Medicare Advantage Plan (MA)

PreciousDove

PreciousDove

Member
I read an article from AARP that people will choose between traditional Medicare and Medicare Advantage.
Will this effect any member here? Will you even get this?
Here's the article I read from them.

https://www.aarp.org/health/medicare-insurance/info-2022/medicare-advantage-increased-enrollment.html?cmp=EMC-DSM-NLC-OTH-DLY-247401-320001-6610574-NA-082922-TheDailyDeployments-MS5-NA-TXT-CTRL-Medicare&encparam=s2ustBOk0dz6iQoS5zcaUIHYEPDxevl0oi+BjOjfXg7ZekbscaBPbrsrkDptW6iX
 

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What will "take effect" soon? I've had Medicare Advantage for a few years. Affect anybody here? You can sign up for MA or not, up to you. With it, you'll have a good bit of coverage for vision, hearing, dental care. Without it, you pay OOP for all of it.

In addition, I get $150/quarter to use for healthy foods (fruits, veggies, even Ensure), OTC meds. That amount depends on your insurer. One of my brothers gets $90/month from his insurer.
 

Another vote for Medicare Advantage Plans. I’ve had one or another ever since
I became eligible for Medicare. They all usually have all the Medicare requirements plus frills like free gym memberships or a certain amount of OTC products.. for example.
 
PreciousDove said:
I read an article from AARP that people will choose between traditional Medicare and Medicare Advantage.
Will this effect any member here? Will you even get this?
Here's the article I read from them.

https://www.aarp.org/health/medicare-insurance/info-2022/medicare-advantage-increased-enrollment.html?cmp=EMC-DSM-NLC-OTH-DLY-247401-320001-6610574-NA-082922-TheDailyDeployments-MS5-NA-TXT-CTRL-Medicare&encparam=snior forum2ustBve answer Ok0dz6iQoS5zcaUIHYEPDxevl0oi+BjOjfXg7ZekbscaBPbrsrkDptW6iXe
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This is a senior forum and you haven't received a definitive answer from members here before now??? I personally dont consider under something like age 64 to be real seniors. Almost no one on this forum provides their ages on replies like this, so you dont know if they have or dont have Medicare coverage/knowledge. I dont trust AARP (allow 55 plus) to provide trustworthy and complete answers. Medicare can be as simple as A B C D if you let it. By "traditional Medicare" you (and AARP?) are probably referring to the collective programs known officially as Medicare A & B & D. Medicare Advantage is A DIFFERENT program known officially as Medicare C. Since Medicare B is considered insufficient coverage by nearly everyone additional coverages are available from private companies by Supplements (labeled unfortunately by letters). You cannot have both Supplements and Medicare Advantage. In simplest terms the most popular Supplement plans cost an extra $150 to $200 per month while Medicare Advantage plans often are free or nearly so. In addition the required Medicare D (D for drug) is extra cost to "traditional Medicare" as you (and AARP?) called it, while most companies that provide Medicare Advantage include Medicare D coverage in their plans. Wy pay for Supplements? - there are benefits for obtaining such coverage, especially for certain medical conditions. This is a simplified, not exhaustive answer.
 
Good explanation Ron! Personally I won’t touch anything that has the AARP label attached. Seniors, they might have originated as an advocacy org way way back, but their sole purpose now is to make money off of YOU! They offer an advantage plan in this area that isn’t even accepted by some of the major providers.
 
Geezerette said:
Good explanation Ron! Personally I won’t touch anything that has the AARP label attached. Seniors, they might have originated as an advocacy org way way back, but their sole purpose now is to make money off of YOU! They offer an advantage plan in this area that isn’t even accepted by some of the major providers.
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Thanks for you reply. I was a little fearful of being criticised for my opinion. AARP does NOT have a Medicare Advantage plan. United Health Care pays AARP a royalty fee to use the AARP name on UHC's Medicare Advantage plan. Vast numbers of people don't know that. ARRP then leapt into the market place to offer Supplement plans. I would guess they don't even own that - they collect more royalty fees from another company?

Many private insurance companies, such as Kaiser also sell Medicare Advantage Insurance.
 
I've had the Kaiser Permanente Senior Advantage HMO plan for 5+ years now and before retiring for 7 years was on a KP plan with my employer. So rolled over after going on SS, keeping the same primary doctor. Looks like it is costing me an extra $75/month ($900 annual) beyond the base Medicare fee that is deducted out of the monthly SS benefit check auto deposited in my bank. That doesn't include dental, and I currently have some kind of jaw/tooth pain I may have to pay out of pocket. KP is the most highly rated of senior medicare plans and I've been taken care of well. They have a huge relatively modern hospital in my local area with sophisticated resources.
 
I will not have a advantage plan because they are paid a flat fee to provide medical care per person. The less they spend on you the more profit for them. Plus they are allowed to make you go through a step program if you need a expensive medication or procedure. This means that they can make you try less expensive options and they must fail to move to the next step.

By the time you are eligible to get what you need you are dead or it’s too late to work. You can also have a big out of pocket amount to pay if you are hospitalized. Once you have a advantage plan you must pass medical writing to go back to regular Medicare. There’s a reason most are free.
 
Teacher Terry said:
I will not have a advantage plan because they are paid a flat fee to provide medical care per person. The less they spend on you the more profit for them. Plus they are allowed to make you go through a step program if you need a expensive medication or procedure. This means that they can make you try less expensive options and they must fail to move to the next step.

By the time you are eligible to get what you need you are dead or it’s too late to work. You can also have a big out of pocket amount to pay if you are hospitalized. Once you have a advantage plan you must pass medical writing to go back to regular Medicare. There’s a reason most are free.
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Step Therapy is for medication only, you may need prior authorization for both medical and prescriptions.
"This means that they can make you try less expensive options and they must fail to move to the next step." -There are many reasons for step therapy' money being one. Remember, it is in your best interest to use a lower cost Rx also. Lower copy and less and cost going toward the Doughnut hole.
The Hospital Copays are usually much lower then Medicare part A's and you have Maximum out of pocket limit coverage (MOOP) to protect you unlike Original Medicare.
You can go back to "Original Medicare" with no underwriting. To get a supplement again you may have to go through underwriting but this is not always the case.
They are not "Free", some are zero premium to you. You must keep paying your Medicare part B premium monthly and that money goes to the insurance company.
 
Dude, you can only go back to regular Medicare without medical underwriting for a short period of time in many states. Rules vary by state. Medicare without a supplemental plan would be very foolish to have as you would be responsible for 20% of the bills which can be substantial. I wouldn’t even consider it.

My friends with advantages plans have had to change doctors frequently, can’t see who they want, contracts have been canceled before the year is up and they have had to cancel planned surgery, etc. Another friend has been hospitalized for a few weeks in the past 3 years and ended up paying the maximum out of pocket of 10k each of those years.
 
There are HMO's Health Maintenance Organizations, and PPO's - Preferred Provider Organizations and both offer Medicare Advantage Plans. A major difference is that an HMO has a group of providers - doctors, hospitals and various medical advisors that members generally must use to obtain service. If your current medical provider is not part of the HMO you may have very limited coverage. If you do not use an HMO provider coverage may be very limited. A PPO has a large network of doctors, hospitals and medical provides, often on a national basis. You may use any facility that is a provider for the PPO - usually without the need for a referral. If you do use a provider that is not in the PPO network, your costs may be higher. Many companies like Humana, United Health Care, Blue Cross, etc offer both HMO's and PPO's. Understand the difference before deciding on a carrier. BTW, you DO NOT HAVE TO JOIN AAPR to enroll in United Health Care's AARP Medicare Advantage Plan.
 
I only want not for profit medicare as my gate keeper not a for profit insurer ..

nothing is ever a problem with advantage plans until it’s a problem .

i have seen way to many hit those problems .

remember ,while you ware told your advantage plan will cover everything medicare does , that is only true in a broad sense .

when it comes down to your individual path of treatment you dont have Medicare to prove what Medicare would have done in your case when the insurer denies something and your insurer knows this
 
I have insurance coverage via my State of N.J. retiree benefits. I was transferred quite seamlessly from Aetna HMO to Aetna Medicare HMO when it was time. I love both. In one way Aetna Medicare was even better because I no longer had to get referrals to see specialists. But for the first time in 28 years, I had to pay (regular Medicare) premiums but the state reimburses me $46 a month. Earlier this year I changed from Aetna Medicare HMO to Aetna Medicare PPO, which offers the same copay for in and out of network doctors. I think each of those plans are considered Medicare advantage plans.
 
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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mathjak107 said:
We have govt medicare and a high deductible f-plan supplement .

we pay 95 a month and since it has silver sneakers they pay 2 gym memberships I have .

one i was paying 65 a month for and then other 33 a month .

so we have all the benefits of govt medicare at an advantage plan price
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I’m confused. You have what the government calls “original Medicare” with a supplemental, but then you also have a gym membership, which I thought was available with an Advantage plan only. What company is offering a supplemental with a silver sneakers membership?
I’m not doubting you, buy would like to check into this for my friend in Florida.
 
Been There said:
I’m confused. You have what the government calls “original Medicare” with a supplemental, but then you also have a gym membership, which I thought was available with an Advantage plan only. What company is offering a supplemental with a silver sneakers membership?
I’m not doubting you, buy would like to check into this for my friend in Florida., silver sneakers comes
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Humana gives you silver sneakers with their medigap plans too…even the high deductible one includes it
 
mathjak107 said:
Humana gives you silver sneakers with their medigap plans too…even the high deductible one includes it
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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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