Oh joy, Oh joy, Oct.15 Opening Medicare Plan Season

Murrmurr said:
It's my understanding (emphasis on "my understanding") that medical providers are not happy with the negotiated payments, so they are no longer taking patients with advantage plans and "Managed Care" plans.
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That has not been my experience at all, even as I needed specialists out of state.
 

Murrmurr said:
There's big changes on the horizon. And the horizon isn't far away.

If you want, check out YT channel "Christopher Westfall | Senior Savings Network" and his most recent video.

Or channel "Medicare on Video - Healthplan65"

Or channel "Clear Value Tax"
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I appreciate you worrying about us but l don't take medical advice or the like from a discussion forum.
 
I spent a lot of time researching before I decided against an advantage plan. 60 minutes did a segment on how bad they are. MA plans as a retiree benefit are superior to the ones that anyone can buy.

These plans allow step therapy when you have a serious illness. By the time you get to the step that you needed all along such as an expensive drug you are dead or too sick to benefit.

If you require specialized care out of network or state you will be denied. I know 2 people only alive because they could have the best surgeon out of state operate on them. If you never get a serious or rare illness you will probably be fine. I’m not gambling with my life.
 
Teacher Terry said:
If you require specialized care out of network or state you will be denied. I know 2 people only alive because they could have the best surgeon out of state operate on them. If you never get a serious or rare illness you will probably be fine. I’m not gambling with my life.
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That was me, this past summer.
I needed specialized surgery in a different state (out of network AND out of state) ... Medicare Advantage covered all surgical expenses except for $225.00.
Plans differ, even within Medicare Advantage; we all need to find what works for us!
 
That Lady in PA said:
That was me, this past summer.
I needed specialized surgery in a different state (out of network AND out of state) ... Medicare Advantage covered all surgical expenses except for $225.00.
Plans differ, even within Medicare Advantage; we all need to find what works for us!
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Curious if you have an employer plan for retirees? Glad it worked for you. One of my friends had a million dollar brain surgery that very few neurologists can perform. It’s a rare type of tumor that took 14 hours to perform and she had no deficiencies afterwards.
 
Happyflowerlady said:
Are you saying you had an advantage plan and had problems with it , @Murrmurr ? What company plan did you have the problems with and what happened ?
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Might have been Blue Cross/Blue Shield, but I'm not sure. I know it was 4 years ago, so one of the ones that offered it then.

The literature says you can keep your same doctors, but to maximize the benefits, I would have to change doctors. I would have to switch to another pharmacy for the same reason. The cost was not very significant from my perspective, so I kept my doctors and specialists. But a monthly premium was deducted from my check, which is not the case with straight medicare, and that made the cost of keeping my doctors significant. Plus, they had some kind of billing issue with my secondary coverage and they didn't like my PCP's billing codes, so that was kind of a mess, especially for my PCP.

The only advantage (for me) was their customer service. It was excellent!...very helpful.

Anyway, I switched back within the 90-day period or whatever it was, and made an appointment w/my financial advisor. He went over a bunch of details and projections with me, and advised me to stick with straight medicare plus my secondary coverage.

As it is now, I only pay $2.75/mo for my 2 Rxs, and nothing else. No other costs whatsoever, not for any surgeries or procedures, lab work or hospital stays. And I'm not required to have certain things done routinely in order to keep my benefits entact, like colonoscopies or physicals or blood tests...in other words, there's no "preventive care" required (I don't know if Advantage still requires that).
 
Oh, @Happyflowerlady -

Another issue was that my secondary insurance was awarded by a court due to a lawsuit for a major fall I took off a ridge at a state park. It's supposed to fully cover any and all injuries and future problems caused by that fall. Ever since I was approved for disability back in 2014, they've paid in full after SSDI medicare is billed.

The Advantage plan had an issue with that in that they treated these particular medical issues as though they're not my medical history, or not related to that accident, to be more precise. That complicated things.
 
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Teacher Terry said:
Curious if you have an employer plan for retirees? Glad it worked for you. One of my friends had a million dollar brain surgery that very few neurologists can perform. It’s a rare type of tumor that took 14 hours to perform and she had no deficiencies afterwards.
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No employer plan
 
My problem with the incessant Advantage ads is the bait and switch. The ads start off by saying their Advantage plan won't cost a dime. Then. without saying, these benefits will cost an arm and a leg, the ads suggest you get limos to and from you Doc, maid service, etc.- all for nothing.
 
There's one of those commercials on TV now. It starts off with "Hi I'm Damian Clark". The he began his spiel.
 

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