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Respected Contributor
Posts: 2,664
Registered: ‎05-13-2010

Re: Getting medicare costs under control

The whole idea of advantage is to ration care.  I don't want that.

Honored Contributor
Posts: 12,889
Registered: ‎03-09-2010

Re: Getting medicare costs under control


@KarenQVC wrote:

I have Plan F because I hate hunting and pecking for doctors.  I like to just call any specialist and make an appt.  I was once in an HMO and got the worst medical care of my life.  The internist tried to do it all and it just didn't work.  I assume that can happen to people with advantage plans and I want no part of it.

 

 

@KarenQVC- I ran into that in the HMO early years.  I changed to an HMO (this was in 1983).......and......then I got sick.  Reallly sick.  No one could figure out what was wrong sick.  Kept going to the primary as he would need to request referrals from the HMO for everything.  He was fresh off his residency.  I'd go and then 3 weeks would go by and then he would finally refer me to a specialist.  Then, back to him and yet 3 more weeks to another specialist.  Then he'd balk at the referral even though he didn't have a clue what was wrong with me.  I went through all of 1984 like that (I got sick in Dec. 1983).  I swore that if I ever had the chance to get out of the HMO, I would and when open enrollment came for 1985, one year on the HMO was enough for me.  I went back to the PPO or whatever they were called then.  Back to my "old" doctor.

 

My husband has Plan F supplement.  I'm not Medicare eligible yet.

 

I'm sure HMO's have come a LONG way, after all, that was 1983-84, but I'm really, really leery of them.


 


Why is it, when I have a 50/50 guess at something, I'm always 100% wrong?
Respected Contributor
Posts: 4,627
Registered: ‎03-10-2010

Re: Getting medicare costs under control


@KarenQVC wrote:

I have Plan F because I hate hunting and pecking for doctors.  I like to just call any specialist and make an appt.  I was once in an HMO and got the worst medical care of my life.  The internist tried to do it all and it just didn't work.  I assume that can happen to people with advantage plans and I want no part of it.


 

It's not just Plan F that allows you to go to any doctor.  With the exception of plan C, the Advantage plans, none of the other Medicare supplement plans require you to hunt for doctors, except for the fact the all of the supplement plans require that you go to doctor who accept Medicare.  The Advantage plans are the only ones that use networks of doctors.  All other plans allow you to go to any doctor who accepts Medicare.

Esteemed Contributor
Posts: 5,616
Registered: ‎10-01-2014

Re: Getting medicare costs under control

I have a Plan F that I pay $93 a month for, plus a drug plan for $25, so with the $104 that I pay for basic Medicare, for a total of $222, considerably less than the lesser plan I was on pre-Medicare for $700 per month. 

 

My Plan F is with one of the two large hospital/clinic groups in my state, so I have to stay with a doc affiliated with my plan group. This doesn't bother me at all, both groups have excellent physicians. Our medical community is called Little Mayo due to the excellence of care and the talented docs it attracts.

 

I've only had one small issue. Went to my Derm last November, had a biopsy, got an EOB from my plan last month saying they weren't paying the $184 lab bill for the biopsy since it was sent to the other group. Billing error in the Derm's office. I haven't gotten the actual bill from the lab yet, but when and if I do, I'm taking it to my Derm's office and telling them to pay it since they admitted it was their error. Small town living at its best!

No act of kindness, no matter how small, is ever wasted. - Aesop
Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: Getting medicare costs under control


@KarenQVC wrote:

The whole idea of advantage is to ration care.  I don't want that.


 Well, how do you think they should control the abusers, those who doctor shop until they find one who will do exactly what they want? or the hypocondriacs who go running to a specialist every week for something? These behaviors are rampant among medicare patients because they can and it doesn't cost them one dime.

We were out fishing last week with some friends on their boat and the guy is a real hypocondriac - always running to the specialist. He cut his finger with a small fish hook , so I washed it and put a bandaid on it. That afternoon when he got home he called his plastic surgeon to get stitches in it. While we were driving back I asked him how it was and he said it had stopped bleeding so what would be the reason to go to a surgeon for stitches? Of course it was all paid for 100% by you and I.

Esteemed Contributor
Posts: 6,287
Registered: ‎01-24-2013

Re: Getting medicare costs under control


@151949 wrote:

@Lila Belle wrote:
Why would anyone purchase an advantage plan and not Plan F?

COST. Where I live to get a plan F + Rx plan would cost over $800/month for the two of us. Our advantage plan is only the $104 they take from each of our SS checks, or $208/month. Quite a difference.Plus advantage plans also save us a lot on things like $60/month for our YMCA memberships because they pay for additiobnal benefits medicare doesn't offer, For instance I am a cancer survivor and I have a + BRAC gene so I am supposed to get a special  digital, spiral mammo. Medicare doesn't pay for it but my advantage plan I called them and they have approved it so they pay for it. I don't htink advanatge plans are the best thing for everyone but at least for right now it is best for us. 


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@151949I went with my aunt when she chose her options for Medicare and it was my understanding that once you have chosen an Advantage plan you can't switch to a supplement Plan F.

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

Re: Getting medicare costs under control

[ Edited ]

@Lila Belle wrote:

@151949 wrote:

@Lila Belle wrote:
Why would anyone purchase an advantage plan and not Plan F?

COST. Where I live to get a plan F + Rx plan would cost over $800/month for the two of us. Our advantage plan is only the $104 they take from each of our SS checks, or $208/month. Quite a difference.Plus advantage plans also save us a lot on things like $60/month for our YMCA memberships because they pay for additiobnal benefits medicare doesn't offer, For instance I am a cancer survivor and I have a + BRAC gene so I am supposed to get a special  digital, spiral mammo. Medicare doesn't pay for it but my advantage plan I called them and they have approved it so they pay for it. I don't htink advanatge plans are the best thing for everyone but at least for right now it is best for us. 


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@151949I went with my aunt when she chose her options for Medicare and it was my understanding that once you have chosen an Advantage plan you can't switch to a supplement Plan F.


Not so - as long as you are not undergoing any treatment - say you were diagnosed with cancer - you would have to finish your treatments on your advantage plan but then would be free to switch to a supplement in the next sign up period. This was told to us at a town hall meeting by a rep from medicare, and our agent. the medicare rep was encouraging people to sign up for advantage plans if they are younger retirees and still relatively healthy.

Honored Contributor
Posts: 18,604
Registered: ‎10-25-2010

Re: Getting medicare costs under control


@151949 wrote:

This is NOT a discussion of advantage plans vs regular medicare - it is about medicare supplements may go to being HMO/PPO plans. 


It would not make a bit of sense for Medicare supplements to change to HMO/PPO plans.

 

Medicare is primary, which means they pay first.  They generally pay 80% of the allowed doctor's tee.  With Medicare you can visit with any doctor of your choosing.

 

A suppliment pays the 20% of the Medicare allowed fee.  

 

Why would Medicare save money if your supplement was an HMO/PPO plan?  And why would the government require the supplements to change.... The cost of those plans are paid for by the consumer?

 

if you could,choose any doctor for Medicare, but your 20% would only be paid if your doctor was in the PPO or HMO network would be CRAZY!

 

Are you trying to say that Medicare would become. PPO/HMO program, much like the advantage plans?  Advantage plans cost Medicare more then the Traditional plans and the insurance companies are losing money on them too.  

 

 

 

 

 

 

 

 

 

 

 

 

Honored Contributor
Posts: 18,604
Registered: ‎10-25-2010

Re: Getting medicare costs under control


@151949 wrote:

@Lila Belle wrote:

@151949 wrote:

@Lila Belle wrote:
Why would anyone purchase an advantage plan and not Plan F?

COST. Where I live to get a plan F + Rx plan would cost over $800/month for the two of us. Our advantage plan is only the $104 they take from each of our SS checks, or $208/month. Quite a difference.Plus advantage plans also save us a lot on things like $60/month for our YMCA memberships because they pay for additiobnal benefits medicare doesn't offer, For instance I am a cancer survivor and I have a + BRAC gene so I am supposed to get a special  digital, spiral mammo. Medicare doesn't pay for it but my advantage plan I called them and they have approved it so they pay for it. I don't htink advanatge plans are the best thing for everyone but at least for right now it is best for us. 


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@151949I went with my aunt when she chose her options for Medicare and it was my understanding that once you have chosen an Advantage plan you can't switch to a supplement Plan F.


Not so - as long as you are not undergoing any treatment - say you were diagnosed with cancer - you would have to finish your treatments on your advantage plan but then would be free to switch to a supplement in the next sign up period. This was told to us at a town hall meeting by a rep from medicare, and our agent. the medicare rep was encouraging people to sign up for advantage plans if they are younger retirees and still relatively healthy.


151949, you should stick to nursing and stay away health insurance information.

 

Yes, you can change from an Advantage plan back to Traditional Medicare during the open enrollment period,  the problem is...it will be almost impossible to get a suppliment plan at that time.  Because you did not pick up a suppliment within 6 months of getting Medicare Part B, you will be penalized with a VERY, VERY high rate for that supplemental plan.

 

So, if you change your mind, you will probably have Medicare only without the supplemental plan. So... Plan F is out of the.picture for most people.

 

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

Re: Getting medicare costs under control


@Carmie wrote:

@151949 wrote:

This is NOT a discussion of advantage plans vs regular medicare - it is about medicare supplements may go to being HMO/PPO plans. 


It would not make a bit of sense for Medicare supplements to change to HMO/PPO plans.

 

Medicare is primary, which means they pay first.  They generally pay 80% of the allowed doctor's tee.  With Medicare you can visit with any doctor of your choosing.

 

A suppliment pays the 20% of the Medicare allowed fee.  

 

Why would Medicare save money if your supplement was an HMO/PPO plan?  And why would the government require the supplements to change.... The cost of those plans are paid for by the consumer?

 

if you could,choose any doctor for Medicare, but your 20% would only be paid if your doctor was in the PPO or HMO network would be CRAZY!

 

Are you trying to say that Medicare would become. PPO/HMO program, much like the advantage plans?  Advantage plans cost Medicare more then the Traditional plans and the insurance companies are losing money on them too.  

 

 

The way it works now leaves the system open to abuse by patients who doctor shop and hypocondriacs who are constantly going to the doctor and other abusers - druggies etc. They go to doctor after doctor after doctor and medicare pays and pays and pays again. Something needs to be done to manage medicare patients care. Someone needs to stop this abuse - it is costing too much. This is why health ins. co. went to managed care (HMO?PPO) in the first place, and I ask again - why should medicare patients  have insurance that is so much better than almost all of the general public - since almost everyone else is on a managed care plan.