don't buy Medicare Advantage?

[GrayHare]

A recent Parade magazine article suggested avoiding Medicare Advantage Plans because many greatly limit one's choice of doctors while standard Medicare is accepted by 90% of doctors. That's opposite my understanding which is that far fewer than 90% of doctors will accept new patients who have only standard Medicare. What has your experience been?

 

[lem1955]

DW is on Medicare Advantage and has been for 5 years. No problems with access to doctors or specialists.

 

[Bamaman]

I only have the finest of doctors, and they really don't like to accept new patients even if they're on Medicare. All their patients have Medicare Advantage plans too. And they won't even talk to someone on Medicaid.

If you find physicians that don't take Medicare, they may have a different type of practice--like a cash pay or pay by the month out of pocket practice. I've never seen one of them in our area, however. All the good doctors in our medical market take Medicare.

 

[Gotadimple]

A recent Parade magazine article suggested avoiding Medicare Advantage Plans because many greatly limit one's choice of doctors while standard Medicare is accepted by 90% of doctors. That's opposite my understanding which is that far fewer than 90% of doctors will accept new patients who have only standard Medicare. What has your experience been?

In many states insurance carriers only offer HMO plans for Medicare Advantage. These limit your choice of doctors to those in their provider network.

* There are many providers who do not accept Medicare, but, those that do are listed on the Medicare.gov site. However, you need to check if they are still accepting Medicare patients.
* There are very few PPO Medicare Advantage plans which give you access to broader networks
* HMO Plans with broad (large) networks do exist in some of the more populated urban areas.

I personally have chosen a Medicare Advantage PPO plan, because the large multi-specialty clinic I use does not contract with Medicare Advantage HMO plans. And, I don't need a referral to use any doctor in the clinic.

The alternative to MA is to purchase a Medicare Supplement, but one still needs to find physicians who accept Medicare. That whole issue is taken away with a Medicare Advantage plan - but you might not be able to get a broad range of doctors or hospitals in the MA plan you choose.


Rita

 

[razztazz]

Not exactly my personal experience but my mother's.

She's had Medicare Advantage as long as its been around (it was known as something else before medicare Advantage I believe)

She has never, to my knowledge, had any problem finding doctors, horspistols, clinics or etcs to do their thing to her, And she's diabetic, has had a heart attack and a multi-bypass, a hip operation, a serious back operation, and has had eye problems. ie age related macular degeneration and diabetic neuropathy.

She lives in a rural-ish but fairly densely populated area along the I-95 corridor. She does not have any money but that area is a bedroom community of Top-2%er commuters to New York and Philly. That might have something to do with it. Economics and demographics ooze and undulate from area to area and they directly affect these things. So some places will be hard-up and some will have no problem.

 

[youbet]

A recent Parade magazine article suggested avoiding Medicare Advantage Plans because many greatly limit one's choice of doctors while standard Medicare is accepted by 90% of doctors.

SOME Medicare Advantage plans have rather constricted networks but others, such as my DW's plan, let you go to any provider that accepts Medicare assignment. You need to read and understand the plan.


My DW has been on a Medicare Advantage plan for a couple of years ever since Illinois booted retired teachers over 65 off the Teacher Retirement Insurance Plan. So far she's been OK with it. She didn't have to change any docs and hasn't felt limited in choices, at least so far.

 

[haha]

I personally have chosen a Medicare Advantage PPO plan, because the large multi-specialty clinic I use does not contract with Medicare Advantage HMO plans. And, I don't need a referral to use any doctor in the clinic.


Rita

Hi Rita. My cousin from LA came by last week. She and her husband have Kaiser in LA County. He is medicare age, but she has LA county employee retirement coverage. He got very sick with some kind brain abscess, and he is finally completely well. They both had nothing but praise for Kaiser which they have had for many years, including while raising children. Ann said that after recent government regs have made it harder for private practitioners to make a living, Kaiser, particularly their big Hollywood hospital, has gotten a big infusion of prominent specialists.

My girlfriend has Group Health, the big HMO in Seattle and some other Washington areas, and she has been very happy with it also.

Ha

 

[Gotadimple]

Hi Rita. My cousin from LA came by last week. She and her husband have Kaiser in LA County. He is medicare age, but she has LA county employee retirement coverage. He got very sick with some kind brain abscess, and he is finally completely well. They both had nothing but praise for Kaiser which they have had for many years, including while raising children. Ann said that after recent government regs have made it harder for private practitioners to make a living, Kaiser, particularly their big Hollywood hospital, has gotten a big infusion of prominent specialists.

My girlfriend has Group Health, the big HMO in Seattle and some other Washington areas, and she has been very happy with it also.

Ha

Hi, Ha,
Kaiser has a wonderful reputation, as does Group Health in the Seattle area. Both have really big networks and serve thousands of patients. Coincidentally both were hospital-clinic practices that eventually added insurance coverage as a business unit. They have great integration between the insurance carrier and patient care businesses.

If GH was closer to me, I'd pick them. For now, though, Virginia Mason is almost the same - without the insurance carrier part.

Rita

 

[Options]

My mother has been on MA since going on Medicare years ago and is very happy with it. In the SF Bay Area, she saw a Gerontologist. She had a stroke last year and was quite pleased with her care.

 

[Katsmeow]

That's opposite my understanding which is that far fewer than 90% of doctors will accept new patients who have only standard Medicare. What has your experience been?

My husband has been on standard Medicare for 3 years. During that time he has seen a number of doctors (including orthopedic surgeon, cardiologist, urologist, ophthalmologist) and had major shoulder surgery. He has yet to want to see any doctor that doesn't accept Medicare. By the way these are all doctors new to him since he went on Medicare as we moved about that time and he needed to change doctors.

Maybe there are some areas where some doctors don't accept Medicare, but around here he has had zero issue finding a doctor. He has Plan F supplemental policy so basically has had everything paid (refraction isn't covered, nor are eyeglasses). It has been very nice that he has pretty much been able to go anywhere without having to worry about in network versus out of network.

Oh. My mother who is 91 is on standard Medicare (same state, different city) and she hasn't had problems finding doctors either.

We considered Medicare Advantage and I agree there may be some nice features to it. But, the restrictions on who you can see made it very unappealing to us.

 

[nun]

A recent Parade magazine article suggested avoiding Medicare Advantage Plans because many greatly limit one's choice of doctors while standard Medicare is accepted by 90% of doctors. That's opposite my understanding which is that far fewer than 90% of doctors will accept new patients who have only standard Medicare. What has your experience been?

If you have a good network a Medicare Advantage Plan can make things easy and if you've been on an HMO type plan through and employer or ACA it's simple just to use the same insurer's Advantage plan when you reach Medicare age.

 

[aja8888]

Supplemental Plan F (full) here for DW and I.

I picked the best hip replacement surgeon in Houston for my "anterior procedure" implant and didn't pay a cent in deductibles or anything else. MA plans here are not good and if I was on one, I would have not been able to choose the procedure or the doctor.

DW has COPD and is generally been hospitalized in the early part of each year for 10 -14 days (last 3 years) and we have the same cost experience with her ($0).

MA plans in some areas of the country are good, but not in these parts. If one of us gets cancer, we want the ability to choose doctors and hospitals, a choice we may not have on an MA plan.

 

[GrayHare]

I don't see how adding a Medicare Advantage plan would limit one's choice of doctors compared to Standard Medicare. Is it that some doctors will a see patient who has Standard Medicare, but won't if the doctor is outside that same patient's Medicare Advantage plan?

 

[molly312]

When you join a Medicare Advantage plan you are agreeing to let the insurance company manage your healthcare according to their providers. Medicare is involved in setting up the plans. They pay your insurance carrier a fixed sum/year to cover you. The Advantage insurer decides which doctors and which hospitals you may use in order to obtain insurance coverage. With Original Medicare - Any doctor or hospital that accepts Medicare - you can use. Original Medicare covers 80% and your Medigap Plan ---- depending on the "letter" covers either all or most of the remaining 20%. Medicare Advantage = insurance company is driving the bus. Original Medicare with Medigap Supplement requires that you purchase a separate drug plan.

 

[Birchwood]

I just turned 65. After studying the different issues, I decided on a regular medicare part A & B, then a medigap supplemental policy thru Blue shield blue cross, and another prescription drug benefit thru Humana.

The health care is monopolized by two system in my region and if I get a medicare advantage thru one, they are going to steer me to their system no matter what and then I will end up paying more if I try to get off and wanted to go to another hospital system.

I want one that will cover me anywhere in USA. I think that if I move, I may have to modify or adjust to what is covering the new residence.

 

[molly312]

Birchwood -

If you move, you can start all over again based on what plans are available in the new area. You are right though - with Original Medicare and Medigap, you are covered anyplace in the US.....or outside the US (with limitations).

This entire Medicare thing is very confusing when you first try to figure it out. It is more like Apples and Oranges - not different varieties of Apples. It took me several months and much reading to get comfortable with the choices.

 

[meierlde]

As long as you stay in the US all hospital emergency rooms are in network with original medicare, and physicians must either take medicare fees or not serve folks over 65. So if in an emergency situation any physicians that treat you will be in network with original medicare (I suspect that most hospital emergency physicians take medicare patients, just like most hospitals take medicare patients because unless it is a specialized institution, that is where the patients come from.)