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

Re: Getting switched with little warning into Medicare Advantage


@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.


This has NOTHING to do with the "government messing in insurance".

Nothing. At. All.

This is why you need to open and read notices from your insurance carrier.

It's a sad case of someone not being interested enough in her own insurance to keep informed.

As someone who does sell HI, seniors must remember to check every year. Medicare Plans change EVERY YEAR. Most seniors I have advised are very knowledgable...they study the literature very closely and ask lots of informed questions.

This woman made a lazy mistake. Its her fault - 100%.

QVC Customer Care
Posts: 1,879
Registered: ‎06-14-2015

Re: Getting switched with little warning into Medicare Advantage

QVC Customer Care
Posts: 1,879
Registered: ‎06-14-2015

Re: Getting switched with little warning into Medicare Advantage

Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: Getting switched with little warning into Medicare Advantage

I think a  person would have to be incredibly irresponsible to get themselves into this situation in the first place - it is practically impossible for this to happen. When you go to the hospital they look into your insurance immediately and they would certainly make you sign something assuring you would pay the bill and make you pay something up front.My friend has just had surgery last week and her insurance has a copay of $300/day for 5 days and she was required to pay that whole $1500 up front.As for the woman not knowing what insurance she has - wouldn't getting a bill for the premium or having money deducted from your SS check for the premium be a hint to you ????? This is too incredible to be true.

Respected Contributor
Posts: 3,314
Registered: ‎04-04-2015

Re: Getting switched with little warning into Medicare Advantage


@151949 wrote:

I think a  person would have to be incredibly irresponsible to get themselves into this situation in the first place - it is practically impossible for this to happen. When you go to the hospital they look into your insurance immediately and they would certainly make you sign something assuring you would pay the bill and make you pay something up front.My friend has just had surgery last week and her insurance has a copay of $300/day for 5 days and she was required to pay that whole $1500 up front.As for the woman not knowing what insurance she has - wouldn't getting a bill for the premium or having money deducted from your SS check for the premium be a hint to you ????? This is too incredible to be true.

 

This was the question I originally asked - wouldn't Medicare Advantage just involve one payment rather than two - one to traditional Medicare and one to your supplement.

 

Then people said that Medicare Advantage is all over the place with the way payments are made - sometimes it's one payment, but sometimes it's two.

 

So if it were the latter, she might not have realized what happened.

 

And, in any case, I still think it is more above board - particularly after someone has clearly chosen traditional medicare and thinks they are continuing their other insurance as a supplement - for any changes to that status to be on an "opt in" rather than an "opt out" basis.


 

Respected Contributor
Posts: 3,970
Registered: ‎03-16-2010

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


______________________________________________________

 

@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! 


* Freedom has a taste the protected will never know *
Respected Contributor
Posts: 3,314
Registered: ‎04-04-2015

Re: Getting switched with little warning into Medicare Advantage

OK now I'm even further confused.

 

Pitdakota says that "by law Medicare Advantage must cover what traditional Medicare covers."

 

So if that is the case, then what is the woman complaining about - and how can traditional Medicare suddenly cover her hospitalization when her Advantage plan couldn't - if Medicare Advantage has to offer the "same" coverage?

Honored Contributor
Posts: 31,611
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage


@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.

Respected Contributor
Posts: 3,970
Registered: ‎03-16-2010

Re: Getting switched with little warning into Medicare Advantage

[ Edited ]

@Isobel Archer wrote:

OK now I'm even further confused.

 

Pitdakota says that "by law Medicare Advantage must cover what traditional Medicare covers."

 

So if that is the case, then what is the woman complaining about - and how can traditional Medicare suddenly cover her hospitalization when her Advantage plan couldn't - if Medicare Advantage has to offer the "same" coverage?


____________________________________________________

 

@Isobel Archer, because the woman went to a facility that was not "in network" for that particular medicare advantage plan.  The medicare advantage plan usually identifies only certain hospitals or doctors that subscribers must use if you enroll in their plan. 

 

The statement "by law" medicare advantage plans must cover means that medicare advantage plans cannot limit their coverage under what typical health care expenditures medicare covers. Meaning the medicare advantage plans cannot refuse to cover any and all hospice expenses, since medicare does cover hospice.

 

However, the medicare advantage plan can and does put rules and regulations in place for their subscribers. So in order to have this paid for, the subscriber must use their approved providers, facilities, etc.

 

No different than any other private health insurance company that is a type of HMO.


* Freedom has a taste the protected will never know *
Honored Contributor
Posts: 31,611
Registered: ‎08-23-2010

Re: Getting switched with little warning into Medicare Advantage


@Isobel Archer wrote:

OK now I'm even further confused.

 

Pitdakota says that "by law Medicare Advantage must cover what traditional Medicare covers."

 

So if that is the case, then what is the woman complaining about - and how can traditional Medicare suddenly cover her hospitalization when her Advantage plan couldn't - if Medicare Advantage has to offer the "same" coverage?


@Isobel Archer

 

Think of Medicare Advantage as similar to an HMO like Kaiser.    You must go to their network of doctors.  If you choose to go to a doctor that isn't part of the Kaiser network, you will be out of pocket a LOT more money.  

 

In this woman's confusing case, when she went for that procedure, her doctors etc weren't in the Medicare Advantage network she was enrolled in.  

 

As it turns out, people helped her get this sorted out and her bills will be covered.   Whew!