Advantage plans & co pay for in hospital care ... - Page 6

151949 · ‎03-09-2010

@151949 wrote:
People on this board are constantly saying that medicare advantage plans are so bad - and the copays are so awful etc etc.My DH just had to have major surgery - 4 days in the hospital post op care. This all started out with a colonoscopy that included polyp removal. So in the end - grand total out of pocket to us -- $550. That includes surgicenter for colonscopy and co pays in the hospital.
We pay only the amount deducted from our SS check for our advantage plan, our monthly premium is $0. We were careful to stay in network, as we always are. The doctors my husband had were certainly first class and I doubt anyone could say that the out of pocket expense was bad. If we were buying a plan F supplement this would be about 2 months of premiums. So - to those naysayers who claim so much bad about- advantage plans - I think it is good to have insurance but not to be insurance poor. We were a little nervous about what this was going to cost us but it was unnecessary worry. He has been in the hospital twice now - his stroke for a week and this surgery , and both times the bil for the copay l was very reasonable.

@Katcat1 Pease read bolded portions & the title of the thread.

Katcat1 · ‎07-21-2011

@151949, When I applied several years ago because I was on disability, it was not called an Advantage Plan but a supplemental plan and you had choices between PPO and HMO. The PPO was too expensive and I did the HMO. If you are not using medical that often then nothing is coming out of your monthly income only Parts A & B. It makes more sense to do the HMO because you can put aside for emergencies in your savings versus getting a PPO and paying $200 plus a month coming out of your SS check.

kindness is strength

Cakers3 · ‎06-17-2015

I see this as an unfair attack at posters who may have had problems with an Advantage Plan. Not all plans are equal and vary state by state.

While HMOs are typically cheaper, my PCP has not acceptedt any HMOs for new patients for quite some time. We actually prefer the PPO anyway and have similiar benefits-one eye exam/yr and Silver Sneakers. Our eye doctor is also PPO only.

Also the Medicare book clearly indicates that Advantage plans MAY pay more than what original Medicare allows but can also pay LESS than original Medicare allows for certain services.

It's coordinated care between Medicare and the insurance company.

There is also a difference between routine screening and a diagnostic procedure.

Colonoscopies and mammograms (screenings) are 100% covered regardless. So are certain routine blood tests at annual physicals. Our state requires mandatory coverage for a host of blood tests and other coverage for HPV screenings with PAP tests.

It all depends upon where you live and what type of plan you choose. You have to do your homework. I always call customer service, obtain the name of the person I spoke with, then follow-up with a message through their message center so that I have a reply IN WRITING to my question.

One may also good health but keep in mind a catastrophic event can happen at anytime. Don't just look for the everyday coverage; look at the bigger picture "just in case".

"" Compassion is a verb."-Thich Nhat Hanh

151949 · ‎03-09-2010

@Yardlie You need only read this thread - esp. the last post to have your answer to not ever seeing any negative posts about advantage plans.

151949 · ‎03-09-2010

@Cakers3 Guess what - supplements are not all the same and also vary from place to place. They also vary greatly in price.

As I said before - advantage plans have a max out of pocket amount so if you do have a catastropic event , after you reach your max out of pocket , guess what? it is all covered 100%.

Advantage plans are required by law to cover everything medicare covers. So my routine screening tests like colonoscopys and mammos atre covered 100% too.

As for doctors - when we started on omedicare we were new to this area so we chose a doctor from the network. However, our former doctor from when we lived in Pa is also an in network doctor with our ins co. I have actually never spoken to anyone IRL that had any issue finding a doctor that would take medicare. I only hear about that on this board. Since advantage plans are managed care plans it is simple to just chose a doctor from their network. He'd be guaranteed to take your insurance.

Cakers3 · ‎06-17-2015

@151949 wrote:
@Cakers3 Guess what - supplements are not all the same and also vary from place to place. They also vary greatly in price.
As I said before - advantage plans have a max out of pocket amount so if you do have a catastropic event , after you reach your max out of pocket , guess what? it is all covered 100%.
Advantage plans are required by law to cover everything medicare covers. So my routine screening tests like colonoscopys and mammos atre covered 100% too.
As for doctors - when we started on omedicare we were new to this area so we chose a doctor from the network. However, our former doctor from when we lived in Pa is also an in network doctor with our ins co. I have actually never spoken to anyone IRL that had any issue finding a doctor that would take medicare. I only hear about that on this board. Since advantage plans are managed care plans it is simple to just chose a doctor from their network. He'd be guaranteed to take your insurance.

@151949 I don't have to guess. I know the supplemental plans also vary. I didn't say I had one. We don't.

Again, read your Medicare book. Some services may cost more than Medicare allows if you have an Advantage plan.

Whether a doctor accepts straight Medicare OR any advantage plan it the crux of the matter. Doctors in our area lean to PPOs and not HMOs. Our choice was to keep our PCP and thus chose our plans accordingly.

I also already said that mammogram and colonoscopy screenings are covered. It's mandatory. The diagnostic tests after, if needed, begin to have a $ tag.

I've seen the UHC plans and they were not for us. Again, folks need to ask questions and do some footwork to find what is comfortable for them.

As far as maximum out of pocket, who in the world would think that there is no worry once all that is reached??? You woudl still have the $6700 to pay. And that's annual, not lifetime.

There may be some complaints on this thread but not everyone lives where you live or has the same experience with finances and health issues.

It would have been nicer to leave out the usual poking at others while crowing about your success with your plan.

A little compassion and explanation about why your plan works for YOU was all that was necessary.

Just sayin'.

"" Compassion is a verb."-Thich Nhat Hanh

Moonchilde · ‎05-23-2010

@Cakers3 wrote:
@151949 wrote:
@Cakers3 Guess what - supplements are not all the same and also vary from place to place. They also vary greatly in price.
As I said before - advantage plans have a max out of pocket amount so if you do have a catastropic event , after you reach your max out of pocket , guess what? it is all covered 100%.
Advantage plans are required by law to cover everything medicare covers. So my routine screening tests like colonoscopys and mammos atre covered 100% too.
As for doctors - when we started on omedicare we were new to this area so we chose a doctor from the network. However, our former doctor from when we lived in Pa is also an in network doctor with our ins co. I have actually never spoken to anyone IRL that had any issue finding a doctor that would take medicare. I only hear about that on this board. Since advantage plans are managed care plans it is simple to just chose a doctor from their network. He'd be guaranteed to take your insurance.
@151949 I don't have to guess. I know the supplemental plans also vary. I didn't say I had one. We don't.

Again, read your Medicare book. Some services may cost more than Medicare allows if you have an Advantage plan.

Whether a doctor accepts straight Medicare OR any advantage plan it the crux of the matter. Doctors in our area lean to PPOs and not HMOs. Our choice was to keep our PCP and thus chose our plans accordingly.

I also already said that mammogram and colonoscopy screenings are covered. It's mandatory. The diagnostic tests after, if needed, begin to have a $ tag.

I've seen the UHC plans and they were not for us. Again, folks need to ask questions and do some footwork to find what is comfortable for them.

As far as maximum out of pocket, who in the world would think that there is no worry once all that is reached??? You woudl still have the $6700 to pay. And that's annual, not lifetime.

There may be some complaints on this thread but not everyone lives where you live or has the same experience with finances and health issues.

It would have been nicer to leave out the usual poking at others while crowing about your success with your plan.

A little compassion and explanation about why your plan works for YOU was all that was necessary.

Just sayin'.

@Cakers3 - Guess what?

Never going to happen on these forums.

Life without Mexican food is no life at all

Carmie · ‎10-25-2010

@151949 wrote:
People on this board are constantly saying that medicare advantage plans are so bad - and the copays are so awful etc etc.My DH just had to have major surgery - 4 days in the hospital post op care. This all started out with a colonoscopy that included polyp removal. So in the end - grand total out of pocket to us -- $550. That includes surgicenter for colonscopy and co pays in the hospital.
We pay only the amount deducted from our SS check for our advantage plan, our monthly premium is $0. We were careful to stay in network, as we always are. The doctors my husband had were certainly first class and I doubt anyone could say that the out of pocket expense was bad. If we were buying a plan F supplement this would be about 2 months of premiums. So - to those naysayers who claim so much bad about advantage plans -- I think it is good to have insurance but not to be insurance poor. We were a little nervous about what this was going to cost us but it was unnecessary worry. He has been in the hospital twice now - his stroke for a week and this surgery , and both times the bil for the copay l was very reasonable.

All Advantage Plans are not alike. They differ from state to state. Some are PPO and some are HMO. Florida seems to have many good Advantage plans, some states don't.

A member of my family now has an Advantage plan because she lost her group RX program through her deceased spouse employer. Because of finances she had to choose an Advantage Plan and pays $90 a month for it.

Her policy has a $200 deductible for inpatient care for the first seven days. As luck would have it, she spent seven days in the hospital last month. The bill hasn't come yet, but she will owe $1400, which she will never be able to pay.

As for your bragging, I hope you or or DH does not require medical when you come to PA this summer. You mentioned that you now have an HMO Advantage Plan because your PPO Plan no longer covered your gym.

HMO's can be a nightmare when you are out of state. I hope you never find out.

Carmie · ‎10-25-2010

@151949 wrote:
@CLHS68 Sorry I don't have an answer for you on this because here in Florida it is illegal for them to do this. If you have to use anesthesia or radiology at an in network facility and you have no choice to use someone else who is in network - they are required to pay the same as if he is in network. I would just pay it and then turn it in to be reimbursed.

Turn it In to whom for reimbursement? If you have an Advantage Plan and your doctor is not in network you are responsible for the amount not paid by your insurance plan. There is no where to turn it in. The doctor does not have to accept the payment and the patient is responsible for the balance.

Carmie · ‎10-25-2010

@151949 wrote:
@Cakers3 Guess what - supplements are not all the same and also vary from place to place. They also vary greatly in price.
As I said before - advantage plans have a max out of pocket amount so if you do have a catastropic event , after you reach your max out of pocket , guess what? it is all covered 100%.
Advantage plans are required by law to cover everything medicare covers. So my routine screening tests like colonoscopys and mammos atre covered 100% too.
As for doctors - when we started on omedicare we were new to this area so we chose a doctor from the network. However, our former doctor from when we lived in Pa is also an in network doctor with our ins co. I have actually never spoken to anyone IRL that had any issue finding a doctor that would take medicare. I only hear about that on this board. Since advantage plans are managed care plans it is simple to just chose a doctor from their network. He'd be guaranteed to take your insurance.

You are 100% WRONG. Medicare supplements are standard.

Also Advantage Plans cover the same items as Traditional Medicare, but they don't pay the same.

You are always negative about Traditional Medicare and Supplemental Plans. It seems you try to justify Advantage Plans because you can't afford Traditional Medicare and especially Plan F.

I remember the many times you were crying about your Advantage Plan not covering things and getting stuck with bills. You seem to forget when it's suits you.

You will be crying again if you or DH have a serious medical program while you're in PA with that HMO. There are no in network doctors for your Florida HMO in PA.