Wellness

[millieshops]

Unless things have changed since I monitored my aunt through homecare, various hospitalizations, and a long stint in a nursing home, even traditional Medicare can be withdrawn before the patient reaches that deadline.

[shoesnbags]

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@mac116 wrote:

I have a Medicare Advantage plan, and I LOVE it!  The coverage is explained in detail in the membership booklet.  The booklet is something that I sat down with, highlighter in hand, to see EXACTLY what was covered for the year.  I have several medical issues, been on the plan for 9 years, and never had a problem.  My premium is $85 per month which is $200 less than I was paying for my employee plan.

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@mac116 

How long was your nursing home stay? This thread is about Advantage plans denying longer nursing home/rehab stays.  We're not comparing premium costs.  I know I'm paying more for my regular Medicare plus a supplement, but that's not the point.  I don't want to be held to a shorter stay in rehab at some point in the future because it saves the Advantage plan some money.

[mac116]

@shoesnbags 

The nursing home stay is what I think is the standard Medicare allowance of 20 days. I was not in a nursing home, just reporting on my coverage. 

[conlt]

I am a RN and have worked with the elderly as an RN for 41 years. I work in home health administration and see the heart break that happens to people when they sign up for the Advantage Plans. I must say, that I toot my horn about this every year on these boards and I am always criticized by those who are happy with their advantage plans. 

I turn 65 next June and will be on Medicare Part A and Part B and a supplement plan G. Here goes:

Advantage plans advertise low costs, all types of benefits that traditional Medicare does not: Gym membership, money back, dental, and on and on. Once you sign up for an Advantage Plan, you can go back to traditional Medicare but to purchase a supplement plan, you most likely, will have to go through a health assessment from the insurance company. In contrast, when you sign up for a supplement plan when eligible for Medicare, you do not have to go through a health assessment. 

The slick advertisements, offer of free dinners, increased benefits etc, lure unsuspecting seniors in and many, without knowing it, sign themselves into an Advantage Plan. 

Many are limited in care and participating providers. Your story is a great example. In a skilled facility for rehab, under Medicare the patient is  provided 21 days of therapy, paid at 100%. If the patient still needs therapy after 21 days, he or she can stay up to 100 Days paid at 80% and the supplement sill pay the additional 20%. 

The clinical team documents if the patient is making progress and that is how the decisions are made as the whether the patient should stay or has reached his/her potential. 

I have seen so many patients, suffer care limits under these plans. Large copay, surprise costs, and on and on.

They advertise these plans as "the same coverage as Medicare" but with additional benefits. Once you sign up, you are stuck and may find yourself in a situation where services are not covered. Most likely, you will be stuck in the Advantage Plan world for the rest of your life. The plans are certainly not kind to the very elderly, who require more care.

My advice: Do not go on an advantage plan unless you absolutely cannot afford Medicare and a Supplement. I know I will get backlash for this opinion but this is my experience, heartbreak talking to hundreds of patients, and true knowledge that I have on this topic. 

[shoesnbags]

@conlt 

Thank you for posting this and trying to educate people!  Hopefully some will investigate further and see that you are telling the truth.  Maybe you should bold your first two sentences which explain how and why you are so knowledgeable about this subject. 

[sydsgma1]

we have had a top tier advantage plan that we pay a lot of $ for. My dh was in rehab for 2 months and it was completely covered. Whe he needed an extension, it was granted.

I really think the quality of advantage plans is determined by how expensive they are. We are very fortunate to be able to afford the top tier.

[Effie54]

There's no advantage to the Medicare Advantage plan. They push it because it costs so much less in payouts. They make patients jump through hoops, high deductibles, etc. our Medicare agent said that they make a much higher percentage rate when they sign a person up for the advantage plan. I stuck to the regular Medicare, I don't want to go anywhere near the Advantage plan. 

[Trinity11]

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@Effie54 wrote:

There's no advantage to the Medicare Advantage plan. They push it because it costs so much less in payouts. They make patients jump through hoops, high deductibles, etc. our Medicare agent said that they make a much higher percentage rate when they sign a person up for the advantage plan. I stuck to the regular Medicare, I don't want to go anywhere near the Advantage plan. 

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We have an Aetna PPO Advantage Plan @Effie54 . A  Company retiree plan with Caremark for our drugs Part D. $250.00 deductible and my $100,000.00 hospital stay in July was completely covered. My physicians are the same as when we had a supplement and straight Medicare. Not all Advantage plans are the same. We also have no lifetime caps in benefits. I am a Type 1 diabetic with a heart condition and other health issues, I receive excellent care with our PPO Aetna Advantage Plan and we have never had issues finding physicians that accept it...

[Hmmmmm24]

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@sann wrote:

I know someone who does have a Medicare Advantage Plan...she frequently has mentioned that it's free...but it's not free...if she has any type of medical procedure money up front is required...if she goes to the ER money up front again is required...if she's admitted to the hospital once again more money is required...no way is it free...now as far as how much money...she doesn't say !!!!

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Not true! I have my Advantage plan through Aetna. I pay $0 additional on top of what Medicare takes out. I went to the ER in May to have a tick removed that was inside my ear, that I couldn't reach myself. My ER co-pay is $90.00. I have yet to see a bill for it. When I check my EOB, it looks like they wrote it off.

I also pay $0 for my meds. I'm on a BP med and Synthroid.

[Trailrun23]

All Medicare insurance is basically pay them now or pay them later....am looking at changing to a supplement but don't get much specific info on it. SIL has only Medicare and she is having trouble finding drs who will take Medicare without a supplement or other plan. I don't want to drop my current plan and not be able to see my specialists without paying housands of dollars for an office visit and bloodwork.