Hospitals and doctors dropping Medicare Advantage Plans

[Breedlove]

We have changed to Humana for next year . Thursday I went to MY nephrologist.
Again his name is on the list of doctors accepting Humana . We went the PPO side . But I told his staff that I was changing next year and the lady said we accept Humana . She asked if I got the PPO and told us it is the way to go. When I was in with the doctor I told him and he told me I would like Humana . Now when I go to see him as a specialist I will pay 35.00 Humana picks up the rest . But he sees me for 15 minutes so that is 140.00 an hour . I have no clue how much Humana pays beyond that . But everyone of my doctors accept Humana and my hospital Memorial Herman does also. ….AllI can say we will find out .

 

[teej1985]

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.

The birthday rule does not allow one to switch from Advantage to Medigap.

 

[ShokWaveRider]

The birthday rule does not allow one to switch from Advantage to Medigap.

OK, but whatever Connecticut, Maine, Massachusetts, and New York do should be for every state. That is what I was implying.

 

[RetMD21]

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.

The 6 months might have included the MA approval and the scheduling delay. That seems pretty typical.

I don't think most beneficiaries know or care about the details of getting MA approval. We used to go to level 2 appeals routinely and I did one level 3 with a administrative law judge. When you are told that your MA plan won't cover something it's hard to know if a little more advocacy would have helped.

Here's a link to a booklet on the Medicare appeals process: https://www.cms.gov/outreach-and-ed...products/downloads/medicareappealsprocess.pdf

 

[MichaelB]

So I guess I don't get all the MA plan bashing. Maybe some are pretty good?

My mum’s employer sponsored plan is quite similar, and I agree that some MA plans are good and the bashing is overdone.

I think the statistics prove that advertising works. That, and the lower entry price.

Yes to both, and I think there’s still more to it. There’s greater simplicity to MA that appeals to people who find the traditional Medicare +MediGap + Plan D too complex. MA also appears to those looking to minimize their health care premiums.

 

[teej1985]

OK, but whatever Connecticut, Maine, Massachusetts, and New York do should be for every state. That is what I was implying.

It sure would simplify things if the federal government mandated it. I don't think it'll happen though. So one needs to move to one of the aforementioned states for a year if they are stuck in Advantage.

 

[RetMD21]

My mum’s employer sponsored plan is quite similar, and I agree that some MA plans are good and the bashing is overdone.


Yes to both, and I think there’s still more to it. There’s greater simplicity to MA that appeals to people who find the traditional Medicare +MediGap + Plan D too complex. MA also appears to those looking to minimize their health care premiums.

Most people won't face an ordeal like the one in ShokWaveRider's video link but the potential is there for any MA plan to deny services that would have been available to a traditional Medicare enrollee.

MIL was moved out of post hospital rehab at her CCRC earlier than her therapists recommended but it didn't matter much since her CCRC benefits took over. Her MA plan is emloyer sponsored and "good."

 

[grayv]

OK, but whatever Connecticut, Maine, Massachusetts, and New York do should be for every state. That is what I was implying.

if you want high flexibility, the rates will be higher.

accept Humana and my hospital Memorial Herman does also. ….AllI can say we will find out .

take a look at the Humana announcement on the front page.


https://www.memorialhermann.org/



"Effective January 1, 2024, Memorial Hermann Health System will no longer contract with Humana Medicare Advantage."

 

[aja8888]

take a look at the Humana announcement on the front page.


https://www.memorialhermann.org/



"Effective January 1, 2024, Memorial Hermann Health System will no longer contract with Humana Medicare Advantage."

That's pretty significant as they are a huge hospital system here in the south Texas area.

 

[Breedlove]

Interesting , as our GP Dr Gould works under Memorial And he says he accepts Humana.

 

[aja8888]

Interesting , as our GP Dr Gould works under Memorial And he says he accepts Humana.

Humana sells more than MA plans.

I use Memorial Herman and I have a Humana Medigap plan (G). Have had it for years, had both hips replaced there at only a $226 cost to me (each hip).

 

[Breedlove]

That’s. Bargain : )

 

[teej1985]

Humana sells more than MA plans.

I use Memorial Herman and I have a Humana Medigap plan (G). Have had it for years, had both hips replaced there at only a $226 cost to me (each hip).

There's no such thing as "accepting a Humana Medigap". If they accept medicare, the medigap will pay the balance. Everwhere and every time.

 

[copyright1997reloaded]

I'm following this thread as I will soon be retiring (finally) at the end of the year.

I have some health care funny money (i.e a notational fund paid from operating income) from a previous mega-cap company that can only be used for their specialized MA plan (done by UHC). I can delay using this (which I've done now as I have traditional employer coverage from my current employer), but if delayed I can't use the $ for anything until I eventually sign up for their plan.

For my current employer, I have accumulated sick days which I can get paid out in cash at 50% OR I can use it toward their retiree MA plan (a Humana group MA plan). If I do 60% of the sick bank $ then I can get 40% out in cash. (Taxes on the sick bank are done assuming 50%.) Thus, putting the 60% towards the Humana group MA plan money bank only costs me 10% of my sick bank $ (as I would have lost 50% of it if choosing all cash).

For both of these, we are talking non-trivial amounts. For my ex-mega-corp, over $30K and for my current employer about $20K. So I have an incentive to use the Humana group coverage first and eventually the mega-corp UHC MA plan.

However, this topic is getting me nervous. While my health is pretty good (outside of high blood pressure and pre-diabetic but controlled by excersize and diet), one never knows. Another factor is that I currently live in NY which has guarenteed MA->Medigap (on the annual enrollment) BUT I am most likely to eventually move from NY.

My current plan is to enroll in in current companys Humana group MA plan and "see". The monthly premiums aren't super cheap (a little under $200 estimated for 2024 per month) but it is "mostly" using the sick-bank funny money. The copays etc. seem good (less than my current employee plan, e.g. $0 for hospital admit, $10-$20 hospital outpaitent, $10 PCP, $15 specialist, $75 ER (no admit). These are the same for in-network and out-of-network. It does mention "Some services may require prior authorization" with no other details. Skilled nursing is included, "Our plan covers up to 100 days in
a SNF.
No 3-day hospital stay is
required.
Plan pays $0 after 100 days."

So, still trying to decide what to do. If I didn't have the funny money, my decision would be an easier one....medicare plus a medigap plan.

 

[aja8888]

There's no such thing as "accepting a Humana Medigap". If they accept medicare, the medigap will pay the balance. Everwhere and every time.

I know that quite well and I never said anything about "accepting a Humana Medigap", I have been on Medicare/Medigap (supplemental insurance) it for 15 years. I was responding to Breedlove about Humana selling more than MA plans.

 

[misanman]

A local hospital system has just started to offer their own Medicare Advantage plan. Up to $150 per month cash back rebate. I can see where that would be hard to resist.

 

[Koolau]

A local hospital system has just started to offer their own Medicare Advantage plan. Up to $150 per month cash back rebate. I can see where that would be hard to resist.

Yeah, I always figured there was a reason they could offer that cash-back deal. NOT authorizing treatment would be a good way to do it IMHO. Never interested in MA and seeing Joe Namath selling these plans doesn't do anything for me either.


https://newrepublic.com/article/164692/joe-namath-medicare-advantage-benefytt-technologies

 

[Teacher Terry]

I'm following this thread as I will soon be retiring (finally) at the end of the year.

I have some health care funny money (i.e a notational fund paid from operating income) from a previous mega-cap company that can only be used for their specialized MA plan (done by UHC). I can delay using this (which I've done now as I have traditional employer coverage from my current employer), but if delayed I can't use the $ for anything until I eventually sign up for their plan.

For my current employer, I have accumulated sick days which I can get paid out in cash at 50% OR I can use it toward their retiree MA plan (a Humana group MA plan). If I do 60% of the sick bank $ then I can get 40% out in cash. (Taxes on the sick bank are done assuming 50%.) Thus, putting the 60% towards the Humana group MA plan money bank only costs me 10% of my sick bank $ (as I would have lost 50% of it if choosing all cash).

For both of these, we are talking non-trivial amounts. For my ex-mega-corp, over $30K and for my current employer about $20K. So I have an incentive to use the Humana group coverage first and eventually the mega-corp UHC MA plan.

However, this topic is getting me nervous. While my health is pretty good (outside of high blood pressure and pre-diabetic but controlled by excersize and diet), one never knows. Another factor is that I currently live in NY which has guarenteed MA->Medigap (on the annual enrollment) BUT I am most likely to eventually move from NY.

My current plan is to enroll in in current companys Humana group MA plan and "see". The monthly premiums aren't super cheap (a little under $200 estimated for 2024 per month) but it is "mostly" using the sick-bank funny money. The copays etc. seem good (less than my current employee plan, e.g. $0 for hospital admit, $10-$20 hospital outpaitent, $10 PCP, $15 specialist, $75 ER (no admit). These are the same for in-network and out-of-network. It does mention "Some services may require prior authorization" with no other details. Skilled nursing is included, "Our plan covers up to 100 days in
a SNF.
No 3-day hospital stay is
required.
Plan pays $0 after 100 days."

So, still trying to decide what to do. If I didn't have the funny money, my decision would be an easier one....medicare plus a medigap plan.

As long as you live in New York you are protected and can change to regular Medicare yearly. If you decide to leave New York I would change before you go and then you will have medigap locked in place.

The other night I was watching a true story of a man with Medicare advantage that was supposed to go to rehab after brain surgery for 3 months and they sent him home after 2 weeks despite his family appealing. That’s one way they save money is not paying for rehab which can make a difference for people to become independent again.

 

[badatmath]

I see UHC being sued over their alogrithimic care denials: https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage/

 

[Koolau]

I'm pretty much convinced that plans as heavily advertised as Medicare Advantage have some real issues. This thread now makes it pretty clear what some of those issues are. I think I'd avoid them. YMMV

 

[sengsational]

^ Another bit of wisdom from my dad... if the product has a "hard sell", I don't want it

 

[RetMD21]

I see UHC being sued over their alogrithimic care denials: https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage/

Horrible treatment of the insured. UHC is nothing special in MA. In one of these threads someone was talking looking at UHC medigap was talking about low ratings probably based on UHC MA plans. I'm not sure that the algorithms are worse than the doctors rubber stamping denials.

 

[Koolau]

Years ago, my Megacorp shifted their retiree health care plan to an outside broker and gave us so much per year to fund it. First order of business was to pick a plan. The broker steered us away from MA plans without actually bad mouthing them. I think MA plans would have been cheaper up front, but it sounded like the traditional plans were more or less set in stone. IF MC covers it, then your plan covers it (up to the limits of the particular letter plan you choose.) SO, no haggling. I liked that. So glad I went that way though YMMV.

 

[RetMD21]

According to NPR, CMS is planning to continue to tighten the rules about advertising for MA plans. Plans may have to tell you about unused benefits. Also

"Another new rule that should prevent enrollments from going awry prohibits plans from touting benefits that are not available where the prospective member lives.

https://www.npr.org/sections/health...31/crackdown-medicare-advantage-sales-tactics

 

[ERD50]

According to NPR, CMS is planning to continue to tighten the rules about advertising for MA plans. ...

I wish they'd tighten the rules on their 'spam' calls. I get calls for Medicare, from call centers spoofing their Caller ID. That should be illegal, and their license should be suspended for not displaying a legitimate name/number.

They supposedly can't stop the out-of-country spammers, but if supposedly legitimate Medicare sales people are doing this, they should be held to it.

-ERD50