Probably because most people have little or no choice in whether or not to have a managed care plan before they become eligible for government socialized medical insurance. If they have bad experiences with managed care, then they may say “why would I choose that?”.
But then hasn’t Medicare had the opposite problem, paying for anything but at low rates, encouraging excessive procedures?
Do you mean that the medical facilities tack on extra unnecessary stuff in order to run up the bill to Medicare?
@jym626 (post #71)
Medicare Supplement providers can require underwriting UNLESS you sign up during a guaranteed issue period. See https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights
Note that Plan G will also be Guaranteed issue from 2020 going forward.
Thanks, @calmom and @bluebayou. I had considered waiting a year and enrolling in the medigap during the enrollment period in year 2 of my being on Medicare B. But if we can reimburse ourselves as a medical expense from HSA for the Medicare B premium, that may solve the problem. I don’t want to have to use HSA funds for something non-medical and be subject to being taxed on the HSA withdrawl.
Some questions about your “D”(supplement) plans:
1: How do you best guess what drugs you MIGHT use next year? Anyone have a reasonable list of common ones most often prescribed (antibiotics? Pain meds? etc.). We have always picked the cheapest plan, and of course, wouldn’t you know it, needed some new $$ medications toward the end of the year – but only short term, so won’t need again next year.
My pharmacy told me I needed preauthorization for a recently prescribed (short term) medicine. Is that typical? I’ve never experienced this pre-Medicare.
When you use GoodRx coupons, does that mean it will not count toward your deductible? We have a large deductible on our current plan. If I run it through insurance, it will cost $300 per dose. If I use Good Rx coupon, it is only $90 per dose. Huge difference.
Yes, and that Medicare can be slow in catching excessive or even outright fraudulent billing.
Be careful with GoodRX prices. For two recent vaccines I got, the prices listed on GoodRX were higher than the list prices at the pharmacies that were listed. So look at the coupons, but compare the non coupon price before using.
The fine print- Good Rx has it, the price may be different. I have used different pharmacies than my drug plan when the costs were cheaper. Walmart’s $10 for 3 months is one example. And I guess Publix is looking for more grocery business when they offer $0 cost or cheaper than plan pricing.
I/we (I did most of the work) had to figure out which type of insurance was most cost effective for us, hence the time. One thing learned on the phone- our area has two very similar policies through one company which the guy on the phone explained that the other policy was older and being phased out but some people don’t like to change. Have to remember that in the future- take the time to reevaluate each year. Another thing that made me drop consideration for Aetna (was considering policies our physician accepted) was in two separate calls when I inquired if the Mayo Clinic was in their network (the original one we would consider for potential extremely difficult situations) was the need for the zip code of Mayo. What??? The famous clinic in Rochester, MN that may have only one zip code and they couldn’t look it up??? btw- I did find their website and they don’t give the address/zip code on the home page. The other two companies did give me the in/out of network status easily (decided it was not the deciding factor and classmates who worked there retired and moved- no longer an easy zip code source).
Yes, most people may not spend the time but with our medical knowledge we want the best for us. It is so nice that Medicare regulates how the choices can offer coverage- unlike the private sector. After all those years paying into the system it is nice to reap the benefits and protections. And to be safe from exorbitant pricing or exclusions. It is a lot of work for the companies offering insurance to their employees- my final year of that type of insurance reflected a change in companies because the company’s costs were going up based on some high expenses for a few employees with bad luck healthwise. Being a Boomer also means enough of us with clout to be sure we are not ignored in the future.
Here’s a thought. Once retired we need something to occupy our time and keep our brains active. This is the ONLY reason they made things so complicated. And if you believe that…
Perhaps that is why Kaiser has relatively high satisfaction compared to other HMOs – it is easier to know which providers and facilities are in-network than with other plans.
I mentioned in the recent hearing aid thread that I now handle all the finances for elderly relatives, so I’ll just share my experience in dealing with a Medicare Supplement Plan vs a Medicare Advantage Plan as it relates to billing.
After reviewing different plans, I thought I could save them around $2K by switching them from their Medicare Supplement Plan F through (AARP) United Health Care to a Medicare Advantage Plan through Blue Shield after determining they could switch back later without underwriting. This is a couple in differing stages and types of dementia, don’t remember who their doctors are and started using the ER like their general practitioner’s office. They also had a few 911 calls due to falls, a life threatening allergic reaction to a new med, hospitalizations for an infection, gallbladder surgery, a broken shoulder, and two different month-long stays at a rehab facility.
With the United Health Care Medicare Supplement Plan through AARP, there has never been one mixup of any kind and I have never received one bill. Not one, and this is through the hospitalizations and rehab stays longer than Medicare alone covers. I’ve called them a couple of times when I thought something might not be covered and the level of customer service was beyond my expectations. They’ve told me not to worry and they’d handle everything, and they did.
With the Medicare Advantage Plan through Blue Shield, I was dealing with what seemed like a mountain of paperwork. Sometimes they’d pay the doctor or hospital directly, but sometimes they’d send checks to the insured and I’d have to pay the bills, and there was no rhyme or reason for the difference in how this was handled. Sometimes the claims would initially get denied because the wrong codes were used or there was some other mixup, and everyone seemed to be passing the buck blaming someone else. They’d eventually pay, but I’d spend significant amounts of time digging through and organizing paperwork, sending copies of things they requested, or on the phone trying to straighten things out, etc. Sometimes I’d just pay the bill and have to wait to be reimbursed. It was a mess.
Needless to say, I switched them back to the UHC Supplement Plan after one year on the Blue Shield Advantage Plan. They did save some $, but it simply wasn’t worth the stress, anxiety, and confusion all the mail and bills caused them or unnecessary work it created for me.
YMMV, based on my experience, I’d only advise someone to go with a Medicare Advantage Plan if you’re relatively healthy, don’t anticipate any significant health issues or bills, and are getting it “just in case.” Or, it may be worth it if saving $ is the most important consideration, you can save a significant enough amount to make it worth the paperwork and billing issues you may have to deal with if you do have a health crisis, and have someone who can handle it for you if you should have major health issues that would make it difficult to handle it yourselves. Otherwise, if you want the peace of mind of having all billing matters handled correctly and efficiently on your behalf at a time when it may be difficult to handle the stress and anxiety of handling it yourself, I’d highy recommend the UHC Supplement Plans.
It was a no-brainer for us to sign up Part B Medicare supplement AARP United Healthcare Plan G. For Part D, my H has Aetna and I have AARP UnitedHealthcare.
We got plan G because no other plans covers us while we are in CA and NY where we spend considerable time with our kids and grandkids. With our plan G, there is no requirement for a referral visit. We can just call up any specialist and request an appointment. In addition, if we have a serious illness or need care from a specialist, all the top specialists in the country are available to us( ie anyone who takes medicare)and no worries about whether they are in or out of network.
I’ve read an article in WSJ a while ago (and I can’t find it now) chronicling a nightmarish story about a man who had a Medicare HMO plan and who needed an emergency operation while visiting an area out of state. His emergency operation was paid for by his HMO, however after a few days, he suffered another complication and needed more hospitalization but this time his doctors’ bills were not paid because it was not directly caused by his emergency and it amounted to a large amount of money.
Since we do a lot of travel, the plan G gives me peace of mind.
If we are sharing anecdotes…I know a number of people with significant health issues who have had no difficulty with the Medicare Advantage Plan I have which is a Premier PPO Plan. You know…there are different levels of Medicare Advantage Plans. Perhaps this couple had an HMO Medicare Advantage Plan that had a limited network or something.
I handled my mother’s Medicare and Bc/BS supplement payments when she had dementia and couldn’t do anything herself. It was a PITA to keep track of all of the bills, EOBs, payments from Medicare, and payments from the supplement. I knew everything was fully covered…but I can’t tell you how many copies of things I made, and how many billing offices I needed to speak with to straighten things out.
I think folks cast a very broad brush when talking about Medicare Advantage Plans. Sure, they are not probably the right thing for everyone…but they can be good also.
Let’s just say…neither system is perfect.
DH got a plan G supplement as well, and I likely will when I’m eligible for Medicare. We also travel to see kids and grandkids and don’t want the hassle of being OON if something were to happen. The peace of mind is worth the higher premium.
@thumper1 , I don’t disagree. Just sharing my admittedly anectdotal experience because the difference was night and day, but no, it was not an HMO or limited network, and everything did get covered. It was a PPO that covered everything Plan F would cover at about the same cost, BUT included Part D which is where the savings came in ($85 for two x12 = about $2K). The billing was just a mess in this case.
So it sounnds like we had the exact same experience with BC/BS, although yours was a Supplement Plan and this was an Advantage Plan.
It wouldn’t have mattered which supplement plan my mother had. She still would have had a doc bill, an EOB from Medicare, and payments from the supplement to keep track of. I kept a notebook…and a year after she died, I was still dealing with bills that were not quite right.
There was one bill my mother paid…which was subsequently paid by insurance. Did you ever try to get money back from a doctor? Especially for someone who is no longer alive? It was an experience I don’t want to repeat.
Insurance bills and billing are definitely worth considering — hassle factor can really add up and IMHO opinion is worth asking the billing offices of providers you see if the have preferences and companies/policies they HATE dealing with.
With supplements, for the most part the providers don’t even deal with the private insurers, as Medicare automatically forwards the bill. The only thing I’ve learned along the way is that it’s important that the provider be informed about the supplemental, so their billing office knows to expect the second payment, rather than billing the patient for the balance based on the Medicare statement)
We have a United Healthcare Medicare Advantage HMO plan. I called to check about travel. Within the US, we call them two days before traveling to activate the “passport” plan. Then if we need healthcare while in another state we would be covered. Overseas, it’s for emergencies only with a $90 co-pay. It’s very frustrating because I cannot find one word about that easily.
https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/Passport-FAQs.pdf
I have an Advantage Plan with BC/BS that is a PPO, not managed care, and very happy with it.
Medicare is/was often slow to send EOBs to patients (I am remembering from when I had to manage all my dad’s bills) and often they had, IIRC, several
Months of claims from different providers on them. Some doctors offices billing systems send out monthly statements which will include bills sent to insurance but not necessarily processed by the primary (or more commonly the secondary). So one had to be careful to wait until all claims had been processed by both insurers before paying any outstanding balance. It occasionally required a call to the physician’s office but only with one weird situation where the Dr. was in network when services were in the hospital but OON when done as an outpatient ( and one was, IIRC BCBS and one UHC). That was a bit of a pain to deal with. We had the opposite experience of @thumper1 - there were some balances due, not huge but a few hundred dollars, after all claims paid on my late dad. They wrote off the balance.