General Discussion

moniss

(5,534 posts)

227. You also need to understand that

Wed Sep 18, 2024, 03:07 AM

Sep 18

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.

Edit history

Please sign in to view edit histories.

238 replies

= new reply since forum marked as read

Highlight:

Holy shit. Be prepared for the consumer to get screwed on your healthcare advantage programs. [View all] LilElf70 Sep 16 OP

I would never purchase Medicare Advantage radical noodle Sep 16 #1

I've had an Advantage plan for five years. Costs me $0 additional. I love it. Sibelius Fan Sep 16 #3

I have the same thing. 0 out of pocket LilElf70 Sep 16 #6

it's costs the governemnt and the taxpayers PLENTY Skittles Sep 16 #7

It is part of Medicare. former9thward Sep 16 #23

Calling Advantage "Part C" is part of the bait & switch dflprincess Sep 16 #39

Clinics love to overbill and upbill routine procedures. former9thward Sep 16 #42

Clinic systems have contracts with insurers and the reimbursement rates are already negotiated dflprincess Sep 16 #52

How is your friend Blue_Roses Sep 17 #151

Hanging in there dflprincess Sep 17 #163

Oh, that's great! Blue_Roses Sep 18 #231

We agree. Silent Type Sep 16 #108

Quick Tip. OldBaldy1701E Sep 17 #156

Agree. former9thward Sep 17 #168

Medicare Advantage is privatized Medicare vapor2 Sep 16 #48

They get commissions on advantage and drug plans too, which are private insurers. Silent Type Sep 16 #109

Thanks for this article. Nt spooky3 Sep 16 #35

Traditional Medicare is paid for by the government too. Demsrule86 Sep 17 #187

EDUCATE YOURSELF Skittles Sep 18 #222

doctor's visitss VGuerra276 Sep 16 #27

My GP visits are $5. All my prescriptions except one are $0. enough Sep 16 #34

I have no copay for doctor visits. Generic drugs are $0. A three-month supply of Sibelius Fan Sep 17 #181

In 5 years. "0" out of pocket. Medicare a UH advantage plan. OAITW r.2.0 Sep 17 #127

What supplement do you have? jmbar2 Sep 16 #12

I have Florida Blue radical noodle Sep 16 #25

Thanks for the info jmbar2 Sep 16 #118

In the last few years radical noodle Sep 17 #159

So true jmbar2 Sep 17 #167

I have $2000 worth of dental work that needs to be done next month which I now will get done elocs Sep 17 #173

Is that Medigap, or an Advantage plan? jmbar2 Sep 17 #175

Advantage. But Wisconsin's Medicaid (BadgerCare) has dental coverage. n/t elocs Sep 17 #183

Humana has a plan which covers dental extensively in Ohio...I have never been on it but good reviews. Demsrule86 Sep 17 #188

Thanks for the info - will put it on my research list for Oregon jmbar2 Sep 18 #235

Fortunately, I have had excellent coverage from the UHC Advantage Plan. elocs Sep 17 #177

"I know some people are limited financially and must go with what they can afford" elocs Sep 17 #176

Call your local Council on Aging and/or your senior center SheltieLover Sep 16 #106

Great advice - thank you so much jmbar2 Sep 16 #119

You are most welcome! SheltieLover Sep 17 #125

Here is the Medicare.gov website detailing the gap plans SheltieLover Sep 17 #129

Thanks again! jmbar2 Sep 17 #137

YW! SheltieLover Sep 17 #140

You can't get F anymore. G is now the one to get. kerry-is-my-prez Sep 17 #184

Bummer! SheltieLover Sep 17 #185

I could not afford any of these plans...and it is still private insurance. Demsrule86 Sep 17 #190

Yes - you have to be able to afford it. On the other hand, having to pay the 20% of B could be bankrupting. kerry-is-my-prez Sep 17 #215

"Supplement" is the wrong term if you are talking about privatized Medicare Jmb 4 Harris-Walz Sep 17 #192

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

Yup, Medicare Advantage is privatized Medicare. My concierge dr won't take you if you have a disadvantage program vapor2 Sep 16 #50

Your concierge doc probably does not take traditional Medicare either, especially new patients. Silent Type Sep 16 #110

Who is your supplement with? MiKenMi33 Sep 16 #54

AARP United Health Care Medicare supplement we can do it Sep 16 #95

Thank you! MiKenMi33 Sep 16 #115

Thanks! jmbar2 Sep 16 #120

Not everyone has guaranteed issue for a Medigap policy dlk Sep 16 #82

You are initially, don't fall for advantage if you're going to be new to Medicare. we can do it Sep 16 #97

It must be nice to have the choice because many of us do not. n/t elocs Sep 17 #174

I think it all depends on the Advantage Plan that was chosen. There are several to choose from; suggest you Jmb 4 Harris-Walz Sep 17 #194

Max out-of-pocket for prescriptions drops to $2000 next year. That's $3,000 in savings. Sibelius Fan Sep 16 #2

I think that's a big deal; however I'm not sure what that will do to premiums. Silent Type Sep 16 #111

From what i have read BigMin28 Sep 16 #4

Not difficult, but it requires planning: NameAlreadyTaken Sep 16 #43

You can switch back to Original Medicare. Demobrat Sep 16 #77

Pricing of those Medigap plans, slightlv Sep 16 #99

Get a new plan...you can switch Advantage plans. Demsrule86 Sep 17 #191

The switch is possible in some states but not all. nt pnwmom Sep 17 #131

I'm almost reluctant to comment soandso Sep 17 #217

I spent 46 days in hospital, had open heart surgery, two subsequent heart surgeries and take Eliquis- Demsrule86 Sep 16 #46

What health care plan do you have? n/t halobeam Sep 16 #67

Humana Gold Advantage PPR give back ( GB means I get just over 100 back monthly from part B) Demsrule86 Sep 17 #193

What "plan" are you referring to which you have if I may inquire? Tarzanrock Sep 16 #73

Part C is medicare advantage Kali999 Sep 16 #86

I have Humana Gold. You have regular Medicare. I couldn't afford it. I pay no premiums and get 100 + a month back in Demsrule86 Sep 17 #186

Part C is Advantage...you have traditional now. And Medigap covers the 20% Part B doesn't cover and insurance companies Demsrule86 Sep 17 #198

I have gym membership free with my supplement and can go to any doc who takes Medicare w/o asking insurance permission. we can do it Sep 16 #100

It was signed in 1997. jimfields33 Sep 16 #107

I'm sorry. leftieNanner Sep 16 #5

Same here Rebl2 Sep 16 #38

Do you realize that Advantage plans are private plans and not Medicare plans? Think. Again. Sep 16 #8

The U.S. government and Medicare says you are wrong. former9thward Sep 16 #20

Nope, Advantage plans are offered and run by private companies... Think. Again. Sep 16 #24

It is part C of Medicare. former9thward Sep 16 #32

You should read the link you provided. Think. Again. Sep 16 #37

Your statement is not true. Big Blue Marble Sep 16 #47

Part C is part of Medicare. former9thward Sep 16 #53

Part C is only nominally a Medicare Option. Big Blue Marble Sep 16 #76

THIS!!! MotownPgh Sep 17 #152

And insurance companies sell Medi-gap policies...so I don't see the difference. Demsrule86 Sep 17 #199

Then you need to study the system. Big Blue Marble Sep 17 #207

That is your opinion. I have advantage and I get 100 per month back on part B, no premium and everything is Demsrule86 Sep 17 #209

It is more than my opinion. Big Blue Marble Sep 17 #216

Amen LilElf70 Sep 18 #233

Medicare works with it, but doesn't administer it. Medicare gives Medicare Advantage pnwmom Sep 17 #142

That's just a label -- it means it's approved by Medicare as an option, but it's not managed pnwmom Sep 17 #135

That's a practical fallacy!! Tadpole Raisin Sep 17 #154

Your drug and MediGap policy are private too. And private insurance companies do all the admin Silent Type Sep 16 #113

So is Medi-gap coverage. I don't see the difference. Other than I pay more for traditional. Demsrule86 Sep 17 #195

The difference is Medicare is a government program while Advantage (and medi-gap) are corporate programs. Think. Again. Sep 17 #200

No, they are private plans that Medicare regulates and pays on your behalf. The plans aren't run by Medicare. pnwmom Sep 16 #83

That is BS. Unless you want to pay 20 % out of pocket, you have to get an additional plan with a commercial insurer Demsrule86 Sep 16 #49

The supplement plans are not subject to networks or preapprovals dflprincess Sep 16 #55

That is not true. My sister in law had regular Medicare and she was denied care. They can and will deny you. Demsrule86 Sep 17 #204

She should have fought that denial dflprincess Sep 17 #214

Are you asking me how a federal plan is different from a commercial plan? Think. Again. Sep 16 #56

I am sorry Aetna which has a medi-gap plan is not a government insurer. Demsrule86 Sep 17 #205

Exactly! You're SO close! Think. Again. Sep 17 #208

You misinterpret...you pay Medi-gap plans for coverage..and these plans are insurance based...not different that Demsrule86 Sep 17 #210

I never meant to be arguing, but you're right, let's just drop it. Think. Again. Sep 17 #212

The difference is whether your own doctors and hospital decide on the care you need, pnwmom Sep 16 #87

You are kidding yourself if you think traditional Medicare doesn't deny certain procedures. Demsrule86 Sep 17 #206

The Advantage plans have limited provider networks, which can eliminate pnwmom Sep 18 #224

The supplement plans are basically check-writing plans. Ms. Toad Sep 16 #96

Supplements are private insurance plans, though with little discretion. As are drug plans, Silent Type Sep 16 #114

But the lack of discretion is the key piece. pnwmom Sep 17 #130

You need to take a look at original Medicare policies that limit all kinds of coverage for "excessive" Silent Type Sep 17 #132

Original Medicare doesn't restrict you to certain doctors or hospitals. pnwmom Sep 17 #136

+1. An extremely important distinction dalton99a Sep 16 #121

Medicare Advantage DC77 Sep 16 #9

I have never been LilElf70 Sep 16 #22

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 LauraInLA Sep 16 #98

Have you or your wife ever needed X-ray treatments that cost more than $10K each? pnwmom Sep 17 #128

Bad news. Private insurers get paid billions to administer original Medicare too. So you Silent Type Sep 16 #116

No, they don't. Medicare itself administers Parts A & b with the money people pay into it. pnwmom Sep 17 #150

Absolutely wrong. Private insurers have subsidiaries that administer original Medicare. Give me your state and Silent Type Sep 17 #165

Medicare "Advantage" is a rip off.... gainesvillenole Sep 16 #10

what is a supplement and who makes them nt msongs Sep 16 #15

Insurance companies make them, I guess. My mother, who died in 2009, had the United American supplemental plan, LauraInLA Sep 16 #103

AARP is one place that sells a good supplement. nt pnwmom Sep 17 #178

I went through a broker who does both Supplemental or Advantage. kerry-is-my-prez Sep 17 #189

+1 dalton99a Sep 16 #19

I live in Cleveland on my Advantage plan...I can us Cleveland Clinic, UH or Metro...all fine insurers. Demsrule86 Sep 16 #51

It's Only An HMO RobinA Sep 17 #169

yeah I had read that would be happening Skittles Sep 16 #11

Medicare "advantage" Cirsium Sep 16 #13

I agree LilElf70 Sep 16 #18

all the money being wasted on the "Advantage" scam Skittles Sep 16 #78

Bill Clinton was the one that signed it into law in 1997 MichMan Sep 16 #28

This message was self-deleted by its author Chin music Sep 16 #45

"No Democrat should be supporting or praising this right wing privatization scam, this assault on Medicare. " MichMan Sep 16 #57

This message was self-deleted by its author Chin music Sep 16 #58

Show me where I have a history of jumping on Bill Clinton MichMan Sep 16 #62

This message was self-deleted by its author Chin music Sep 16 #71

He was wrong Cirsium Sep 17 #170

This message was self-deleted by its author Chin music Sep 17 #182

I have family in Ireland and universal is not working real well lately. Demsrule86 Sep 17 #211

Fox in the henhouse Cirsium Sep 18 #236

thank you Skittles Sep 16 #44

I stuck with regular Medicare. Ocelot II Sep 16 #14

That's the way to go BOSSHOG Sep 16 #31

LOL Auggie Sep 16 #60

My 2024 benefits LilElf70 Sep 16 #17

the 2025 changes that save the beneficiaries money shift the financial burden to the plans Coexist Sep 16 #21

Once you get locked in, it may be difficult to go back to original Medicare. They now own you. keithbvadu2 Sep 16 #26

THIS Auggie Sep 16 #61

You can go back to original Medicare (parts a & b) at any time during open enrollment hot2na Sep 17 #149

You can go back to traditional. Big Blue Marble Sep 17 #218

Just getting caught up to the inflationary effects the last few years MichMan Sep 16 #29

Rightly or wrongly, MA rates were cut. Personally, until our government-- regardless of party -- Silent Type Sep 16 #30

For comparison with Traditional Medicare plus supplement Otto_Harper Sep 16 #33

Thom Hartmann has talked about Medicare Advantage pitfalls repeatedly live love laugh Sep 16 #36

Most people that dislike dabbing LilElf70 Sep 16 #59

The issue is the trade-off. We turned down Advantage and its freebies (free dental, gym, etc) pnwmom Sep 16 #80

Might be worth checking the AARP United HC Medicare Supplement. It provides gym memberships. we can do it Sep 16 #104

We could afford a gym membership if we wanted one. What we can't afford pnwmom Sep 17 #126

I get it. Your situation like half of Medicare eligible people is unfortunate and you're right Cheezoholic Sep 16 #85

Bingo!!! Rhiannon12866 Sep 16 #102

So sorry you're facing that LearnedHand Sep 16 #40

I plan to stick with traditional Medicare when I retire next spring dflprincess Sep 16 #41

Wow. I've had an Advantage plan for 10 years. Joinfortmill Sep 16 #63

There's An Element On DU RobinA Sep 17 #172

Medicare advantage is NO ADVANTAGE AT ALL. READ THE FINE PRINT. ashredux Sep 16 #64

If you already have Medicare Part "A;" Part "B;" and, Part "D" ... Tarzanrock Sep 16 #65

Part C is an "advantage" plan SheltieLover Sep 17 #133

Thanks. I appreciate the reply and the answer. Tarzanrock Sep 17 #146

Medigap coverage pays copays & possibly other charges. SheltieLover Sep 17 #147

I get Medicare and pay UH @ $300/m0. 70 YO. OAITW r.2.0 Sep 16 #66

300 a month? LilElf70 Sep 16 #89

Stay with real Medicare. Advantage will eventually rip you off. Liberal In Texas Sep 16 #68

Less hospital overnights paid IGoToDU Sep 16 #69

Did you recently have a milestone birthday? SocialDemocrat61 Sep 16 #70

We are looking for a plan now samplegirl Sep 16 #72

Call you senior center and / or council on aging. SheltieLover Sep 17 #138

Why now? Because they wait till it's too late for you to switch back to Medicare, pnwmom Sep 16 #74

Well, CMS is cutting rates for next year. Whether that is justification for cutting "extra" benefits Silent Type Sep 16 #123

Medicare Advantage has always been a scam! WVreaper Sep 16 #75

As a pharmacy tech... buzzycrumbhunger Sep 16 #84

When I was checking policies bobandrileysmom Sep 16 #79

Medicare Advantage is a ripoff, and I would never choose such a plan. Buyer beware! Martin68 Sep 16 #81

Consumer expert Clark Howard: Why I Think Medicare Advantage Plans Stink Pinback Sep 16 #88

❣️ . . . . . . . Seek advice from your local HICAP advisor . . . . . . . ❣️ CoopersDad Sep 16 #90

It's an election year. And the current administration is democratic. Vdizzle Sep 16 #91

First thread of ten thousand! dpibel Sep 16 #92

The private insurers running MA plans have been subsidized, to the disadvantage of regular Medicare. Ms. Toad Sep 16 #93

It's happening now to affect the election. ecstatic Sep 16 #94

No, I think people are just bringing it up, to shed medicare in a bad light during an election, and stoke discontent. Think. Again. Sep 16 #122

If we're going anecdotal... markodochartaigh Sep 16 #101

It's amazing how it's always the friend of a sister dpibel Sep 16 #117

I saw tens of thousands of my husband's co-retirees threatened with the loss of their doctors pnwmom Sep 17 #134

Almost... dpibel Sep 17 #141

That kind of BS doesn't go on between regular Medicare and providers. pnwmom Sep 17 #143

That's a bit of a diversion, isn't it? dpibel Sep 17 #145

The people screwed by advantage are dead...they aren't going to answer questionseverything Sep 17 #155

One of the biggest providers in the city will not take Advantage anymore. kerry-is-my-prez Sep 17 #202

My friend needed a cochlear implant mcar Sep 17 #164

Need advice! I have original Medicare and I want to add Medigap (in Minnesota) now KatK Sep 16 #105

There are no pre-existing conditions for a Medigap plan. Ms. Toad Sep 17 #197

Thanks! KatK Sep 24 #238

I've had an Advantage plan for about 20 years. Dem2theMax Sep 16 #112

Lots of people are happy with MA. That's why 52% of Medicare beneficiaries choose it. Silent Type Sep 16 #124

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, pnwmom Sep 17 #139

I know, some folks think that 52% are too stupid to make the right decision for them. Silent Type Sep 17 #166

In the insurance industry they have a phrase moniss Sep 17 #144

Medicare Disadvantage - 11 years ago when I was considering 'Advantage' plans, that's what an agent called it GoneOffShore Sep 17 #148

I posted about this awhile back. Supposedly it is the unintended Tadpole Raisin Sep 17 #153

ISN'T MEDICARE ADVANTAGE A REPUBLICAN INVENTION HagathaCrispy Sep 17 #157

If it involves profiting off the average American and Tadpole Raisin Sep 17 #158

Actually Bill Clinton signed it into law. Silent Type Sep 17 #179

There is nothing free, especially from a health insurance Co.. nt Hotler Sep 17 #160

Hospitals are dropping Medicare Advantage plans left and right dalton99a Sep 17 #161

hospitals and clinics are not getting adequate reimbursement from them travelingthrulife Sep 17 #162

I gave up on them. I just use regular Medicare Part A & B. n/t Jacson6 Sep 17 #171

Medicare DISadvantage has always been trash. Jirel Sep 17 #180

How did I know that the doom and gloom post would be from a relatively new member? ZonkerHarris Sep 17 #196

You're a real LilElf70 Sep 18 #232

ironic from you ZonkerHarris Sep 18 #234

Not really. LilElf70 Sep 18 #237

I get a ton of calls trying to sell me an advantage plan LetMyPeopleVote Sep 17 #201

Medicare Advantage is designed to destroy Medicare. Eliot Rosewater Sep 17 #203

This sums it up perfectly. Big Blue Marble Sep 17 #219

In case you haven't noticed, the only significant upgrades to our healthcare system-- ACA, drug plans, Medicaid Silent Type Sep 17 #220

Amen LilElf70 Sep 18 #226

THANK YOU Skittles Sep 18 #223

There is nothing more confusing than Medicare. I still haven't wrapped my head around it but someone stopped me from kerry-is-my-prez Sep 17 #213

I have Medicare and Tricare for Life so I don't need or want Medicare Advantage LogDog75 Sep 17 #221

UPDATE: LilElf70 Sep 18 #225

You also need to understand that moniss Sep 18 #227

I get what you're saying LilElf70 Sep 18 #228

Amen and I have written before about moniss Sep 18 #230

All the back-and-forthing is moot to me. Straw Man Sep 18 #229