That is NOT the fault of Medicare Advantage…it’s the fault of the patient. It’s awful to have to ask whether a doctor takes your plan…but it’s necessary.
As a reference…my ACA kids both have issues with doctors not taking their plans…huge issues. They have to ask every time they call for an appointment…even with the same docs…because the network keeps changing. And they are paying more per month than I pay for my Medicare and Medicare Advantage combined.
Where I am, Medicare Advantage plans do have out of network coverage…so that Texas story would not have happened here. The copay would have been higher for out of network to Medicare Advantage…but coverage would have been available.
There are LOTS of variations to Medicare Advantage. As I mentioned upstream, mine is a PPO Medicare Advantage Plan with a huge network of doctors.
The thing everyone needs to do is read read read…and call and ask questions. These places all have help lines.
The Medicare Advantage story sounds like they were not in a group retiree plan, and may or may not have understood that what they had was an HMO plan. They might have been told by some agent (if they used an insurance agent) that it was just as good as regular Medicare, and they didn’t understand that not every doc who took Medicare accepted MA… Who knows. As you know, when a family member is in the hospital dying of cancer and the treating doc calls in a specialist, the spouse may or may not even be there when the order is written in the chart for the consult and/or when the doctor sees the patient, so they might not have even crossed paths with the doctor and/or thought to figure out a way to ask if they took Medicare Advantage. Honestly, i feel badly for the spouse. i doubt she knew who was called in when, even if she did understand her insurance (which I have to wonder).
IMO its EXACTLY for reasons like that, that caveat emptor. Where I live there are Medicare Advantage plans that are PPOs (the state health benefit retiree plan, for example), but there are HMO Medicare Advantage plans that many doctors, and maybe some facilities, do not take. Ya get what ya pay for sometimes. Many doctors in many states accept regular Medicare but NOT Medicare Advantage HMOs. The state cannot require them to take it. It is up to the provider to decide whether or not to enroll in the plan to be a provider.
Bottom line, There are many different MA plans. The state health retiree MA plan is a good one. But the HMO plans, I would steer clear of. I don’t think all MA plans have OON benefits. Enough said.
HMOs are HMOs whether they are Medicare Advantage or not. In most cases HMO plans have a more limited Doctor network because only those who are in that HMO will take the plan.
I agree @jym626 that folks need to understand what they are buying. I also agree that the offers coming in the mail and via phone can be very confusing to folks who don’t have a working knowledge of health insurance plans. I think that is terrible.
Agreed. Its like a shell game. They don’t give complete information. And they are hard to understand even if they DO give complete information. I looked up a random state (Ohio) and random county (Allen ) and there were 33 different MA plans available. https://q1medicare.com/2018/MedicareAdvantage-2018CHealthPlansMAPDHMOPPOOhioOH.php
My comments have been directed at MA HMO plans. I wouldn’t touch one. Even if the network was fabulous in one’s area, what happens if the person travels? Can be a problem. And because the MA plans can be so confusing, my plan is to just avoid them. The sad part is that some people are limited financially and that’s what they can afford.
I think the problem is that the Medigap plans might also be unavailable in some areas. I’m having a hard time getting a handle on that right now – the plan-finder on the Medicare.gov site tells me that there are NO medigap plans for my zip code — but when I go to the websites for insurers that offer MA plans I am also finding medigap.
The other problem-- not so much for me but for others-- is that the Medigap premiums are higher – so adding the Part B to the Medigap premium plus needing to buy the part D separately could be cost-prohibitive to some who are retired & living on a fixed income.
As far as I can figure right now, the problem is the medical underwriting part – if I start with a Medigap plan as soon as I hit age 65, I can get guaranteed issue and also (I think) lock in a lower premium rate … but as I am healthy, I’m really buying insurance for the “what if” scenario rather than getting immediate benefit. But if I pass on the Medigap… I may not be able to get it down the line. The local MA plans do all seem to be HMO’s… which means I would lose an option that I’ve never actually used (basically, seeing a specialist without first getting a referral from my primary).
My worry is that I opt for the more costly plan during my 60’s while I am still relatively healthy and earning income… but that in my 70’s or 80’s I reach a point where I can no longer afford the higher premiums, just at the same time as sky-high costs start to kick in.
I can see that happening with my LTC policy as well… still reasonably affordable now when I don’t need it… but I’m 64 now, and maybe I’ll be needing the policy when I’m 94 but running out of funds when I’m 90.
Another hidden difference in Advantage vs Gap plans is skilled nursing coverage. As it was explained to me, the gap plans require you to have stayed in the hospital for 3 days before they will cover skilled nursing. The advantage plans do not have this requirement and will begin coverage right away.
Again, as explained to me by the Medicare counselor (not a broker and no vested interest in what I pick) doctors usually will work with a gap patient to fulfill the 3 day requirement. But it’s another case of caveat emptor.
I really did think this would be easier than managing our own small group plan for the past decade.
The universe has already proved me wrong.
My parents (dad is now gone) have been on Kaiser with the associated advantage plan. I have managed all their healthcare for years. It has been problem free. Kaiser finally arrived in our area which has been completely dominated by a ‘big bad price gouging - should have a RICO suite filed against them’ company. However, Kaiser does not yet take Medicare.
The big bad price gouging company (BBPGC) has to take my H as a medicare patient because he’s established with the practice which BBPGC recently ‘absorbed’. They will have to take the piddly Medicare reimbursement and he’s holding off on some expensive (but non life threatening stuff). They are not accepting any new Medicare patients. I plan to keep a footprint with the BBPGC in a manner sufficient that they would have to also accept me when the time comes.
It is a hospital and doctor network. They have taken over Northern California. They have set their contracted rates to be the fully allowed rates. Their rates are 3-4 times as high as the other providers.
I’m turning 65 next month and have health insurance through my husband’s employer. He is 3 years younger. I “thought” I only signed up for Medicare part a in April, but I recently got a bill for $402 for part b. Am I supposed to have both now, even though I have other insurance? Once I turn 65, which one is primary? When DH retires, will I have another window of time to choose a supplemental plan without penalty? This is all so confusing and I’m feeling a bit stupid.
DH went on Medicare last year. He signed up for Part A (free), Part B (402/qtr), Supplemental (139/mo), and prescription (29/mo). That’s $300/mo for gold-plated coverage – no deductible, no copays. He does pay for Rx’s but those are vastly reduced.
We didn’t come up with this on our own. We first looked at the website, but got more and more confused. Insurance scares me to death, so we went to see a broker who clearly explained everything, showed us the best options, made recommendations, and did the paperwork to sign him up. I HIGHLY recommend that. HIGHLY! As she said, “There are a lot of moving parts.” And there are some aspects of it that, if you make a wrong decision now, you’ll be paying for it forever.
ETA – The broker shouldn’t charge you anything, so there’s no downside to letting an expert guide you through this.
Yes, your situation is different than ours. But if you’re not going to have your husband’s insurance for the rest of your life, be aware that you pay a 10% penalty for every year that you delay signing up for Part B – forever. That’s my understanding, at least. Like I said, a broker can help you address your specific situation.