The private group Medicare Advantage Plans (which I don’t have access to) are the only Advantage plan I would ever even briefly consider. My office associate will no longe take ANY and at age plan as even though they are supposed to pay for the services he provides, they don’t or do at a very reduced rate, and no one will resolve the problems for him (and this is a problem throughout the specialty- its not just him).
And as consumers, are we allowed to know which companies do this? How far down do you have to dig to find out? Did the article say?
You know…there are a LOT of employer chosen health insurance plans that have a managed care component…and require preauthorization for certain things. My positively excellent employer plan required preauthorization for everything it seemed…including ER. Now really…how can that be preauthorized?
Just because a plan requires preauthorization doesn’t mean your benefits will be denied.
Yes, conversations might need to take place between your doctor and the provider. Some folks interpret this as meaning YOU have no say. Don’t you all communicate with your doctors?
My kid is having surgery that had to be preapproved by her school sponsored health insurance plan. It is not elective in any way. She had numerous conversations with her doctor about this. They never got to the doctor to company review level…it was approved prior to that. But the doctor had all the necessary info to get an approval.
I have a Medicare advantage Premier PPO plan. So do many of my former colleagues. Even with preauthorization needed, they have had numerous procedures done…heart surgery, knee and hip replacements, chemotherapy, etc.
It bothers me that managed care is viewed as the devil when associated with Medicare Advantage plans but no one seems to bat an eyelash at managed care with their employer sponsored plans.
When I started on Medicare I assumed that people I know who were already on Medicare would be a good resource for information. That has not been the case. It’s surprising how many people don’t know if they have supplemental or replacement policies, or what the difference is. I have a co-worker whose husband has been having some health issues and she says the copays are really adding up with their Medicare. I told her I don’t have any copays (I have Plan G) and she wasn’t aware that was possible. I have another friend who didn’t know whether she had a Part D. I get the feeling that some people just sign up for whatever Medicare iteration their friends or relatives have without really looking into it.
It’s difficult at best. I am sure there are lots of people who cannot understand or navigate it at all. It’s a shame. And a real volunteer opp at a lot of senior centers!
It’s complex and difficult. I spent 20+ years in health care finance and working for Benefits at MegaCorp, and it took me a couple of months to figure it out. (and I know what questions to ask.)
Definitely worth a call to your state SHIP (or visit local office if available) which offers unbiased advice:
Yes, but if you wait there is no guaranteed issue and you can be subject to medical underwriting. So if you are in excellent health and just feel that you don’t need secondary insurance while your husband’s plan provides coverage, that might be an appropriate risk to take. Just be sure you understand that is the choice you will be making.
I think all private insurers do that (deny approval for procedures that should be covered), to some extent. Even if they are going to ultimately allow the procedure, there is a financial benefit to the company to make the process of getting approval difficult enough to discourage some people from pressing.
There are various resources you can use to find records of consumer complaints. For example, in California there is an online report card for health insurance companies here - https://interactive.web.insurance.ca.gov/ppo/front (for PPOs) and https://reportcard.opa.ca.gov/rc/hmorating.aspx (for HMOs). That’s for regular insurance, not Medicare Advantage – but the companies are generally the same and I don’t think it likely that there’s going to be that much difference in how any given company administers their MA plan vs. their general plans.
Well, I’ve never had an employer-sponsored plan (due to being self-employed), but I’ve spent about 36 years hating whatever insurance plan I’ve managed to have, due to ever-increasing premiums, deductibles, copays, restricted networks & all of the unpleasant surprises about things that I thought were covered but turned out not to be – so no hypocrisy here. But I didn’t have the choice of a single-payer government run plan coupled with a backup supplemental plan until I turned 65 this year. If a “public option” had been included with ACA, I probably would have signed up for it and then maybe the transition to regular Medicare wouldn’t have seemed like such a welcome relief.
@bluebayou not sure what you are referencing. I didn’t go to a “meeting” at the hospital financial counseling offices. I had three individual appointments. The whole array of options was presented, but then they gave me a recommendation based on info I gave them. I didn’t go to anything hosted by Advantage Plans. In fact, SHINE results in many people signing up for regular Medicare.
H and I have been figuring out what works best for us. No one size fits all. We have the advantage of medical knowledge (can run through possible scenarios) and enough money to pay extra. But we’re also frugal.
If you go with Medicare A and B you want D- the drug plan- because there are forever penalties (a small pecentage times the months without) for waiting because you figure you don’t need that now.
If you have large money reserves you can draw on if needed and no known high expenses likely it doesn’t make sense to me to add extra monthly payments for supplemental/Medigap insurance- that go up with age. But- with a fixed budget that can be worth it to save the retirement funds. Among those you need to decide which of many flavors to choose.
Then there are the Advantage plans © that replace A, B and (usually) D. Had some expenses this year and we’re only getting older so will opt for more than drug coverage. We discovered that there are different formularies for the Advantage and the drug plans from the same company! We found the same tiers for different C plans among different companies while the D plans often cost more for the same drugs at the same company (higher tiers- 1 is usually free while 2/3 cost more and more).
Plan C can be an HMO, PPO or other. Have figured an HMO works if you never leave and you like the doctors in the plan. But- we like our physician and want the option to be elsewhere for care so we were able to narrow down the choices.
Discovered drug formularies to be the same tiers among companies (PPO) but costs per tier a bit different. Made phone calls to some companies to figure out which PPO plans work, then could narrow it down. Looked at copays in and out of network. I don’t understand how these for profit insurance companies come up with their differing numbers. $X for 8 days in the hospital then $) for one while the other has $X++ for 4 days then zero… Hmm- how long am I likely to be hospitalized with a problem to make one or the other… Saw plans that had no limits on what you pay for out of network care- and I thought $10,000 was a large sum.
After many hours online plus a few phone calls we have a winner. AARP United Healthcare Advantage Plan XXXXX (it wouldn’t matter if I divulged the plan number because yours would be different in another city/state). Know an elderly (90+) physician with this and he likes it. I guess it amounts to the ongoing costs of medications and coverage for catastrophes. We’re used to footing the bill for some things not covered but want to avoid huge costs. Our costs will presumably be cheaper than A, B, D. I’m not doing the math for worst case scenarios where my 20% with original could possibly be cheaper. If it comes to that I’ll be lucky to be alive and use up the money I can’t take with me when I die.
Bottom line- no plans can be less coverage than original Medicare. They can’t deny you care. Costs can vary, however. But the baseline is the Medicare rate, the dollar amount or percentage you pay is based off of that, not an inflated rate. Confusing because we can try to tailor coverage to our savings/income plus known and predicted ongoing expenses.
PS- I feel like I deserve some college/ continuing education credits for the effort I’ve put in this month. 3? 5? And I knew what to consider going in. I do know Medicare seems to be cheaper than the group insurance for retirees we once had, and a lot cheaper than the policy I needed for two months between my COBRA and 65th birthday month. Plus better coverage.
@calmom-
I will stay on DH’s insurance until he retires and either goes on COBRA or works until he is 65, whichever he decides. My question is whether, when the time comes, to take a supplemental when we go on Medicare B (will
Likely take G since F will be gone and IMO G is probably a better choice anyway) or wait and use the HSA for copays etc and buy a supplemental (USAA or AARP or whatever) later. Is there underwriting needed for a supplemental?
Can’t easily read this or type on my phone, but someone upthread said they hadn’t seen people gripe about managed care with traditional insurance? That’s surprising to hear, since mangled care (as many healthcare providers call it) is a blight on healthcare. They don’t save the subscribers any money - they just put in a layer of bureaucratic garbage between the patient and the provider. Managed care’s role seems to be to stall or deny care and keep $$$$ in the insurers coffers. Disgusting.
Wis, I’m sorry it took you so much effort. Way way back I mentioned that 80-90% of my 65+ patients use UHC/AARP. 4% have United American. You can have full coverage (no yearly deductible, all co-payments, or several less expensive plans, where the first 2K are yours to pay, then UAm kicks in). That second plan is good for the healthy 65-70 year olds, BC/BS in FL also has several different plans in my state. Then USAA, Continental General, Horizon, Bankers, &Mutual of Oregon. Some have plans from their employer.
I actually said that many regular health insurance plans have managed care. But the griping seems to be about Medicare Advantage plans with managed care.
You being on Cobra on your husband’s plan (should he retire) is different than being on his employer sponsored plan. I’m not sure you get the ability to delay taking coverage without penalty if you are on cobra.
Hoping someone else more knowledgeable will comment…because I could be wrong.
@thumper1 - I will not be on COBRA. If DH opts for COBRA I will go immediately onto Medicare B. Cobra is not creditable coverage for medicare. My question has to do with whether I can wait a year or so to buy a supplemental if he is on Cobra and I am on medicare. I know I have to take the Rx plan (D).
As for Managed care, it is frequently complained about, but its often the carve out for mental health from within the parent healthcare company.
I think I asked this upthread but cant find it so will ask again: Can I use HSA money to pay for a Medicare Supplemental policy? I dont think I can use it to pay for Medicare B, but can I use it to pay for a supplemental (medical) plan? If I could use the HSA money to pay for either Medicare B or a supplemental, that would solve my dilemma.
Hoping someone can verify what i found with a google search.
You can not use HSA money to pay for a Medicare supplement, but you can use it to pay for Medicare premiums, any deductibles, and any copays.
And I believe you can use it to pay for Medicare Advantage premiums. But not sure!
Is that correct? Because…sometimes a google search isn’t accurate.
I posted an answer to this question in a different thread in September; see http://talk.qa.collegeconfidential.com/discussion/comment/22400378/#Comment_22400378
jym, per IRS Pub 969
As long as it is your account, you can reimburse yourself for Part B premiums,
No, you cannot reimburse yourself for supplement (Medigap) premiums
https://www.irs.gov/publications/p969#en_US_2018_publink1000204083