Medicare vs Medicare Advantage

[Colliemom]

I came across this article earlier this week and one of the local newspapers and thought I would share it with you because Medicare is a discussion on here every once in a while. And ad are are running all the time.

https://www.nerdwallet.com/article/insu ... tion=tiles

[Cudedog]

I came across this article earlier this week and one of the local newspapers and thought I would share it with you because Medicare is a discussion on here every once in a while. And ad are are running all the time.

https://www.nerdwallet.com/article/insu ... tion=tiles

Sue, just speaking for myself, I went with regular Medicare and a supplemental insurance (AARP/United Healthcare) that pays for what Medicare does not. The supplemental plan has a monthly premium.

My ex-husband signed up for Medicare Advantage, which does not have a monthly premium.

He is extremely unhappy (and, as the article states, one can't go back to regular Medicare and a supplement).

Basically, Advantage puts an insurance company between you and your heath care choices - in other words the insurance company (not you) gets to "decide" what kind of health care you get, and where you can get it. Wanna move somewhere Advantage doesn't cover? Wanna take a trip outta your local "coverage area"? Wanna doc that isn't on their plan? Have a medical "issue" that the insurance company doesn't think is a problem, even though you and your doctor do?

Too bad, so sad. You are pretty much SOL. And I'm not referring to how the sun shines here.

Anne

[Bethers]

There are good and bad advantage plans. But if you can pass underwriting, you can switch back. I have regular and a supplement. After my first year I switched from the UHC policy to another company to save money (plans are identical). Now 4 years down the road I'm applying to switch again. No red flags so I'm expected to pass underwriting again. I have a great insurance broker and can use them so customer service of the company doesn't matter to me if I need help.

I have a friend who is happy with her advantage plan. For me, still traveling, I needed to know my coverage would be the same everywhere. I've seen doctors in Arizona, Texas and Utah with no problem. And my residence for Medicare and supplement is SD.

[Shirlv]

I have regular Medicare and AARP/United Health supplement. I’m satisfied and not changing.

[MandysMom]

I have friends in AZ who due to costs could only get Advantage. Every problem they have had, has been a knock down drag out fight to get approved. Dr says you need standard blood work- nope not approved. Her husband needs a tumor removed from his brain, nope not approved. Years ago we had to do a managed care plan for a while during Mel's switch from fed to state. He needed back surgery. The only, so called surgeon, on their list,I wouldn't trust to cut a hangnail! He was known to be awful! We waited 3 mo to get the preferred provider plan we wanted and a much better surgeon. I am very lucky, due to Mel's state retirement the state retirement pays most of our cost for Blue Cross Anthem for Chris and I. It's been a huge blessing for us. It pairs with our Medicare to pay almost everything with no copay. just from my own experience with the managed care and the experience of long time friends with various advantage plans, MedicarevAdvantage is hard No from me.
Velda

[OregonLuvr]

There were alot of articles circulating here during the "switch" period. None were favorable for older folks on Advantage. If you are healthy and remain healthy might be a good idea but how many of us can say that. They offer hearing aids and dental ha ha what a joke. First you have to have a referral...next you have to find a doctor willing to take you, even then they dont pay much for either. I too have a friend on Advantage she has to have a referral for everything thru the insurance company and has been denied several things her doctor wanted her to have. It doesn't matter what the doctor wants it is what the insurance will pay for. I have UHC also. I dont pay a penny for any procedures. In fact I havent paid a penny for Urgent care, my surgery, ambulance ride, MRI, CT scan, Labs. Pulmonologist. My infusions that cost $13,000 twice a year. My eye injections that are around $6000 every month plus all the scans and eye exams that go along with it. Now I am doing so well with those that I go every 8 weeks instead of 4. I can go to any doctor that doesnt require a referral.....like Rheumatologist and Pulmonologist I had to have a referral for those BUT insurance didnt need to approve it. I can see any doctor in any city or state as I dont have a "network" like you have to have for Advantage. And if you are out of network and you see a doctor you pay out of network $$$ If you go to the ER and you are not admitted again you will pay big $$$.
I pay a good premium every month but it is totally worth it to me. I am not changing a thing.

[JudyJB]

Ditto to all of the comments. I have had traditional Medicare and a supplement plan for the past 15 years, and have never paid a copay for anything except small ones for prescriptions. And I have been to urgent care and emergency rooms all over the country, but have chosen my own doctors without ever needing a referral. And most importantly, I never have needed an approval to have ANY procedure or surgery done!

I think a Medicare Advantage plan "might" be appropriate for someone who has very, very few resources in terms of money, never leaves their city, and whose entire family lives nearby. I am a good example of a person who was relatively healthy, until I wasn't! And by that time, it is often too late to change plans.

The pills I took for CLL (assuming I had not been part of a research study) cost $13,000 per month. I can imagine the process of trying to get approval for those in an Advantage Plan if someone like me goes out of remission and needs them. Plus, that person in an Advantage Plan would have to stick to whatever oncologist that is in their plan, whether they are up-to-date on this disease or not. With traditional Medicare, I was able to choose a doctor who is a research specialist in CLL. (At the time I chose a doctor for this fairly rare disease, I eliminated the University of Michigan Hospitals oncologists and those from Cleveland Clinic, because they were not on the list of experts provided by the CLL Society or the Leukemia & Lymphoma Society!)

[Colliemom]

I have regular Medicare and Blue Cross Blue supplement. Works out great for me.

[snowball]

I have regular medicare and a supplemental with AARP I went with a 50 50 plan I wish I hadn't been cheap and gone with the full coverage but hopefully I can change that one day before it's to late
it sounds like the Advantage is a joke I think that is what my sister has... but she is pretty much home bound although she is in a nursing facility not rehab because of her broken leg she made the statement that the dr didn't decide when she goes home but the facility and insurance I said that sounds scary she said not really regardless I think that insurance being able to tell the drs what is best for the patient is scary
sheila

[Cudedog]

I think that insurance being able to tell the drs what is best for the patient is scary
sheila

Sheila, I couldn't agree more. And it sounds like this is exactly what is happening with Advantage.

I remember my Dad telling me long ago that I needed to understand that private insurance companies - all private insurance companies (no matter how fancy and "caring" they try to present themselves) are ALL in the business of collecting money - as much money as they possibly can - by way of premiums from policy holders.

Private insurance companies are NOT in the business of paying out claims, and will absolutely avoid doing so where ever and when ever they can.

This made no sense to me as a young person, these days I can see that dear old Dad was absolutely, positively, 100% correct.

Anne

[monik7]

I really don’t understand all the negative comments. I’ve had Kaiser insurance since I got married back in the Stone Age. Starting three years later having my children each cost $60. Now I have Medicare and Kaiser Senior Advantage included. Never had a problem all these years and none since adding Medicare and Senior Advantage. I’m completely happy with my ablation procedure and overnight hospital stay at the end of last October. I felt my $200 payment was fair for a $135,000 procedure and overnight hospital stay. Care was wonderful. Correction, it was $190.
Sandi

[MandysMom]

Sandi, from what I have seen with friends, Kaiser Advantage is way different than typical Medicare Advantage plans. Like comparing a very green Pippin apple to a beautiful golden delicious. Both are apples, but one tastes way better. Kaiser being the golden delicious, well run, well funded and other typical Advantage plans being the Sour Pippin, which will do, and is an apple but if you put in your child's lunch, said child won't be happy. I've met many who love even Kaiser Advantage, but never met anyone with standard Advantahe who was completely happy.
Velda

[Cudedog]

Sandi, from what I have seen with friends, Kaiser Advantage is way different than typical Medicare Advantage plans. Like comparing a very green Pippin apple to a beautiful golden delicious. Both are apples, but one tastes way better. Kaiser being the golden delicious, well run, well funded and other typical Advantage plans being the Sour Pippin, which will do, and is an apple but if you put in your child's lunch, said child won't be happy. I've met many who love even Kaiser Advantage, but never met anyone with standard Advantahe who was completely happy.
Velda

All that Velda said. Yep.

I would only add that Kaiser availability is not widespread, one can only get Kaiser in a few, well-defined, areas. Make that very few. So even if a person wanted Kaiser Advantage, they likely would not be able to get it.

Sandi, count yourself lucky.

Anne

[Bethers]

There really are some other decent advantage plans. Kaiser is the diamond. My sister and bil are on an advantage plan because it was what came with his pension. His union made sure it was good. I have a gf that can only afford an advantage plan. I will never write them all off. And no one should. We have to do what's best for ourselves individually. It's like I check rates on my supplement yearly and don't understand anyone who doesn't because "it's done good for them". A plan G is a plan G no matter what company it comes from. Same with n, etc. The minor differences could be optional extras that can be with a plan one year and gone the next. So as long as I can pass underwriting I'll check rates and switch companies without any hesitation. I'm not willing to give any of these insurance companies more money than necessary.

[SoCalGalcas]

Count meas another who has Kaiser Advantage. I am very pleased and have no desire to change. However, I am not traveling, stick pretty
Much to home. I buy all my medications from them, very inexpensive and free mailing to my home. Very satisfied with my doctors.
Lyn