Medicare Advantage Question - Page 3

Shelbelle · ‎03-09-2010

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.

Teddixat · ‎10-04-2010

@MrsCat21 the people who say they don't want the government telling them what to do are just plain ignorant. In many advantage plans you are confined to the doctors in their groups which doesn't work for many people. I used to have an Advantage plan but I didn't like the doctors in the groups I had to choose from. Every state and every county in that state are different so you have to find what works for you or what works for anyone else..

Teddixat · ‎10-04-2010

@MrsCat21 Also remember your broker gets paid for pushing certain plans as do all brokers. Your decision has to be made based on your needs and what you can afford

Still Raining · ‎03-30-2014

The common wisdom is that Medicare Advantage is run by big, bad insurance companies.

Never on this board have I seen a discussion about how traditional Medicare is administered. Who the heck do you think processes bills, denies coverage and handles appeals?

Right, a big, bad insurance company has the MAC.

Read up folks.

Ainhisg · ‎03-09-2010

@MrsCat21 that is my understanding.

Sooner · ‎03-10-2010

As I understand it, the Advantage plan is between you and Medicare--and basically decides what Medicare benefits you are going to get, how much, and in what instances.

It is not a charity, so somewhere along the way someone is making big bucks.

Carmie · ‎10-25-2010

Advantage plans are all different. They are not like Supplements with Traditional Medicare where all benefits are the same in all 50 states.

Advantage plans are not " free"

You must have Medicare Part B which will cost $174.70 for most people.

Your Advantage plan could be at no extra charge, or it could cost you a monthly premium.

There are two types of Advantage Plans, an HMO and a PPO.

With an HMO, your out of pocket expenses like deductibles and coinsurance could be nonexistent, or there could be payments due. You MUST use a provider in your network and get " permission" to see specialists. If your provider is out of network, or you are out of the area....like on vacation, you will have higher out of pocket expenses.

With a PPO, you will have in network benefits and out of network benefits. Most, but not all PPO plans have copayments and deductibles....example $10 copay to see your doctor and $25 to see a specialist. You may or not have deductibles before your plans pays.

Most, but not all Advantage plans include dental,vision, RX, gym membership. Some include a card that is loaded $ to use for health products....example $200 every quarter to use for vitamins, over the counter drugs, wrist brace, readers, etc.

All Advantage plans must cover the same things as regular Medicare.

If you choose Traditional Medicare, you will still pay $174.70 a month for Part B.

Medicare has an inpatient deductible and an out patient deductible. It also has a 20% coinsurance for outpatient services. There are no benefits for RX drugs, dental,vision, gym memberships or benefit cards to use to buy health products.

You are able to purchase a supplemental plan to pay your inpatient deductible and outpatient 20% coinsurance. For most people, they also must pay $240 for the outpatient deductible every year.

You're no longer able to purchase a supplement that covers the $240. Some people who where eligible for Medicare prior to January 1, 2020 have or are able to purchase a supplement plan that covers this expense.

In addition, with Traditional Medicare, you must purchase your RX coverage separately. If you do not purchase RX coverage when first eligible, you will be penalized with higher costs if you decide to enroll later.

There is no right or wrong when choosing either a supplement or advantage plan.

Supplements are expensive and some people just can't afford them.

Everyone's situation is different. You need to choose something you can afford being careful that if you choose an advantage plan, your deductible and copays will not be too pricey if you get really ill.

You can change your Advantage Plan every year at open enrollment if you wish. There is no guarantee that your advantage plan benefits won't change every year or be discontinued.

Supplemental benefits are stable and very seldom change.

millieshops · ‎03-09-2010

@MrsCat21 I believe you should be talking directly with an insurance agent who knows the current laws and can help you choose what's best for you now AND for the many years ahead of you. The decision you make now may not work for you in the future, but what you choose today could give you options or limit your future options.

Someone who doesn't know the details of your physical and financial health can sensibly choose for you.

Kachina624 · ‎03-10-2010

@Ainhisg wrote:
My mom was in assisted living for 6 years, and I became friends with the administrator who has to deal with Medicare, Medicaid, and Medicare Advantage plans. She is extremely knowledgeable about all of it. She recently posted this on her personal FB page, and I took a screenshot of it. For me, there is no way I will choose a Medicare Advantage plan when the time comes in a few years.

ETA: She also stated that agents get commissions on Advantage plans, so they have reason to promote them.

@Ainhisg. Once again its all depends on you Advantage plan. In 2011, I had knee replacement surgery, and living alone had no one to help me. So I went and stayed at a rehab/nursing home. They probably would have kept me forever but after 2 weeks I knew I could care for myself. I told them I was leaving on a certain day, they said they would prepare discharge papers. When my ride came, there were no papers so I bid them adios and walked out. Never heard a word from them. Their game was obviously to keep patients as long as possible and beyond the point of needing their services.

New Mexico☀️Land Of Enchantment

Carmie · ‎10-25-2010

@Ainhisg wrote:
My mom was in assisted living for 6 years, and I became friends with the administrator who has to deal with Medicare, Medicaid, and Medicare Advantage plans. She is extremely knowledgeable about all of it. She recently posted this on her personalFBB page, and I took ascreenshott of it. For me, there is no way I will choose a Medicare Advantage plan when the time comes in a few years.

ETA: She also stated that agents get commissions on Advantage plans, so they have reason to promote them.

While I am not saying the writer of this article is wrong, they're clearly confused. It is true that some services including Physical therapy are monitored under Advantage Plans, they're also monitored by Traditional Medicare too.

Computers don't fix benefits. They may stop a payment from being released until the claim has been reviewed by the MEDICAL DIRECTOR or nurses who work under the Director. This is done for both types of Medicare.

PT is only covered until a patient has reached their maximum improved potential, then it is discontinued. That means if you are not improving, it will be discontinued.

All health insurance does that. Period.

If you have a car accident, auto insurance will pay your claims. Medicare, or private insurance won't pay a thing unless your auto insurance has run out.

I can tell the article was written by a caregiver who knows nothing about health insurance.

Traditional Medicare would have also cut this person's physical therapy benefits off if there was no improvement.

If Medicare denies your benefits, your supplemental won't pay either.

Also, agents receive commissions when they sell supplements too, not just advantage plans.

Most people who are in assisted living, have Medicaid in addition to either their Medicare/supplement or Advantage Plan. Medicaid also follows the same rule for physical therapy benefits.

I have fielded a lot of angry people who have had their PT benefits stopped before they were able to fully recover.