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Honored Contributor
Posts: 31,684
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage


@Kalli wrote:

@scotnovel wrote:

It seems unlikely that the OP would have only received one notification before being switched.  I personally received several letters from my insurance company over a period of several months before I was eligible for medicare regarding the potential upcoming switch.  I chose to go with a different company and simply called mine to make sure my existing policy was cancelled in a timely fashion.  

 

This is another lesson that we are all responsible for understanding what is happening with our own health care and financial business especially when it is time to get medicare.   


 

 

I don't disagree but sometimes we don't even know that we don't know something.  She didn't know that signing up with a different plan wasn't enough.  She probably thought the rest of the mail was more solicitations.  She made a mistake.  But sometimes we just don't know we're doing something the wrong way.  I know I'd have thought if I signed up for a certain insurance, that that's the insurance I'd have.  I wouldn't have thought the previous insurance had rights to continue considering me their client after I switched.

 

I think there's a reason the previous insurance did what they did...because they CAN.  Not because they should.  There's $$$ involved - that's why they're doing this.   They have the right to send letters and if there's no response, they can continue to believe you're their customer.  It should be the other way around.  

 

What if this was the case with every business you patronize???  


@Kalli

 

Well, let's keep in mind that there's the issue of providing continuity, too.    In many cases, people like what they are familiar with ....  what they know well.  

 

If someone doesn't even bother to review the finer points of their coverage, and whether they need to select each year, or it automatically rolls over, there can be consequences.

 

 

Honored Contributor
Posts: 13,954
Registered: ‎03-10-2010

Re: Getting switched with little warning into Medicare Advantage

@Mary BaileyI'm sorry I don't have any specific advice, but here is some info that you might find useful.

Medicare, as you know, doesn't cover all health care needs. So private insurance companies have the option of offering plans that can cover the difference.

Private insurers are graded every year on the service and value they offer to consumers. It's a complicated series of criteria. Their annual "grade" determines how much reimbursement they receive from the federal Medicare program - and thus helps them set rates for the next year.

They al selling a product to you. Like any other product, they try to keep their costs as low as possible, while offering services that will get them a good annual grade too. Some programs include things like "Silver Sneakers"; others may have low prices - but a limited number of doctors and hospitals.

Every year the companies have to submit their rate requests to their state financial boards, county by county (at least that is how markets are determined in NY State).

So a program you like one year may change radically the next.

Because you are literally "on your own" - not usually working through an employers group - you have to be an informed consumer.

The government mails updated info every year to every Medicare recipient. You can also call insurers directly, go to county senior service departments, or even a private insurance broker (although I have found they can be abrupt with individuals - not enough commission in individual plans!)

You don't have to wait for enrollment time to call your insurer. In fact, that is the worst time to call - IMO. Insurance companies hire hundreds of part time seasonal help during enrollment and many now outsource their call centers - even to overseas!

If you call now you'll be speaking to a real full time professional agent - the companies hire a few of the very best to work full time. So call now before it's busy when you can make an informed choice with the best employees to assist you.

Good luck!

Esteemed Contributor
Posts: 6,085
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage

Thank You IamMrsG I book marked it
Esteemed Contributor
Posts: 6,085
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage

Thank You terrier3 I appreciate all the info. It makes sense.
Honored Contributor
Posts: 13,954
Registered: ‎03-10-2010

Re: Getting switched with little warning into Medicare Advantage

[ Edited ]

@mominohio wrote:

Wow. I certainly am no expert on the field of health insurance, but it seems like quite a racket probably designed 'to keep people insured' without loss of coverage as the excuse, but actually another instance where the government messing in the insurance creates havoc for the insured.

 

There have been a couple of time where we were 'automatically' signed up for something, and shocked when it happened. I think it should be illegal to do, and a signature required before something can be 'automatic' like this. A simple letter informing is not enough.


Medicare Advantage plans were created in the early 2000s. The leader at the time believed that private companies could do a better job insuring people for less money than the government. He decided to create Advantage plans to gradually wean people off Medicare and eventually end the program.

 

At the start, they gave huge subsidies to insurance companies to get people to leave regular Medicare. That is how insurers were able to add goodies like gym memberships, messages, etc. After a while, it was determined that Advantage plans actually cost MORE and deliver no better care. The insurers didn't want to see their subsidies go away - but when people choose to go with Advantage - we, the taxpayers foot the extra bill.

The ACA reformed the way insurers are subsidized. They get way less money and must reach certain health & wellness goals for their patients.

Single payer for all with no middlemen companies would save money and eliminate a lot of waste.

 

Medicare was originally created as part of the War on Poverty. Seniors were at the mercy of private insurers and often couldn't get ANY coverage when they retired, due to pre-existing conditions and increased health costs of the aged. Before Medicare, seniors were the poorest segment of society. Now seniors have more assets and money that any other age group.

Honored Contributor
Posts: 14,946
Registered: ‎10-25-2010

Re: Getting switched with little warning into Medicare Advantage


@wonderfulworld wrote:

I have had traditional BC/BS at almost $900.00 a month for just me, auto deduction from my checking account.. My husband is already on Medicare.

 

I also received the letter about seamlessly being enrolled in their Medicare Advantage plan. I in no way wanted to continue with BC/BS and definitely did not want an Advantage Plan. I had to send them a letter 'opting out' of the Advantage plan.

 

To make sure I did not get stuck with them I cancelled my auto deduction and paid by check for my last several months of traditional BC/BS.

 

I am not receiving social security so I write three checks a month...one for medicare, one to Mutual of Omaha for my Medicare Supplement plan and one to Humana for prescription drug coverage. It is a bit less than half of what I have been paying.

 

 

Heads up: in my recent research I was told that Congress has mandated that Medicare supplement Plan F  be eliminated in 2020. Those who have it can continue but it is anticipated that the price will go up quickly as the number enrolled decreases.

Has anyone else heard this? My husband has F. Our agent recommended plan G for me.


Please check out Plan C instead of Plan G.  Plan C and Plan F both cover the coinsurance from day 21 to day100 in a skilled Nursing facility ( SNF) It is very common for people to use more than 20 days in a SNF due to car accidents, a hip or knee replacements.

 

I spent way over 20 years working in customer service for a health insurance company.  I have heard many people cry and scream with they find that they don't have enough coverage for a SNF.  You could receive a bill for thousands of dollars or have to be sent home before you are ready.

 

This is a VERY IMPORTANT benfit.  Think about it carefully. Just saying....

Honored Contributor
Posts: 14,946
Registered: ‎10-25-2010

Re: Getting switched with little warning into Medicare Advantage


@Tinkrbl44 wrote:

@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


Medicare Advantage Plans are either a PPO or HMO.  Traditional Medicare is a horse of a different color altogether.

Honored Contributor
Posts: 14,946
Registered: ‎10-25-2010

Re: Getting switched with little warning into Medicare Advantage


@Tinkrbl44 wrote:

@pitdakota wrote:

@Tinkrbl44 wrote:

@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


______________________________________________________

 

@Tinkrbl44, I just want to make sure that posters do not read this and think of Medicare B as a supplement, because it isn't.

 

So for clarity:  Medicare A is coverage for expenses related to hospitalization, home health, hospice, or limited coverage related to rehab in a long term care facility for a short period of time.

 

Part B covers other components of necessary medical care, and should not really be considered a supplement.  In fact, it is quite necessary.  Part B covers doctor's office visits, labs, durable medical equipment, mammograms, some vaccinations, etc.

 

So with your example, someone with only Part A coverage in a traditional plan would only be covered for hospital expenses, home health, hospice, etc.  It would not cover any doctor office visits, labs or tests performed if the person was not in the hosptial or recieivng home health services.

 

I just want to make sure people understand that both Part A and Part B are necessary for full coverage health insurance.  Doesn't matter whether it is traditional Medicare of some type of a Medicare Advantage plan.  Thanks! 


@pitdakota

 

I thought my stating "You will need to select a Medicare Supplement (part B) to cover doctors, labwork etc"  was pretty clear.   Part B IS a supplement which covers you,  in conjunction with Part A.   

 

Depending on which informational website you review, the Part B is often referred to a "supplement" or "Medigap policy. " Supplement"  does not mean optional.   I think that's pretty clear.   The words aren't interchangeable by any stretch of the imagination.

 

However ..... I disagree with your last paragraph ... You DO NOT need Part B coverage if you're going with a Medicare Advantage plan (Part C).

 

Hope that clears it up for anyone reading this.


PART B IS NOT A MEDICARE SUPPLIMENT!!!!  It is Medicare insurance for professional providers and out- patient hospital insurance.  When you enroll in Medicare you can purchase Medicare Part B.  It is usually paid for by taking a fee from your SS benefits.

 

That said.... There is a Medicare Supplimental PLAN B.  You can purchase this plan to,suppliment Medicare PART A and B.

 

There is a BIG difference between PART B and PLAN B.

Honored Contributor
Posts: 14,946
Registered: ‎10-25-2010

Re: Getting switched with little warning into Medicare Advantage


@hyacinth003 wrote:

I have never been so darn confused as this Medicare thing.  I have handled all financial/medical stuff all my adult life, but this got me!

 

My husband needs to enroll.  We have been inundated with phone calls and mail.

 

We have had a company to work with via his employer.  It is really so confusing at first, and I am just hoping we get it now!

 

He has enrollment in Part A and B.  Then, we are choosing a Medigap policy (referred to as Part F) and a prescription drug plan, which is separate.  At first we were going to do a Medicare Advantage plan, but after some explanations, decided on the alternative.  Both the plans we chose are Blue Cross Blue Shield.

 

I found it very overwhelming, and hope we chose correctly!

 

Hyacinth


You did good... You got the best there is.

Honored Contributor
Posts: 30,574
Registered: ‎08-19-2010

Re: Getting switched with little warning into Medicare Advantage


@wonderfulworld wrote:

I have had traditional BC/BS at almost $900.00 a month for just me, auto deduction from my checking account.. My husband is already on Medicare.

 

I also received the letter about seamlessly being enrolled in their Medicare Advantage plan. I in no way wanted to continue with BC/BS and definitely did not want an Advantage Plan. I had to send them a letter 'opting out' of the Advantage plan.

 

To make sure I did not get stuck with them I cancelled my auto deduction and paid by check for my last several months of traditional BC/BS.

 

I am not receiving social security so I write three checks a month...one for medicare, one to Mutual of Omaha for my Medicare Supplement plan and one to Humana for prescription drug coverage. It is a bit less than half of what I have been paying.

 

 

Heads up: in my recent research I was told that Congress has mandated that Medicare supplement Plan F  be eliminated in 2020. Those who have it can continue but it is anticipated that the price will go up quickly as the number enrolled decreases.

Has anyone else heard this? My husband has F. Our agent recommended plan G for me.


If your talking about Mutual of Omaha Plan F supplemental policy then, yes, it's due to expire in 2020, but, we got grandfathered in, my husband was already in it, I will be in Dec. His rate went down 7% when I got on his plan.

Mutual of Omaha Plan F is the best . What I was told. Plan G is 2nd best and a little cheaper.

 

I can't wait to kick Humana private policy to the curb. No more huge premiums to that lot. Getting old can be a good thing sometimes. LOL

 

My insurance man told me with the election we don't know what's coming down the pike regarding future insurance.

 

All I know is my Medicare Part B will be 120 a month taken from my SS check, another 140 we will pay to Mutual for Plan F, but, we should never see a bill. For the both of us 120x2, then, 140x2 still cheaper then the one policy I have on just me , now.