Medicare Advantage Question - Page 6

Josmad · ‎12-10-2018

@kaydee50 wrote:
@MrsCat21 I'm also in IL. I think it may depend on the zip code you live in.

@I am still oxox It's my understanding that if the doctor accepts Medicare they will accept an Advantage plan.

That is incorrect. Advantage plans have networks.ppo plans do have out of network benefits. But a provider is not required to take your Advantage plan just because they accept Medicare.

Josmad · ‎12-10-2018

@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.

Agents gets commissions on ALL plans that they sell.

Mindy D · ‎05-23-2010

@Sooner wrote:
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.

@Sooner @That is not true. Legally, advantage plans must give you the same benefits as Medicare or can give you more than Medicare. They do make decidions whether your treatments meet criteria or not.

Mindy D · ‎05-23-2010

@MrsCat21 wrote:
@geezerette Yes, that was the reason for the post. Why is it free? I wanted to see if anyone had knowledge of both plans and what is the upside/downside of Advantage.

@teganslaw I have had an insurance broker to my house and we went over both Medigap plans and Advantage plans.

@MrsCat21 @It's free, Advantage Plans, because there are copays and deductibles with it and the cost of copays varies if you use some plans with in network providers or not Your costs stop for most things once you reach your maximum annual out of pocket. . Some let you use out of network providers with higher copays and a larger maximum annual out of pocket. You also are limited to WHERE you can use your coverage. For example, I live in Florida, if I wanted to go to the Mayo Clinic in Rochester, Minnesota for treatment that is not an emergency, I am not covered there. Perhaps I might have a need to have non emergency surgery with the best brain surgeon in a New York hospital, I would not have that coverage. I would have to choose providers in my coverage area.You will owe for services up to your annual out of pocket amount.

Supplements, on the other hand, allow you to travel anywhere in the U.S. to get your treatments. Supplements are also called Medigap Plans. You can go to most hospitals because there is are no networks. When you're hospitalized, you usually will not owe anything afterwards.

proudlyfromNJ · ‎05-01-2010

@Mindy D wrote:
@MrsCat21 wrote:
@geezerette Yes, that was the reason for the post. Why is it free? I wanted to see if anyone had knowledge of both plans and what is the upside/downside of Advantage.

@teganslaw I have had an insurance broker to my house and we went over both Medigap plans and Advantage plans.
@MrsCat21 @It's free, Advantage Plans, because there are copays and deductibles with it and the cost of copays varies if you use some plans with in network providers or not Your costs stop for most things once you reach your maximum annual out of pocket. . Some let you use out of network providers with higher copays and a larger maximum annual out of pocket. You also are limited to WHERE you can use your coverage. For example, I live in Florida, if I wanted to go to the Mayo Clinic in Rochester, Minnesota for treatment that is not an emergency, I am not covered there. Perhaps I might have a need to have non emergency surgery with the best brain surgeon in a New York hospital, I would not have that coverage. I would have to choose providers in my coverage area.You will owe for services up to your annual out of pocket amount.

Supplements, on the other hand, allow you to travel anywhere in the U.S. to get your treatments. Supplements are also called Medigap Plans. You can go to most hospitals because there is are no networks. When you're hospitalized, you usually will not owe anything afterwards.

@Mindy D I have an Advantage plan and have no co pays to see my Doctor.

Mindy D · ‎05-23-2010

@proudlyfromNJ wrote:
@Mindy D wrote:
@MrsCat21 wrote:
@geezerette Yes, that was the reason for the post. Why is it free? I wanted to see if anyone had knowledge of both plans and what is the upside/downside of Advantage.

@teganslaw I have had an insurance broker to my house and we went over both Medigap plans and Advantage plans.
@MrsCat21 @It's free, Advantage Plans, because there are copays and deductibles with it and the cost of copays varies if you use some plans with in network providers or not Your costs stop for most things once you reach your maximum annual out of pocket. . Some let you use out of network providers with higher copays and a larger maximum annual out of pocket. You also are limited to WHERE you can use your coverage. For example, I live in Florida, if I wanted to go to the Mayo Clinic in Rochester, Minnesota for treatment that is not an emergency, I am not covered there. Perhaps I might have a need to have non emergency surgery with the best brain surgeon in a New York hospital, I would not have that coverage. I would have to choose providers in my coverage area.You will owe for services up to your annual out of pocket amount.

Supplements, on the other hand, allow you to travel anywhere in the U.S. to get your treatments. Supplements are also called Medigap Plans. You can go to most hospitals because there is are no networks. When you're hospitalized, you usually will not owe anything afterwards.
@Mindy D I have an Advantage plan and have no co pays to see my Doctor.

@proudlyfromNJ @Most of the Advantage HMO plans have zero copays to see your primary care doctor. I had Florida Blue Advantage HMO for my Florida county and I was given a primary care doctor but was not required to see her for referrals and I had zero copays. They usually have copays to see in network specialists.

Unfortunately, there weren't very good dermatologists in network on the plan and all the out of network ones I called and asked if I could just pay cash said no. Due to this, I wound up switching to the Florida Blue Advantage PPO. There were much better trained dermatologists that acceptedted the PPO. This did not hold true for other specialties. With this version I'm not required to have a primary care doctor, but I still do, the same doctor, however, for my last visit some months ago I had a copay. I was suprised to learn this. The PPO also will be a higher price per day for the first days hospitalized than the HMO version. What I want to do is see the dermatologist I want to see and then switch back to the HMO. The copay at the dermatologist and procedures cost more with the PPO than with the HMO.

conlt · ‎03-16-2010

@proudlyfromNJ It is the lack of choices and restrictions that I do not like about advantage plans. Plus the deductibles and copays. I paid deductibles and copays before I went on Medicare and I am done with those. I know I pay a good amount for my Medicare part B, supplement. My new RX part D plan in 2024 has no monthly premium. My 2023 plan did. However they both cover my medications well.

The other thing to look at with an advantage plan is "are you covered if you get sick out of state."

I am a RN in Florida and have worked with the Medicare population x 43 years. We have had many patients snowbirding from the north who find their Medicare Advantage plan does not pay in our state. Some are regional plans, Florida Blue has a regional plan in NE Florida. My friend and her husband have it.

I will say, if I could not afford Medicare, my supplement, and RX plan, I would rather be on an Advantage plan than nothing at all. I understand some people cannot afford regular Medicare and the costs that come with it.

I do believe that you are going to pay either way. I have seen very sick people with Advantage Plans struggle to get adequate health care. They might not get the best doctors, hospitals and other facilities.

proudlyfromNJ · ‎05-01-2010

@conlt wrote:
@proudlyfromNJ It is the lack of choices and restrictions that I do not like about advantage plans. Plus the deductibles and copays. I paid deductibles and copays before I went on Medicare and I am done with those. I know I pay a good amount for my Medicare part B, supplement. My new RX part D plan in 2024 has no monthly premium. My 2023 plan did. However they both cover my medications well.
The other thing to look at with an advantage plan is "are you covered if you get sick out of state."
I am a RN in Florida and have worked with the Medicare population x 43 years. We have had many patients snowbirding from the north who find their Medicare Advantage plan does not pay in our state. Some are regional plans, Florida Blue has a regional plan in NE Florida. My friend and her husband have it.
I will say, if I could not afford Medicare, my supplement, and RX plan, I would rather be on an Advantage plan than nothing at all. I understand some people cannot afford regular Medicare and the costs that come with it.
I do believe that you are going to pay either way. I have seen very sick people with Advantage Plans struggle to get adequate health care. They might not get the best doctors, hospitals and other facilities.

@conlt I just wanted to say I had no co pay as you said advantage plans have one. My Advantage plan PPO is just fine for me. I've had it for over ten years. What anyone else thinks about my plan does not bother me in the least.

Sooner · ‎03-10-2010

@Mindy D wrote:
@Sooner wrote:
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.
@Sooner @That is not true. Legally, advantage plans must give you the same benefits as Medicare or can give you more than Medicare. They do make decidions whether your treatments meet criteria or not.

@Mindy D Same result for the insured.

Boehm Collector · ‎03-09-2010

@MrsCat21 wrote:
@Kachina624. Yes, each plan is different, but my undersatanding is that all Advantage plans are FREE. So that is the reason for my question. Why would you pay a monthly premium whan you can get the insurance for free?? BTW, sounds like you have a great plan. All the plans Im looking at under the Advantage umbrella have a co pay...

@MrsCat21 nothing is life is "FREE". One way or another you will pay for it.