Went to a town hall meeting about medicare advanta... - Page 2

terrier3 · ‎03-10-2010

On 10/24/2014 ChouChou said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

Medicare Advantage Plans (MAP) are provided by insurers to Medicare recipients who agree to use their plan doctors, hospitals and other providers exclusively. If you choose a MA PLan, Medicare then pays the plan a flat amount to provide you with all the care that Medicare would provide. This is called capitation. I don't know what the capitation amount is now. It varies by region. I know that in SoCal about 15 years ago the capitation was $940/month for Kaiser Permanente. That $940 was to cover all your health care provided by Kaiser. So, if you didn't get sick Kaiser got to keep the money. If you went to the hospital then Kaiser had to eat the cost. There are a lot of variables that go into the formula for capitation. This is just a quick and dirty explanation.

If the plan provides more than Medicare provides, e.g., a fitness program or dental, then the MAP is permitted to charge you a premium for those. Those plans that offer $0 and $0 deductible are either non-profits (such as SCAN in SoCal) or they offer just what Medicare requires them to offer.

Hope this answer helps.

The "0" premium isn't dependent on getting extras.

The insurers who participate in the Advantage plan are rated every year for each of their Medicare policies - on a 5 star basis. They are rated on customer satisfaction, cost efficiency, rate of re-admittance to hospitals - lots of different criteria. The idea is to keep care high, seniors healthy and costs low. Every year their "stars" are awarded. The higher the stars, the more money Medicare pays them for each Advantage plan member.

That is why rates for these plans vary each and every year. If they have lower stars, they have to charge more and offer fewer perks to make money. If they are 5 star, they can charge less - sometimes even "0" and can offer more and still make a profit.

Please check your offered plans every year. Don't just accept a rate increase. You can often get more services for less money if you are willing to switch plans offered by an insurer or change insurance companies.

151949 · ‎03-09-2010

On 10/24/2014 terrier3 said:
On 10/24/2014 ChouChou said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

Medicare Advantage Plans (MAP) are provided by insurers to Medicare recipients who agree to use their plan doctors, hospitals and other providers exclusively. If you choose a MA PLan, Medicare then pays the plan a flat amount to provide you with all the care that Medicare would provide. This is called capitation. I don't know what the capitation amount is now. It varies by region. I know that in SoCal about 15 years ago the capitation was $940/month for Kaiser Permanente. That $940 was to cover all your health care provided by Kaiser. So, if you didn't get sick Kaiser got to keep the money. If you went to the hospital then Kaiser had to eat the cost. There are a lot of variables that go into the formula for capitation. This is just a quick and dirty explanation.

If the plan provides more than Medicare provides, e.g., a fitness program or dental, then the MAP is permitted to charge you a premium for those. Those plans that offer $0 and $0 deductible are either non-profits (such as SCAN in SoCal) or they offer just what Medicare requires them to offer.

Hope this answer helps.

The "0" premium isn't dependent on getting extras.

The insurers who participate in the Advantage plan are rated every year for each of their Medicare policies - on a 5 star basis. They are rated on customer satisfaction, cost efficiency, rate of re-admittance to hospitals - lots of different criteria. The idea is to keep care high, seniors healthy and costs low. Every year their "stars" are awarded. The higher the stars, the more money Medicare pays them for each Advantage plan member.

That is why rates for these plans vary each and every year. If they have lower stars, they have to charge more and offer fewer perks to make money. If they are 5 star, they can charge less - sometimes even "0" and can offer more and still make a profit.

Please check your offered plans every year. Don't just accept a rate increase. You can often get more services for less money if you are willing to switch plans offered by an insurer or change insurance companies.

Yes, they explained this to us at the town hall meeting too. They even rate providers like hospitals and doctors too. They said that last year when UHC dropped all those doctors it was all ones who had 1 or 2 stars and some have improved and if they get up to 4 or 5 stars they will be invited back to UHC.

millieshops · ‎03-09-2010

On 10/24/2014 elated said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

I have Blue Shield and they deduct your premium from your Social Security. It is $104.90 for me. So you do pay a monthly premium.

Yes, that's the Part B premium for anyone with an income up to $85,000. If you earn more than that, you'd pay more but I don't have the whole breakdown. You do have to pay Part B.

If your income is in that range, you can ask - they have the charts.

ritasNo1Fan · ‎03-12-2010

On 10/24/2014 Pianomama said:
My DH will go on Medicare Jan. 1st. He is not yet 65 (will be in July), but he has Alzheimers and is on ss disability. I have an appointment with a gal who will help me wade through all the information of what plan to get. I dread it. It seems so darned complicated, plus I have to decide if I want to keep my own plan with CA Affordable Care. I hope I make the right choices!

It is! I was able to keep my job's health insurance after I retired PLUS I have medicare part A. I have to take Tier 4 meds. so Walgreen's worked up all medicare plans available in my area. So complicated and I did not have any idea who to ask questions.

Gooday · ‎03-23-2010

I just had a lengthy conversation with my cousin who is the office manager and an R.N. for a surgeon's office. Big changes are coming. Many doctors who are in solo practices or smaller practices are leaving and either retiring (if close to retirement age) and some are becoming "Hospitalists" (an employee of a hospital). WHY you ask??? Reimbursements are being cut drastically. So while you and I are paying so little for their premiums, (I for one am paying a lot with BC/BC. I am not Medicare eligible) physicians can no longer sustain paying for employees, high malpractice insurance, rent etc.

I have said it before, we need socialized medicine and the ACA is not going to be the saving grace for the majority of our citizens.

151949 · ‎03-09-2010

On 10/24/2014 Gooday said:
I just had a lengthy conversation with my cousin who is the office manager and an R.N. for a surgeon's office. Big changes are coming. Many doctors who are in solo practices or smaller practices are leaving and either retiring (if close to retirement age) and some are becoming "Hospitalists" (an employee of a hospital). WHY you ask??? Reimbursements are being cut drastically. So while you and I are paying so little for their premiums, (I for one am paying a lot with BC/BC. I am not Medicare eligible) physicians can no longer sustain paying for employees, high malpractice insurance, rent etc.

I have said it before, we need socialized medicine and the ACA is not going to be the saving grace for the majority of our citizens.

The way physician reim bursements actually work is that doctors who get better reviews from their patients and from ins co. get more reimbursements than doctors who get poor reviews. It all goes by the number of stars they are given.

terrier3 · ‎03-10-2010

On 10/24/2014 smokymtngal said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

Just to be clear, our Medicare charge is currently $104.90/mo whether you are on Social Security or not. My husband is on Medicare (he just turned 65) but has not yet applied for Social Security. We pay the $104 directly to Medicare and they pay the Advantage plan that he has selected. So while the Advantage plan advertises no additional premium, we all pay the basic medicare fee. If you are on Social Security, they usually deduct the Medicare fee from that. Most Advantage plans offer more than you would get with basic Medicare, which is why people sign up for them.

Another program (at least in New York State) is EPIC. If you make below a certain income (and it's actually quite high!) you can get help with drug co-pays.

I don't know if other states have similar plans, but it's worth investigating. Many people get $0 premium Medicare through EPIC too.

Tinkrbl44 · ‎08-23-2010

By the way ...... if anyone's interested ........

there is the book MEDICARE FOR DUMMIES, which I ordered on Ebay ......

I need to prepare for this and like when it's provided in small, easy, bite size pieces .... ${#emotions_dlg.thumbup1}$

Kachina624 · ‎03-10-2010

On 10/24/2014 happy housewife said:
On 10/24/2014 ChouChou said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

Medicare Advantage Plans (MAP) are provided by insurers to Medicare recipients who agree to use their plan doctors, hospitals and other providers exclusively. If you choose a MA PLan, Medicare then pays the plan a flat amount to provide you with all the care that Medicare would provide. This is called capitation. I don't know what the capitation amount is now. It varies by region. I know that in SoCal about 15 years ago the capitation was $940/month for Kaiser Permanente. That $940 was to cover all your health care provided by Kaiser. So, if you didn't get sick Kaiser got to keep the money. If you went to the hospital then Kaiser had to eat the cost. There are a lot of variables that go into the formula for capitation. This is just a quick and dirty explanation.

If the plan provides more than Medicare provides, e.g., a fitness program or dental, then the MAP is permitted to charge you a premium for those. Those plans that offer $0 and $0 deductible are either non-profits (such as SCAN in SoCal) or they offer just what Medicare requires them to offer.

Hope this answer helps.

This is not entirely correct information. First - while most advantage plans are HMOs they also offer POS plans and PPO plans. We are in a PPO plan, because we travel and need more flexibility than an HMO offers. second - we are in a $0 premium plan but we do get extras. We get basic dental and vision and The HMO version gets silver sneakers and we have benefits such as last year I participated in a avoiding diabetes program at the YMCA they paid 100% for. Definitely not just the basics that medicare requires of them.

I have a Medicare Advantage Plan and can use any doctor or medical facility that accepts Medicare in the US. I pay nothing excepts for my standard Medicare deduction from SS. I pay no co-pay or deductible. Seems like the way things are now, as soon as someone makes a sweeping statement, several people will cite exceptions. Seems to vary from plan to plan, state to state.

New Mexico☀️Land Of Enchantment

Nuttmeg · ‎03-09-2010

On 10/25/2014 terrier3 said:
On 10/24/2014 smokymtngal said:
On 10/24/2014 Tinkrbl44 said:
I've seen the commercials for these companies and have a question ...... some advertise $0 monthly premium and $0 deductible ...... so HOW do they collect any payment for their policies?

Doesn't make sense to me ........ ${#emotions_dlg.confused1}$

Just to be clear, our Medicare charge is currently $104.90/mo whether you are on Social Security or not. My husband is on Medicare (he just turned 65) but has not yet applied for Social Security. We pay the $104 directly to Medicare and they pay the Advantage plan that he has selected. So while the Advantage plan advertises no additional premium, we all pay the basic medicare fee. If you are on Social Security, they usually deduct the Medicare fee from that. Most Advantage plans offer more than you would get with basic Medicare, which is why people sign up for them.

Another program (at least in New York State) is EPIC. If you make below a certain income (and it's actually quite high!) you can get help with drug co-pays.

I don't know if other states have similar plans, but it's worth investigating. Many people get $0 premium Medicare through EPIC too.

In New Jersey, some folks may qualify for PADD a medicine assistance program for disabled or senior citizens. Medicaid would pay the Medicare premium.