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

[kevink]

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.

 

[ShokWaveRider]

Firstly, folks should know that "Medicare Advantage" is NOT Medicare, it is a play on words by the insurance companies.

It appears is does work for some, depending on what area of the country you live and what support system is available for the limited networks provided.

Agents make a lot of money selling MA, and only a fraction for selling Supplemental plans (N, G etc. controlled by Actual Medicare). Millions of dollars are spent on advertising them for a reason, that money has to come from somewhere.

There are 10 times as many sad stories about MA and very few good ones compared to supplemental plans.

Buyer Beware. As with any Insurance product, but especially Healthcare as you cannot go back to a decent plan without Medical Underwriting.

 

[athena53]

Thanks- I just bookmarked this. It's consistent with what I've read on this Board as well as the sad stories my friend hears in his work for a call center Medicare beneficiaries contact with questions- but its concise and well-documented. I'll be using it next time I see a retirement-related post in FB touting Medicare Advantage plans.

They seem to work fine- as long as you're healthy.

 

[qwerty3656]

Buyer Beware

So where does "Boomer Benefits" fall in the "you can trust what they say" scale? I'm not on Medicare, but probably plan to contact them or someone like them when I do go on Medicare.

 

[Ian S]

Greany makes a lot of good points but when he discusses traditional Medicare copays, he uses a rather benign example of a Part A covered hospital stay. 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. This is not to argue for MA plans which I believe are a ripoff and fraught with fraud especially involving companies artificially inflating their "risk score" to get higher reimbursements from the government along with the insurance industry's long use of denial of services to pad their profits.

As for AARP, it's hardly a secret that it gets a ton of money from UHC. But I don't see AARP at least pushing MA plans over Medicare supplements. Furthermore, the supplement plans offered by AARP/UHC are pretty popular and don't seem to be encumbered by the tactics of others involving closing plans in order to open new ones with lower premiums (younger healthier enrollees.) Paying for a supplement makes sense for me especially considering the number of outpatient procedures I've had over the years and the time saved going over the bills and making co-payments to myriad healthcare providers. YMMV of course.

 

[frank]

I think the part about medical underwriting to go back to a regular supplement is the thing most people don;t realize. they think if they don't like the advantage plan one year then they can switch back, true, but then you have to pay for pre-existing conditions.

 

[athena53]

Paying for a supplement makes sense for me especially considering the number of outpatient procedures I've had over the years and the time saved going over the bills and making co-payments to myriad healthcare providers. YMMV of course.

I agree. The sticker price on my annual echocardiogram, outpatient, of course, was $20,000. My late DH had a lot of chronic issues and we did everything we could to keep him out of hospitals when he got occasional bouts of pneumonia or bronchitis. He was so much happier at home.

The article also does not mention the fact that if you're switching from Medicare Advantage to traditional Medicare the supplement carrier can "re-underwrite you", resulting in your being turned down or in a premium surcharge because of your pre-existing conditions. When our insurance agent told us that when we signed DH up for Medicare, that in itself was a dealbreaker.

 

[Ian S]

So where does "Boomer Benefits" fall in the "you can trust what they say" scale? I'm not on Medicare, but probably plan to contact them or someone like them when I do go on Medicare.

I have not used Boomer Benefits but did go to a local agent's seminar and separately, one on one meetings with an agent whom I knew personally. I did my homework though and ultimately went with the AARP supplement which was not the one promoted by my agent friend. I did have him do the paperwork though!

 

[youbet]

So where does "Boomer Benefits" fall in the "you can trust what they say" scale? I'm not on Medicare, but probably plan to contact them or someone like them when I do go on Medicare.

Understanding your coverage, costs and the viability of the insurance company you choose shares the same advantages of being DIY with your investments. Both Part D and supplements are easy. Part D has an online tool which leads you straight to the best provider for you after you make a few basic entries about the drugs you take and where you live. Supplements are defined by Medicare so it's really just a matter of choosing the provider your want after comparing costs.

There's no financial advisor that's cares as much about your money as you. There is no insurance agent that cares about your health and medical insurance coverage as much as you. And neither are very difficult to handle yourself.

Of course, using free services from various agents and listening critically could be an educational tool. But, in the end, put yourself as the informed decision maker.

 

[youbet]

you will be subject to the full 20% uncapped copay for Part B costs.

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.

I'm happy with my BCBS type F plan as it's nice to never receive a bill, only EOB's showing nothing owed. But I was mulling over the risk of having to pay the 20% copay for Part B services. Most staggering annual medical cost situations (say a million bux/year) involve hospitalizations, much of which is covered by Part A. Of the balance covered by Part B, if you only have to pay 20% of the amount Medicare allows (as opposed to the riduculous full billed amount), it doesn't seem so scary. If The Part B amount of the million bux is $100k, Medicare might allow $20k and 20% of that would be only $4k.

 

[Irishgirlyc58]

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.

I'm happy with my BCBS type F plan as it's nice to never receive a bill, only EOB's showing nothing owed. But I was mulling over the risk of having to pay the 20% copay for Part B services. Most staggering annual medical cost situations (say a million bux/year) involve hospitalizations, much of which is covered by Part A. Of the balance covered by Part B, if you only have to pay 20% of the amount Medicare allows (as opposed to the riduculous full billed amount), it doesn't seem so scary. If The Part B amount of the million bux is $100k, Medicare might allow $20k and 20% of that would be only $4k.

Wouldn’t that information be available from how people were charged the 20% before 1992 and the implementation of medigap plans?

 

[MissMolly]

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.

I'm happy with my BCBS type F plan as it's nice to never receive a bill, only EOB's showing nothing owed. But I was mulling over the risk of having to pay the 20% copay for Part B services. Most staggering annual medical cost situations (say a million bux/year) involve hospitalizations, much of which is covered by Part A. Of the balance covered by Part B, if you only have to pay 20% of the amount Medicare allows (as opposed to the riduculous full billed amount), it doesn't seem so scary. If The Part B amount of the million bux is $100k, Medicare might allow $20k and 20% of that would be only $4k.

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.

 

[Ian S]

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.

What the hospital bills is baloney. The number that matters is what Medicare allows. And that's what your 20% is based on. So it may look like it would be fine to self insure for that 20%. But there is so much these days - including surgeries - that is "outpatient", that the 20% of Medicare allowed costs can really mount up. My own experience includes two rotator cuff surgeries, as well as several endoscopies and a POEM surgery to treat my achalasia. And not just surgeries but as MissMolly points out, expensive chemo would also usually be charged under part B leading to costly copays.

Nah, I can easily afford my G Supplement that provides peace of mind and eliminates the hassle of dealing with a multitude of healthcare provider copay bills.

 

[kevink]

So where does "Boomer Benefits" fall in the "you can trust what they say" scale? I'm not on Medicare, but probably plan to contact them or someone like them when I do go on Medicare.

I turned 65 last year and contacted Boomer Benefits myself (thank-you to the many folks on this board who recommended them). They are fully transparent about how they get paid (by the insurance companies) and certainly didn't in any way try to steer me towards a Medicare Advantage program instead of a supplement.

That said, I don't know how forthcoming they'd have been about the existence of high-deductible Part G insurance, since I already knew about it due to reading Greaney's previous posts and a bunch of other research. But what I've found to be invaluable about Boomers - and I know there are any number of other independent agents and agencies who do this too - is that they save you from endless call-back from insurance salespeople and are happy to help you re-shop both supplement plans and part D (prescription drug coverage) annually during open enrollment - which, sadly, is something one needs to do annually.

 

[Midpack]

So where does "Boomer Benefits" fall in the "you can trust what they say" scale? I'm not on Medicare, but probably plan to contact them or someone like them when I do go on Medicare.

I recommend Boomer Benefits without hesitation. Three months before I enrolled in Medicare, I began learning everything I could about it. Pretty sure I had a very good knowledge of the alternatives and pitfalls. About a month before applying, I became aware of Boomer Benefits and gave them a call, thought why not for no added cost. That was three years ago, and I have been completely satisfied with their recommendations for my Supplemental, Plan D and even dental. They gave me plenty of options, not just one, and were well prepared to discuss the pros and cons of each.

Because I had done so much homework beforehand, I was in a good position to judge their recommendations. And when DW enrolled last year, I had her call, and we got very good recommendations again, even a small discount by taking the same Supplemental.

I have since found a better dental plan, but stayed with the same Supplemental and Part D.

I am sure there are some bad reviews for Boomer Benefits, like ANY service. But I think they provide a great service.

 

[ivinsfan]

Greany makes a lot of good points but when he discusses traditional Medicare copays, he uses a rather benign example of a Part A covered hospital stay. 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. This is not to argue for MA plans which I believe are a ripoff and fraught with fraud especially involving companies artificially inflating their "risk score" to get higher reimbursements from the government along with the insurance industry's long use of denial of services to pad their profits.

As for AARP, it's hardly a secret that it gets a ton of money from UHC. But I don't see AARP at least pushing MA plans over Medicare supplements. Furthermore, the supplement plans offered by AARP/UHC are pretty popular and don't seem to be encumbered by the tactics of others involving closing plans in order to open new ones with lower premiums (younger healthier enrollees.) Paying for a supplement makes sense for me especially considering the number of outpatient procedures I've had over the years and the time saved going over the bills and making co-payments to myriad healthcare providers. YMMV of course.

This post is not very clear...when you say full uncapped copay for Part B what do you mean exactly? For example it might be billed at 10K but knocked down by Medicare to 2K which means your copay would be 400 bucks. Even without a supplement you are getting the magic of the Medicare knockdown. I see you clarified your comment but wouldn't Medicare give the same magic discounts to OP procedures. But unless someone is broke I recommend getting a supplement.

 

[Bamaman]

My wife is recovering from major back surgery and a broken leg--7 weeks in 3 hospitals and 2 rehabs. I'm so thankful for Plan F as there's no telling what the bills will add up to. Maybe $500K+.

20% of those bills could be tough a family's pocketbook.

She's been in the hospital 5 times in just over a year.

What's disturbing is the hospital charges vs. what Medicare pays. A $9,000 service may result in a $800 payment. Yes, Medicare works in mysterious ways.

And we've received very little documentation and have had to pay about $25 at this point. And I don't anything to do with Medicare Advantage Plans.

 

[ivinsfan]

Bamaman I sincerely hope your wife is doing better and will continue to do better...and I hope you are coping with being the caretaker.



I'm with you, it's really hard to pull the trigger on an MA plan knowing you give up the power of Medicare magic pricing. We won't do it. My DH has had 2 open heart procedures. The first one pre 65 costs us our entirely yearly OOP copay around 4K second one costs Zero out of pocket after Medicare and supplement payed.

 

[Ian S]

This post is not very clear...when you say full uncapped copay for Part B what do you mean exactly? For example it might be billed at 10K but knocked down by Medicare to 2K which means your copay would be 400 bucks. Even without a supplement you are getting the magic of the Medicare knockdown. I see you clarified your comment but wouldn't Medicare give the same magic discounts to OP procedures. But unless someone is broke I recommend getting a supplement.

Yes, you would get the nice Medicare discounts for outpatient services. But unlike typical hospitalizations which basically have a deductible and that's it, outpatient Part B services have a copay of 20% and each Part B charge within a calendar year will have that copay as there is no out of pocket maximum. My Part B copays for just one of my outpatient Part B rotator cuff surgeries and associated doctor visits, lab tests, and several months of PT would have been 2-3 times the cost of my G supplement plan for that year. Obviously, that's not typical but I have had two rotator cuff surgeries, numerous endoscopies and the POEM procedure to improve my swallowing all while on Medicare with a G Supplement.

 

[Z3Dreamer]

Things we don't agree on: 1) When to take SS 2) SWR 3) MA vs Medigap.

Was not a fan of MA until I had to choose. Researched too much and with the help of my Boomer Benefit salesperson, selected a good MA plan. I know all of the negatives but I believe it is a good fit for me.

Now to the article. His 5 points are easily refuted. I read the article and the backup "facts". But the question is: Would it sway any of this group?

If Medigap is a good fit for you, wonderful. DW is happy with her Medigap plan. I am happy with my MA.

PS I received no fees for my endorsements.

 

[Irishgirlyc58]

Now to the article. His 5 points are easily refuted. I read the article and the backup "facts". But the question is: Would it sway any of this group?

.

I’ll say they are easily disputed!
I have no idea who the guy is but based on this article I wouldn’t trust anything he says.

 

[kevink]

Things we don't agree on: 1) When to take SS 2) SWR 3) MA vs Medigap.

Was not a fan of MA until I had to choose. Researched too much and with the help of my Boomer Benefit salesperson, selected a good MA plan. I know all of the negatives but I believe it is a good fit for me.

Now to the article. His 5 points are easily refuted. I read the article and the backup "facts". But the question is: Would it sway any of this group?

If Medigap is a good fit for you, wonderful. DW is happy with her Medigap plan. I am happy with my MA.

PS I received no fees for my endorsements.

His 5 points are in fact very well-documented, with links in the body of the post and additional supporting links at the end (I especially recommend the New York Times exposé, a major piece on the graft and corruption of all of the leading Advantage plan providers published just last week). Saying you can easily refute something isn't the same as actually doing so. Good luck with that.

 

[ShokWaveRider]

Things we don't agree on: 1) When to take SS 2) SWR 3) MA vs Medigap.

So true. One has to make one's own decisions, and people will do, say & believe anything to justify their own choice.

I chose Medicare with a supplement, based on my neighbor's experiences with MA. Luckily, he is 2 years older than me. He is constantly fighting with Insurance company minions to get things approved, needing referrals, no Mayo. It was good for 2 years for him, but now he cannot move to a Supplement as they will not take him. So, he is stuck with limited networks and high copays.

It is not that he is poor either, he is very well off in fact and well educated, he can afford anything he wants, but he sometimes makes poor decisions based on cost.

I am not as well off by any means but have had Zero hassle with my BB Recommended AARP Part G Supplement and no Co-Pays or waiting for approvals. Averaging ~$3,000 a year including Part D & the Medicare deductible, I have used probably 50x that in the last 3 years. I am not a sick person either, I do have a Pacemaker that was replaced, and I do get regular CT Scans and Blood Tests etc., more than the norm because of some minor back pain.

No contest in my books. Although I must be honest, if I was in a state that did not require underwriting in order to switch, I would have tried it.

 

[Irishgirlyc58]

His 5 points are in fact very well-documented, with links in the body of the post and additional supporting links at the end (I especially recommend the New York Times exposé, a major piece on the graft and corruption of all of the leading Advantage plan providers published just last week). Saying you can easily refute something isn't the same as actually doing so. Good luck with that.

I believe page 18 of the report link on his first point contradicts what he is saying regarding admin costs.
A 15% admin cap is typical contract language for federal funds/programs.
What’s included in admin vs program costs differs by program.
I don’t see any side by side comparison of admin costs for MA vs admin costs for CMS/Medicare specific to the administration of Medicare A and B.

 

[Z3Dreamer]

His 5 points are in fact very well-documented, with links in the body of the post and additional supporting links at the end (I especially recommend the New York Times exposé, a major piece on the graft and corruption of all of the leading Advantage plan providers published just last week). Saying you can easily refute something isn't the same as actually doing so. Good luck with that.

Challenge accepted. NYT article is behind a paywall, but the section quoted below the hyperlink discusses the IG report (I think) that found MA plans deny too many legitimate pre-authorization requests. This is true, but the author at retireearlyhomepage then drew the conclusion of "There's a lot of suspected for-profit insurance company fraud in Medicare Advantage." Fraud is a totally different animal. Here is a link to the IG's report. https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp

No where in the IG's report is the term "FRAUD" mentioned. Furthermore, the IG recommends improvement to the system, which is an administrative fix. What the author of the article suggests is a criminal proceeding. Totally different.

Furthermore, H.R. 3173 which purports to fix the problem has passed the House. It may never be law, but the issue in the IG report is being looked at, addressed, etc.

So, I am refuting point #4 as the facts do not support his conclusion.