I have been spending a lot of time trying to find the right plan for my parents. The industry is trying to get me to sign them up. They even have lots of commercials where savvy seniors show off there insurance helpers.
Because guiding all that Medicare money into private insurance is going to result in lower costs and better care.
Guess Iām just venting because nothing will change.
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Thatās a poorly written OpEd.
Medicare Advantage Plans are mostly HMOās, so yes, they require pre-certification to see specialists. (A few MA plans are actually PPOās adn do not require pre-cert.) The Kaiser Advantage plan in California is excellent.
Medicare costs the Govt $700b/yr. A $12b āoverpaymentā is noise in the big picture of things. And if fraud exists, prosecute it.
Author claims that MA enrollees have worse care, but offers no outcomes statistics, just anecdata.
Author ignores the cost of Medigap plans ($200-$400 per month) vs MA which can be zero but include extra benefits such as dental & vision. For millions of seniors living on SS alone, that money adds up fast.
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Of course, that is because Kaiser is generally good, and easy to use, unlike many network HMOs where it may be more difficult to find out which providers are in or out of network (and that may change each year).
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Do you have any data to support your claim?
(In a lit review, KFF found similar satisfaction between Original Medicare MA.)
As one who bills both and is soon to make this decision myself, thereās no way on earth that Iād choose an āadvantageā plan. NO WAY. Medicare has a tiny deductible and pays, period. The advantage plans have one purpose, to not pay. Thatās how they make money. Run away!
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Yep. See this daily. I wonāt go into this but I agree. Stay away. It about how much the insurance companies can make not about patient care.
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Are you saying a medi-gap policy is better? Or that neither is needed for the average user?
The biggest reason not to choose an Advantage plan is that you may be stuck with it. If you want to go back to a supplement plan you will be subject to underwriting and could be rejected or charged more.
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Choosing standard Medicare is more complicated. You need a secondary to cover the other 20% and, if you take expensive meds, a drug plan. Still, in my opinion, itās far better. You know up front what youāll pay. Thereās no in and out of network surprises. Theyāre no crazy deductible before the first dollar of coverage. There are no preauthorization hoops to jump through. In general, it removes all the barriers I hate about healthcare coverage.
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I love my BC/BS Advantage Plan. I am in MA and it is a PPO. I pay $79/month. Havenāt had any coverage issues, can see any doc I want, and no referrals needed. It also pays for most of my dental costs.
Noone told me that I would have underwriting if I switched to regular Medicare. I went to three different hospital financial counselors and they all suggested the plan I am on but did not mention difficulties changing to regular Medicare.
Nevertheless, I am happy with what I have. And I have several conditions.
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I just asked my husband about his advantage plan. He also has BCBS and we are in MA. He has had major medical problems and never had an issue with the insurance. He says itās much better than what he had before retiring.
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My husband loves his Advantage plan. He pays zero dollars for it. Theyāve covered everything with no issues. My friendās husband has the same plan. He had back surgery in another state and didnāt have to pay much out of pocket.
DH and I both had ER visits this year. His was more involved than mine. His OOP expense was a little over $100. Mine was $1,200. My monthly premium is about three times his. I canāt wait to turn 65.
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You wouldnāt need to go thru underwriting for original Medicare, but many MediGap plans would require underwriting. And adding MediGap and a PDP (prescription drug plan) to original Medicare makes sense.
I think itās a matter of budget - and realizing that usually nothing is free. Having BETTER coverage than standard Medicare always does come with a cost, in the form of EITHER:
- Medigap premium, prescription plan, etc., or
- the risk of losing coverage elsewhere with an āAdvantageā plan.
For me personally, the possible finality of that choice, and the permitted limitations of the Advantage plans vs. regular Medicare, are enough for me to shy away from them.
But that is, because Iām willing/able to pay for a Medigap/PDP coverage to keep all the Medicare benefits intact AND add on-top of it.
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I share your skepticism about Medicare Advantage plans.
But how do you plan to address the issue of out-of-pocket costs in the event you have a major medical event/treatment? As I understand it, that is the benefit of Medicare Advantage ā out-of-pockets are capped.
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Medicare Medigap plans can certainly be less than the $200-$400/month someone cited above (mine is!). Another thing to keep in mind that people may be able to switch from MA to Medigap plans without underwriting if their states prohibit underwriting. Here is an article about differences between states: Medigap Enrollment and Consumer Protections Vary Across States | KFF
Anyone can switch to a Medigap plan without underwriting if they move out of their network area.
If you self insure for the remaining 20% thereās no limit. If you get a supplemental (aka Medigap) they have max out of pocket limits.
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We had federal PPO BCBS insurance family plan that H had for his 45 years of working for fed govt. Itās secondary and Medicare A&B are primary. We briefly considered other options but have chosen to keep ourselves covered this way. Our disabled dependent D is covered under our BCBS plan and it covers each of us pretty much nationwide.
My younger brother says we donāt need Medicare because our insurance plan is so good and has such low out of pocket maximums but we like the belt and suspenders approach and sleeping well at night. Our insurance plan does a pretty good job of covering our Rx as well.
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