A fine mess for Medicare and ultimately us.

Teacher Terry said:
They need to get rid of Medicare Advantage as it’s costing us more money and providing less treatment to people.
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It almost seems it's us versus them when it comes to benefits. Could be where a person lives that health care via Medicare or MA differs. We my wife & I have excellent treatment

It's a matter of choice. It could be we enjoy better health than many that the broker explained it would benefit to us to have a MA plan rather than standard Medicare. We pay zero out of pocket for our MA plan.

Zero cost for primary care & specialists. Dental $4,000.00 allowance Eye exam zero cost, our Cataract surgery $50.00 out of pocket cost. Cervical spine rebuild from c-1 to c-7 with hospital stay & several weeks of rehab & therapy zero out of pocket cost. My total out of pocket this year $180.00 for two emergency room visits that turned into surgeries & zero cost out of pocket expense. Hearing exam zero cost. Except for Eliquis our meds have zero cost, Eliquis now at $47.00 for 100 caps is reasonable.

Something else our plan is HMO/POS. If we were to travel all we have to do is advise our plan administrator & any medical emergency while traveling will be covered.
 

Knight said:
It almost seems it's us versus them when it comes to benefits. Could be where a person lives that health care via Medicare or MA differs. We my wife & I have excellent treatment

It's a matter of choice. It could be we enjoy better health than many that the broker explained it would benefit to us to have a MA plan rather than standard Medicare. We pay zero out of pocket for our MA plan.

Zero cost for primary care & specialists. Dental $4,000.00 allowance Eye exam zero cost, our Cataract surgery $50.00 out of pocket cost. Cervical spine rebuild from c-1 to c-7 with hospital stay & several weeks of rehab & therapy zero out of pocket cost. My total out of pocket this year $180.00 for two emergency room visits that turned into surgeries & zero cost out of pocket expense. Hearing exam zero cost. Except for Eliquis our meds have zero cost, Eliquis now at $47.00 for 100 caps is reasonable.

Something else our plan is HMO/POS. If we were to travel all we have to do is advise our plan administrator & any medical emergency while traveling will be covered.
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Sounds like a great plan. Which one is it, and which company is it administered by?
 
bobcat said:
Sounds like a great plan. Which one is it, and which company is it administered by?
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United Health Care
UnitedHealth Group is a health care and well-being company with team members in two distinct and complementary businesses — Optum and UnitedHealthcare — working to help build a modern, high-performing health system.

With Optum pharmacy our meds are always refilled automatically. Except for Eliquis @ $47.00 for a 100 day supply all others are 100 day supply at zero cost.
With Optum vision if I wanted to get new hearing aids the cost to me for both ears would be $1658. for tier 5 phonak hearing aids.
Vision already explained zero cost
Dental $4,000.00 a year allowance.

I'm guessing not all MA plans work like ours does.
 

Knight said:
United Health Care
UnitedHealth Group is a health care and well-being company with team members in two distinct and complementary businesses — Optum and UnitedHealthcare — working to help build a modern, high-performing health system.

With Optum pharmacy our meds are always refilled automatically. Except for Eliquis @ $47.00 for a 100 day supply all others are 100 day supply at zero cost.
With Optum vision if I wanted to get new hearing aids the cost to me for both ears would be $1658. for tier 5 phonak hearing aids.
Vision already explained zero cost
Dental $4,000.00 a year allowance.

I'm guessing not all MA plans work like ours does.
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I couldn't find any Advantage plan called Optum. Apparently Optum must be connected with the plan you have.
 
I had Medicare and a supplement. I could see any doctor who accepted Medicare instead of only network doctors, and I didn't have to worry about getting prior authorizations for most medical procedures. I never had a copay for anything. But, when my supplement premium rose to over $200 a month, I had little choice except to switch to an Advantage Plan. With the cost of everything rising, especially home and auto insurance, I am having to make difficult but necessary choices, or savings may not last through retirement.
 
Teacher Terry said:
if you move you have to change your medigap plan to one in that state. It’s not a big deal to do that.
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Ahh, but if I move out of State (or even cross a few lines within the State) I'd have to go out into the open market and then pay higher individual plan rates.

The MA plan that I have lets me move anywhere, without losing the group plan sponsored by my former employer as part of its retiree benefits. The available group plans for Traditional Medicare have no such portability.

So yes, I can move and go open-market Medigap and pay substantially more. But I'd need a pretty good reason to do that.
 
bobcat said:
I couldn't find any Advantage plan called Optum. Apparently Optum must be connected with the plan you have.
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OptumRX is part of UnitedHealthcare. But it is often paired with MA plans from various companies for prescription coverage.

I have an MA plan from BCBS of Michigan along with Delta Dental, EyeMed, and OptumRX.
 
The HMO version of the Advantage plans is more restrictive than the PPO version. Both are no charge but their co-pays and max coverage amounts are different. I switched to the PPO to avoid the too often required referrals, authorizations, and the absolutely ridiculous "in network" requirements. The U.S. health insurance system, Medicare included, seems to be unnecessarily complicated. Medical insurance should be accepted by all doctors, like cash.
 
Olivia said:
In addition, I pay $120 a month for my Medicare Advantage plan. If the MA plans are discontinued l'd have to find a doctor in my location who accepts Medicare. How much more of my flesh do you want?

Plus l'm paying for Long Term Care insurance which is mostly a rip off. And l'm far from being rich.
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Nobody wants your flesh, Olivia, we want you happy and sassy. But from my government I expect honesty and transparency and fairness TO ALL.

Down with Lobbyists!
Down with Bill Riders!
Down with Logrolling!
Up with Term Limits!
 
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My health care comes from only Medicare, and Wellcare ( older people Government program for the poor - prescription coverage ). I can break about even each month with my others bills and mishaps, etc. What I have been noticing more and more is people posting to advertise their Gofundme Site. They are begging for money there. They are all over the place now. I wonder if they work?
 
Dr Oz has been nominated to be in charge of Medicare. It’s not a secret that he wants everyone on Medicare advantage which means his rich friends will get richer as seniors die from lack of care. Good times 😞.
 
We have choices, good for us. I don't know why we need to have to turn everything into a fear fest.

It smells very politically motivated.
 
Here, in the U.S. we pay twice as much for health care than any other nation.

Health Care Costs by Country 2024

In terms of the "Quality" of the worlds health care systems, the U.S. ranks WAAAAY down the list.

The Best Healthcare in the World: Country Rankings

Between the "epidemic" of Obesity, and the money we pay for these ridiculous "ask your doctor" ads, it won't be long before our healthcare costs become a real crisis.
 
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I read the president appointed Dr. Oz as medical chief or something of that nature, a strong advocate for Medicare Advantage. 2022 our town legislature tried to force retired civil service workers to change from Medicare to Medicare Advantage Plan as part of their retirement package. Retirees went to court against city legislators, however, instead ruling in our favor, the legislature withdrew their motion to change insurance because they would have lost in court and to be able to bring forth Medicare Advantage at a later date. If the court had ruled in our favor forced medicare advantage plan would be dead.
 
To me, the situation looks like this:

Original Medicare part B could provide all the same option plans as one gets with Advantage plans, only all the money (Minus overhead) would go toward healthcare because there is no profit involved.

The healthcare you get with an Advantage plan is the same amount (Minus overhead), and also minus the profit they make.

We are handing over our senior healthcare coverage to companies who are only in it for profit. So part of the money we pay in to Part B is not going for our healthcare. It's going to huge conglomerates who will jump through hoops to sell you their plan. Ultimately, their motive is to reap the profit from doing what they do.
 
I attended a Medicare seminar last year, expecting it to to be a hard sell to push an Advantage plan. When I told the speaker I was a former state government employee, she said I have the best plan available to me (traditional Medicare and my Part D is paid by my former employer). The speaker advised me not to change to an Advantage plan. If I change and don't like it, I can't go back to my former insurance. I appreciated her honesty.
 
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Not all but many advantage plans make money by creating so many hoops for people that they either die or will no longer benefit from a higher price drug or procedure by the time they are approved for it. Google step therapy which will explain what they do. Also the specialist you need may not be in your network.

60 minutes did a segment on how it’s costing seniors their lives. People with employer retirement advantage plans typically have much better plans that may not do the negative things that regular advantage plans do.
 
Nobody can force you off traditional Medicare.

In some cases though, your former employer's retiree health benefits might not include paying for or assisting with Part D and Medigap group coverage.

It's pretty simple. I don't see why so many have their hair on fire over this.
 
Teacher Terry said:
Because Dr Oz wants to get rid of regular Medicare and put everyone on an advantage plan.
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A lot can happen between now and "then" which is two months away at the soonest. There are a lot of numbers to crunch yet and I believe they'll factor in public sentiment.

It's a less partisan issue than you might think. MA came about under Clinton in 1997, and that just rewrote and enlarged on earlier efforts. As weird it it might sound, an early big proponent of a single-payer health system was Richard Nixon!

So give it some time.
 

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