@151949 wrote:
@Carmie wrote:
@151949 wrote:
@Carmie I don't know what you mean by "core benefits" but advantage plans are required BY LAW to cover everything medicare covers. Plus they then will offer other incentives to get you to buy their plan like dental,vision, hearing aides , silver sneakers etc. So if an advantage plan is only "core benefits" so is medicare.
Yes, all Advantage Plans cover the same services as original Medicare, plus more. I agree 100%.
Well then please explain what you meant when you wrote "advantage plans only cover core benefits" and "they lack comprehensive benefits ".
I have explained this to you many times and feel like you are baiting me with your questions. I will answer again, but please do not argue or debate me. I am only stating facts. Your HMO Advantage Plan is unlike other HMO Plans. Every Advantage Plan is different and what you have is not available to anyone lose who does not live in your community.
Now, let me tell you that ALL Advantage Plans, Including The PPO and HMO Plans provide coverage for all of the Part A and Part B services as original Medicare.
Advantage Plans cover these services with a different set of rules, restrictions and costs that can affect how and where you can go to receive your services.
for instance, if you are on vacation in Hawaii and need your three month diabetic check and blood work done and have an Advantage HMO, you probably would have to pay out of your own pocket. HMO do not cover non-emergent services when you do not have them provided by your HMO doctor.
if you have an Advantage PPO Plan, you might get payment depending on your plan, but the payment will be lower and you will have to pay the balance yourself.
Advantage Plans encourage you to use their doctors and hospitals to save you and them money and penalize you for going out of network. These penalties can be high.
If you have Original Medicare, you can have services anywhere you choose and the payment is the same. If you go to a non par Medicare provider, you can be balance billed and your supplement can pick that up. In some states, like PA, all doctors must accept the Original Medicare allowance and cannot balance bill you.
that means if you have cancer, for example, you can go to John Hopkins in Baltimore and not need permission or a referral, you can just go. With an Advantage HMO, you could only get coverage if you lived in MD.
some services under Advantage Plans are covered but the number of services you can receive are restricted. People with End Stage Renal Disease are not allowed to purchase Advantage Plans, because there is a limit on the life saving services they need.
( some states, but not all have special advantage plan coverage for ESRD patients)
Both types of Medicare are good for most people, but if you get really, really ill, original Medicare allows more freedom and less restrictions and a greater number of some services.
I forgot to mention that you could lose your Advantage Plan if you need a lifetime of expensive services. Advantage Plans all have a maximum out of pocket each year. Let’s say it’s $7600. It’s a given that if you need dialysis every day to stay alive, you will meet that maximum in no time at all. You Advantage Plan can drop you and force you to go on Original Medicare, which is fine, but you will have a difficult time buying a supplement. The government never made any rules for insurance companies to allow you to purchase a supplement after your six month enrollment period when you were eligible for Medicare Part B.
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