Went to a town hall meeting about medicare advanta... - Page 3

2cockers1cat · ‎03-09-2010

On 10/24/2014 millieshops said:
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.

Sorry, Tried to insert the 2015 chart. Mostly code came up.

barrel racer · ‎03-13-2010

On 10/25/2014 kachina624 said:
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.

The plans do vary from state to state & county to county within the state. It's useless to argue with hh because she knows it all, or think she does. Went through it last year.

barrel racer · ‎03-13-2010

On 10/24/2014 happy housewife said:
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.

True and that is paid to the ins co by medicare. That amount deducted from your SS check is called your part B payment.You would have to pay that no matter if you had a supplement or an advantage plan or neither.

Also discussed at the town hall meeting yesterday was the part D - Rx plan. If a person does not buy a Rx plan they are assessed a fine that can be very steep and is deducted from SS check. You are required to have it. Medicare advantage plans generally include the Rx plan - but supplements rarely do and so you have to buy them in addition to your supplement. (just to be perfectly clear before some uninformed person blames this on the ACA - it is part of the law passed during the B*sh administration that enacted the part D Rx coverage)

Well, I don't have Part D & nothing but $104.97 is deducted from my check. Part D is not mandatory (google it). I don't take any meds except BP & they are $10 for 3 months. If I decide to purchase part D later I will be penalized 3% per year I did not have it. The premiums I would pay far exceed that 3%.

Lindsays Grandma · ‎03-10-2010

I have a supplement with Aetna for $148.86 a month which pays for everything Medicare doesn't pay. I have no co-pays and never see a bill. My beef is with Part D, United Health Care through AARP. I admit the premium is low, $32.86 a month but the cost for my prescriptions are high and some are unaffordable so I do without some pain meds I need. Do any of you have information about Silver Scripts?

This is a bad time for me since we just moved, I'm having my second cataract surgery on Monday and my back and leg pain are going through the roof. I don't have anyone who can help me sort through all the Medicare ifs and buts so any information I can get from you knowledgeable posters will be a big help. tia

The moving finger writes; And having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line Nor all your Tears Wash out a Word of it. Omar Khayam

Beccaboone2 · ‎03-03-2014

On 10/24/2014 happy housewife said:
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.

I usually stay out of threads like this, but I had to respond to this part. I work in senior level management in health care, and last year when UHC dropped an alarming number of providers from its network, I was heavily involved in investigating why, etc. I had frequent contact with my state agencies, national professional groups, etc., and I know a lot about this particular subject.

UHC suddenly, without warning, sent letters to thousands of providers nationally the first couple of weeks in October 2013, telling them that after 12/31/13, they would no longer be part of UHC's Medicare Advantage network. No explanation was given, and there was an appeal process outlined. I personally called UHC several times to learn of how it was determined who was dropped, who wasn't, etc. and I was told several times from different people in UHC that there was no formula or measurement, it was just operational changes and that there was NOT a scoring system in place to make the determination. The local medical society, state medical association, and national professional groups got involved, and they couldn't get additional information. This was done in every state, but Indiana and Connecticut were hit the hardest with the reductions.

I personally handled the appeals process for the company I worked for. I don't know of any provider who went through the lengthy appeals process who actually had the decision reversed. We were all told it was an operational decision, and NOT based on a rating system, etc. It should be noted that UHC's profitability for Q2 2013 were much less than projected, and there was a lot of talk at that time about UHC's solvency.

I have worked in health care for 30 years. These Medicare replacement products save money for people who sign up for them initially, but i have heard over and over and over that members end up paying much more than they would with straight Medicare and a supplement in the event they need surgery, or more than basic medical care. It's frustrating to members when they discover their replacement product does not usually cover things they assumed it would, or that they are severely restricted in their choice of provider. It's interesting to me to read that UHC is telling prospective members that this network reduction was based on patient satisfaction and provider billing patterns, etc., when in fact every single provider who appealed this decision last year was told there was NO scoring or rating system of any kind in place.

My advice is to not only obtain information about plans that interest you from the actual company or insurance agent (who often does not know more than what the insurance company tells them), but do independent research, too. Read about the company. Find out their financials and how solvent they are. Talk to people who currently have this insurance. Ask your doctors what their experiences with that product are. And be prepared to have a very select list of providers to utilize (which may not be a negative thing if you are not overly attached to the providers you currently use or want to switch providers any way). Knowing what I know, I myself would certainly stick with Medicare and a supplement, if at a higher initial cost.

151949 · ‎03-09-2010

On 10/25/2014 straitgirl said:
On 10/24/2014 happy housewife said:
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.

True and that is paid to the ins co by medicare. That amount deducted from your SS check is called your part B payment.You would have to pay that no matter if you had a supplement or an advantage plan or neither.

Also discussed at the town hall meeting yesterday was the part D - Rx plan. If a person does not buy a Rx plan they are assessed a fine that can be very steep and is deducted from SS check. You are required to have it. Medicare advantage plans generally include the Rx plan - but supplements rarely do and so you have to buy them in addition to your supplement. (just to be perfectly clear before some uninformed person blames this on the ACA - it is part of the law passed during the B*sh administration that enacted the part D Rx coverage)

Well, I don't have Part D & nothing but $104.97 is deducted from my check. Part D is not mandatory (google it). I don't take any meds except BP & they are $10 for 3 months. If I decide to purchase part D later I will be penalized 3% per year I did not have it. The premiums I would pay far exceed that 3%.

This may seem like a good idea for now to you but what are you going to do if you find out suddenly you need an expensive drug like chemo? Those can run tens of thousands of dollars per dose.

Also the fine you have to pay for not having part D goes up every year you don't have it - the rep from medicare told us that some people are paying hundreds of dollars a month.