Doctors talk about the impact of Medicare Advantage plans

Medical providers are not at all happy with Managed Care and Advantage plans. Reimbursements are low and take forever, there's a ton of paperwork they have to do for each patient, each visit, and every prescription and treatment, protocols are confusing and sometimes ambiguous, there are frequent billing issues, and denials are common.
 

OldFeller said:
I opted for traditional Medicare because Medicare Advantage just struck me as if it would be giving private insurance companies too much control over medical decisions.
Click to expand...
I avoided Medicare Advantage because I'd had Kaiser Permanente for 10 years in my late 20s/early 30s and they'd seemed great while I didn't need anything unusual, but as soon as I had non-standard issues they failed me in various ways (such as, using 'experts' that were notorious for denial of care; having very subpar doctors; too long wait to see specialists; administrative gatekeepers that prevented seeing doctors that had told me to come in). I've never trusted managed care since then.
 
Nathan said:
I've been with Kaiser Permanente for over 45 years and have had decent care, so when I went on Medicare I made them my Senior Advantage Plus choice.
Click to expand...
I chose a zero dollar Blue Cross Blue Shield advantage plan for the same reason.

In five years I’ve only had one decline that was eventually handled as durable equipment instead of prescriptions.

There is no free ride under Medicare Advantage over traditional Medicare.

Medicare advantage plans have copays and a maximum out of pocket while traditional Medicare has monthly insurance premiums.

At this point, after five years, I’m money ahead using a zero dollar advantage plan but that could change quickly in the years to come.

Understand the rules and reevaluate your situation each year during open enrollment.
 
OldFeller said:
I just retired this year 2024. I opted for traditional Medicare because Medicare Advantage just struck me as if it would be giving private insurance companies too much control over medical decisions. It seems my instincts were right.

Click to expand...
I agree with your thinking about this issue, but I have Medicare Advantage now. I had Medicare and Medigap, but I've been retired longer than you, and premiums on the Medigap policy rose significantly each year, until they became unmanageable.

In the small town where I live, all the doctors take my Advantage plan, and there are a lot of seniors who live here, so I don't see that changing. In other words, I'll get the same care regardless.

However, I do recognize that if I need the care of a specialist outside my area, that I would be restricted to my choice of doctors, and subjected to pre-authorization requirements of the plan. It's a chance I take.

All those factors play into making a decision on which route to go.
 
Medicare parts A&B alone are pretty much useless.

I've got a part C plan that serves my needs well enough.
 
I was with Kaiser for years and liked them until about six years ago. The one in my area seemed short of staff and the check-in window would be closed and patients were directed to some odd department to check in. There was one doctor who gave my son bad advice so we made other arrangements (mostly to support my son). Now I am questioning my current doctor. I have Medicare advantage.
 
MA plans take different forms. There are HMOs and PPOs, and perhaps even other arrangements.

I'm not sure where this weird bias against MA comes from, but it never seems to take long before somebody starts another benighted anti-MA thread here. Maybe there are just some really bad MA plans out there in some States? Maybe some people cheap out and choose rock bottom plans?
 
dilettante said:
MA plans take different forms. There are HMOs and PPOs, and perhaps even other arrangements.

I'm not sure where this weird bias against MA comes from, but it never seems to take long before somebody starts another benighted anti-MA thread here. Maybe there are just some really bad MA plans out there in some States? Maybe some people cheap out and choose rock bottom plans?
Click to expand...
I know, right?!?!
My mom has had MA for ages with ZERO problems. Even with cancer and rehab.
DH and I have MA and have NO issues. Even when I needed specialty surgery out of state.

I do believe that many speaking out against it have never had a MA plan, and everything is hearsay.
 
dilettante said:
MA plans take different forms. There are HMOs and PPOs, and perhaps even other arrangements.

I'm not sure where this weird bias against MA comes from, but it never seems to take long before somebody starts another benighted anti-MA thread here. Maybe there are just some really bad MA plans out there in some States? Maybe some people cheap out and choose rock bottom plans?
Click to expand...

I think it has to do with the mistrust of some who want to privatize everything.
 
Been with Kaiser HMO for decades now. Tried Blue Shield PPO plan once but it was awful in our area - no doctors (we tried for the ENTIRE YEAR to get a GP assigned to us and nobody was accepting new clients despite Blue Shield's "list of available doctors". We gave up and went back to Kaiser. Now have their MA plan (Senior Advantage) and it's been fine.

You have to know how to work Kaiser's system. It did get a lot more efficient when the conversion to e-records, a multi-year process, was finally completed about 5 yrs ago. Made a BIG difference for routine care. Biggest advantage of Kaiser is their own pharmacy and ER depts.

Yes, they are tougher on specialized care. But that actually worked to my advantage when I needed cataract surgery, LOL. Was told I had to go to an optician before getting approved for the opthalmology dept, but altho that was incorrect, it turned out to be a GOOD thing. I got advice from the optician that was essential to making a lens choice that worked best for me. It was an honest "here's the downside" reco that I didn't get from anyone else, even though I researched pretty thoroughly on the Web.

FYI, there's a trick to Kaiser if you're having problems getting care: Kaiser has a Member Services Department. Check the website for their 800 #, or go in person to your main local Kaiser (usually where your GP is). MSD will assign a person in their department to act as your advocate to resolve your problem.
 
I think my plan is considered an advantage plan. I've had Aetna for decades and the State of N.J. Retirement Benefits department seamlessly slid me into Aetna Medicare HMO. I loved my plan and I'm blessed to have a wonderful team of doctors. The HMO was $10 co pays for in network doctors, free labs and imaging tests, free first post surgery visits, no referrals necessary (unlike before I got on Medicare) and no paperwork to deal with. A couple of years ago I switched to their PPO, so now my copays are also $10 for out of network doctors.

Another major benefit...unlimited 35 hours a week of at home care and 120 days of nursing home care per benefit period. Benefit period starts day of admittance and if discharged, 60 days from discharge date if readmitted. I had a cardiac procedure done in 2016. I was in the hospital for a day. I didn't have to pay anything.
 
I have always had an advantage plan, and it has covered any medical issues that I have had with my heart failure and the a-fib. We have a medicare insurance agent that we have had for around the last 10 years, and he goes over the new plans each year to see which company works best for our needs.
We had United Health Care and then went to Humana , and now we have had Devoted Health for the last year. They each have the same basic coverage for everything medical, but the extra benefits package varies from company to company.
 
MrJim said:
Medicare parts A&B alone are pretty much useless.
Click to expand...
I can’t go along with that. There are a lot of gaps, but it still covers most of my charges. There is no free lunch and one must also pay for Medigap insurance.

The problem is not the insurance, but the price of medical care, especially here in the USA. One guy was billed 2400 dollars for an MRI from a hospital. He found out later he could have gone to a small radiology outfit that did such work and got the MRI done for less than the deductible he paid.
 
As more and more seniors migrate away from traditional Medicare, the cost of Medigap (Medicare supplements) which are already expensive, will necessarily rise since there will be a smaller percentage of enrollees in those plans.
 

You must log in or register to reply here.

Back
Top