Do you review your Medicare supplement

Butterfly

Well-known member
Well, I have a friend in Canada right now that is suffering - needing an abdominal hernia operation that her doctor has cleared her to get, but she told me she has no idea how long she will have to wait... when she can get it because its "not life threatening". No matter that she gets sick as a dog sometimes when she eats. Have heard that same thing about standing in line and waiting from other "universal" health care countries. Guess you just get used to whatever health care you have, when you have it!

Told her if that happened here in the US, there would be picketers lined up all around the White House...lol.
A lot of people don't realize that we DO have to wait here for surgeries for non life threatening conditions. When I had my hips replaced (and they were so bad I could not walk) I waited several months to get on the schedule. You have to wait for a spot on the surgeon's calendar, and you also have to wait for an open slot in a suitable operating room.

I wanted the surgeries done by the surgeon I had selected, and he's very busy. He's very busy because he's the best in this area for hips and knees. I was willing to wait -- I suppose I might have been able to get it done earlier if I had been willing to have it done by whoever had the earliest time, but I wasn't. Maybe it wouldn't have mattered, because there are a finite number of operating rooms for orthopedic surgeries. And of course with a non life threatening procedure you are always going to be bumped if there's an emergency which takes precedence.

I guess it's like everything else -- you take a number and wait your turn.
 

Liberty

Well-known member
Location
Texas
Well, scratching my head over the "in network" and "out of network" doctors. As far as I know, with a medicare "supplement" you can go to any doctor you want to ...assuming they take medicare patients of course. We tend toward specialists...like we have a cardiologist who is basically our primary doc - as he does the intensive blood work and testing. I'm not understanding what an "out of network" doctor would be, maybe someone else here can explain, unless its a term pertaining specifically to certain "advantage plans"?
 

GreenSky

Active member
Location
Las Vegas
Original Poster
Well, scratching my head over the "in network" and "out of network" doctors. As far as I know, with a medicare "supplement" you can go to any doctor you want to ...assuming they take medicare patients of course. We tend toward specialists...like we have a cardiologist who is basically our primary doc - as he does the intensive blood work and testing. I'm not understanding what an "out of network" doctor would be, maybe someone else here can explain, unless its a term pertaining specifically to certain "advantage plans"?
You are correct. With Original Medicare you can see any doctor that accepts it. So I guess you could say Medicare is a network plan in that respect, although the network is huge. A PPO will allow you to see doctors who are in network and at a (much) higher price those who will accept payment but not the PPO's limiting charges - hence out of network.

HMO plans have limited networks and with a few exceptions require approval to see specialists. Most contract with medical groups. A few (like Kaiser) are "staff models" meaning they are both the insurance company and the medical group. Many people love Kaiser because everything is under one roof. If you don't like Dr. Kaiser you can see a different Dr. Kaiser. And just to clarify, Kaiser is NOT non-profit, they are not for profit. There is a difference. With not for profit there is no way to know how much money they make.

I know many people who love HMO plans and have probably enrolled over 1,000 people over the years. Fortunately (for the time being) we have a choice in how we receive our healthcare. It should be up to the patient to make the decision that they prefer. You and I have chosen Medicare and a Supplement. Others like a Medicare Advantage Plan, either PPO or HMO. And I'm good with all of this. Nobody should be forced into a "cookie cutter" plan.

Rick
 

GreenSky

Active member
Location
Las Vegas
Original Poster
A lot of people don't realize that we DO have to wait here for surgeries for non life threatening conditions. When I had my hips replaced (and they were so bad I could not walk) I waited several months to get on the schedule. You have to wait for a spot on the surgeon's calendar, and you also have to wait for an open slot in a suitable operating room.

I guess it's like everything else -- you take a number and wait your turn.
I too had hip replacement surgery. Two hips - two surgeries. Fortunately I did not have to wait long - maybe 7-10 days. Can you imagine waiting 6 months to a year for approval? Or never getting approval?

So many in Europe just take medication and use a cane because they can't get care.

We're lucky to live in America.

Rick
 

Liberty

Well-known member
Location
Texas
Ok, thanks Rick for clearing that up. Was wondering, as to the best of my knowledge, have not been billed any extra for anything that I know of. Here in this area Kelsey-Seybold is a non profit that sounds like what you are talking about with Kaiser. With them though I don't think you can choose docs. May be wrong on that.

Do realize premiums are probably the main consideration for choosing one plan or another. We travel sometimes and didn't want to have any issue outside the state if something happened. Last year, went into an ER to get some steriod pills for a serious case of poison ivy, and when the doc and the PA and whoever else saw me, took my temp and gave me the pills there was no charge...the check out lady said "you have Medicare an a Supplement".
 

Butterfly

Well-known member
I too had hip replacement surgery. Two hips - two surgeries. Fortunately I did not have to wait long - maybe 7-10 days. Can you imagine waiting 6 months to a year for approval? Or never getting approval?

So many in Europe just take medication and use a cane because they can't get care.

We're lucky to live in America.

Rick
I got approval right away. The wait was about the doctor's backlog and the wait for the operating room. This area has a great number of older people, and joint replacements are a very common thing. I'm not complaining -- I understand it would probably be worse elsewhere. I was just expressing that we do sometimes have to wait here, also, though certainly not as long as some places do.

I am extremely happy with the results of my hip replacements and of the care I received.
 

mathjak107

Well-known member
Kaiser has an excellent reputation in advantage plans ...they are the only advantage plan I would ever consider .... advantage plans are never a problem until they are a problem ....Kaiser seems to be one of the few I would ever use ...I will only use good ole not for profit government Medicare and a supplement since Kaiser is not in my state ...which shows the problem right there ....

I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.

In theory they are supposed to pay for the things medicare covers but that is a very grey area ... when it comes down to procedures and course of action you can’t prove what Medicare would have paid for in your exact situation since you don’t have Medicare to prove what they would have allowed in your case and the insurers know this and have you over a barrel... they can aye or nay treatment plans solely from a cost standpoint...they did this to a friend of mine .

They had pituitary gland cancer ... the for profit advantage plan refused to pay for both halves to be removed even though the other half was in poor shape ...her surgeons argued this is always allowed by Medicare .they always pay to have both sides done ...but since she has an advantage plan and not government Medicare there is no way to show Medicare would have approved both sides ...so now she needs to wait until the other half has cancer ....just ridiculous......so this is where those cheaper advantage plans can come back and bite you hard
 
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I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.
Amen to that! I wouldn't touch a Medicare Advantage Plan with a 10 foot pole. I have Traditional Medicare as my primary and the BCBS PPO plan that I had when I was working as secondary. I'm covered in all 50 states. And since my BCBS secondary is a group plan I'm not hanging out there all on my lonesome at the mercy of some private insurance company. It's expensive, but I have access to medical care that is almost as good as what I would have as a Canadian for free. That's pretty good for someone living in the Land Of The Free and Home Of The Brave.
 

GreenSky

Active member
Location
Las Vegas
Original Poster
Kaiser has an excellent reputation in advantage plans ...they are the only advantage plan I would ever consider .... advantage plans are never a problem until they are a problem ....Kaiser seems to be one of the few I would ever use ...I will only use good ole not for profit government Medicare and a supplement since Kaiser is not in my state ...which shows the problem right there ....

I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.

In theory they are supposed to pay for the things medicare covers but that is a very grey area ... when it comes down to procedures and course of action you can’t prove what Medicare would have paid for in your exact situation since you don’t have Medicare to prove what they would have allowed in your case and the insurers know this and have you over a barrel... they can aye or nay treatment plans solely from a cost standpoint...they did this to a friend of mine .

They had pituitary gland cancer ... the for profit advantage plan refused to pay for both halves to be removed even though the other half was in poor shape ...her surgeons argued this is always allowed by Medicare .they always pay to have both sides done ...but since she has an advantage plan and not government Medicare there is no way to show Medicare would have approved both sides ...so now she needs to wait until the other half has cancer ....just ridiculous......so this is where those cheaper advantage plans can come back and bite you hard
Kaiser is one of very few plans that are both the insurance company and the medical group. They do indeed have a good reputation and many people I know are happy with them (in California). But every advantage plan - as you wrote - are not a problem until they are a problem.

Friend of a friend had stomach cancer while a Kaiser member. They would do the surgery the traditional way by "gutting" him to remove the cancer. He could have gone to the City of Hope nearby who would do it using a laparoscopic procedure with only a few small punctures. But he had Kaiser.

Again, not knocking Kaiser or any other HMO specifically but if you want the best options nothing beats Original Medicare and a supplement.

Rick
 

Liberty

Well-known member
Location
Texas
GreenSky...is your friend ok? That is so sad to have to suffer more when it could have been avoided. The way I understand it, when joining, you sign over or give your traditional medicare rights to the "managed care provider" who is then empowered to decide if, when and how a treatment will be done and sometimes if it was under medicare it could and would be under different treatment guidelines. Right? Yikes!
 

GreenSky

Active member
Location
Las Vegas
Original Poster
GreenSky...is your friend ok? That is so sad to have to suffer more when it could have been avoided. The way I understand it, when joining, you sign over or give your traditional medicare rights to the "managed care provider" who is then empowered to decide if, when and how a treatment will be done and sometimes if it was under medicare it could and would be under different treatment guidelines. Right? Yikes!
Your understanding is correct. You still are a Medicare beneficiary but your medical is handled 100% by the HMO. I never want anyone to feel that Medicare Advantage is an "evil" option. It is what it is. You are allowing a medical group to make all your healthcare decisions. And it is NOT important if the HMO is for profit or not for profit. They all must spend less than they take in like any business.

All HMO plans must cover at least what Medicare will cover. However they can determine the treatment and cost to the member. Many HMO companies have been and are still merging. And some have purchased large medical groups. Personally I want my doctor and the insurance company to be separate.

My doctor came from an HMO background and still primarily sees HMO patients. She believes in making all the decisions for me. I want to be free to decide my medical fate and see whomever I choose. I've had a nice conversation with her and suggested recommendations are fine. I'll ask for a referral if I decide I want one.

I had hernia surgery two weeks ago. I did not opt for the surgeon my doctor had call me. (Yes, rather than asking she made the decision). I was able to choose one of the very few in Las Vegas, an area known for really terrible medical care, that uses a robotic procedure. 13 days after I played 18 holes of golf. I made the right choice.

As far as the man with stomach cancer, he is a friend of a friend so I don't know his fate.

Rick
 

mathjak107

Well-known member
never forget with an advantage plan your gate keeper for healthcare is a for profit insurer vs non profit gov't medicare ...there can be a big difference in your treatment path between the two and what they approve ... advantage plan insurers know they are in the drivers seat since while they are expected to approve the same things medicare does , you don't have gov't medicare to even know what they would do in your case ...so they got ya .
 

Ken N Tx

Older than Dirt !
Location
Texas
never forget with an advantage plan your gate keeper for healthcare is a for profit insurer vs non profit gov't medicare ...there can be a big difference in your treatment path between the two and what they approve ... advantage plan insurers know they are in the drivers seat since while they are expected to approve the same things medicare does , you don't have gov't medicare to even know what they would do in your case ...so they got ya .
Ditto...I would never sign away my Medicare!!!
 

mathjak107

Well-known member
like i say , with advantage plans nothing is ever a problem -until it's a problem . some are lucky and never hit problems , others wish they never gave up not taking medicare and a supplement. personally i would never go advantage plan as long as i could afford it .. we use medicare and a high deductible f-plan .
 

Liberty

Well-known member
Location
Texas
like i say , with advantage plans nothing is ever a problem -until it's a problem . some are lucky and never hit problems , others wish they never gave up not taking medicare and a supplement. personally i would never go advantage plan as long as i could afford it .. we use medicare and a high deductible f-plan .
So agree, mathjak...we have plan "G". Thinking if you went on an advantage plan and then wanted to get out of it - would probably be hard to get out.
 

mathjak107

Well-known member
it could be hard , but not here in ny ... we pay more for everything but we can switch with no medical underwriting . but only at enrollment time . get sick in between and you are stuck
 
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terry123

Well-known member
Location
Houston, Tx.
I do have an insurance license for TX along with about 12-15 other states. But regardless I'm happy to help everyone save money. I hate to subsidize insurance companies with high premiums.

BTW, I just read an article pointing out that statins are basically worthless. I've had this feeling for years. But then again, I'm not a doctor.

Rick
Rick, are you licensed in Florida?
 

Liberty

Well-known member
Location
Texas
GreenSky...have heard that Florida and various states charge higher prices for medicare supplements. Is that true? I'm guessing they are state regulated or priced?
 

mathjak107

Well-known member
GreenSky...have heard that Florida and various states charge higher prices for medicare supplements. Is that true? I'm guessing they are state regulated or priced?
All states and locations are different....some like New York is community based and we are not charged by age ...we can also switch plans with no medical underwriting.. but we pay more then age based states where you are increased over time by age ..as an example an f-plan can be about 330 a month .....we pay 92 a month for a high deductible f-plan ....we have a 2200 deductible but since we only have about 300 a year in deductibles on the supplement we save a lot ...they also pay the 40 a month for my gym through silver sneakers so we pay very little
 

GreenSky

Active member
Location
Las Vegas
Original Poster
GreenSky...have heard that Florida and various states charge higher prices for medicare supplements. Is that true? I'm guessing they are state regulated or priced?
The reply above is correct. Every state is different. Prices in NY are indeed high because they have the same rate regardless of age and there are no medical questions. If you want low rates move to Oklahoma!

Florida is indeed expensive because so many of us have moved there (I chose Nevada instead). However it is always worth shopping coverage. The company that was well priced at age 65 might be a complete rip-off by age 70. It takes about 3 minutes to check.

Rick
 

Liberty

Well-known member
Location
Texas
The reply above is correct. Every state is different. Prices in NY are indeed high because they have the same rate regardless of age and there are no medical questions. If you want low rates move to Oklahoma!

Florida is indeed expensive because so many of us have moved there (I chose Nevada instead). However it is always worth shopping coverage. The company that was well priced at age 65 might be a complete rip-off by age 70. It takes about 3 minutes to check.

Rick
Very good advice. Another thing to think about if you are moving to another state. Are the variances large or just a few bucks a month?
Also, have heard that you are either accepted or not by the companies...rates are the same no matter what the health condition range might be...that there aren't varying rates within the "acceptance factor"?
 

GreenSky

Active member
Location
Las Vegas
Original Poster
Very good advice. Another thing to think about if you are moving to another state. Are the variances large or just a few bucks a month?
Also, have heard that you are either accepted or not by the companies...rates are the same no matter what the health condition range might be...that there aren't varying rates within the "acceptance factor"?
Moving may not affect the rate. Many companies keep you with the rate you pay in the former state. I had a client in CA that moved to TX. Her rate should have dropped 20% but she was kept at the higher CA rate. (It would have worked the other way also if she moved from a lower rate state to a higher rate state). If she was healthy I could have moved her.

Some companies notably United Healthcare (via AARP) have the ability to issue at a higher rate if health conditions are poor but that kind of thing is the exception rather than the rule. Most companies either accept or don't.

Rick
 


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