Medicare Advantage Plan (MA)

Nathan said:
I'm thinking that Medicare Advantage is the same as what I'm paying Kaiser-Permanente $16/mo. for. Kaiser's Senior Advantage Plus provides vision, hearing,dental and fitness membership.
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Is this available to only California residents?
 

Been There said:
I don’t understand all of this because I retired from the Marines after 30 years, so I have pretty good benefits.

I’m guessing that “medigap” is supplemental? Can any civilian buy these plans or what are the rules?
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Anyone with govt medicare can buy a medigap supplement.. there are different letter plans with different levels of deductibles and out of pockets
 
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mathjak107 said:
The best example of how nothing is a problem with an advantage plan until it’s a problem was my co worker .

she used to brag how little her advantage plan cost compared to govt medicare and a supplement .

she got pituitary gland cancer .

one side was cancerous and the other side not in good shape .

her doctors wanted to remove both halves …her insurer denied both halves .

her doctor argued that Medicare always pays for both sides .

they rejected the request and said don’t tell us what medicare would have allowed ,your patient does not have Medicare .

needless to say she has been living with a time bomb which is turning worse and worse while she waits .

these are the kinds of issues one can have when a for profit insurance company is in the drivers seat as opposed to not for profit medicare.

don’t believe for a second that you have the same coverage , that is only in a non personal way speaking broadly , not individual circumstances.

i consider advantage plans the ANNUITY of healthcare , in that like annuities they have to be pushed and sold .

we see endless commercials and get mailers for them all the time . I can’t tell you the last medicare supplement commercial I have seen …only advantage plans are pushed on you.

ask yourself why that is
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Way to go! Just let Uncle Sam make all the decisions. He and our current crop of elected officials are so wonderful and so god like! Aren't we all blessed that government has all the correct answers to every problem. Except the problems continue to grow and GROW!! Beam me up Scotty!!
 
Seems whenever something that worked becomes "privatized", we end up getting less, and insurance, drug, power company's, etc. get richer. Call me pessimistic, but none of this bodes well for the average American over the long run. Insidious profit creep will surely raise it's ugly head in short order.
 
Why is it that people think the government can fix everything. Look around folks, everything and I mean everything your criminal government touches turns into a worst disaster. Nearly $100 billion dollars or MORE since 1964 and Lyndon Johnson's Great Society Plan to end poverty and in San Francisco alone, we have 150 continuous blocks of homeless living on the street. Right!! Government is the answer. Some folks are stuck in stupid - and you can not fix stupid
 
We have & have had MA for several years. No co pay for yearly eye exams but there was a $50.00 co pay for cataract removal. No cost fitness center membership. This year 2 teeth cleanings & one crown no copay. No copay for primary care or specialists. $75.00 a quarter for med supplies. My spinal surgery 4 years ago zero out of pocket cost.
Most recent was xray for lower back pain, found a growth on my renal gland so ongoing CT scans to monitor for growth zero copay. Part D for meds so $6.00 copay for my 90 day supply for cholesterol isn't a budget buster. So MA works for us.
 
A change in that $75.00 a quarter for med supplies. This year it went to $105.00. Surprising how difficult it is to use the combined $210.00 a quarter to buy supplies.
 
Been There said:
I don’t understand all of this because I retired from the Marines after 30 years, so I have pretty good benefits.

I’m guessing that “medigap” is supplemental? Can any civilian buy these plans or what are the rules?
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These go with Medicare ….as opposed to advantage plans where you don’t have not for profit govt Medicare but a private for profit insurer administering your coverage .
 
oldmontana said:
What is the problem with a profit?
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Well like my co worker found out , having a gate keeper who needs to watch every penny they allow spent is very different then govt Medicare which is not for profit .

time and time again , people get denied procedures by private insurers who wont approve things Medicare always approves when it comes to specific treatments allowed .

and the insurers know you or your doctors can’t tell them in your specific case what govt Medicare would have allowed , since they know you don’t have govt Medicare.

my co worker lover her cheaper advantage plan ..

well that was untilshe got pituitary gland cancer .

her doctors wanted to removed the cancerous side as well as the other half which wasn’t in great shape .

her for profit insurer said they would only approve the cancerous side .

her doctors argued that Medicare always approves both sides , they don’t wait until she gets cancer again .

the insurers answer was you can’t tell us what Medicare would have done in this particular case since your patient does not have Medicare .

stories like this repeat again and again as private insurers deny and deny .

if one is lucky they won’t run in to this with their plan but as long as I can afford govt Medicare I am not rolling the dice with some for profit private insurer
 
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rwb said:
Why is it that people think the government can fix everything. Look around folks, everything and I mean everything your criminal government touches turns into a worst disaster. Nearly $100 billion dollars or MORE since 1964 and Lyndon Johnson's Great Society Plan to end poverty and in San Francisco alone, we have 150 continuous blocks of homeless living on the street. Right!! Government is the answer. Some folks are stuck in stupid - and you can not fix stupid
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I don't think government can fix everything, they make everything worse that they stick their nose in. But guess what, the reason the advantage plans give so much is because the government heavily subsidizes them. It's an attempt to privatize insurance for seniors but from what I understand it is costing the government (aka the taxpayers) more per person when they are healthy. Many of these insurance companies, just like some people, salivate over free money from the government. Many, not all, even commit fraud to increase the free money.

Traditional medicare leaves most of the decisions for your care up to you and your doctor. But you can't call the MA programs "privatized" if the government is funding them. Both MA and traditional medicare are government programs. Just with MA there is one more hand in the pot. MA works for a lot of people and as long as the government pours money into them they will probably be a good deal for most but I'm starting with a high deductible G plan when I turn 65 in March and see how that goes before considering a MA plan.
 
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Insurance brokers recommend advantage plans and people take them not really understanding what will happen if they get really sick. A few of my friends who are very smart people fell for this. Now they can’t pass medical underwriting and are stuck.
 
mathjak107 said:
Well like my co worker found out , having a gate keeper who needs to watch every penny they allow spent is very different then govt Medicare which is not for profit .

time and time again , people get denied procedures by private insurers who wont approve things Medicare always approves when it comes to specific treatments allowed .

and the insurers know you or your doctors can’t tell them in your specific case what govt Medicare would have allowed , since they know you don’t have govt Medicare.

my co worker lover her cheaper advantage plan ..

well that was untilshe got pituitary gland cancer .

her doctors wanted to removed the cancerous side as well as the other half which wasn’t in great shape .

her for profit insurer said they would only approve the cancerous side .

her doctors argued that Medicare always approves both sides , they don’t wait until she gets cancer again .

the insurers answer was you can’t tell us what Medicare would have done in this particular case since your patient does not have Medicare .

stories like this repeat again and again as private insurers deny and deny .

if one is lucky they won’t run in to this with their plan but as long as I can afford govt Medicare I am not rolling the dice with some for profit private insurer
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if one is lucky they won’t run in to this with their plan but as long as I can afford govt Medicare I am not rolling the dice with some for profit private insurer

Not rolling the dice like you say. One must make sure that their doctors and hospitals are in the in network. All of ours are in network.

My wife went to the emergency room. Cost $90, bill $3,876.87. If she just had medicare I believe she would have had to pay 20% of the $3,876.87 .. $775.387.
 
oldmontana said:
if one is lucky they won’t run in to this with their plan but as long as I can afford govt Medicare I am not rolling the dice with some for profit private insurer

Not rolling the dice like you say. One must make sure that their doctors and hospitals are in the in network. All of ours are in network.

My wife went to the emergency room. Cost $90, bill $3,876.87. If she just had medicare I believe she would have had to pay 20% of the $3,876.87 .. $775.387.
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You don’t understand the fact they can deny you procedures and treatments if they chose to
You just haven’t hit anything controversial YET
 
Teacher Terry said:
Insurance brokers recommend advantage plans and people take them not really understanding what will happen if they get really sick. A few of my friends who are very smart people fell for this. Now they can’t pass medical underwriting and are stuck.
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My buddy used to brag all the time about how little he paid for his advantage plan and how every thing was covered

well that was until his wife got breast cancer. The chemo was 4500 dollars out of pocket

plus she got it later in the year When the new year rolled it was another 4500 in out of pockets. Plus he had all his own stuff

needless to say he was lucky because New York is one if the few states that allows one to switch to Medicare at open enrollment with no underwriting. He ditched the advantage plan and learned his lesson
 
Actually what scares me is that the government would like to have everyone on these plans. It will solve financial problems by getting rid of the older sicker people before their time. Think of all the money saved in SS and Medicare.

I received a letter saying that my doctor’s practice has joined an Enhanced Medicare Benefits and you can voluntarily join to have them manage all your care. That’s a precursor to being forced. I will be very careful what I sign when I go for my yearly checkup.
 
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Teacher Terry said:
Actually what scares me is that the government would like to have everyone on these plans. It will solve financial problems by getting rid of the older sicker people before their time. Think of all the money saved in SS and Medicare.

I received a letter saying that my doctor’s practice has joined a (CME) ? and you can voluntarily join to have them manage all your care. That’s a precursor to being forced. I will be very careful what I sign when I go for my yearly checkup.
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There is a reason these are pushed on television. Govt Medicare is far more allowing in doing procedures which are in the patients interest not the shareholders
 
Mathjak, I looked it up and they are calling it Enhanced Medicare Benefits. I think it will turn out to be anything but.
 
Teacher Terry said:
Mathjak, I looked it up and they are calling it Enhanced Medicare Benefits. I think it will turn out to be anything but.
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Anytime there is profit involved and especially shareholders. Run

they will look to deny whatever they can even if it’s not in your best interest

we have govt Medicare and a high deductible F plan. We love it
Both my wife and I were hospitalized for weeks with Covid two years ago

our bill was 250k. We paid about 1k and that was for ambulances back and forth
 

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