I hate health care plan selection season.

It's health care plan selection season til Dec. 7th (?). If your not on Medicare, you will be, so be prepared for feeling like prey, by roving bands of insurance companies. My mail box is filled with thick envelopes telling me how much an insurance company loves me, and all the money it'll save me. Every commercial on TV will be kind, caring insurance companies, going bankrupt by saving me all that money. They drive a truck up to your house, and just shovel cash at you. But there's one health care plan commercial, I can't stand. It's the one where seniors start dancing when they sign up for a plan. Talk about nausea.
 

Knight

Senior Member
We stream commercial free T V. Caller ID on our phones if we don't recognize the number we don't answer & add it to call blocking. Our plan suits our needs so all the paper ads are put in the recycle bin. No program delays due to adds & we're helping the environment by recycling.
 

hawkdon

New Member
Something that gets me also, just now had robocall "live" and could hear a bunch of kids carrying on then the lady came on and gave me a pitch about hearing aids......it's so unprofessional to
have the kids hollering in the background if you are trying to
make a living.....imo.....:(
 

Don M.

Well-known Member
Location
central Missouri
It looks like the "health" spam has even invaded this forum....there are a couple of new members who are wanting to share their "secrets" for better health and weight loss.

I was pleasantly surprised earlier when I looked at our health care options, and found that our current Advantage plan is going Down $5 a month, and another very similar is only about half our current premiums. That's rather unexpected, given all the expenses this virus has created. I'll be doing some serious research in coming days.
 

Aunt Bea

SF VIP
Location
Near Mount Pilot
It annoys me when the insurance companies try to make the basic Medicare benefits sound like additional benefits that are coming directly from them and not from Medicare.

Most of it is just smoke and mirrors but it does indicate what a cash cow we all must be to the insurance companies if they are fighting so hard to manage our Medicare benefits on behalf of the government.

For me, it boils down to finding the insurance company with the best customer service and a fair/reasonable system for authorizing treatment and approving claims.
 

Liberty

Well-known Member
Location
Texas
It annoys me when the insurance companies try to make the basic Medicare benefits sound like additional benefits that are coming directly from them and not from Medicare.

Most of it is just smoke and mirrors but it does indicate what a cash cow we all must be to the insurance companies if they are fighting so hard to manage our Medicare benefits on behalf of the government.

For me, it boils down to finding the insurance company with the best customer service and a fair/reasonable system for authorizing treatment and approving claims.
Yep, for us its about going to what doctor (specialists) we choose without the in or out of network crap and no referrals. You don't have insurance for what's not happening...you have it for what MAY happen.
 

Mairett

New Member
Location
USA
This is my first year choosing a plan. I use to never pay attention to all the commercials etc. But now, I have been studying all the plans and trying to figure it all out.
 

Liberty

Well-known Member
Location
Texas
This is my first year choosing a plan. I use to never pay attention to all the commercials etc. But now, I have been studying all the plans and trying to figure it all out.
Basically, the plans advertising big time now during what is called the "open enrollment time" are "Advantage plans"...which are "managed care". You go to their doctors (usually) and go by their "managed care" rules and regulations. Advantage plans "care"are not not always an even match with "medicare" care so just be viligent. Medicare is true medicare, managed care is what it says it is.

They always say they are less expensive than having a supplement. Do your homework and then you'll be an Einstein on senior medical care plans...lol.
Read the fine print and do realize prices can increase no matter what plan you opt for. One size definitely doesn't fit all.

We have medicare supplement plan "G". Not an Advantage plan, but a standard "Medicare Supplement." We go to any doctor, specialists included and everything is paid for except the standard $184 yearly deductible. We've had it for many years and are happy. Our cardiologist is our primary physician...lol.
 

OneEyedDiva

Well-known Member
Location
Nrw Jersey
I just called Americare and United Healthcare to tell them to take me off their mailing list. One of them they are sending stuff in my former name and current name. I have one more company to call....Well Care.
 

hiraeth2018

Member
Location
Oregon
I know it didn't used to be this complicated... I remember when my mom retired, her choice was just signing up for medicare period. Good or bad, I agree the choices in the insurance market can be overwhelming to wade through. I recently moved to a small beach side community but in the same state. Finding a doctor here in this small town who is currently taking medicare patients is close to zero. My current doctor (previous move) told me he wouldn't have taken me if I was a new medicare patient... but since I have been going to him for the last 15 years he wouldn't drop me. So... I drive 2 hours for a check up. Doesn't seem fair but there it is.
 

Liberty

Well-known Member
Location
Texas
I know it didn't used to be this complicated... I remember when my mom retired, her choice was just signing up for medicare period. Good or bad, I agree the choices in the insurance market can be overwhelming to wade through. I recently moved to a small beach side community but in the same state. Finding a doctor here in this small town who is currently taking medicare patients is close to zero. My current doctor (previous move) told me he wouldn't have taken me if I was a new medicare patient... but since I have been going to him for the last 15 years he wouldn't drop me. So... I drive 2 hours for a check up. Doesn't seem fair but there it is.
That's interesting about docs that won't take medicare patients. I've never heard of any in this area that won't. If you have medicare and a supplement the docs are usually all over you like "white on rice"...lol.
 

Aneeda72

Well-known Member
Something that gets me also, just now had robocall "live" and could hear a bunch of kids carrying on then the lady came on and gave me a pitch about hearing aids......it's so unprofessional to
have the kids hollering in the background if you are trying to
make a living.....imo.....:(
It’s the work at home generation, and lots of schools are still closed. It’s not any more unprofessional than my husband’s clients hearing me playing WOW in the background. @hawkdon after all it’s not like the kids can be dropped off at the library, which in our area is still not opened. It’s not like I’m going to stop playing WOW. 😂
 

hiraeth2018

Member
Location
Oregon
That's interesting about docs that won't take medicare patients. I've never heard of any in this area that won't. If you have medicare and a supplement the docs are usually all over you like "white on rice"...lol.
Interesting... I can only guess here but the doctor and hospital fees that are charged here in the NW are probably way above what medicare will pay for. Therefore in their minds there are too many other options to get their money.
 

Liberty

Well-known Member
Location
Texas
Interesting... I can only guess here but the doctor and hospital fees that are charged here in the NW are probably way above what medicare will pay for. Therefore in their minds there are too many other options to get their money.
Well, the doctors will bill the supplement plans for the excess, so it shouldn't just be about medicare only. I know one dermatologist that has a sign that says "patient will be billed for 20% of charges if no medicare supplement is provided." The supplement pays the 20% normally.
 

Autumn

Member
Location
Boston
I live in MA and I have an excellent advantage plan that I'm very happy with. Last year, my surrogate brother, who lives in Maine, retired and asked me to help him choose a plan. It was an education for me. I never realized that there were significant differences between plans in different states. He had fewer options, and I really struggled to get him the best deal possible. I worked in a doctor's office for many years and was very familiar with health insurance, but I was shocked at how deceptive some of these companies can be. Choosing health insurance shouldn't be as stressful as it is, and all of the companies bombarding us with ads don't help at all.
 

Liberty

Well-known Member
Location
Texas
I live in MA and I have an excellent advantage plan that I'm very happy with. Last year, my surrogate brother, who lives in Maine, retired and asked me to help him choose a plan. It was an education for me. I never realized that there were significant differences between plans in different states. He had fewer options, and I really struggled to get him the best deal possible. I worked in a doctor's office for many years and was very familiar with health insurance, but I was shocked at how deceptive some of these companies can be. Choosing health insurance shouldn't be as stressful as it is, and all of the companies bombarding us with ads don't help at all.
Well, the main difference it whether you will have Medicare and a supplement or "managed care". Under Managed Care you may or may not get the same level of care as Medicare and usually can't see your preferred specialists. Can be fine unless you happen to fall in a crack sometime like I've heard from some that really had issues.
 
When I went on Medicare, I was forced by my former employer to take the "traditional" Part A & B so they would pay for my prescription plan. The advantage plans sound enticing, but I am concrned that if I change, then I'll be placed on another prescription plan for which I would have to pay. I also am dubious about talking to these companies that say they will find the best plan for you. You probably have to disclose a lot of personal information to them. Who knows what hey do with it?
 
Well, the main difference it whether you will have Medicare and a supplement or "managed care". Under Managed Care you may or may not get the same level of care as Medicare and usually can't see your preferred specialists. Can be fine unless you happen to fall in a crack sometime like I've heard from some that really had issues.
Actually, by law, the Advantage plans are required to provide the same level of care as Medicare. They can provide more, but not less.

The seeing specialists largely depends on where you are and how many specialists will accept the advantage plan. Where I live, the selection of specialists includes most of the specialists in Albuquerque, so I can get a referral to pretty much whomever I want. I've had my Advantage plan for going on 8 years and am delighted with it as is my sister, who has the same plan. She has complex medical issues and sees a bunch of specialists and has been happy with the care she's received. We get the same care from specialists as do their other patients who are not on our Advantage plan.
 

Liberty

Well-known Member
Location
Texas
Actually, by law, the Advantage plans are required to provide the same level of care as Medicare. They can provide more, but not less.

The seeing specialists largely depends on where you are and how many specialists will accept the advantage plan. Where I live, the selection of specialists includes most of the specialists in Albuquerque, so I can get a referral to pretty much whomever I want. I've had my Advantage plan for going on 8 years and am delighted with it as is my sister, who has the same plan. She has complex medical issues and sees a bunch of specialists and has been happy with the care she's received. We get the same care from specialists as do their other patients who are not on our Advantage plan.
Don't think that's always true Butterfly. Have heard bad things about some "managed care" plans. My broker's mom almost died and that's why he won't even write an Advantage policy even though they pay him over $500 to do it. He gets much less to write a supplement policy. Some on this forum have shared stories.

Think it depends on whether you fall through a crack or not. Obviously you have a plan you are happy with and hopefully will never have a situation arise. Hope you'll always be happy with the doctors and not have to deal with any questionable issues. Plans are different and administration is "Managed Care" not supplement plus Medicare. That's the big difference.

Excerpt from the link below:

Primary Care Physician Funnel
Another way plans strive to reduce costs is to require that all care be funneled through a primary care physician. This doctor makes all decisions about whether or not to refer you to a specialist. You cannot make an appointment with a specialist on your own. The primary care physician is strongly encouraged to take care of all medical problems and refer you to a specialist only when absolutely necessary. Medicare does require, however, that Medicare Advantage plans allow patients with serious conditions, such as heart disease, kidney failure, and cancer, to see specialists without referrals from their primary care physicians. Also, routine preventive women’s health care screening must be available without a referral.

For many, managed care’s most disagreeable cost-cutting strategy is the common requirement that your primary care physician obtains the plan’s approval before you can receive certain medical services. If the plan administrators disagree with your physician that a procedure is medically necessary, the plan may refuse to pay for it. Plans also attempt to reduce costs by allowing their members shorter periods of hospital and nursing home care than Medicare beneficiaries generally receive. In addition, managed care plans provide fewer rehabilitative services like home health care and outpatient therapies than does traditional Medicare. Not all managed care plans are so restrictive, but the less restrictive plans are more expensive. Some offer what’s known as a “point of service” option that allows you to see physicians or other providers that are not in their network. If you go outside of the network, however, you will pay a higher portion of the bill than if you saw an in-network physician.

In addition, a report by the Medicare Rights Center finds that Medicare Advantage plans have serious disadvantages over original Medicare. The report, based on thousands of beneficiary calls to the Medicare Rights Center, lists nine common problems with Medicare Advantage plans, including problems getting emergency or urgent care, problems getting care while away from home, and problems getting a continuity of care. To read more about the report, click here.

https://reedwilsoncase.com/medicare-advantage-plans-the-good-the-bad-and-the-ugly/
 
By law, Advantage plans must offer the same coverage as original Medicare. Check at Medicare.gov for comparisons between Advantage plans and original Medicare, and what the law requires of Advantage plans.

I have also heard some stories about people's struggles with original Medicare. Many people also believe Medicare covers everything, but it does not.

Advantage plans are a good fit for many people. You have to carefully research whether or not a plan will work for you, but to label all Advantage plans as bad is not realistic or accurate. And, of course all Advantage plans are not the same in how they deal with the people covered by them, providers, etc. Some are excellent, some are not. And, Advantage plans can be a very good choice for those who cannot afford a supplement, because original Medicare can leave you with big bills because Medicare doesn't cover all the cost of medical care, but only a percentage (usually it's 80/20).

I had both hips replaced under my Advantage plan for a total out of pocket of just shy of $1,000, by the surgeon of my choice (arguably the best in my area) and at the hospital of my choice (the best in the area) with a private room. I would have paid a heck of a lot more than that with either original Medicare, or by paying the cost of a supplement. My sister, under the same plan, consistently gets excellent care from cardiologists, pulmonary specialists and hematologists in addition to having one of her hips replaced, as well.

Advantage plans are not intrinsically bad, and are a great choice for many.
 

Liberty

Well-known Member
Location
Texas
By law, Advantage plans must offer the same coverage as original Medicare. Check at Medicare.gov for comparisons between Advantage plans and original Medicare, and what the law requires of Advantage plans.

I have also heard some stories about people's struggles with original Medicare. Many people also believe Medicare covers everything, but it does not.

Advantage plans are a good fit for many people. You have to carefully research whether or not a plan will work for you, but to label all Advantage plans as bad is not realistic or accurate. And, of course all Advantage plans are not the same in how they deal with the people covered by them, providers, etc. Some are excellent, some are not. And, Advantage plans can be a very good choice for those who cannot afford a supplement, because original Medicare can leave you with big bills because Medicare doesn't cover all the cost of medical care, but only a percentage (usually it's 80/20).

I had both hips replaced under my Advantage plan for a total out of pocket of just shy of $1,000, by the surgeon of my choice (arguably the best in my area) and at the hospital of my choice (the best in the area) with a private room. I would have paid a heck of a lot more than that with either original Medicare, or by paying the cost of a supplement. My sister, under the same plan, consistently gets excellent care from cardiologists, pulmonary specialists and hematologists in addition to having one of her hips replaced, as well.

Advantage plans are not intrinsically bad, and are a great choice for many.
Sounds like you have an exceptional Advantage plan. Good for you, is it a "non profit" one?

Think most folks really have to do their homework on the plans to be sure before getting involved.

Luckily our supplements aren't expensive and we have unlimited choice of top docs with zip out of pocket costs. That's what we like, but agree if finances were an issue then we might have to look at them. Hey, 5 star Kelsey Seybold is right down the road. Good to know just in case we'd ever have to. Glad you have a good one, Butterfly. One less big thing to be concerned about!
 


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