Hospitals and doctors dropping Medicare Advantage Plans

[troutnut1]

Medicare "advantage" will go down in history as one of the biggest frauds ever perpetrated on our seniors.

 

[athena53]

Fortunately there seem to be a lot of articles cautioning people against MA plans and listing drawbacks. In the comments section one guy was bragging about all the $$ he saved having MA because traditional Medicare covered only 80% of expenses. I pointed out Medigap and Plan D, but noted that after being in MA for years he might not be able to buy it if he changed his mind. Someone chimed in and reminded me that many seniors didn't have the $$ for Medigap and Plan D.

I know that, of course, and maybe that's the appropriate market for MA. Low or no out-of-pocket premiums, limited coverage but a safety net of sorts, with a little extra for things they might neglect completely such as dental care.

I just wish they'd cut the window dressing like gym memberships and "free money" for groceries and use those funds for medical care.

 

[SojoMojo]

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.

 

[USGrant1962]

Fortunately there seem to be a lot of articles cautioning people against MA plans and listing drawbacks.
...

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.

 

[Teacher Terry]

I know quite a few people that can easily afford regular Medicare but believe that they are getting the same care plus extra benefits like grocery money. Of course by the time they find out the truth they have preexisting conditions and can’t switch back.

 

[MarieC]

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. One of us had open heart surgery requiring a 2 week hospital stay and a trauma event requiring time in a trauma center and several days at a rehab facility. The other has had more common problems with back and knee problems as well as some other chronic issues. We have had 0 problems and have paid 0 for anything other than Rx. We don't pay a copay. It's a PPO and we can see any Dr. we want even if they are not in network they will be paid the same. Our Rx are not covered as well as we'd like but none are overly expensive. I do sometimes feel like the payments should probably be more than the providers are receiving but they always pay pretty quickly. 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.

 

[Z3Dreamer]

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.

An MA plan sponsored by an employer/union is not the same as one of the MA plans that most are on. Every time I look at the details of plans like yours, I am amazed at how wonderful they are.

Having said that, I am on one of the standard MA plans that some feel are bad, fraud, etc. I like it. It is not for everyone. The chief negatives are the gatekeeper concept (pre-approval in some instances) and a network (local or nationwide). Minor negatives are the funds allocated to preventative things (some call them non-medical items meant to lure in unsuspecting seniors). Major emotions against are the marketing campaigns. Another emotion/negative is that the co-pays backed by a high maximum out of pocket ($2,900 to $10,000 or higher) will bankrupt seniors. I am not denying these issues or emotions. Just stating that you need to understand them before getting in such a plan.

Another negative is that many, most, maybe all doctors do not like MA plans. Many doctor's offices have horror stories about denials or delays. I have a different view. I can go into detail, if you want.

 

[Cayman]

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.

 

[Z3Dreamer]

This. Alone. Should weigh heavily when considering MA plans.

It does weigh heavily, but a six months wait for a heart procedure? I don't believe it. I believe sojomojo reported what they were told.

 

[athena53]

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.

 

[Z3Dreamer]

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.

 

[ShokWaveRider]

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.

Maybe just clickbait, but worth thinking about.

 

[Z3Dreamer]

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.

 

[ShokWaveRider]

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.

You are spot on. I have listened to too many "actual" sob/sad stories from folks who were personally affected and from local doctor friends to even consider them, and we live in an area where lots of docs take MA. I have never waited for anything or been denied service with Real Medicare and Plan G. So much that even though my DW is healthy and rarely goes to the doctor, I just signed her up for the Same G that I have. Not even worth the risk, no matter however low that risk may be.

The ONLY exception to this is my next door neighbor, he has a sponsored "MA Style" plan that was part of his retirement from his business. But he was a Judge, so one would expect that his retirement health plan would be good. He pays nothing for it either and has Zero issues, makes me very jealous.

It is bad enough checking every prescription that doctors prescribe for a more economical payment. IMHO Medicare Part D is the weak link in the Medicare system, slowly that seems to be being addressed.

 

[Teacher Terry]

The video was excellent. It recommended that if Plan G gets too expensive then look at a plan N. I intend to look at what the difference is. I know people that have had horrendous experiences with Medicare advantage plans and one of my friends almost died because it took 6 months to get the tests and treatment she needed even though she had a serious lung condition.

 

[Car-Guy]

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?

 

[Qs Laptop]

New Medicare and Medigap (part N) participant here. Previously I was on my wife's employer's health care plan which uses a doctor's network. I was seeing a urologist under her plan. Typical appointment wait times for the urologist (MD) was 23 to 24 weeks. I could see a physician's assistant in about 8 weeks. I had been getting ongoing "treatment" via messaging the physician's assistant's nurse through the MyChart system. This was ridiculous, IMO, and I wasn't going to put up with it anymore. Wait times to see a doctor within an in-network plan was unacceptable to me, which is why I avoided Medicare Advantage plans and went with a medigap plan.

When I got on Medicare I searched for a urologist, any urologist I wanted to see. If they took Medicare I could see them. In early September I got an appointment for 8 days later. I tried to see my previous urologist but he was booked until next April. If I wanted to see the most recent urologist hired at the in-network place I could see him in January.

Recently I decided I wanted to see a dermatologist. Again, using the same in-network system my wife's employer uses I was looking at a March appointment at the earliest. With medigap, I could pick any dermatologist and was able to find one that could see me in 10 days.

Avoiding wait times for appointments by having lots of doctor choices is the number one reason to get a medigap policy. I'd say the number two reason is portability when traveling.

 

[athena53]

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.

Medicare Advantage insurers get paid on a per capita basis, so that's all they get to treat people and pay for the fringe benefits they advertise. I believe they do get more $$ for people who have particular health conditions and are higher risk. (One practice in my area that took only MA advertised that "Our doctors get paid more if they keep you healthy!", although I have a more jaundiced interpretation of that pitch.)

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.

 

[zl55lz]

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?

Many of the employer MA plans are what are called an EGWP (Employer Group Waiver Plan) and supposedly are better than public MA plans. They 1) are specially designed for the employer, and 2) some do have a significant premium.

Federal FEHB has been introducing these the past few years and there are now quite a few. They look great, supposedly zero out of pocket and zero catastrophic max, etc.

However, I do not consider them cheap. A few I know of range from $275/mo for an eligible couple to over $600/mo. This on top of the Part B premiums.

The issue for me always comes down to the stories about MA plans and authorizations. Are these EGWP plans any different in that regard? I have read few reponses about this critical issue. Perhaps time will tell.

 

[ShokWaveRider]

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?

I think you fall into the same "MA Style" as my neighbor. His is great and I wish I had it. But unfortunately, they are not all created equal, especially those that are touted by has been celebrities.

 

[MBSC]

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.

Between May and June 2023, original Medicare had a net loss of 12,500 enrollees. Advantage had a net gain of 121,600. This is not an outlier. It is consistent with most months. The most recent data shows MA gained 114,000 from September to October.

For the first 9 months of this year, United Healthcare (UHC) had a net loss of 30,000 Medigap enrollees and a net gain of 540,000 Advantage enrollees.

 

[sengsational]

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

 

[ShokWaveRider]

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.

 

[misanman]

BIL picked MA plan entirely based on cost. He had no idea that MA and traditional Medicare have different "business" models. His idea was that Medicare was Medicare except that some plans have more "benefits". He particularly likes the membership to the local YMCA. I don't think they have had any particular issues but they don't really travel. Their dominant local health care organization threatened to drop the plan a couple of years ago and that would have been bad but they ultimately came to terms and all is well, I guess.

 

[athena53]

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.

Yes, I'd consider that. My cardiologist would have to be in network, though, and I would NOT change dentists or oral surgeons if they were out of network for dental benefits.