Top 5 Things your Medicare Advantage salesman won't tell you

[CRLLS]

Aren't most MA plans HMO?

HMOs limit which doctors are in-network.

If you find a doctor in-network that you like, He/she could be out of network next year. And getting back into an "original Medicare" plan might require underwriting. Some of you lucky ones live in states that prohibit that. Not us.

Which brings up something I have been wondering. Has anyone heard of doing a "permanent change of address" move to one of those states, only to change plans without underwriting, then move back to their original home state? It sounds like it could be done.

 

[RetMD21]

Sorry but it is behind a paywall. It is suspect because they use the terms "Most" and "Accused". Something like: MA plan xyz ordered to pay $x billion to CMS because of fraud would be better.

There are many sources
of information including the justice department
https://www.justice.gov/opa/pr/just...s-and-judgments-exceed-56-billion-fiscal-year

Even if some plans get accused of overbilling, do you want to get into a discussion of the medigap side of this which is medical professionals overbilling Medicare?[

Do you have any information to suggest that there is less "overbilling' in MA? The MA specific fraud is based on making patients out to be sicker than they are to get a higher monthly payment. This isn't an issue with standard medicare.

 

[RetMD21]

No one would want to be in that situation. If you feel that it is a real possibility and it bothers you greatly, MA's are not for you. The MA denials that I am aware of have been reasonable. YMMV.

Obviously it is a real possibility although likely very small. People will have different preferences. Most folks are fine with MA.

 

[RetMD21]

OP had a well thought out article by someone he had a lot of respect for. The article happened to agree with his knowledge about MA plans. I am on the opposite end and I had time to kill, so I decided to present the other side, in great detail. I may be wrong, but my points are well researched. As I said in my first post, I doubted that I could convince anyone of my side. But I think that if I post anymore to this thread: I will will be banned. Sent for OCD treatment. Drawn and quartered.

I am stepping out gracefully, not conceding. Please continue to bash MA plans without me responding.

Many folks are fine with MA plans. If you sell them or otherwise have a financial interest that's fine too. Selling insurance is a legal and honorable way to make a living.

The original idea of the plans was to save the government money but they don't. That's my main objection.

8/10 of the largest plans have been accused of overbilling by the IG according to the WSJ article. SDNY has filed against Cigna this week. Link:

https://www.justice.gov/usao-sdny/p...suit-against-cigna-artificially-inflating-its

 

[W2R]

I've never had a Medicare Advantage plan, so I'm not going to argue for or against them.

However, Frank has been on one for the past 3 years. He chose one that has an absolutely stellar local reputation and that frankly, just about all retirees around here choose unless they have a work related plan like I do. His plan doesn't seem to have any of the disadvantages that people talk about on the internet. All of the doctors and medical facilities that he wants or ever used are included. He doesn't have to pay anything, and he even gets an allowance for free OTC items of his choice, off a list (like vitamins, knee brace, that kind of thing).

OK, his plan might be a problem if he got sick in another state or country, but we never travel so that doesn't apply for us. I don't think he could keep his MA plan if we moved out of the area but we have no plans to do that, either.

So, he likes it and we have a hard time imagining any serious issues with it. I have FEHB (federal employee/retiree health insurance) which I like, but if it were not available my second choice would be his MA plan.

 

[Gotadimple]

If you find a doctor in-network that you like, He/she could be out of network next year. And getting back into an "original Medicare" plan might require underwriting. Some of you lucky ones live in states that prohibit that. Not us.

Which brings up something I have been wondering. Has anyone heard of doing a "permanent change of address" move to one of those states, only to change plans without underwriting, then move back to their original home state? It sounds like it could be done.

Just to clarify: Getting back to Traditional Medicare is easy, you just make a choice and you are on the plan. But! Getting back to a Medicare Supplement plan could be harder if you have pre-existing conditions because when you switch from MA to Supplement you are subject to underwriting.

Your second point: that would be fraud and the insurer will find out eventually.

- Rita

 

[Gotadimple]

There are many sources
of information including the justice department
https://www.justice.gov/opa/pr/just...s-and-judgments-exceed-56-billion-fiscal-year

Do you have any information to suggest that there is less "overbilling' in MA? The MA specific fraud is based on making patients out to be sicker than they are to get a higher monthly payment. This isn't an issue with standard medicare.

Overbilling not an issue with standard Medicare? Of course it is. But instead of a plan inflating how sick their MA population is to get a higher reimbursement rate, the physicians submit bills to Medicare when there has never been a service provided. Billions of $ worth.

- Rita

 

[Sunset]

I didn't talk to any Medicare Advantage salesmen, just signed up all by myself.

You should claim the signup fee as you deserve to be paid

 

[RetMD21]

Overbilling not an issue with standard Medicare? Of course it is. But instead of a plan inflating how sick their MA population is to get a higher reimbursement rate, the physicians submit bills to Medicare when there has never been a service provided. Billions of $ worth.

- Rita

MA has both types of overbilling, If not please provide facts.

 

[misanman]

Saw this today and thought it might be relevant (actually, I thought this was standard practice for a MA plan so was a bit surprised that Cigna is being called out on it.)

In a civil suit filed on Monday, the federal government alleges that the healthcare giant made certain Medicare Part C recipients seem sicker than they actually were. They claim Cigna structured home visits for the primary purpose of capturing and recording lucrative diagnosis codes from their patients. This resulted in the company obtaining tens of millions of dollars in unsubstantiated Medicare funding. Cigna has rejected the lawsuit’s merits and will vigorously defend itself. More from ABC News.

 

[ShokWaveRider]

This is GREAT news. No more Misleading MA Ads as of January 1st. Definately worth a viewing. I found this and have no affiliation with them.

 

[VanWinkle]

I agree it will be nice to not see the commercials. Is there some reason they aren't also reducing/eliminating the auto Insurance commercials saying they save 700.00 avg for anyone changing to their company? MA advertises because not all plans are the same, unlike Plan G medigap which is exactly the same no matter where you buy it.

 

[CRLLS]

Did I miss where they said no more advertising? I read that they simply need to meet the CMS's "file and use" requirements. Certainly the adverts we see now are very misleading. I hope they change that, but we will still be inundated with advertising, especially if advertising will be changing.

 

[Katsmeow]

The problem with this are things like chemotherapy. Chemotherapy is generally covered under Part B - not Part A and not Part D. With no Part B you would be on the hook for the entire cost - and it can easily surpass a million dollars.

Unfortunately, he ignores the fact that many procedures are now done without a hospital stay i.e. on an outpatient basis where you will be subject to the full 20% uncapped copay for Part B costs.

For most people here, I think the Part B being uncapped is a red herring. That is because most of us can and will buy a supplement that will pick up that 20%.

I have Plan G. I pay the Part B deductible which be $226 next year. Once I pay that I'm done.

Now -- there are people who can't afford to pay for a Medicare Supplement that pays that 20%. In my opinion, this is the only group of people that might want to consider a MA plan. (Well, I could consider it in a state that does not allow underwriting a return to a supplement). But, most members can afford to pay for a supplement that pays the 20% so it isn't a concern at all.

 

[RobbieB]

I can afford it and chose MA. Glad I did, excellent care with little delay. Fast and easy appointments, very little time waiting in the reception area. Excellent covid vaccine availability, pneumonia, shingles, flu vaccines.

No problems yet, very satisfied.

 

[copyright1997reloaded]

The venerable John Greaney, who as far as I know was the first person to have a website devoted to the then-new notion of FIRE, only posts a couple of times a year now but when he does it tends to be memorable.

Here's his update on the financial realities of Medicare Advantage, just in time for open enrollment (which starts today):

https://retireearlyhomepage.com/medicare2022.html

It sure would be nice if the realities he discusses here about financial incentives for these insurance agents and what AARP is actually about were as widely viewed as glossy ads for Advantage plans.

Just wanted to say that I followed John's site way, way back when (e.g. 2000 or so) and while I was always a good saver and investor, that site was THE THING getting me serious about being able to FIRE. It was that site that somehow led me here (perhaps via Firecalc).

 

[Teacher Terry]

My friend is having a major problem with her MA insurance. She has been sick for 3 weeks. It’s a long story but she needs tests, etc that she’s not getting even though urgent care told her what she needs. Her oxygen level has been dropping below 90 plus she is wheezing badly and has a heart issue. MA is dragging things out and scheduled only a pulmonary function test but she won’t get to see a doctor when she goes. I am very worried.

 

[ShokWaveRider]

I can afford it and chose MA. Glad I did, excellent care with little delay. Fast and easy appointments, very little time waiting in the reception area. Excellent covid vaccine availability, pneumonia, shingles, flu vaccines.

No problems yet, very satisfied.

Yes, but Robbie that is in California, one of the Healthcare friendly states. Not so for some other states. BTW what is your monthly premium if any?

 

[RetMD21]

Did I miss where they said no more advertising? I read that they simply need to meet the CMS's "file and use" requirements. Certainly the adverts we see now are very misleading. I hope they change that, but we will still be inundated with advertising, especially if advertising will be changing.

Well the original advertising post says

This is GREAT news. No more Misleading MA Ads as of January 1st. Definately worth a viewing. I found this and have no affiliation with them

I am not sure there is any disagreement

 

[Gotadimple]

For most people here, I think the Part B being uncapped is a red herring. That is because most of us can and will buy a supplement that will pick up that 20%.

I have Plan G. I pay the Part B deductible which be $226 next year. Once I pay that I'm done.

Now -- there are people who can't afford to pay for a Medicare Supplement that pays that 20%. In my opinion, this is the only group of people that might want to consider a MA plan. (Well, I could consider it in a state that does not allow underwriting a return to a supplement). But, most members can afford to pay for a supplement that pays the 20% so it isn't a concern at all.

I have been on MA for a long time. This year, I looked at what my expenses would be using a supplement. The premium costs alone (Gap + D) would be more than what I pay out of pocket: MA prem (includes D) + co-pays. That's because I am relatively healthy and drug costs are reasonable under MA for Tier 1 drugs.

It depends on: the state you live in and how often you need services.

 

[djsander]

Last year our senior center had a nice man passing out water bottles and business cards everyday for Medicare info. They then set up a meeting to discuss Medicare and did a pretty good big picture. My wife made an appointment for a one on one discussion. The guy came to the house and discussed mainly advantage plans and said he changed to Humana MA from UHC MA as he had to many problems. He then proceeded to push the Humana plan, but would help with any plan, even mention a couple of Medicare only practices. When asked about moving back to a supplemental plan he talked around it and said yeah you can do it with out a lot of problems. Overly, nice but definitely selling MA. In the end my wife signed up for UHC part G as we wanted the most options possible. It’s a personal choice just like when to take SS based on your own requirements.

 

[rk911]

Would you, or anyone really, know whether the "uncapped copay" is based on the amount the provider originally charges or on the amount Medicare allows? For example, my cardiologist sends me for stress test and the hospital bills it at $20k. Medicare allows $3k and pays 80% or $2.4k. Would I be on the hook for only $600 or would it be for 20% of $20k - $2.4k or $3.52k...

without a medicare supplement the most you would owe is $600. depending on the supp. plan you might owe $0 or pretty close to $0. we have supp. plan F and we haven't paid anything out of pocket. i think plan F is no longer offfered.

 

[MissMolly]

Failing to enroll in Part B also means you cannot enroll in Part D or get a Medicare Supplement or a Medicare Advantage Policy. If you change your mind later, you will pay a late enrollment penalty for the rest of your life. I have been unable to determine what amount you would pay if you did not enroll in Part B. I suspect, but don't know for a fact, you would be on the hook for the full amount since Medicare would not be controlling cost since you wouldn't have Part B. I don't know why you would expect Medicare pricing if Medicare isn't involved.

 

[LV_Travel]

Medicare Advantage Humana has been a Godsend

Over the past 15 years, my 80 year old mother has had four major hospitalizations including three cancer surgeries amd a Re admittance due to a bad staff infection. She has been treated at the top rated hospital in our large city, had the chief of surgery each time and no incremental bills ! Plus coverage for all the ancillary services medicare excludes. While there have been plenty of issues with routine care and check ups over the years do to poor administrative staff at various dr offices, it is no different than i have experienced with a platinum plated ppo. While there are plenty of horror stories with medicare advantage plans, her experience has been that it can’t be beat.

She has renewed every year since turning 65. Now they do manage what is deemed “unnecessary tests”. In those cases, you will have to be your own advocate and sometimes be politely aggressive. we have had some of those battles. But again this is no different than my experience with my employer provided very expensive platinum plated ppo.

I am not saying that other people haven’t had horror stories, i am sure they have. Just thought it is important to know that some people love it amd renew every year because it is the best option available. .

 

[RobbieB]

Yes, but Robbie that is in California, one of the Healthcare friendly states. Not so for some other states. BTW what is your monthly premium if any?

I am on Kaiser (Nor Cal) senior advantage basic. Cost zero. Last year cost fifteen bucks / mo.

Just had my first colonoscopy after blood found in annual stool test. Procedure scheduled 6 weeks after positive find, procedure went well, 6 polyps removed, no bleeding after, re-scope scheduled 3 years. My copay for the whole thing was $300.

I've heard all the Kaiser horror stories. My employer switched while I was still working and I found no horror so I stayed with them through cobra and even after. When it was Medicare time I didn't even look at alternatives.

Quite happy with Kaiser.