for Medicare and the timing of events.

The eyes through which you see others may be the same as how they see you.
Respected Contributor
Posts: 4,376
Registered: ‎04-04-2015

Re: Getting switched with little warning into Medicare Advantage

Yes she was enrolled in BCBS when she signed up for Medicare.  I couldn't tell from the article whether she intended to keep BCBS as her supplement or if she intended to just sign up for Medicare with no supplement.

 

But in any case, it does seem that BCBS properly notified her.

 

Now the issue of whether companies should be allowed to make you opt out of their Advantage plans rather than opt in is definitely one that needs to be resolved.

Respected Contributor
Posts: 2,764
Registered: ‎03-11-2010

Re: Getting switched with little warning into Medicare Advantage

My DH will be 65 in 3 months.  The amount of calls and mailings are overbearing!  Just yesterday we went to the Area Agency on Aging office for our county, met with the person who specializes in helping folks choose the right plan(s) and his decision has been made.  

 

I could ABSOLUTELY see something like what happened to Judy Hanttula, happening to him.  He's no longer interested in reading anything that has to do with his insurance changes at this point.  His info was faxed by the Area Agency on Aging person and he's already signed up for coverage.  He's signed up for a Medicare supplement plan and a drug plan.  We spent an hour and a half doing that in the meeting.  In our minds, this is done.

 

I'm thankful that I read this thread.  I'm going to call Area Agency on Aging tomorrow and speak to the woman we met with, just to be sure this can't happen to us.  I'm thinking maybe it can't because he's on my Cobra plan and according to Cobra reps, once he's on Medicare he can't be on Cobra anymore.

Honored Contributor
Posts: 39,574
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage


@Kalli wrote:

My DH will be 65 in 3 months.  The amount of calls and mailings are overbearing!  Just yesterday we went to the Area Agency on Aging office for our county, met with the person who specializes in helping folks choose the right plan(s) and his decision has been made.  

 

I could ABSOLUTELY see something like what happened to Judy Hanttula, happening to him.  He's no longer interested in reading anything that has to do with his insurance changes at this point.  His info was faxed by the Area Agency on Aging person and he's already signed up for coverage.  He's signed up for a Medicare supplement plan and a drug plan.  We spent an hour and a half doing that in the meeting.

 

 In our minds, this is done. 

 

I'm thankful that I read this thread.  I'm going to call Area Agency on Aging tomorrow and speak to the woman we met with, just to be sure this can't happen to us.  I'm thinking maybe it can't because he's on my Cobra plan and according to Cobra reps, once he's on Medicare he can't be on Cobra anymore.


@Kalli

 

I understand that you get a lot of solicitations from different companies, etc.   However, I would think it's still prudent to slice open the envelopes and at least read the first paragraph of your insurance company.  

 

Ignoring notices from them makes no sense at all, IMO.

Esteemed Contributor
Posts: 5,657
Registered: ‎06-09-2010

Re: Getting switched with little warning into Medicare Advantage

Did she ever get a Medicare card from the company that she chose? If she did not, then that was a big red flag and should have called that company. Also, what you are saying that the plan they transferred her to did not cover this hospital because it was out of network. She had coverage but could only use certain doctors and hospitals, etc. That is what happens when people are not concerned about their personal affairs. If you don't take care of yourself no one else will. As you get older, people or companies are more likely to take advantage of you because they think you don't understand. I always know what is going on with finances and medical care. I call Aetna all the time if I have complaints or questions. I recently received a bill from a hospital that said I owed them an additional $2,300. They said Medicare had taken back some of the money because they overpaid. They wanted to make payment arranges with me. I told them I needed to call Aetna and find out what is happening. Aetna told me they will handle and let the hospital know that I don't need to pay the difference. They took care of it.  It was two weeks later that I got another bill from the hospital and I called. They said I owed nothing and that it was an error. Before I retired I was a Credit and Collection Manager so I was always researching accounts. I always research anything I am told to make sure it is correct. I am single and therefore, if I don't look out for me, no one else will.