Holy shit. Be prepared for the consumer to get screwed on your healthcare advantage programs.

[LilElf70]

It's that time of year to make a decision on your healthcare for next year. I just got my 2025 Medicare benefit package from Aetna. Everything is worse. From Medical, to Drugs, to ambulance rides, to dental, hearing, vision, fitness. It goes on and on. I'd like to hear from others on this subject. Especially ones that have started receiving the bad news. It's pretty horrendous. There are so many negative changes that I can't list them all here.

I find it very strange that this is happening. Up to now, each year it has become better for us seniors as far as healthcare is concerned for Medicare consumers. Is this political? Is it greed? I don't know yet. A lot of us have used the medicare dollars to purchase these "Medicare Advantage" programs on the market in the past. It was proven to be better than original Medicare. You always got more for your buck. Those days now appear to be over.

So why now? Why so drastic? I will be contacting my Medicare broker tomorrow and talk to her about this whole situation. I'm sure Aetna is not the only company doing this. If I find out anything new from her, I'll post it here.

Be prepared. The bad news is probably on its way to your mailbox.

This is total bullshit!!!

Buyer beware. It's coming.

Am I pissed? You bet I am. Just one more way to screw the seniors in this country. When are we ever going to catch a break?

[radical noodle]

1. I would never purchase Medicare Advantage

I have A & B Medicare and a good supplement with a Part D policy that costs me nothing. I know too many people who've been screwed by their Advantage plans.

Are they charging a lot more or are they taking away benefits?

[Sibelius Fan]

3. I've had an Advantage plan for five years. Costs me $0 additional. I love it.

[LilElf70]

6. I have the same thing. 0 out of pocket

Of course you realize the 0 out of pocket cost you 174 a month, typically taken out of your SS.

They listed the 2024 benefits, and then the 2025 benefits. 95% of the comparisons are worse for 2025.

[Skittles]

7. it's costs the governemnt and the taxpayers PLENTY

yes it does

https://www.statnews.com/2024/02/28/medicare-advantage-traditional-overpayment-patient-dissatisfaction-investors/

[former9thward]

23. It is part of Medicare.

MA is Medicare Part C.

[dflprincess]

39. Calling Advantage "Part C" is part of the bait & switch

Medicare Advantage plans are strictly private insurance policies. That's why health care systems can refuse to accept them.

In Arizona, the Mayo Clinic in Scottsdale refuses all Advantages plans.

In Minnesota, two of the large clinic systems (HealthPartners & Essentia) have announce they will not accept Humana or UnitedHealth Care Advantage plans. The reason being is both plans have high rates of claim denials.

Pay attention to how hard the insurance companies push these plans, they are not doing it because the love us.

[former9thward]

42. Clinics love to overbill and upbill routine procedures.

Maybe that is the cause of claim denials. Big Monopoly Clinics may not like MA but average people do. That is why the majority of people take MA.

[dflprincess]

52. Clinic systems have contracts with insurers and the reimbursement rates are already negotiated

Apparently you aren't familiar with UnitedHealth and the tricks they use to avoid paying claims and padding it's bottom line.

I have a friend who works there, she is covered by UHC's employee plan. A year ago she was diagnosed with pancreatic cancer that had spread to her liver. Standard of care at that point calls for a PET scan (and insurers love to yammer about "standard of care&quot . They denied the claim. Her "in network" oncologist told her not to worry about it, his office would deal witb it as they UHC pulls this all the time.

That they are doing this to Medicare Advantage members is no surpise, they're banking on most of the patients giving up and just paying out of pocket.

[Blue_Roses]

151. How is your friend

doing?

[dflprincess]

163. Hanging in there

The liver tumor appears to be gone & the pancreatic one has shrunk. The doctor says they can't cure it, but are hoping to turn it into a chronic condition & buy her a few years. Fortunately, she tolerates the treatments well.

[Blue_Roses]

231. Oh, that's great!

Pancreatic cancer seems to be hard to treat, but it looks like they are making strides with it. I have a friend whose husband found out he had stage 4 Pancreatic cancer and passed away a month later. I am so glad to hear your friend is hanging in there. It gives us all hope.

[Silent Type]

108. We agree.

[OldBaldy1701E]

156. Quick Tip.

I learned this a while back. If you have medical bills, you can and should demand a detailed statement. You want each charge listed. According to what I read, when this was applied, each bill came down by several hundred dollars. It certainly lowered my bill for the kidney stone I had removed.

They are padding the bills. They know it and they hope we will be typical Americans ad not think about it.

[former9thward]

168. Agree.

The whole thing is a game and we are caught in the middle.

[vapor2]

48. Medicare Advantage is privatized Medicare

and what I heard is that the agent that enrolls you in an advantage program gets roughly $700. Politicians get kickbacks also.

[Silent Type]

109. They get commissions on advantage and drug plans too, which are private insurers.

[spooky3]

35. Thanks for this article. Nt

[Demsrule86]

187. Traditional Medicare is paid for by the government too.

[Skittles]

222. EDUCATE YOURSELF

https://www.thenation.com/article/society/medicare-advantage-privatization-inequity-fraud/

[VGuerra276]

27. doctor's visitss

So what does it cost to go to the doctor or buy prescriptions?

[enough]

34. My GP visits are $5. All my prescriptions except one are $0.

[Sibelius Fan]

181. I have no copay for doctor visits. Generic drugs are $0. A three-month supply of

Pradaxa cost me $3.16 this month.

[OAITW r.2.0]

127. In 5 years. "0" out of pocket. Medicare a UH advantage plan.

Check ups/Car Scans (2), Outpatient surgery and follow ups. No additional costs,

[jmbar2]

12. What supplement do you have?

I need to start shopping for one soon. Not sure where to begin.

[radical noodle]

25. I have Florida Blue

which is Anthem. I have never had a quarrel with them over anything. The only thing they've ever refused to pay is a tetanus shot when my dog poked her nail into my leg and it got infected. It cost me $45.

There are a lot of doctors near me who won't take Advantage plans at all, and I like to be able to choose my doctor rather than going to the one someone approves for me.

There are different supplemental plans (designated by letters) that pay different ways, so be cautious. And all plans will raise prices as we age. I'll be 77 next month.

[jmbar2]

118. Thanks for the info

I didn't realize that the prices go up - that's a bummer.

[radical noodle]

159. In the last few years

The supplement has paid quite a bit more for just my husband than we've paid in premiums for both of us combined. It's a crap shoot like any insurance, but one cannot predict health problems in advance.

A friend of ours gambled on good health for herself but since her husband smoked, she kept his good policy and "saved money" by getting a cheap policy for herself. Sadly, she got breast cancer and was in treatment for a couple of years which nearly broke them due to her money saving policy.

Nonetheless, I know some people are limited financially and must go with what they can afford and hope to hell it's enough. It's a sad system for seniors who need health care more than any other group.

[jmbar2]

167. So true

I think a major weakness for seniors is the lack of good dental coverage. I am a fanatic about my teeth because I know I cannot afford to be otherwise.

I hope that we can get a good strong Democratic majority to begin shoring up our healthcare system for the next generation.

[elocs]

173. I have $2000 worth of dental work that needs to be done next month which I now will get done

because I know my United Healthcare plan will be worse next year. But when you're poor, living under the 100% federal poverty level, you must do what you can to get along. I'm under the dual care program since I'm covered by my state Medicaid program here in Wisconsin as well.
I've done very well by United Health Care so far and have no complaints.

[jmbar2]

175. Is that Medigap, or an Advantage plan?

I'm also covered - for now - under my state Medicaid plan, but it has no dental that I am aware of. I've been doing substitute teaching and my earnings may push me over the income limit. I due for recertification this month, so a little nervous about it.

[elocs]

183. Advantage. But Wisconsin's Medicaid (BadgerCare) has dental coverage. n/t

[Demsrule86]

188. Humana has a plan which covers dental extensively in Ohio...I have never been on it but good reviews.

[jmbar2]

235. Thanks for the info - will put it on my research list for Oregon

[elocs]

177. Fortunately, I have had excellent coverage from the UHC Advantage Plan.

I will be having a crown replaced next month for over $2000 and I won't be paying a cent for it to be done. It will, however pretty much wipe out my coverage for this year.

[elocs]

176. "I know some people are limited financially and must go with what they can afford"

Absolutely true! How different from reading some smug replies from some here how THEY would never by an Advantage Plan. When you are poor you must do what you can just to get by.
Fortunately, I have Medicaid coverage as well.

[SheltieLover]

106. Call your local Council on Aging and/or your senior center

The Council on Aging rep was able to give me quotes by plan. I have Farm Bureau gap & have never had a problem with them.

Each gap plan in,each category must have identical coverages, so it's really about determining which plan you want & can afford, then finding the best price.

At the time I signed up, my gap plan was something like $125/mo & I have the best olan offered. It even covers the annual deductible. Other identical plans were well into the $350/mo range!

Unlike part d for drugs. What a scam!

Anyway call your senior center & ask if they are going to have Council on Aging reps come in,to sign people up during the enrollment period.

Good luck!

[jmbar2]

119. Great advice - thank you so much

I have a good rep at my senior center. Didn't even think to start there.

I learn so much from DUers. Grateful to have everyone as a resource.

[SheltieLover]

125. You are most welcome!

I love my senior center. And I share your sentiments about DU!

[SheltieLover]

129. Here is the Medicare.gov website detailing the gap plans

I think I chose Plan F. There are restrictions on who can opt for this, but your senior center staff should know.

I recall that if I'd chosen a lower level gap plan, I would never be able to get Plan F.

Mine covers everything including my annual Part B deductible whuch I realize is built into the price. I use my Medicare, so I know I'm getting my money's worth.

Good luck to you!

https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits

[jmbar2]

137. Thanks again!

[SheltieLover]

140. YW!

I think I still only pay around $150/ mo & it's been,a few years...

[kerry-is-my-prez]

184. You can't get F anymore. G is now the one to get.

[SheltieLover]

185. Bummer!

Not sure why not because although F includes the annual deductible, I pay that much more for that gap policy.

After years as a corporate slave never being able to actually use the benefits I payed bug bucks for each month, I use my benefits now. Frequently. So it makes sense for me to have gotten the little bit more expensive plan.

[Demsrule86]

190. I could not afford any of these plans...and it is still private insurance.

[kerry-is-my-prez]

215. Yes - you have to be able to afford it. On the other hand, having to pay the 20% of B could be bankrupting.

Luckily, I’m in a 2 income household because I wouldn’t be able to afford it if it was just me in charge of bills. I would have to move out of my expensive cost of living area.

[Jmb 4 Harris-Walz]

192. "Supplement" is the wrong term if you are talking about privatized Medicare

Advantage plans are privatized Medicare and there are usually several to choose from. Basically you are foregoing Government Medicare and selecting a private plan.

There is actually a SUPPLEMENTAL plan to the Government Medicare you can purchase (it’s 200+ a month) which is over and above what you pay for the regular Medicare plan, BUT it doesn’t cover drugs so you still would need to enroll in Part D for drug coverage though there is one plan in my area for less than $1 a month.

I would suggest that anyone seeking information on Medicare choices to do a google search in your area for Medicare counseling. There are usually senior services who provide free sessions to assist seniors in making their choice. In Minnesota you can contact Senior LinkAge Line 1-800-333-2433; www.MinnesotaHelp.Info

[lostnfound]

16. If something seems too good to be true, it definitely is. We won't get Medicare Advantage either.

Just another effort to divide and conquer, Incentivize 1000 people to go private, and intentionally screw over the 50 or 100 that are most expensive patients. The ones that need the expensive biological to live, or a complicated surgery.

I don’t blame the people who take it for making their choices, people have to do what they have to do. I blame the corrupt politicians and the ideologues against every actual social safety net.

[vapor2]

50. Yup, Medicare Advantage is privatized Medicare. My concierge dr won't take you if you have a disadvantage program

[Silent Type]

110. Your concierge doc probably does not take traditional Medicare either, especially new patients.

[MiKenMi33]

54. Who is your supplement with?

I’ll be turning 65 and I already know I don’t want an advantage plan. I’d be interested to know who your supplement is with. I thought all of them costed plenty but I admit I haven’t researched it yet. Did you research this on your own or did you have a broker to help you navigate? I’m just not sure where to start.

[we can do it]

95. AARP United Health Care Medicare supplement

[MiKenMi33]

115. Thank you!

[jmbar2]

120. Thanks!

[dlk]

82. Not everyone has guaranteed issue for a Medigap policy

And medical underwriting for seniors can be brutal.

[we can do it]

97. You are initially, don't fall for advantage if you're going to be new to Medicare.

[elocs]

174. It must be nice to have the choice because many of us do not. n/t

[Jmb 4 Harris-Walz]

194. I think it all depends on the Advantage Plan that was chosen. There are several to choose from; suggest you

advise the “many people who’ve been screwed” to chose a different Advantage Plan this year for 2025.

[Sibelius Fan]

2. Max out-of-pocket for prescriptions drops to $2000 next year. That's $3,000 in savings.

How is that worse than before?

[Silent Type]

111. I think that's a big deal; however I'm not sure what that will do to premiums.

[BigMin28]

4. From what i have read

You get more bang for your buck until you need a treatment for which you are denied. The Advantage plans were a giveaway to to the insurance industry, brought to us by George W and the rethugs. Once on a Advatage plan it is very difficult to change to traditional Medicare, where you won't be denied treatment.

[NameAlreadyTaken]

43. Not difficult, but it requires planning:

You can switch from a Medicare Advantage plan to original Medicare during two periods each year: Medicare Advantage open enrollment (January 1 to March 31) and Medicare open enrollment (October 15 to December 7).

Leaving your Medicare Advantage plan for original Medicare could expand your provider options and may reduce your out-of-pocket expenses.

But there are multiple factors to consider. Many Medicare Advantage plans include Part D prescription medication coverage, while original Medicare requires you to purchase a standalone Part D plan. Though, with original Medicare, you may be able to buy a Medicare supplement insurance (Medigap) plan to help cover your out-of-pocket costs.

[Demobrat]

77. You can switch back to Original Medicare.

The problem is finding a supplement. If you have a preexisting condition they can turn you down or charge you so much it’s out of reach.

If you sign up for OM and a supplement initially, it’s no problem.

If people could start out with a $0 premium Advantage Plan and keep it as long as it worked, and then switch over to OM with a supplement when the AP denied them care, everyone would do it. They don’t make it easy.

I actually did it, with the help of a savvy insurance broker. It took a while, but I’m out of HMO hell and I’m never going back in.

[slightlv]

99. Pricing of those Medigap plans,

once you've been on MA, is completely prohibitive for most "average" seniors. I know I nearly dropped my teeth when I was quoted. I was put on MA by an unscrupulous broker in the very beginning, and although I called the first workday afterwards to explain what happened, it was too late... the change had been made and was now on record.

I'm on Aetna MA, and been fairly okay with them up to now. Just another thing, along with my property tax increase, to keep stomach in an uproar!

[Demsrule86]

191. Get a new plan...you can switch Advantage plans.

[pnwmom]

131. The switch is possible in some states but not all. nt

[soandso]

217. I'm almost reluctant to comment

because I find this all very confusing. I have regular Medicare, parts A & B. I was not required to purchase Part D (prescription coverage). My pharmacy signed me up for something called Good RX (it's free) which gives a huge discount on drug prices.

From what some friends have told me who chose an Advantage plan, they get money (each month) from the insurance company that covers the cost of their plan (sometimes with money left over) and additional benefits like eye exams, glasses and some dental. HOWEVER, and you're probably aware, their plans are like HMOs and they are limited to "in network" providers, whereas with regular Medicare you are not limited. I'm mainly writing for the benefit for someone who may not know that.

While I am low income (but not low enough for Medicaid) and could definitely use a monthly payout from an insurance company and some dental and eye coverage, it was here that I read, years ago, NOT to get Advantage because of the restrictions against out of network and so many claim denials.

Also, with regular Medicare, you need even need a primary care physician referral to go to a specialist, unless that specialist requires a referral (and not all do). When they do, I just tell my internist to give me the referral to the specialist of my choice and they do. Freedom of choice and not worrying about claims being denied was a big deal for me. they trade off was no dental or eye glasses. I did have cataract surgery and regular Medicare covered a large %age.

[Demsrule86]

46. I spent 46 days in hospital, had open heart surgery, two subsequent heart surgeries and take Eliquis-

a very expensive blood thinner among other meds...only the eliquis has a co-pay. The rest are $0. I pay no premium and get over $100. of Medicare part B back every month. I have vision, dental, and multiple gyms. Traditional Medicare would cost a premium, would not give money back for part B and I would have to get a separate pharmacy plan...no dental, no silver sneakers, no vision. I can't afford traditional Medicare.

[halobeam]

67. What health care plan do you have? n/t

[Demsrule86]

193. Humana Gold Advantage PPR give back ( GB means I get just over 100 back monthly from part B)

There is no premium and I am covered out of state Although out of network it costs more. ( I do travel from time to time). I have been pleased. I live in the Cleveland area and we have really good hospitals...Cleveland Clinic, University Hospital and Metro. All take my insurance.

[Tarzanrock]

73. What "plan" are you referring to which you have if I may inquire?

I have Medicare Part "A;" Part "B;" and, Part "D" coverage. What is "Medigap?" How do I get this Part "C" coverage or do I even need Part "C" coverage? I have that 3/4 inch thick Medicare 2025 book (came in the mail on Saturday) and it is nothing but confusing to me.

[Kali999]

86. Part C is medicare advantage

If you have A and B you need to get a supplement to pay the 20 % Medicare doesn't cover. If you don't get a supplement in 6 months your subject to underwriting and a higher premium. Same if you drop Advantage. I'm getting a N plan. Cigna . You have to pay a small copay. And 254 deductible from the supplement or Medicare A and B. So its cheaper than plan G in monthly premiums. Plan G is very popular but the premiums are 20 30 bucks higher. Not sure but i hear part D is really cheap to start with. Like 40 cents for my neighbors. That's drug costs. If you don't get that they can penalize you and take it out of your monthly check for life. Lots of youtube videos on it.

[Demsrule86]

186. I have Humana Gold. You have regular Medicare. I couldn't afford it. I pay no premiums and get 100 + a month back in

Part B premium. I have co-pays. But they are pretty good. Primary free, specialists 40.. .Part C is the Advantage plan which many here hate. I have had no issues with mine.

[Demsrule86]

198. Part C is Advantage...you have traditional now. And Medigap covers the 20% Part B doesn't cover and insurance companies

sell medigap policies...I find it very expensive to have Part B, Medigap, and prescription plans...

[we can do it]

100. I have gym membership free with my supplement and can go to any doc who takes Medicare w/o asking insurance permission.

[jimfields33]

107. It was signed in 1997.

The Balanced Budget Act of 1997 (BBA 97) created Medicare Part C—originally called Medicare+Choice and now known as Medicare Advantage—and made significant changes to Medicare's interactions with managed care plans.


https://www.medicarerights.org/pdf/medicare-advantage-101-legislative-milestones.pdf

[leftieNanner]

5. I'm sorry.

I was encouraged to get traditional Medicare instead of Advantage. We have been happy with it. Good luck.

[Rebl2]

38. Same here

One of my doctors told me stick with employer insurance as long as I can.

[Think. Again.]

8. Do you realize that Advantage plans are private plans and not Medicare plans?

[former9thward]

20. The U.S. government and Medicare says you are wrong.

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html

[Think. Again.]

24. Nope, Advantage plans are offered and run by private companies...

From another page in the link you posted:

"If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C” or an “MA plan.” This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare."

https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options

[former9thward]

32. It is part C of Medicare.

Like it or not. BTW, you do know, don't you, that traditional Medicare plans are run by private companies? The government has nothing to do with them.

[Think. Again.]

37. You should read the link you provided.

[Big Blue Marble]

47. Your statement is not true.

"The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare," Part C (Advantage Care is administrated by private corporations whose
main interest is profits over people. Last I checked, HHS is an agency of the government.

https://en.wikipedia.org/wiki/Medicare_(United_States)

[former9thward]

53. Part C is part of Medicare.

I linked to the government website -- not Wiki. And you threw in "profits over people" which is not part of your link.

[Big Blue Marble]

76. Part C is only nominally a Medicare Option.

It is a fully privatized benefits plan intended to syphon off Medicare recipients into a for-profit scheme.
The primary benefits accrue to the CEO's and stockholders. Medicare Part A and P are non-profit
plans administered by the government.

[MotownPgh]

152. THIS!!!

[Demsrule86]

199. And insurance companies sell Medi-gap policies...so I don't see the difference.

[Big Blue Marble]

207. Then you need to study the system.

Medicare pays for hospitalization Part A and 80a% of outpatient visits and physician charges.
Medigap policies are only covering the 20% remaining balances. The fees are determined by
Medicare not the supplemental insurance. There are no PPO's or HMO"s involved.You select
your doctors.

Part C coverage is a HMO capitation model where you are limited to the network of hospitals and doctors;
the HMO has to approve of your treatment every step of way: and primarily are for profit businesses
where you are the product and the investors are the customers. These companies make the most
money when they provide the least services..

[Demsrule86]

209. That is your opinion. I have advantage and I get 100 per month back on part B, no premium and everything is

included. I have meds, dental, vision and silver sneakers. I pay 0 for my primary and 40 for my specialist. I had a bad valve (genetic) so I have used it a great deal...open heart surgery, four cardioversions, two ablations. I spent 46 days in hospital mostly in intensive care. I was not refused any treatment deemed necessary by my doctor. I am not saying it doesn't happen but it has not thus far. But I know for a fact traditional Medicare turned down my sister-in-law for certain procedures...so it cuts both ways.

[Big Blue Marble]

216. It is more than my opinion.

Part C has become highly profitable industry . Humana has canceled all other plans and only provides
Part C plans. I am glad that you are happy with your plan. You've had to depend on it for quite a lot.

During my spouse's lengthy hospitalization including ICU, we payed nothing with A and B with
supplemental F, no deductibles or copays. We could access all doctors necessary to treat a
very complex situation which include two abdominal surgeries and sepsis with kidney failure.

[LilElf70]

233. Amen

I'm glad to see this. I've been on Medicare Advantage for 7 years now. I have never been turned down by anyone. And my docs are related to a hospital that is one of the top 10 in the country. Until that changes, I'm staying right where I am.

Hey, the government gives me 174 a month to cover my healthcare. The government system is 1 option. Thank God it's not the ONLY system. I think that might be called a monopoly. It's is up to the consumer how to spend the money, not the government.

Badda Bing...... Badda BOOM!!!!!

[pnwmom]

142. Medicare works with it, but doesn't administer it. Medicare gives Medicare Advantage

the money Medicare collects from each recipient. Then Advantage decides how to allocate the money. They can allocate some to gym memberships, for example, while cutting other funds from cancer treatments. Patients often don't understand how limited their options have become till they are denied a treatment that regular Medicare with a supplement would have covered.

[pnwmom]

135. That's just a label -- it means it's approved by Medicare as an option, but it's not managed

by Medicare. It operates very differently from Medicare supplements.

[Tadpole Raisin]

154. That's a practical fallacy!!

Medicare gives them a certain amount of money per patient and the MA plans ‘manage’ the care. If they get $3000 from Medicare (or whatever the amount is) and only spend $1000 on them, MA pockets the rest. Their admin costs (read profit) are much higher than MC as well.

There are some requirements but they have never been required to explain their denials and give justification for denying something as not medically necessary. There has been talk of requiring that MA plans pay something like ~ 95% of funds received on care but good luck getting that passed in Congress.

Years ago Medicare HMOs went to senior centers where they knew a lot of the healthy seniors were and tried to get people to sign up. The healthy people loved it. The HMO people were getting massive bonuses. It’s obscene.

There are plenty of congressional hearings on this and Elizabeth Warren has been on the forefront. Google or YouTube Medicare Advantage Congressional hearings. Funny I think a lot of Rs skip those hearings. I wonder why

[Silent Type]

113. Your drug and MediGap policy are private too. And private insurance companies do all the admin

work for original Medicare including paying claims, answering your questions, credentialing of providers, audits, sending EOBs, interpreting Medicare rules, etc.

[Demsrule86]

195. So is Medi-gap coverage. I don't see the difference. Other than I pay more for traditional.

[Think. Again.]

200. The difference is Medicare is a government program while Advantage (and medi-gap) are corporate programs.

[pnwmom]

83. No, they are private plans that Medicare regulates and pays on your behalf. The plans aren't run by Medicare.

From your link:

"Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year."

[Demsrule86]

49. That is BS. Unless you want to pay 20 % out of pocket, you have to get an additional plan with a commercial insurer

How is that different really?

[dflprincess]

55. The supplement plans are not subject to networks or preapprovals

and have to cover everything Medicare B covers. What I don't get is why they cost more than Medicare B when they only cover 20% of the cost.

If your provider accepts Medicare, they have to accept your supplement. However, a provider that accepts traditiona Medicare does not have to accept Advantage plans.

[Demsrule86]

204. That is not true. My sister in law had regular Medicare and she was denied care. They can and will deny you.

There are all sorts of things they don't cover like yearly paps.

[dflprincess]

214. She should have fought that denial

https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings#:~:text=Medicare%20covers%20these%20screening%20tests,tests%20once%20every%2012%20months.

Cervical & vaginal cancer screenings
Medicare Part B (Medical Insurance) covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer. Medicare covers these screening tests once every 24 months in most cases. If you’re at high risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.

Your costs in Original Medicare
If your doctor or other health care provider accepts assignment, you pay nothing for:
the lab Pap test
the lab HPV with the Pap test
the Pap test specimen collection
the pelvic and breast exams

Frequency of services

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

[Think. Again.]

56. Are you asking me how a federal plan is different from a commercial plan?

One is federal, and one is commercial.

[Demsrule86]

205. I am sorry Aetna which has a medi-gap plan is not a government insurer.

[Think. Again.]

208. Exactly! You're SO close!

So, Medicare is a government plan, and Medicare Advantage is not a government plan.

See?

[Demsrule86]

210. You misinterpret...you pay Medi-gap plans for coverage..and these plans are insurance based...not different that

Advantage. I don't know why we argue about this live and let live. Private Medicare is pricey. I have an affordable plan that is part of Medicare (C) which I like.

[Think. Again.]

212. I never meant to be arguing, but you're right, let's just drop it.

[pnwmom]

87. The difference is whether your own doctors and hospital decide on the care you need,

or a bean counter at a profit making insurance company.

The Advantage plans are free to exclude doctors and hospitals from their system. Medicare covers all licensed doctors who accept Medicare. I've heard too many horror stories about care being denied -- including cancer care -- to trust my care to a profit-making Advantage company.

How would you feel if you needed SBRT radiation for cancer and you were denied by your Advantage plan? That doesn't happen with regular Medicare and supplement plans.

[Demsrule86]

206. You are kidding yourself if you think traditional Medicare doesn't deny certain procedures.

Some of you haveTraditional plans that are no longer available and newer ones are more costly.

[pnwmom]

224. The Advantage plans have limited provider networks, which can eliminate

major cancer centers and university hospitals, depending on the plan. Also, they're often limited to providers in a limited area. So if a specialist is in another metro area, it wouldn't be covered. And even if an Advantage plan seems to have generous coverage now, that doesn't mean they will if your health needs require specialized care in the future. And it will be too late to be guaranteed acceptance by a supplement plan if you have developed a "preexisting condition."

The Supplement plans must pay for care anywhere that accepts Medicare. They don't come with all the freebies of the Advantage plans, but if you need specialized care for a serious condition, you can get that care at any hospital you and your doctor choose.

[Ms. Toad]

96. The supplement plans are basically check-writing plans.

Unlike MA, the insurance carriers for supplement plans have zero discretion as to whether to pay for a covered procedure. If the service is authorized by Medicare, all they do is write a check to the provider for the 20%.

That is significantly different from a MA plan, which has a ton of discretion to make your life miserable - AND - that plan controls your use not only of the additional 20% - but of the 80% you would otherwise be entitled to use anywhere in the US, with pretty much any provider, without pre-approval.

[Silent Type]

114. Supplements are private insurance plans, though with little discretion. As are drug plans,

but they have more input into plan design.

Heck, private insurers administer original Medicare under gov’t rules and make good money doing so. So private insurers are still making money off original Medicare.

[pnwmom]

130. But the lack of discretion is the key piece.

Most of us don't want some bean counter at an insurance company second-guessing the treatments our doctors recommend.

[Silent Type]

132. You need to take a look at original Medicare policies that limit all kinds of coverage for "excessive"

doctor visits, questionable diagnoses and treatments, etc. It’s not like original Medicare is without restrictions.

Plus, original Medicare has a lot of fraud that does not get caught until years later. By then, scammers have left country.

But, get what you consider best for you. Other people should do same.

[pnwmom]

136. Original Medicare doesn't restrict you to certain doctors or hospitals.

Medicare Advantage does. And every time it renegotiates contracts with hospitals, it threatens to end its relationship with them so that patients have to leave their doctor and hospital for one that is part of Advantage.

I've already seen this twice, most recently with the Advantage plan Boeing dumped its retirees into.

[dalton99a]

121. +1. An extremely important distinction

Advantage plans are great until you need serious medical care

[DC77]

9. Medicare Advantage

is neither Medicare nor an Advantage. Why do you think you see and hear 1,000s of these ads a year? A program designed to cannabilize and end real Medicare. The agents selling them make thousands per policy; the insurers that market them deny and limit coverage for the most essential care.

Medicare at age zero. Screw the for-profit health insurance companies.

[LilElf70]

22. I have never been

denied. My doctor and dentist and hospital and drugs were always covered. They even paid for my wife's hearing aids. My vision was less than 100 out of pocket. I agree that screw the private companies, but until Medicare can match their benefits, I'm going to go with the package that will keep the benjamins in my pocket. It's quite important, being on a fixed income.

[LauraInLA]

98. I'm really glad it's worked so well for you up to now. It appears less stellar in other regions. I'm sorry the

rates are becoming less favorable.

[pnwmom]

128. Have you or your wife ever needed X-ray treatments that cost more than $10K each?

We don't have to worry about that because we're not on an Advantage plan.

Care Denied: The Dirty Secret Behind Medicare Advantage

Coffey, a former EMT from Manchester, New Hampshire, went on Medicare, the government health insurance program for seniors and others with disabilities, after a breast cancer diagnosis left her unable to work. Like an increasing number of Medicare beneficiaries, she ended up on a for-profit Medicare Advantage plan; a marketer directed her to an option administered by UnitedHealth Group, a $450 billion insurer.

But instead of finding the program a relief, Coffey, 51, says UnitedHeath constantly rejected or second-guessed the care options her doctors suggested for her cancer recovery and for a rare and painful secondary disease that has no standard treatment plan. “There’s lots of ways that they deny stuff that you need,” she said. “So many times that I had the opportunity to try different treatments and medications, the response was, ‘They won’t cover.’”

. . . . A 2022 investigation by the Inspector General of the Department of Health and Human Services found that in 2019, 13 percent of the total prior authorization requests denied by Medicare Advantage plans would have been covered under traditional Medicare, leading to an estimated 85,000 additional care denials. That year, Medicare Advantage plans also wrongly denied 18 percent of payment claims — covering an estimated 1.5 million claims — reducing the likelihood that doctors will recommend the costliest yet often most effective care, for fear of not being paid.

In the subsequent two years, as total Medicare Advantage enrollment increased from 22 million to 27 million, such denials have reportedly skyrocketed. A February report from the Kaiser Family Foundation found that two million prior authorization requests had been denied by Medicare Advantage in 2021, more than triple the 640,000 prior authorization requests these plans denied in 2019, according to an estimate in the Inspector General’s report.

https://www.levernews.com/care-denied-the-dirty-secret-behind-medicare-advantage/

[Silent Type]

116. Bad news. Private insurers get paid billions to administer original Medicare too. So you

are still paying them.

[pnwmom]

150. No, they don't. Medicare itself administers Parts A & b with the money people pay into it.

With Advantage, Medicare hands over to the private company an amount equal to what Medicare would be spending on regular Medicare -- but they let Advantage decide how to spend it for their customers.

[Silent Type]

165. Absolutely wrong. Private insurers have subsidiaries that administer original Medicare. Give me your state and

I'll tell you who administers it-- Blue Cross, Cigna, United Healthcare, Nordian, etc., or their subsidiary.

They pay claims, credential providers, audit providers, answer your questions, etc.

In fact, Noridian which is the Part B Medicare Administrative Contractor for states like Washington and Oregon grew out of North Dakota's Blue Cross Blue Shield.

[gainesvillenole]

10. Medicare "Advantage" is a rip off....

It’s basically an HMO and depending on your area can result in very limited choices in doctors. And there’s the dreaded “out of network” merry go round, pre-approval nightmare of private for profit health insurance.
Regular Medicare with a supplement basically pays everything.

[msongs]

15. what is a supplement and who makes them nt

[LauraInLA]

103. Insurance companies make them, I guess. My mother, who died in 2009, had the United American supplemental plan,

which was fantastic. I don’t know if it’s still good or still exists.

[pnwmom]

178. AARP is one place that sells a good supplement. nt

[kerry-is-my-prez]

189. I went through a broker who does both Supplemental or Advantage.

Maybe you can google Medicare supplemental brokers for someone in your area. My broker is in SW Florida. I would give you her name and number if you live in that area.

[dalton99a]

19. +1

[Demsrule86]

51. I live in Cleveland on my Advantage plan...I can us Cleveland Clinic, UH or Metro...all fine insurers.

And their are private doctors too.

[RobinA]

169. It's Only An HMO

if you buy an HMO plan. There are plenty of PPO Advantage plans.

[Skittles]

11. yeah I had read that would be happening

https://www.statnews.com/2024/09/13/2025-medicare-advantage-plans-analysis-humana-aetna-unitedhealth/

[Cirsium]

13. Medicare "advantage"

No Democrat should be supporting or praising this right wing privatization scam, this assault on Medicare.

[LilElf70]

18. I agree

Then offer me the same benefits. It's all about the benajmins, which as a lot of us know is hard to come by on a fixed income.

[Skittles]

78. all the money being wasted on the "Advantage" scam

SHOULD be used to improve traditional Medicare

[MichMan]

28. Bill Clinton was the one that signed it into law in 1997

[MichMan]

57. "No Democrat should be supporting or praising this right wing privatization scam, this assault on Medicare. "

Bill Clinton, whom we all agree was a Democrat, did in fact support it, and was in fact the one that signed it into law.

I'm sorry if you find facts inconvenient.

[MichMan]

62. Show me where I have a history of jumping on Bill Clinton

If I do it all the time like you say, shouldn't be too hard to find some examples. I doubt you find any

By the way, I like my MA plan, so why would I jump on him for creating it?

MA is quite popular with those who have it. That may be why you don't hear any politician running on eliminating it.

[Cirsium]

170. He was wrong

Democratic politicians can make mistakes, especially when they are not getting support for doing the right thing. When their constituents run around defending various right wing ideas and schemes that puts them in a bind. "Don't let the perfect be the enemy of the good" means they feel obligated to play footsie across the aisle and do the bipartisan two step or else be tossed from office. I can't tell you the number of times a politician has told me "don't get me wrong, I agree with you, but the support just isn't there."

We should not reject the "good" because it isn't perfect, of course - the name "Jill Stein" comes to mind - but that does not mean we should stop advocating for the supposedly "perfect." In this case the "perfect" is universal health care.

[Demsrule86]

211. I have family in Ireland and universal is not working real well lately.

[Cirsium]

236. Fox in the henhouse

This is the same old right wing playbook - sabotage progressive reforms and then claim "it doesn't work!"

Though many European countries moved toward universal health care in the period after World War II, the powerful positions of the Catholic Church and the medical profession in Ireland were instrumental in impeding reform through the first half of the 20th century. The Catholic Church, fearful of socialism or reforms that would dilute Catholic control of health care institutions and sexual morality, allied with the medical profession who feared state employment and loss of private fee income, opposed reforms that would have increased state provision of health care. This lack of significant reform, coupled with a history of underfunding, has resulted in a health care system that requires structural reform as well as more investment in order to improve access to health care services.

...

The existence of powerful vested interests can be sufficient to block progress toward universal health care. For example, in the Irish context, opposition to universality may arise from attachment to a private market in health care from various groups, including those with PHI, medical personnel working within the private system, and private insurance companies.

https://www.tandfonline.com/doi/pdf/10.1080/23288604.2018.1551700

[Skittles]

44. thank you

I do understand that some people choose MA for financial reasons, but they should not be celebrating the efforts to get rid of Medicare.

[Ocelot II]

14. I stuck with regular Medicare.

[BOSSHOG]

31. That's the way to go

Their commercials, if it sounds to good, etc.

Three weeks at Club Med with unlimited sex at no extra charge.

[Auggie]

60. LOL

[LilElf70]

17. My 2024 benefits

Advantage - 3250 dental. They covered everyone. It's down to 2K for 2025. Vision coverage is less coverage, more out of your pocket. Fitness allowed 1200 a year for activities. That's all gone. So much for promoting seniors to be more active. Hearing aid allowance cut in 1/2. It goes on and on. I used many of these services and enjoyed paying very little, if any. I'm pretty sure original Medicare does not cover this. Especially for 0 out of pocket.

[Coexist]

21. the 2025 changes that save the beneficiaries money shift the financial burden to the plans

and its possible they are passing that along to you in the form of limiting coverages if the monthly cost has not gone up to cover it. They might be splitting the excess between both of them too. This is more likely if your medical and rx coverage are combined.

There is the $2k rx cap, 60% burden of rx (used to be 20) that has changed.

It's not fair, but there are market factors driving it, and I just wanted to share. Shop around! You might find a better plan, and I hope you do.

[keithbvadu2]

26. Once you get locked in, it may be difficult to go back to original Medicare. They now own you.

I kept the original Medicare because it was more flexible even though I paid for the Part B.

[Auggie]

61. THIS

[hot2na]

149. You can go back to original Medicare (parts a & b) at any time during open enrollment

The problem though is then getting a supplement (medigap) plan that is affordable.

This is the problem with choosing an advantage plan; you are stuck with it. I strongly urge people to choose original Medicare. Medicare Advantage is a scam.

Read Thom Hartmann “The Medicare Advantage Ripoff that Every American Should Know”

https://hartmannreport.com/p/the-medicare-advantage-ripoff-that-462

[Big Blue Marble]

218. You can go back to traditional.

But they will health-rate your plan. If you are very healthy then no problem.
If you, like most seniors, have existing conditions, you will be charged more.

[MichMan]

29. Just getting caught up to the inflationary effects the last few years

[Silent Type]

30. Rightly or wrongly, MA rates were cut. Personally, until our government-- regardless of party --

improves original Medicare where poorer people can afford it, a supplement, drug coverage, etc., and get a little extra as far as dental, groceries, etc., I don’t think rates should be cut.

I also think MA should absorb cuts, certainly short-term.

[Otto_Harper]

33. For comparison with Traditional Medicare plus supplement

I have just returned home from a post-covid stay in the health care system. A total of 11 weeks of ICU, Step-Down, acute rehab and post acute rehab. That's 3 months in hospitals and care facilities.

Total out of pocket is about $1000.

There were no denials of care and treatments along the way.

try that out with you "Advantage" plan.

[live love laugh]

36. Thom Hartmann has talked about Medicare Advantage pitfalls repeatedly

Check YT or hs podcasts for info.

I am sharing your OP with people I know who have Medicare Advantage. Looking forward to hearing what your broker says.

[LilElf70]

59. Most people that dislike dabbing

into the private healthcare system, have very good points. Especially Hartmann. He has hated private healthcare for decades. And he has a lot of good points. Hartmann is totally against private healthcare because of the for profits behind it. I get it. Their profits are way to high. They are money hungry leaches. But until you put yourself in my shoes, with limited income, there is no reason to critique the system I use. As for the medical portion, I had an angiogram this past year. It is a very complex procedure. The total bill was 68K for about 3 hours work. I paid 250 dollars. I also had to utilize an ambulance this past year. My costs was 100 bucks. We have used many services from a 0 out of pocket healthcare system.

However, I have to look out for myself. It's all a matter of survival. For me and my wife, using my medicare bucks to purchase a good private policy with additional benefits that would normally cost me thousands was the way to go. Have you been to a dentist lately? 1 filling is hundreds. Bought a good pair of glasses? Again, hundreds. Paid for a decent hearing aid? It all adds up. All of these items practically cost me nothing with an advantage program with 0 out of pocket. And now my wife needs upper dentures, which will involve pulling 13 teeth. Have you ever priced that? With a little luck , all of this will be paid for, if I play my cards right.

For what it's worth, I'm going to stick with what we have and let my broker help us decide our future healthcare needs. I have to do what I have to do. I need the best I can get for my buck, and not lose my house to the healthcare system. Like all of us, we have to look out for number 1.

The whole idea behind this post was to inform others that there is something going on in the healthcare system.

God help us all.

[pnwmom]

80. The issue is the trade-off. We turned down Advantage and its freebies (free dental, gym, etc)

because we were most concerned about getting the doctors and hospitals we needed when we needed them.
So when my husband's employer tried to switch retirees to an Aetna Advantage plan, we said no
and stayed with regular Medicare plus a good supplement.

Now, when it's too late for the retirees who got switched to Aetna to change their minds, the changes
got dumped on them -- including being dropped from two of the major hospitals here.

Medicare Advantage is a scam.

[we can do it]

104. Might be worth checking the AARP United HC Medicare Supplement. It provides gym memberships.

[pnwmom]

126. We could afford a gym membership if we wanted one. What we can't afford

is to be denied timely cancer treatment or qualified doctors.

[Cheezoholic]

85. I get it. Your situation like half of Medicare eligible people is unfortunate and you're right

you gotta do what YOU can to get the best health care possible that you can AFFORD. The big problem with traditional Medicare is that damn 20%. That wasn't what was originally Medicare, it had no "gap coverage". But the repukes back in the 60's demanded that the 20% "gap" in coverage be put in so insurance companies wouldn't be cut out of the picture (they insure people their whole lives they can eat it after we retire IMO). So the Medicare 20% "gap" was put in because it was the only way the repukes would pass Medicare out of the gate.
As 40 years passed and medical costs soared that optional "gap" private insurance coverage got out of control. It was one of the main areas of insurance that originally denied due to pre-existing conditions. Then Raygun started taxing SS and SS lagged way behind the cost of living increases for 40 years, it started to put seniors in very tuff spots. So the repukes came to save the day "inventing" part C where Private Insurance "manages" your Medicare for you. They started offering all these perks like old banks offering toasters. And financially it FORCES people in your situation to go the "private insurance" route.

It truly is the culmination of a 50 year attempt to privatize our healthcare in this country and it's working. The great perks and no copays aren't gonna last. That money is gonna kick in on the backend and once they get enough locked in they will jack it full stop. Medicare Advantage companies "profited" 150 billion Medicare dollars last year. That would've been enough to give everyone on Medicare their coverage for free, no gap and the added dental and vision.

I understand yours and many others situations and I personally am not gonna knock it. One thing is, and this is important, the Dems have said if they get full control they are gonna re-vamp Medicare and basically do away the "gap" and make part C irrelevant. Just another reason to vote straight D!!

[Rhiannon12866]

102. Bingo!!!

[LearnedHand]

40. So sorry you're facing that

But please. DUers, a hugely intelligent hive mind, have been saying avoid Medicare Advantage plans for years. And providing the research to back it up. THEY ARE PRIVATE HEALTH PLANS, not Medicare. They suck you in with the promise of hearing and vision coverage and then shaft you and the doctors right up the kazoo. If there's any possible way you can do it, move to traditional Medicare and stay with it.

[dflprincess]

41. I plan to stick with traditional Medicare when I retire next spring

It will cost more but even the insurance agent I spoke to told me to stay away from Advantage.

[Joinfortmill]

63. Wow. I've had an Advantage plan for 10 years.

Last edited Tue Sep 17, 2024, 07:39 AM - Edit history (1)

I've never had an issue. I've shared before that I had 88k brain aneurysm endovascular procedure and my total out of pocket expense was the $350 hospital bed cost. My insurance for that was Aetna. I'll update folks on what changes my current Humana plan has made.

[RobinA]

172. There's An Element On DU

that has to crap on Advantage plans. It's never anybody who HAS an Advantage plan, it's the "I stuck with original Medicare" crowd. If people can afford the $400 + gap plan, fine and dandy. For those of us for whom a monthly $400+ bill is real money, it's off to buy the best Advantage plan they can afford. I find this Advantage plan fear-mongering disgusting.

[ashredux]

64. Medicare advantage is NO ADVANTAGE AT ALL. READ THE FINE PRINT.

[Tarzanrock]

65. If you already have Medicare Part "A;" Part "B;" and, Part "D" ...

how do you get Medicare Part "C" or do you even need it if you have Parts "A;" "B;" and, "D?" One would think that the Federal government would be able to explain this a whole lot simpler than the confusing gibberish which is in that 3/4 inch thick Medicare 2025 book they just mailed out. I telephoned Medicare and spent the better part of an hour speaking with a couple of Medicare people and none of those people could coherently answer that question: How do you get Medicare Part "C" or do you even need it if you already have Medicare Parts "A;" "B;" and, "D?"

[SheltieLover]

133. Part C is an "advantage" plan

So no. If you have A, B & D, you do not need C.

[Tarzanrock]

146. Thanks. I appreciate the reply and the answer.

I have a follow-up question: what is "Medigap" coverage? I have Medicare Part "A;" Medicare Part "B;" and, Medicare Part "D" [Part "D" was initially provided by the government through Aetna and some Aetna "Silver Script" policy but last year the government unilaterally changed that Part "D" coverage over to a Florida insurance entity called "Wellcare." [I think that the government has sued Aetna for Medicare Fraudulent practices or is involved with some type of coercive regulatory actions against Aetna.] I'm in Los Angeles and I believe that "Wellcare" operates some kind of California HMO which I am not so certain that "Wellcare" provides coverage for many of the hospitals. I've been trying to understand this stuff for weeks now and I still am confused by it. I've now talked to Medicare, I've spoken with several different Medicare bureaucrats as well as 2 different insurance agents (Wellcare) and another California provider which actually provides insurance coverage for my neighborhood hospitals here in L.A. and not one of these individuals has yet been able to explain these matters to me.

[SheltieLover]

147. Medigap coverage pays copays & possibly other charges.

So your doc charges $100 & Medicare pays 80%, or $80.

Without gap coverage, your out of pocket is $20.

With gap coverage, you would not pay anything.

Easy peasy. Not sure why professionals can't explain these things.

Pls let me know if you have more questions. I do not work in the field. Just speaking from experience.

Pls see my posts above.

[OAITW r.2.0]

66. I get Medicare and pay UH @ $300/m0. 70 YO.

I have not paid any out of pocket in 4 years, Includes visits, CT scans, Outpatient Urological and follow-up. NADA, Love my healthcare providers,

[LilElf70]

89. 300 a month?

That's 3600 a year, per person. That's a decent car payment.

No offense, but I pay nothing out of pocket monthly. And small co pays when I need them. I never pay for my PCP, no matter how many times I see him. I have maximum out of pocket costs, as most policies do. Any specialist I need is 25 bucks. Even with all the co pays, and/or deductibles, I have come nowhere close to 3600 in a year. To each his own, right? You feel comfortable with your decision, I feel comfortable with mine. Life is a risk, no matter which way you go. I have been doing this for 7 years, and I'm way ahead what I would have paid out of pocket.

[Liberal In Texas]

68. Stay with real Medicare. Advantage will eventually rip you off.

If you get ill and need lots of long term care or surgeries many times they will find ways to start denying coverage. You might also get a notice saying you've reached your lifetime maximum. This doesn't happen with Medicare.

Many times Advantage is an HMO. You have to use doctors on their list. In their region. Don't go on vacation and end up needing hospitalization in a region that you are not enrolled in. You'll get huge bills because they will not cover or only cover some as you are "Out of Network."

Also, with Advantage if you need an MRI you have to have a prior authorization. Sometimes the Advantage company will drag their feet and it could take weeks before you get the MRI you doc needs. If they don't outright deny it. With Medicare, if one of my docs wants an MRI or a CT or labs, I just go and have it done. No questions.

Doctors and hospitals also like Medicare over Advantage. They get paid in a timely manner by CMS. They don't have to have one of their employees spend hours on the phone arguing with the insurance company to get paid.

[IGoToDU]

69. Less hospital overnights paid

That’s what I found out was the difference. Kept my mom on her original Medicare.

[SocialDemocrat61]

70. Did you recently have a milestone birthday?

A lot of these insurance companies break policy holders into age groups (65 -74, 75-80, etc.).

[samplegirl]

72. We are looking for a plan now

So not sure what to do.

[SheltieLover]

138. Call you senior center and / or council on aging.

Pls see my posts 106, 125 & 129 above.

[pnwmom]

74. Why now? Because they wait till it's too late for you to switch back to Medicare,

and then they hit you with the bad news.

[Silent Type]

123. Well, CMS is cutting rates for next year. Whether that is justification for cutting "extra" benefits

is questionable

[WVreaper]

75. Medicare Advantage has always been a scam!

Medicare is run by the government, Medicare Advantage is run by the insurance companies. Gee, I guess I trust the government more than insurance companies ripping you off!

[buzzycrumbhunger]

84. As a pharmacy tech...

I can attest that Advantage plans are BULLSHIT. They cover fewer and fewer things and now increasing numbers of providers are refusing to take patients with Advantage plans.

Medicare itself has a lot of issues, most notably that you can’t use copay cards or get patient assistance, but the Advantage plans have always been a scam. Just wait until you. need some drug that’s not even cutting edge but costs $40-80K a MONTH and your insurance denies it.

Remember when Obama was talking up healthcare based on our income? I recall the calculator floating around to convince us of how wonderful it was going to be, that you plugged in your income and it declared your premium would be $X (mine was like $5/mo for me and two kids). Then at the last minute, he sold us out to private insurors. That’s what spawned shit like Medicare Advantage.

When I hear people crow about how we lead first-world countries, I see red. We are at the BOTTOM of that list because we’re a damned oligarchy and politicians are largely riding the gravy train instead of fighting for US. That fake lure of “healthcare for all” is at the top of the list of things they’ve screwed us on.

[bobandrileysmom]

79. When I was checking policies

When I was checking policies, the lady with a MA company told me NOT to get an Advantage plan. As she put it, “ The MA plans look good on the front end, but will be horrible on the back end.” So I went with Medicare and got a supplemental instead. Does it cost some every month? Yes, but yearly colonoscopies, an adrenalectomy, back surgery, and regular doctor stuff has cost me zero out of pocket dollars. I think the $150,000 back surgery, the 25,000 adrenalectomy, and the others that I had was more than worth the extra I pay for a supplemental.

[Martin68]

81. Medicare Advantage is a ripoff, and I would never choose such a plan. Buyer beware!

Every year I get free help from a retired professional to make sure I get the best plan available. Their unanimous advice is to avoid medicare "Advantage" at any cost. Advantage has not been better than traditional Medicare since the ACA regulations came into effect. BTW, I got off the Aetna drug benefit last yer because their prices went up across the board. I got a plan with Wellcare plan with no premium and lower drug costs.

[Pinback]

88. Consumer expert Clark Howard: Why I Think Medicare Advantage Plans Stink

https://clark.com/insurance/health-insurance/medicare-advantage-plans/

If you’re approaching your 65th birthday, you may be shocked by how many solicitations you’re getting from Medicare Advantage plans. By comparison, you may receive only one official notice about traditional Medicare. Salespeople, mailers, phone calls, and other forms of communication will tell someone turning 65 that the only wise choice is Advantage.

(SNIP)

Avoid Medicare Advantage Plans

You should know I warn people away from Medicare Advantage plans.

About half of people who are eligible for Medicare choose Advantage plans for any of a number of reasons. And many people are happy with the Advantage plans they’ve picked. In fact, every time I say something negative about them, I hear from people who are upset with me because they are beyond thrilled with the Advantage plan they chose.

My objections are simple. Once you are in an Advantage plan, it’s difficult to switch to regular Medicare. After your first 11 months, in most states, you can’t easily buy a supplement without passing a medical evaluation. And you likely will have trouble switching to a competitor’s Advantage plan if yours turns out to be a bad choice.

In other words, you could end up being a prisoner of the Advantage plan you pick at 65 for the rest of your life — even if it turns out to be crummy or becomes rotten over time. In my opinion, this is a fatal flaw of Medicare Advantage plans. You could also end up with a serious illness, and the choice of doctors and facilities you are allowed under your particular Advantage plan could be the difference between life and death. With traditional Medicare, you have many more options to seek out the best care, best specialists and best hospitals for your illness.

Yes, traditional Medicare is more difficult to understand and buy upfront. Your premiums may be higher. But you are your own boss of your healthcare. With Medicare Advantage, understand that the insurer makes money by limiting your care and your options.

That lower cost could kill you.

More at link above.

Clark talks about this frequently on his podcast. FYI, I have Traditional Medicare + a “Medigap” supplemental plan myself.

[CoopersDad]

90. ❣️ . . . . . . . Seek advice from your local HICAP advisor . . . . . . . ❣️

If you're in California, that is: https://cahealthadvocates.org/hicap/

I hope other states have a similar nonprofit advisory group to help make decisions.

Working from their documents, two free meetings, and checking on DU and other places I just got on these programs this month.

Medicare Part B
Medicare Part C aka Medigap --- NOT Advantage
Medicare Part D

Medicare Part D for me is only $0.40/month, no copays on my prescriptions, so far!

[Vdizzle]

91. It's an election year. And the current administration is democratic.

They want to make you think the negative changes are the fault of the current politic. Even though the exact opposite is true. If their guy wins, it will be a swine orgy at the trough of cash flow. The more cuts the better. Get the cash while you can because the house of cards is going to collapse.

[dpibel]

92. First thread of ten thousand!

Congratulations!

Every autumn, DU, which is majority superannuated people, has endless threads on this topic.

"You are a dupe for having the """""""advantage"""""" you dupe!!"

"I have advantage and it hasn't caused me any problems!!!"

"You just wait!!"

So nice to know we're back to that season again.

[Ms. Toad]

93. The private insurers running MA plans have been subsidized, to the disadvantage of regular Medicare.

sounds like the gravy train for insurers may be dying down, which means MA plans may finally be forced to charge consumers what they actually cost.

I feel for people who got sucked in to the too-good-to-be-true advertising, especially since it isn't clear at the time of enrollment that if you choose a MA plan rather than a supplement you never have a guaranteed option to buy into the supplement system (and if they let you buy in, it will cost you more). But I'm not sorry to see some equalization going on.

[ecstatic]

94. It's happening now to affect the election.

Stoke discontent.

[Think. Again.]

122. No, I think people are just bringing it up, to shed medicare in a bad light during an election, and stoke discontent.

[markodochartaigh]

101. If we're going anecdotal...

My sister has a friend who was her office manager. She retired at 66 1/2 and took Medicare Advantage. She is a Republican, and that is the last that I will say about that. She did great, her hypertension really improved after she retired and her Advantage plan was great. For about two years. Then, as so often happens to us retirees the excrement hit the electrical oscillating device. Her daughter's large dog knocked her over accidentally and broke her hip. Advantage was still OK. But the stress caused her blood pressure to go back up, really high, like it had been for decades before she retired. There are few doctors in her town of 300k who take her plan, and she couldn't afford to switch plans. Everything in our bodies is connected and when we are older one thing leads to another. She needs care from specialists and the nearest ones who take her plan are 350 miles away. And Advantage has started to deny procedures and treatments, on top of making some more difficult to get by a long process of getting approvals. Did I mention that all of this hasn't helped her mental acuity? My sister is a nurse practitioner and has been helping, but she is still working and navigating the insurance swamp literally takes hours.

[dpibel]

117. It's amazing how it's always the friend of a sister

I've asked many times on these endless "Advantage is a scam" threads for anyone--anyone at all--to say, "This shitty thing happened TO ME."

So far, nothing.

Many dire warnings.

Many stories of friend of a friend.

And not a single person who has detailed how they, personally, got fucked over by Advantage.

As I have said many many times:

If it's so bad, why aren't there many many people joining these threads to detail how they got abused and ripped off?

All I see is people saying, "I've had it for 10 years, and it's been great."

And people responding, "Oh, you just wait and see."

[pnwmom]

134. I saw tens of thousands of my husband's co-retirees threatened with the loss of their doctors

and preferred hospitals when their company's new Advantage plan had failed to negotiate a contract with the major hospitals here.

At the end, some kind of agreement was made, but this for-profit Advantage plan could play hardball with the two non-profit hospitals here because so many patients were involved.

Last year, the same thing happened with a different for-profit Advantage plan -- trying to eek out every bit of profit for their shareholders from the good non-profit hospitals here.

[dpibel]

141. Almost...

That must have been disturbing.

But it all came out OK, right?

So it's really not quite a "I could not get the treatment I needed because...Advantage" story, is it?

This kind of BS goes on between providers and insurers all the time.

[pnwmom]

143. That kind of BS doesn't go on between regular Medicare and providers.

We have regular Medicare so we can go to any doctor or hospital anywhere in the US. That's not true for Advantage plans, which only have contracts with some providers.

[dpibel]

145. That's a bit of a diversion, isn't it?

So sorry I introduced the BS variable.

I think the original proposition was: "Where are the people who have been screwed by Advantage?"

Your response was: "This almost happened, except it didn't."

That, I respectfully submit, is not a first person account of being denied care by the evil Advantage.

Do we not agree on that?

[questionseverything]

155. The people screwed by advantage are dead...they aren't going to answer

[kerry-is-my-prez]

202. One of the biggest providers in the city will not take Advantage anymore.

My neighbor got a letter telling her they would no longer treat her. She still doesn’t get that it’s because she has Medicare Advantage. I go to that provider with my Supplemental with no problem.

[mcar]

164. My friend needed a cochlear implant

went through all the hoops to get the approval from her MA plan. She had to have one final appt with her PCP before having the procedure - a new guy she hadn't seen before.

He spent the entire appointment trying to talk her out of having the procedure and sticking with hearing aids instead. She kept saying she was going ahead with it.

He finally said to her that if she had the procedure, she'd be taking treatment funds away from cancer patients!

Same lowlife, several years later, refused to let her see an orthopedist after she strained her Achilles tendon. She didn't realize at the time that she didn't need to get a referral to see a specialist. The MA PCP's push that myth so they can hold onto the money.

By the time she finally saw a specialist, it was too late. Her Achilles had torn. She'll walk with a limp for the rest of her life.

[KatK]

105. Need advice! I have original Medicare and I want to add Medigap (in Minnesota) now

I know that I may not be able to add Medigap (that I can be refused). That it will be more expensive than if I had signed up at age 65. That they won't cover existing conditions.

Will a good broker be able to help me choose a Medigap plan? Can anyone recommend a broker who works with Minnesota plans?

Also, will I know in advance which pre-existing conditions will not be covered? For example, if I have high cholesterol, but no high blood pressure or other heart issues, will they cover treatment of heart disease? I would like to know in advance what a particular insurer will cover.

Thanks so much for any pointer!!!!

[Ms. Toad]

197. There are no pre-existing conditions for a Medigap plan.

The way Medigap plans work is that what they pay is specified by law based on the plan letter (For example, Plan G covers 100% of everything Medicare covers at 80%, except for an annual deductible - no matter which insurance company you buy it from).

If they decide you have too many pre-existing conditions, they just won't offer you a plan - since they don't have to. But if they offer you one, you are entitled to the exact same coverage as if you bought it at 65. A good broker might be able to tell you which carriers are easier to get into after age 65 and/or charge lower rates in that circumstances. Make sure you find one that works with lots of insurance companies so you aren't stuck with whatever they sell. I don't have connections in Minnesota.

[KatK]

238. Thanks!

Just saw your reply. Thanks so much, this gives me a leg up.

[Dem2theMax]

112. I've had an Advantage plan for about 20 years.

Was put on permanent disability. Don't even remember how I ended up on an Advantage plan.
I am extremely low income.

Last year, I paid $220.00 for the entire year of coverage.
Even though it's an Advantage plan, I still have secondary insurance through the state as well. Between both insurances, almost everything is picked up, including copays at any doctor's office, and hospital visits and stays as well.

I have dental and vision coverage. Probably have coverage for hearing aids, but thankfully don't need them, at least not at this point in time.

I am on a biologic medication that costs somewhere in the ballpark of $7,000 per month. I pay less than $4.00 for a month's supply. That $4.00 disappears once I've hit a certain point. And then I pay nothing for any medication for the rest of the year.

Two years ago, the insurance plan started covering transportation to and from medical appointments. Has come in quite handy because I've been without a car for a while.

The only time I saw an increase in costs, was while Trump was making a mess of the country. It went down again when Biden took control. Will have to wait and see what happens when I get my packet this year.

I've read through the entire thread, and my head is swimming. I can't make sense out of any of it. I had a seizure last year and my brain doesn't work the way it used to. If for no other reason than I cannot understand what I'm reading, I'm stuck with my Advantage plan. And I don't know if I would be better off if I switched to something else.

[Silent Type]

124. Lots of people are happy with MA. That's why 52% of Medicare beneficiaries choose it.

I still have original Medicare, but the supplement and drug plans are getting very expensive, not to mention “extra” benefits like dental.

Even if it’s only $1000 in coverage, it’s much better than Medicare’s ZERO coverage for dental. Hell, up until last year traditional Medicare wouldn’t even cover tooth extractions required for radiation cancer treatment.

[pnwmom]

139. When they join they can only hope they'll be happy long term. And in most states, if you wait too long to switch back,

you lose the option.

[Silent Type]

166. I know, some folks think that 52% are too stupid to make the right decision for them.

[moniss]

144. In the insurance industry they have a phrase

"buying the business". The insurance industry is all about cash flows. Premiums in and claims paid out. So when they see a huge potential pool of cash, in this case the normal payments people had been making for Medicare, they develop schemes to get that money coming their way as much as possible. So what they do is come up with a sweet looking program of benefits at a reduced cost to woo people over to them. They may price this ridiculously cheap compared to their actual cost but they will also begin to hassle getting claims paid or deny coverage at all. Meanwhile those non-stop ads are telling you all about how you can get this great program for a savings to boot. They're spending money to woo people over especially because they know that moving back to Medicare may be difficult especially if your health changes.

"Buy the business" means your monthly payments are the business they are buying. They want that cash flow. So after they run the program for a certain time they begin to cut benefits, raise premiums and ramp up their efforts to not pay claims. They have all kinds of people employed to figure out all the numbers and make their scheme hum right along. They crunch the numbers for how much the scheme will cost year to year versus how much "business" will come their way and you can make book that they have all kinds of graphs and charts showing them where the lines start to get close to each other and they have it planned out what to cut, how to cut it, how to present it to the public and they have their forecasts for how many people will leave them, how many will be somewhat trapped because of health changes etc. This is what they do all day long. Crunch the numbers, forecast and come up with "plans" for how to maximize the money grab and minimize the cash out the door for claims.

They used to do this with homeowner's insurance. They would select really stable suburbs with newer homes and they would offer dirt cheap premiums for the homeowner's insurance in those zip codes. They would do it to get a "foot in the door" to try and get people to switch their car insurance, life insurance etc. The banks etc. do it now with offering people $200 if they will bring their checking account over even if you're opening a "no fee" account. They'll get a certain amount of other business from a certain number of people and they have it all "crunched" so their numbers go in their favor after awhile. For example I was thinking of opening an account with Fidelity a couple of years ago and so I went to their web site and saw they were offering $500 for opening a new account. No minimum deposit and no minimum balance required. You got the $500 after like 6 months or the first year if I remember right. I couldn't believe it and so I called them and they said it was totally on the level. They want those investment funds on the books and the account holders will be there to market other products to. "Buying the business". They appear to give something for almost nothing but it's not like that really. To them they are not deceptive they are just making an "offer". It's like the grocery store that runs a coupon to give away a free bottle of ketchup with a $10 purchase. They're not really giving anything away because they just raise the prices slightly on other things to make up the cost.

[GoneOffShore]

148. Medicare Disadvantage - 11 years ago when I was considering 'Advantage' plans, that's what an agent called it

Yes, I know, "but MY Advantage plan yadda, yadda, yadda, something, something" and YMMV, but the plans are meant to privatize Medicare.

Just say NO to Disadvantage.

[Tadpole Raisin]

153. I posted about this awhile back. Supposedly it is the unintended

consequences of the inflation reduction act. Although the Biden administration tried to spread the ‘pain’ around by, for example, choosing only 1 med per pharmaceutical company to cut back on the price, the Medicare advantage people are not going to give up 1 cent of profit!!

Even if the plan looks the same when you get your letter, better dive in deep because there will be lots of trap doors hidden in the plan that will cost you big time.

They are sneaky ruthless bastards! I just hope this doesn’t blow up with repubs accusing dems of messing with healthcare, since they want to get rid of it entirely.

Either way, I’m concerned - especially for the citizens whose budget is already razor thin!

[HagathaCrispy]

157. ISN'T MEDICARE ADVANTAGE A REPUBLICAN INVENTION

At the end of the year and I remember this starting in 2013 it was because I had never seen it advertisement before they started putting these Medicare advertisements on open enrollment on television I had never seen them before and I know they weren't on television before 2013. I have a very good memory by the way can someone please tell me why 2013 is stuck in my head? Anyway Medicare Advantage is Republican bullshit or at the very least was some sort of compromise when they were in the distinct minority.

[Tadpole Raisin]

158. If it involves profiting off the average American and

stealing their health and life blood, it absolutely is republican!

I like your name!

[Silent Type]

179. Actually Bill Clinton signed it into law.

[Hotler]

160. There is nothing free, especially from a health insurance Co.. nt

[dalton99a]

161. Hospitals are dropping Medicare Advantage plans left and right

From last December:

https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html

Hospitals are dropping Medicare Advantage plans left and right
Jakob Emerson - Updated Thursday, December 14th, 2023

Medicare Advantage provides health coverage to more than half of the nation's seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with the private plans altogether.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.

"It's become a game of delay, deny and not pay,'' Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker's. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed."

In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.

Here are 13 more recent instances of hospitals dropping Medicare Advantage contracts:

...

[travelingthrulife]

162. hospitals and clinics are not getting adequate reimbursement from them

My health clinic refused to accept Advantage plans. large local chain.

[Jacson6]

171. I gave up on them. I just use regular Medicare Part A & B. n/t

[Jirel]

180. Medicare DISadvantage has always been trash.

I am a disability attorney. I routinely advise my winning clients to only buy into traditional Medicare. Why?

* DISadvantage plans are almost all the worst sort of HMOs (except in a handful of places where other types of plans are required or HMOs are banned, like SD) that exist to deny care or put up barriers for the sake of profit$.

* They are actively marketed to the youngest and healthiest seniors who barely use their medical benefits.

* Because they are crappy HMOs, good docs don’t join their networks. In general that means fewer docs with a larger patient load, and longer waits for an appointment, and crappier care including the heavy use of nurses and PAs.

* This particularly creates a problem for people in more rural and poorer areas, where the networks are slim indeed. Often, patients may wait a year or more for a specialist, and may have to drive 50+ miles.

* DISadvantage plans also are famous for removing fairly common, much needed meds from their formularies, leaving patients without any recourse except to pay out of pocket or go without.

At no time have DISadvantage plans been a good choice, ever.

[ZonkerHarris]

196. How did I know that the doom and gloom post would be from a relatively new member?

Because that's where a lot of them are coming from lately.
If I see a click baity negative post I can just spidersense it's from someone who just signed up this summer and has a low number of posts.
I wonder why they all sound the so much the same about their "concerns?"

[LilElf70]

232. You're a real

pick me up. Free country. Free speech.

Have ya ever looked into that negativity mirror and see something you don't like?

It must be a real bummer, being you.

I'm so sorry I am not up the the standards YOU have set for this site.

Cheer up. Say something positive.

[ZonkerHarris]

234. ironic from you

[LilElf70]

237. Not really.

I was notifying others with a similar healthcare plan of the changes coming. Unfortunately they were not in our favor this round. I was just stating the facts, ma'am. And now it seems to be across the board with the insurance companies. I am not surprised at all. It's like a virus.

[LetMyPeopleVote]

201. I get a ton of calls trying to sell me an advantage plan

These plans are scams

[Eliot Rosewater]

203. Medicare Advantage is designed to destroy Medicare.

And then you will have nothing at all.

In case you havent figured it out yet, they start out offering much better coverage (seemingly, it never was) and then when they destroy Medicare by taking all the money away, they put in pre existing clauses and start denying claims, etc.

You all were warned over and over.

[Big Blue Marble]

219. This sums it up perfectly.

I do not understand why some do no see what is happening. In addition to your points, we will lose
our ability to make our own health care decision as well.

[Silent Type]

220. In case you haven't noticed, the only significant upgrades to our healthcare system-- ACA, drug plans, Medicaid

expansion, disease care, etc. — involve private insurers who debatably “manage care.”

We can lament it, bash it, whatever, but that’s the only way we are going to get an “upgrade” to our healthcare system.

We may hate it, be disgusted by it, etc., but unless we get 61 Senators and a big majority in House, we’ll be sitting here 20 years from now slapping ourselves on the back for being virtuous, with absolutely no progress on our healthcare system and coverage for poor.

[LilElf70]

226. Amen

BINGO!!!! You nailed it.

[Skittles]

223. THANK YOU

I detest seeing people pimping for these plans, UGH.

[kerry-is-my-prez]

213. There is nothing more confusing than Medicare. I still haven't wrapped my head around it but someone stopped me from

signing up for Advantage and I’m glad they did. All of the research I have done has backed up my decision to go with Supplemental. I pay $222 a month for my United Healthcare (through AARP) and $46 a month for my Humana drug coverage. I spent 6 days in the hospital with appendicitis. My money-grubbing surgeon billed over the amount that was covered (excess charges) by my insurance so I had to pay him $260 something. Where I live they cannot charge more than about $268 in excess charges. I think it’s somewhat rare to be charged for that by a doctor.

[LogDog75]

221. I have Medicare and Tricare for Life so I don't need or want Medicare Advantage

I retired from the Air Force so I'm covered by Tricare, the military insurance, which I pay about $500 a year. Being over 65, Medicare is the first payer followed by Tricare. I've gotten my medical care at a Navy base clinic in San Diego and if there is anything serious or something they can't handle I'm referred to the Navy regional hospital in San Diego or a local hospital. I get my vaccinations and prescriptions through the Navy pharmacy at no cost. So far, in the 20 years I've been retired I haven't received a bill for anything. I use a local optometrist for my annual eye exams and Medical pays for that.

If I didn't have Tricare I still wouldn't signup for Medicare Advantage. When it comes to money, I tend to study up on what I might spend my money on. Although I don't need it, from what I've read of Medicare Advantage, you're basically having the government gives the Medical Advantage insurance company you chose the money Medicare allocates for you. Then, you pay an additional payment for the Medicare Advantage policy. Like most private insurance policies, the insurance company can limit what they'll pay for and deny you care for an existing condition. Also, you have to get permission from the company to see a provider outside their network. Thanks, but no thanks.

[LilElf70]

225. UPDATE:

I am shocked this subject has so many opinions. Gee what a touchy subject. With that said, I have a few updates. The bottom line for me, as it is with a lot of seniors is saving the benjamins. We no longer have the option of making big bucks. Most baby boomers have not saved a ton of money for retirement. Being frugal with our limited income is quite important.

First of all. I have Aetna's version of Medicare Advantage. For 2024 and the past 7 years, I pay nothing out of pocket initially. They take my allowed payment I would have spent for Medicare, which for this year is 174.00. Next year it will go up about 11.00. It is transparent and is taken directly out of my SS, just like it would do if I had standard Medicare. What comes out of my pocket is co pays, which are extremely cheap. I pay nothing for my PCP, no matter how many times I see him in the year. Any specialist is 25.00 copay. Everything for A and B are reduced and my out of pocket is extremely low. PT is a very low co pay. I have a limit of 2400 a year on what I would have to spend out of pocket. After that's it's nothing out of pocket. I have come nowhere close to that. Overall I spent about 200K for medical bills (A&B) for 2023. My out of pocket was about 700.00. This year it's about 125K and 250.00 out of pocket. My drugs are covered at 100% up to 5K a year. That should get anyone on schedule 1 drugs through the year. After that its a percentage out of pocket until I reach a certain dollar amount. I never have maxed out and I'm diabetic 2, with high blood pressure and cholesterol. They give me 120 a quarter to cover OTC drugs. I use all of it. I have a 3250 allowance for dental, no matter who I go to. I will use all of that too. They pay 400.00 towards vision, 1000 towards hearing aids. I have the option to bump up my allowances by paying an additional monthly premium. IE. For an additional 170 a month, that will get me 7K in dental coverage. Does standard Medicare cover all this at this rate? I think not. Being on a fixed income, and at my age, I live for the moment, and try to not spend a lot of benjamins on healthcare. I was on the ACA from 62 to 65. What a waste of money that was, but I needed healthcare. The deductibles were extremely high(7K), which stopped you from using it. I called it catastrophic insurance. As you look and compare the above issues, this could cost a you lot over a year, based on all the variables above, if I was on Standard Medicare.

I see both sides of this story (Govt vs private care). For the time being, my current situation dictates I follow my current route. I'm not going to argue over whether or not I could go back to Medicare if I want to, tomorrow. I find it hard to believe my government would do this to it's citizens. My parents went this route a decade ago and they eventually went broke. They had no problem going back to Medicare and then Medicaid for a nursing home until they died.

As for my insurance broker, she replied with the following: It is anticipated that all carriers will be heavily impacted for 2025. She has until October 1 to review all the policies out there and will get back with me then so I can pick the best plan for me.

[moniss]

227. You also need to understand that

it is very common for people with Medicare Advantage plans to have health issues develop and then find out that their "plan" won't let them go to a specialist, won't cover certain aspects of treatment etc. Then the person is faced with the choice of putting up with not getting proper treatment and seeing their health worsen or incur the costs themselves. So that plan that supposedly saved you money might be the death of you or it may at least fail to pay the bills.

We used to see this with companies issuing car insurance policies for super cheap rates. Then when a claim comes they go cheap on the repairs/estimates or drag their feet on paying at all. So maybe you saved a few hundred on premiums but in exchange you end up with a mess and having to fight with your own insurance company for months and maybe years. The same with health insurance and other forms of insurance.

I'll give you two examples. I have a friend who took an Advantage plan instead of Medicare. Came time for a knee replacement. The doctors he wanted to do the surgery weren't in "the Plan" and so he was restricted in coverage to a surgical group that didn't have a great reputation. They botched his replacement and now he has lot's of problems. He complained heavily to no avail. What's done is done they told him. Now the other knee needs replacing but the "Plan" and the clinic are refusing to help him. Likely because he raised so much hell with them when they screwed up the first. The surgical group with the best reputation doesn't do Advantage plans and only does Medicare. Now he has to try and get Medicare to take him back.

The second example is a man I know who received a cancer diagnosis. He has Medicare. But he was not satisfied with the treatment program recommended to him by his local clinic. So he and his wife called the Cleveland Clinic and got him in there and a whole different treatment program and after 18 months of combinations of inpatient and outpatient treatment he is cancer free.
They had basic coverage for a supplement to go along with Medicare. The point being when you have Medicare you can go anywhere in the country at any time and you don't need "permission". Sadly I have known people with "Plans" who asked for and didn't get "permission" to see specialists etc. I used to see it with young families who would have "Managed Care"/"HMO" plans and they would have a child with a chronic condition and they couldn't get permission to see specialists etc.

My friend with the bad knees thought he was saving money but now he realizes what he got was no bargain at all.

[LilElf70]

228. I get what you're saying

Fortunately, I have not run across either of those situations. I do know this. At this time, my PCP belongs to a hospital group that has the reputation of being the top 10 in the country. As long as the insurance company continues to cover him and the hospital group and it's doctors, I will stick with what I have. I have zero complaints. If that changes, the formula changes. I have had 2 angiograms over the past 5 years with some of the top docs in the country. I'm quite pleased with the results. There have been no rumors about any hospital in the area that will not take Medicare Advantage, private, or with the government, in the future.
I know someone that has Medicare Advantage, that will soon be going thru a kidney transplant, and a knee replacement. This person will be getting the best care around, and there has been no mention of no treatment, financial issues, etc.

Again, until the situation changes, I will continue to stick with what I got and save thousands of out of pocket expenses annually. Being a senior, this is the best route for me and my wife at this time. I wish us luck, based on all the negativity this post has generated. It's good to know though. Hell I could go tomorrow.

I really cannot afford to spend an amount (monthly) that is equivalent to a car payment, for health care. Yeah, it looks like a risk, but its a risk, I am willing to take at this time. Shit, life is a risk, and we sure as hell aren't going to get out of this alive. I'd like to retire without being restricted to my house forever, and not being able to afford to go out once in a while. Even take a small vacation, while I still can. Every day life has been very hard to keep up with lately. Have you priced car insurance lately? Home owners insurance? Gas? Water? Electric? Food? It's insane. How do you keep up with it on a fixed income?

Every day, we all get closer to the final chapter, and based on what I see from others, it's not pretty. I still wanna have some fun. And that takes money, the root of all evil.

Now let's talk about fixing this permanently, and get expanded medicare for all(everything). Especially for the citizens in the richest country in the world. Has anyone been counting how much we spend helping everyone else in the world? And yet not covering healthcare for everyone at home? Yes, this is insane too.

[moniss]

230. Amen and I have written before about

what it was like for older people before Medicare. So many today have no idea of how it was to be old and have health issues but not being able to go for treatment.

[Straw Man]

229. All the back-and-forthing is moot to me.

I have a Aetna Medicare Advantage PPO plan, and it's 100% paid by my former employer as part of a retirement incentive I took. I'm sticking with it, for better or worse. So far (two years in), it has been OK. Got my fingers crossed ...