troutnut1
Recycles dryer sheets
Medicare "advantage" will go down in history as one of the biggest frauds ever perpetrated on our seniors.
Fortunately there seem to be a lot of articles cautioning people against MA plans and listing drawbacks.
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I don't really understand what is so bad about MA. Could someone explain? We have had UHC MA with a supplement (not sure if that's the right name for it) offered by former employers union for years with no problems. Is it the union coverage portion that makes this work for us? We do pay a premium of about $200/mo. for each of us.
I have ORIGINAL Medicare. Last week, I spoke with my cardiac surgeon’s assistant for a heart procedure. The assistant said it would be 6 months before they can do the heart procedure. The next day, I get a call from the doctor’s scheduler who tells me that they have scheduled me for an MRI at the end of this month (November) and the heart procedure for late January 2024. Since I had been previously told that the wait would be 6 months, I was stunned at how quickly they’re able to proceed with my heart procedure.. The scheduler said that if I had Medicare Advantage, it would take six months to get pre-approval. Since I had ORIGINAL Medicare, the hospital moved me to the front of the line since no pre-approval was necessary.
This. Alone. Should weigh heavily when considering MA plans.
I dunno - the current AARP newspaper has a long article that says MA plans continue to gain market share and are now over 50% of Medicare users. They do mention the downsides of limited HMO/PPO networks and possible denials of certain procedures, as well as the fact that the premiums are cheaper and they include extra benefits like dental/eye/hearing. But anyone that has had most Megacorp plans for the last 20 years is used to that.
Networks vary all over the place- even by insurer. One employer's plan might have a broader network and a higher premium than another with the same insurer. When I was on ACA, every year the insurer would tell me that last year's plan wasn't available but "here's another plan we offer that you might like". It always had a narrower network and I'd have to go looking again. Thank heaven I had no serious health issues in those 4 years on ACA.
My concern would be that a network that works just fine for me now could decrease in future years and then I'd have a hard time getting back to traditional Medicare.
I am sure you already know this but for those who don't, in that year when the network is too small, another option is to switch MA plans. I have a number of plans I can choose from. No underwriting when switching MA plans. I can look at who is in the plan before I choose. Yes, the providers can drop in a nanosecond.
This should say something. Why is there no underwriting between MA plans but there are to Original Medicare Supplement plans. Something fishy there. MA perhaps do not care as they can always prolong the process and deny service ......... Original Medicare and a Supplement cannot.
I think that an MA plan would not be good for you. I do not believe that anything I could tell you would change how you feel. I am happy with my MA plan.
This should say something. Why is there no underwriting between MA plans but there are to Original Medicare Supplement plans. Something fishy there. MA perhaps do not care as they can always prolong the process and deny service ......... Original Medicare and a Supplement cannot.
So my MA plan is sponsored by my previous employer and is "administered" by Aetna for medical and Express Scrips for drugs. Supposedly it's unique/specific plan to my ex-company. The literature I've received also says it's as good as or better than regular medicare. That's what they say anyway, but I have no easy way of knowing if that's true.
Anyway, to my point. In this plan, we have no "networks" of doctors or medical facilities to deal with. If they accept Medicare assignments, we can use them, and we have never found one that didn't. We have an annual max out of pocket (OOP) limit on both our medical and drug plans, which to be honest, are both low enough I consider them trivial from my POV. Getting "quick" pre-authorizations can be a little slower than I'd like, but they have all been approved in a matter of days in the past. (I'd prefer hours Now with that said, I don't particularly like Aetna or Express Scripts but they do follow the documented plans and both "now" have pretty good customer services. Although I have had a few disputes in the past that were eventually resolved to my satisfaction.
So I guess I don't get all the MA plan bashing. Maybe some are pretty good?
So my MA plan is sponsored by my previous employer and is "administered" by Aetna for medical and Express Scrips for drugs. Supposedly it's unique/specific plan to my ex-company. The literature I've received also says it's as good as or better than regular medicare. That's what they say anyway, but I have no easy way of knowing if that's true.
Anyway, to my point. In this plan, we have no "networks" of doctors or medical facilities to deal with. If they accept Medicare assignments, we can use them, and we have never found one that didn't. We have an annual max out of pocket (OOP) limit on both our medical and drug plans, which to be honest, are both low enough I consider them trivial from my POV. Getting "quick" pre-authorizations can be a little slower than I'd like, but they have all been approved in a matter of days in the past. (I'd prefer hours Now with that said, I don't particularly like Aetna or Express Scripts but they do follow the documented plans and both "now" have pretty good customer services. Although I have had a few disputes in the past that were eventually resolved to my satisfaction.
So I guess I don't get all the MA plan bashing. Maybe some are pretty good?
What all insurers want to avoid is the death spiral of adverse selection- in this case, younger seniors with minimal health issues (and those who can't afford Medigap and Part D) select MA till they get something serious and then if they can afford it, jump to traditional Medicare and Medigap. It would make Medigap and traditional Medicare the insurers of an older and sicker group and we'd all pay more for them.
I think if things were changed and no medical underwriting was required to shift to a better healthcare plan, that things would be different. That would be a good nationwide policy IMHO. I wonder that in states that allow it on one's anniversary (Birthday) date, how many move back to Medigap.