Satisfied Socal/LA area Kaiser user approaching 65 - can i do kaiser (advantage?) but switch later if i think maybe conventional plan G is better ?

[jw72]

OK, if you say so. I only know nurses at UC Davis in Sacremento area. I will ask her for specific pay information.

 

[pacergal]

One of the reasons we were hesitant to use Kaiser was history of "bad care". However, I had not heard any bad outcome stories from anyone I knew who had Kaiser. Many of the PCP docs who worked with me eventually left FOR Kaiser--much better pay, 9-5 hours, no hospital work, no need to ferret out where to send people--just do a referral and the kaiser system took over.

Two of the specialists DH or I have seen came from Harvard Medical, my PCP is from UCLA. Good docs.

Like any medical system, you can find good employees or bad employees, knowledgeable ones and not so smart.
With Kaiser, I think you do need to be more of a guide in our own medical care. Any referral DH or I have wanted, when presented to the doc with rational points why, were given without hesitation. Same thing with medication or labs.
Caveat--I am an RN with 40 years experience, however, I firmly believe we all need to be well educated stewards of our health. Don't rely on your doc to be on point every single time. They may have bad days too.

 

[aja8888]

I don't know as much as you folks about doctor qualifications, etc, but having been on Medicare with a Plan F supplement for 16 years, I really like the ability to pick my specialists, and I have picked a few really top notch ones over the years. Remember, in all things, you get what you pay for.

 

[RetiredHappy]

One of the reasons we were hesitant to use Kaiser was history of "bad care". However, I had not heard any bad outcome stories from anyone I knew who had Kaiser. Many of the PCP docs who worked with me eventually left FOR Kaiser--much better pay, 9-5 hours, no hospital work, no need to ferret out where to send people--just do a referral and the kaiser system took over.

Two of the specialists DH or I have seen came from Harvard Medical, my PCP is from UCLA. Good docs.

Like any medical system, you can find good employees or bad employees, knowledgeable ones and not so smart.
With Kaiser, I think you do need to be more of a guide in our own medical care. Any referral DH or I have wanted, when presented to the doc with rational points why, were given without hesitation. Same thing with medication or labs.
Caveat--I am an RN with 40 years experience, however, I firmly believe we all need to be well educated stewards of our health. Don't rely on your doc to be on point every single time. They may have bad days too.

I had a great PCP and OBGYN at Kaiser and had HORRIBLE care from gastroenterologists, allergists and dermatologists. The allergists overdosed me with drugs that did not work and I was so miserable that I didn't want to wake up each morning. Just imagine being itchy from head to toes from inside out, taking 16 pills a day and went through a tube of Clobetasol every week to stop the itch and nothing worked. I had rashes and open wounds all over my skin. It went on for years. We moved out of state and had a great allergist/immunologist who stopped the drugs and gave me one medication and the itch stopped.

 

[Irishgirlyc58]

I had Kaiser for approximately 25 years in Northern California- Sacramento Valley. I loved it. If I saw a doctor that I didn’t like I just went online and selected a new doctor.
I ended up with a great PCP who lived locally- I know that from conversations we had.
I have always had gastrointestinal issues and had good experiences with the GI docs.
I was immediately (as in an appointment that same day) referred to the dermatologist when I questioned the spot on my arm to the NP I saw for another minor issue.
The dermatologist highly suspected melanoma and removed the spot right then. A week later they removed a larger area once the cancer was confirmed.
The dermatologist I had for a few years was great but she left and I did go through a spat of meh dermatologists but ended with one that I really liked.

I only left Kaiser because I was planning on retiring and I don’t live in the covered area. I was eligible through my employer.
I switched in 2021 so this is my 4th year outside Kaiser.
I’m currently using Sutter Health which I think is only in Northern California. I like the doctors I’ve seen- but even though theoretically you don’t need a referral to see a specialist the health system itself requires it.
I could switch to UC Davis medical but last I heard they aren’t accepting new patients.
This whole you can see whoever you want seems to be a pipe dream. I’m sure it works sometimes but not always- in my experience.
I miss Kaiser and would go back to it in a heartbeat.

 

[Joseph]

Pensions and post retirement benefits are great for physicians
Pediatrics salaries aren’t close to 346k
Under 300k but that’s 5 days a week. Most work 4 days because the amount of electronic paperwork, meetings, meeting about meetings etc make a 4 day week 45-50 hrs of intense workload. Solid living but lotsa burnout. Quiet a few of them are staggering

to that retirement age (60)

 

[Joseph]

Pensions and post retirement benefits are great for physicians
Pediatrics salaries aren’t close to 346k
Under 300k but that’s 5 days a week. Most work 4 days because the amount of electronic paperwork, meetings, meeting about meetings etc make a 4 day week 45-50 hrs of intense workload. Solid living but lotsa burnout. Quiet a few of them are staggering

to that retirement age (60)

That being said, went off track with replay. Veering off topic too much.

 

[mh]

A radical cystectomy with ileal conduit is probably the most major surgery a urologist performs. If you’ve been pleased with the care you received by both your urologist and your oncologist at Kaiser, it seems reasonable to stay with Kaiser. I’m not sure of the time limit, but I had heard the window for changing from a Medicare Advantage plan to traditional Medicare with a medigap plan in California was 6 months rather than the 12 months someone else mentioned earlier. But that was anecdotal information I read in the local paper, not an official healthcare website.

that is my current reasoning. so i’m glad someone else thinks it’s a reasonable route to go. if i had to make a choice in 5 seconds i think i’d stay with kaiser but i’m still weighing the issue.. thanks.

 

[jazz4cash]

We are satisfied with Kaiser too. DW and I are caregivers for a family member going through a medical challenge. She is ‘stuck’ with a Kaiser ACA plan. Over the years we’ve heard various complaints about HMOs in general and Kaiser in particular but those gripes mostly seem to be vague, narrow, and very old. We have been very pleased with the Kaiser care plan and beautiful newish facilities. Our family member got a 2nd opinion which Kaiser was receptive to. The Kaiser staff all seem to take pride in their jobs….that is huge. We just hope things continue to go well for our family member.

I understand some folks have had bad experiences but that doesn’t necessarily reflect on the whole organization and everyone else’s experience.

 

[Lstansbury]

For the love of all things holy, PLEASE LOOK UP GUARANTEED ISSUE RIGHTS for medigap/med supplement plans. You have a six month open enrollment period for med supp when you turn 65 (or when you are first enrolled in Medicare Part A & B). The insurer HAS to take you. t means you would be on original medicare, with a supplement.. so you can basically go anywhere and the supp just pays whatever 20% Medicare didn't pick up. If you don't enroll during that time period, then you lose that right, and will have to go through underwriting in future. Or if you enroll in an advantage plan first, change your mind, and want to get into a supp plan later, you've lost that GI right.

Once you go on an Advantage plan, you can't necessarily ever go back to original Medicare with a supplement. You can stay be in A&B, of course, but if you don't get a supp, you'll be exposed to the 20% coinsurance. If you try to get supplement coverage to pay the 20%, the med/supp insurance company could pull your medical files back for years before approving you. Note: But you can go from Med Supp to an Advantage plan anytime you qualify for an enrollment period (like the AEP we are entering in Ocrober). Switcheroony easy peasy.

And the Med Supp plans are actually for those who want to to be able to go anywhere, anytime and have a few extra bucks a month to pay the plan premium and the part D pharmacy plan that you will also need. Check what is available in your zip code. TALK TO AN INDEPENDENT AGENT. Someone like me represents 7 or 8 plans, not just one. It is free. If you don't like the agent, talk to another one. You can talk to SHIIP too, but an agent goes through more required training.

I'm a licensed agent, but not in your state. I worked for a Medicare quality improvement organization for 8 years, educating beneficiaries and providers. I'm not trying to sell you anything!

It's just so dang sad when I run into people who want to go back to their supplement plan and they don't pass underwriting.... and the advantage plan they still have has cut their doc out of their network (or vice versa) or dropped their dental rider (ahem, looking at you 2025 Humana), or dropped their over the counter benefits (ahem, looking at you Humana again for 2025)... Or mysteriously cut the preauthorization for a Skilled Nursing Facility stay (jettisoning your sorry wheelchair bound rear end back home way soon)... Or suddenly tacked on big copays for days 1-10 in the hospital which would be covered by a supp plan (looking at almost any advantage plan with this one.)

Don't get me wrong, Advantage plans can be great for a lot of people, especially those on limited incomes. They actually give beneficiaries food cards (at least this year) and the beneficiaries get dental benefits in the thousands that they may not have had access to before. I'm a big fan.

But that guaranteed issue right is pretty sweet for those who can afford what we in the business call "the Cadillac version of coverage" - which is original Medicare with a med supp and part d pharmacy plan. Please do your homework before you give it up.

 

[Koolau]

For the love of all things holy, PLEASE LOOK UP GUARANTEED ISSUE RIGHTS for medigap/med supplement plans. You have a six month open enrollment period for med supp when you turn 65 (or when you are first enrolled in Medicare Part A & B). The insurer HAS to take you. t means you would be on original medicare, with a supplement.. so you can basically go anywhere and the supp just pays whatever 20% Medicare didn't pick up. If you don't enroll during that time period, then you lose that right, and will have to go through underwriting in future. Or if you enroll in an advantage plan first, change your mind, and want to get into a supp plan later, you've lost that GI right.

Once you go on an Advantage plan, you can't necessarily ever go back to original Medicare with a supplement. You can stay be in A&B, of course, but if you don't get a supp, you'll be exposed to the 20% coinsurance. If you try to get supplement coverage to pay the 20%, the med/supp insurance company could pull your medical files back for years before approving you. Note: But you can go from Med Supp to an Advantage plan anytime you qualify for an enrollment period (like the AEP we are entering in Ocrober). Switcheroony easy peasy.

And the Med Supp plans are actually for those who want to to be able to go anywhere, anytime and have a few extra bucks a month to pay the plan premium and the part D pharmacy plan that you will also need. Check what is available in your zip code. TALK TO AN INDEPENDENT AGENT. Someone like me represents 7 or 8 plans, not just one. It is free. If you don't like the agent, talk to another one. You can talk to SHIIP too, but an agent goes through more required training.

I'm a licensed agent, but not in your state. I worked for a Medicare quality improvement organization for 8 years, educating beneficiaries and providers. I'm not trying to sell you anything!

It's just so dang sad when I run into people who want to go back to their supplement plan and they don't pass underwriting.... and the advantage plan they still have has cut their doc out of their network (or vice versa) or dropped their dental rider (ahem, looking at you 2025 Humana), or dropped their over the counter benefits (ahem, looking at you Humana again for 2025)... Or mysteriously cut the preauthorization for a Skilled Nursing Facility stay (jettisoning your sorry wheelchair bound rear end back home way soon)... Or suddenly tacked on big copays for days 1-10 in the hospital which would be covered by a supp plan (looking at almost any advantage plan with this one.)

Don't get me wrong, Advantage plans can be great for a lot of people, especially those on limited incomes. They actually give beneficiaries food cards (at least this year) and the beneficiaries get dental benefits in the thousands that they may not have had access to before. I'm a big fan.

But that guaranteed issue right is pretty sweet for those who can afford what we in the business call "the Cadillac version of coverage" - which is original Medicare with a med supp and part d pharmacy plan. Please do your homework before you give it up.

I've come to the conclusion that few things in life are as valuable as your health and paying a bit extra to get the "Cadillac" (or at least Buick) version is likely money well spent. That's basically what we did. No regrets though it ain't cheap.

 

[GoBears]

You can always try standard Medicare plus MediGap and a drug plan. If you don’t like it, Kaiser will welcome you back with open arms. I know because they continue to send solicitations asking me to return. I won’t because we ultimately will relocate to Nevada and I was disappointed with some aspects of Kaiser - the Walnut Creek ER’s capacity is inadequate (there is 1 Kaiser ER compared to 5 non-Kaiser ERs in the service area), inability to get a timely urgent care appointment (8 day delay), and appointment durations that are not long enough to discuss more than one or two concerns.

 

[mh]

i’m still listening to all your comments, for which i thank you.

I've come to the conclusion that few things in life are as valuable as your health and paying a bit extra to get the "Cadillac" (or at least Buick) version is likely money well spent. That's basically what we did. No regrets though it ain't cheap.

i understand all that you are saying. i wasn't going with kaiser because the advantage plan was cheaper. i was going to stay because i thought they did a good job with my bladder cancer surgery & chemo. I do understand that it if stay with them i won’t have as much in the way of choices to switch later if i change my mind. i’m still thinking about it. i am giving more weight to going medicare+medigap+drugplan now