General Discussion
In reply to the discussion: Holy shit. Be prepared for the consumer to get screwed on your healthcare advantage programs. [View all]Liberal In Texas
(14,761 posts)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.