Wellness

[Bookplate]

Keep in mind that Advantage plans are owned and operated by private insurance companies.  They are managed care, by a for-profit organization.

They HAVE to make money, and they do this by limiting your choices of doctors, hospitals and medical offices, and requiring pre-approvals for standard procedures.  The pre-approvals alone delay and often defer required care, often with complications.  Who do you want to decide your treatment - a doctor or an insurance company?

A provider who accepts Medicare does NOT have to accept Medicare Advantage.

[jlkz]

@Carmie 

You are absolutely right about PT being monitored.  When my Mom had Alzheimer's and was in a nursing home, she stopped making any type of progress.  They were going to stop it but since I requested another few days to see if indeed there was no hope for progress, they continued it.

It became readily apparent their first decision was the correct one.  I know I shouldn't have denied their first request, but I wanted one more chance for her sake.

[blinksmom]

I started medicare on Dec 1st. I had so many questions and everyone I spoke to had different advice. It really does differ state to state. I ended up going onto Medicare.gov. I was able to set up a phone consultation( optional, not necessary) The woman that I spoke to was so patient and really explained my options.I got my advantage plan thru the medicare website-they are approved by medicare. I also opted for a call back for a few weeks later to answer any addtional questions I might have. I hope this helps.

[Carmie]

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@Bookplate wrote:

Keep in mind that Advantage plans are owned and operated by private insurance companies.  They are managed care, by a for-profit organization.

They HAVE to make money, and they do this by limiting your choices of doctors, hospitals and medical offices, and requiring pre-approvals for standard procedures.  The pre-approvals alone delay and often defer required care, often with complications.  Who do you want to decide your treatment - a doctor or an insurance company?

A provider who accepts Medicare does NOT have to accept Medicare Advantage.

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Who do you think monitors and processes Medicare claims?

The government does not have anything to do with health insurance claims.  What they do is pay health insurance companies to monitor, process and pay claims.

Large insurance companies like Blue Cross, Aetna and United Health Care process Medicare claims.  The government has a contract to reimburse them and pay them for their services.

They do an audit every month, if they find an error in claims or customer service, the insurance company gets a fine.  

 The government is super strict.  Here in PA, quite a few health insurance employees on the top tier had to do jail time for their errors.

I did customer service for Medicare one day and the next day I did customer service for a private insurance company.  I handled all types of health insurance.

Private insurance companies follow the Medicare guidelines for their advantage plans and for their plans sold to the public.  Medicare is the template.

Advantage Plans are all so different.  Some are awful, others are much better than Traditional Medicare.  There is no one size fits all.

You have to do your homework before you sign up.

[Jaspertimes]

In my area, inpatient hospitalization would not be covered until the fifth day with Advantage.  That won't work for me.  

[Kachina624]

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@Bookplate wrote:

Keep in mind that Advantage plans are owned and operated by private insurance companies.  They are managed care, by a for-profit organization.

They HAVE to make money, and they do this by limiting your choices of doctors, hospitals and medical offices, and requiring pre-approvals for standard procedures.  The pre-approvals alone delay and often defer required care, often with complications.  Who do you want to decide your treatment - a doctor or an insurance company?

A provider who accepts Medicare does NOT have to accept Medicare Advantage.  I can use any licensed provider or facility of my choice

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@Bookplate   Once again there are many exceptions that make your statement untrue.  My Advantage plan is self insured and is not owned by any corporation.  The only approval needed is for surgery and it was that way before I had Medicare.  I can use any licensed provider or facility of my choice.

I assume any entity with enough money can set up its own Advantage plan and pay benefits with their funds.  This is fairly common with government agencies at various levels.

[CelticCrafter]

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@Shelbelle wrote:

We have and love Aetna Medicare, our copays are just $5 and they pay for everything, pay for our vision checkups since ours are for medical issues too. Only thing we pay for is for a private dental plan with Met Life, which is also very good. I have had a knee surgery and 2 cataract surguries in the last 2 years and Aetna paid every penny, I never even saw any bills. 

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Cataract surgeries are covered whether you have an Advantage Plan or original Medicare with a supplement.

[Mindy D]

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@I am still oxox wrote:

It is my understanding that is covers less than tradational Medicare and you still will have a co pay. If you do not have any chronic considering it might be a consideration. You also might have diffiuclty finding doctors that accept the plan. 

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@I am still oxox @Under the regulations for all advantage plans they can cover more than traditional Medicare but they can not cover less. 

[sandy53]

The government wants out of the insurance business and that's why these Advantage programs have been allowed in the last few years.  I predict that we will all be on Advantage plans in a few years because the government will opt out entirely, preferring to pay private companies to provide coverage through Advantage plans.

What I don't understand is why is it legal for coverage to depend on where you live?  Why should my benefits in rural Iowa be any different from anywhere else?  That seems discriminatory to me.  It would be so much easier, so much less confusing, if everyone was covered in the same way. 

[Mindy D]

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@MrsCat21 wrote:

I am  about to sign up for Medicare and I think I am going to go with an Advantage Plan.  If anyone is on the Advantage side, are there any downsides in choosing Advantage over a Medigap plan?  It now has a PPO option so all my doctors and my dentist are in the plan, so its not the plan of the past  (HMO).

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@MrsCat21 @One disadvantage compared to Medigap plans is that you can not use your advantage plan to cover you out of state except in the case of emergencies. You can use it in out of state ER visits and doctor's offices if it is considered an emergency visit. An example of when this might be important in your decision in choosing an advantage plan is if you have a condition and you want it to be treated in another state.

Each advantage plan varies by company, state and county. There are both HMO and PPO advantage plans to choose from. Advantage plans include Medicare Part C, prescription drug coverage with them as part of the plan. They legally must cover at least everything original Medicare covers but they can also cover more than what original Medicare covers, (Part A), hospital costs., They do this through making arrangements with the govt. to be used in place of Medicare. They also cover doctors benefits, Part B, also done the same way as Original Medicare and also required to cover as much or more as original medicare. There are many plans with no monthly premium for the plan. Here in Florida, most of the Advantage plans have no premium, however, you do pay the Medicare monthly premium of 174.70 for 2024. This is usually taken out of your social security each month. Many advantage plans offer additional benefits at no additional cost, such as dental, vision, gym, transportation and an allowance for a few over the counter products you can select online or through a catalog. Some are now offering special policies for those with specific chronic conditions such as diabetes. They are known as special needs plans. These plans often include additional benefits, such as meals following release from a hospital stay...Blue Cross' special advantage plan, Florida Blue Medicare Advantage Plan for diabetics has this benefit here in my county.  

You have copays and deductibles with advantage plans. It's important to check what your annual out of pocket will be with each advantage plan. That's the maximum you will pay per year. It's also important to look at the the plans summary of benefits and check the costs and copayments for skilled nursing care. 

Since Medigap plans (also known as Medicare Supplemental Insurance, or also called a supplement)  have monthly premiums which can vary greatly by plan, you usually do not have the same copays, deductibles  and the higher annual out of pockets you have with advantage plans because you pay those amounts by paying  monthly premiums and for paying for a separate prescription drug plan, Part C. Medigap plans have Medicare Part A, which covers hospital costs and Part B, doctor coverage. The Medigap monthly premiums you pay for these plans are in addition to the basic Medicare premium which will be $174.70 for 2024. The premiums can be expensive depending on the company and with some of the companies the premiums can rise as you age. You should check this as you choose any plan. He premium prices vary substantially by provider and also vary by which plan type (each plan type is labeled with a letter, for example, Plan N, would be the name of a supplement plan type and Plans N can cost more or less from different insurance providers even though all of the Plans N will cover the exact same thing, no matter where you live). 

In your first year of eligibility, Medigap plans (AKA Supplements or Medicare Supplemental Insurance Plans) can not turn you down for a preexisting confition, however, once this window passes, the company has the option to cover you or not. 

Most of the big insurance companies offer both advantage plans and supplement plans.