Wellness

[Carmie]

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@Jan100 wrote:

The "money" to follow is the difference between what your healthcare providers bill to Medicare Advantage and what Medicare Advantage then turns around and bills to Medicare. They are sucking Medicare dry, it is deliberate and a plan. It will ultimately allow them to privatize Medicare and at that point, everyone will have their eyes opened for them.

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Are you aware that Medicare pays insurance companies to administer Advantage plans?  Advantage plans do not bill Medicare for every service.  They get a contracted price every month that doesn't change if you use services or not.  Their payment stays the same.

In addition, insurance companies are paid to administer and pay claims for Traditional Medicare too.  The government does not have Medicare employees to process claims.

Most of the prominent health insurance companies process all Medicare claims and are contracted to do so.

I have done Customer Service for Advantage Plans and Traditional Medicare as well as non Medicare policies and for Medicare supplements all from the same building, same desk, same seat....all depending on where I was needed on any given day.  My heath insurance employer handled just about everything health insurance related.

[ciao_bella]

@conlt   I totally agree with you about keeping Traditional Medicare vs an Advantage Plan.   All those so called 'perks' and extras that Advantage plans give you, come at a price when you need it most.  Bear in mind that Advantage plans are for profit by insurance companies.  Medicare is Medicare and not insurance companies for profit.  

As an example as a retired school employee we had excellent choices of either the Traditional Medicare with a supplement or the Advantage PPO plan that was suppose to 'mirror' the Traditional Medicare and supplement plan. 

 I was in both the Advantage PPO plan and then changed back to Traditional Medicare.  With my Traditional Medicare and BCBS supplement, I was able to go to Hospital for Special Surgeries in NYC for both my total knee replacements.  When I switched to the Advantage PPO plan, because I was sucked in my all those 'extra perks they give you, when I had to go back to Hospital for Special Surgeries for a shoulder issue, not one doctor there takes any Advantage plans.  So, when it says you can use an advantage plan out of state, that doesn't mean your choice of what hospitals or doctors will accept it.  

When you give up Traditional Medicare, you're allowing the Advantage plan's insurance company to have complete control over your coverage; what's covered, where it's covered and who will accept the coverage.  Also, advantage plans have prior authorization requirements that put you through ridiculous wait periods or denials, etc. 

Like I said before, those 'extra, too good to turn down perks' the Advantage plans give you up front are not because they actually care about you, it's to take complete control of your healthcare.  If it seems too good to be true, it probably is!  

[conlt]

The other thing that we see quite frequently in Florida with Advantage Plans is people come to this State to snowbird, break a hip etc, and find out that their Advantage Plan is regional to their State. Watch that too people, if you choose an advantage plan, make sure it is accepted out of state. 

[Still Raining]

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@Teddixat wrote:

@Still Raining   HUH?   What does IMAC have to do with anything

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@Teddixat 

MAC stands for Medicare Administrative Contractor.  There are several for various services and regions.

They make coverage determinations and denials for traditional Medicare.  

And are up for renewal and bidding 😂

[ciao_bella]

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@conlt wrote:

The other thing that we see quite frequently in Florida with Advantage Plans is people come to this State to snowbird, break a hip etc, and find out that their Advantage Plan is regional to their State. Watch that too people, if you choose an advantage plan, make sure it is accepted out of state. 

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@conlt  Not only if it will be accepted out of state, but often who will accept it.  Many 'top rated' doctors and/or hospitals do no accept Advantage plans at all.  They don't get paid enough or in a timely manner and more times than not have to deal with the insurance company's denied tests, procedures, medications, etc.