Medicare Advantage Plan (MA)

mathjak107 said:
It isn’t a reasonable question at all because an advantage plan is part. C which is Medicare and a supplement and drug plan all rolled into one package issued by a private insurer .

thr comparison is Medicare a supplement and a drug plan , always Or secondary Coverage from a job .

I doubt anyone here even has Medicare all alone and if they do then they are foolish since if they can’t afford all parts they should have the then they should find a cheaper advantage plan .

it isn’t even a question a rational person would ask if they were comparing costs and expenses in an advantage plan to Medicare …Medicare is rarely used as a stand alone ,if ever and if it is it is the exception as well as foolish .

so yes the cost as it should be compared is zero vs 4500 in the advantage plan
Click to expand...
And how much would have it been if he had just Medicare? A reasonable question. Got a reasonable answer?Top

I see you do not have a answer. Telling!

Enough of your "I know more than you" etc!

Bye!
 

oldmontana said:
10% of people have Medicare alone.
Click to expand...
Exactly my point

90% would never use it alone and so it is the exception to have no other coverage and not the norm.

I don’t answer questions based on a few exceptions , I answer them based on what’s the norm

here Is a simple answer ..don’t reply to my posts . Your logic and responses seem to usually be flawed
 
Last edited:
So now it appears advantage plans have been defrauding Medicare .
An investigation shows to increase their profits they have been doing what is called upcoding
That's coding to make the patient appear sicker then they are
Medicare estimates they did this to the tune of an extra 650 million dollars.

if it isn’t their insured they are taking advantage of , it’s Medicare they are taking advantage of .

no wonder they call them advantage plans.

as stated in the article

“A cash cow for big insurers, the for-profit version of Medicare has not been a great deal for the American public. Medicare Advantage plans cost the government more per beneficiary than traditional Medicare, and often wrongfullydeny care.”

What’s more, federal audits have found Medicare Advantage plans systematically overbilling the public — mostly by billing as if patients are sicker than they really are, a scheme known as “upcoding.” Officials estimate the private plans collected $650 million in overpayments from 2011 to 2013.

https://www.levernews.com/insurers-are-fighting-to-protect-their-medicare-fraud/
 
Last edited:
Teacher Terry said:
I have read this before and wondered why the government hasn’t gotten rid of these since they aren’t saving money.
Click to expand...
I would say it is because many can’t afford govt Medicare and supplements so advantage plans offer cheaper alternatives with some being pretty much pay as you go .

for healthy people with no real issues it can be a much cheaper option …they just have to hope they don’t hit any reasons to have to have their gate keeper decide their treatment path and turn it down.

There is a reason all these advantage plans have to advertise or get stars for commercial to lure people in …..when was the last time you saw a star having to promote govt Medicare and an F , G or N plan ?

i always recommend staying away from the advantage plans unless you cannot afford govt Medicare and the supplements.
it’s just another potential hornets nest …… the saying nothing is ever a problem until it’s a problem was created for these plans
 
Last edited:
mathjak107 said:
I would say it is because many can’t afford govt Medicare and supplements so advantage plans offer cheaper alternatives with some being pretty much pay as you go .
Click to expand...
Yes but if the government wasn't pouring all this money into the insurance companies, they might be able to provide better medicare benefits and then it wouldn't cost so much for the senior.

There's a MA plan where I live that gives you the part b premium back, only has a $1,900 max out of pocket, gives around $50 a month for over the counter supplies, gym membership, transportation, etc. Only catch is that it is a HMO so limited number of doctors. You have to know the government is paying them very well that the ins companies can provide all that and still make a hefty profit.
 
KathyAnn said:
Yes but if the government wasn't pouring all this money into the insurance companies, they might be able to provide better medicare benefits and then it wouldn't cost so much for the senior.

There's a MA plan where I live that gives you the part b premium back, only has a $1,900 max out of pocket, gives around $50 a month for over the counter supplies, gym membership, transportation, etc. Only catch is that it is a HMO so limited number of doctors. You have to know the government is paying them very well that the ins companies can provide all that and still make a hefty profit.
Click to expand...
..the insurers get a fixed amount of money to take you off of of medicares hands …

How Much Does the Government Pay Medicare Advantage Plans? The federal government pays out over $1,000 each month for each enrollment for every individual.

now the insurer has to take the good with the bad …they can have people they insure that can ring up a 100k bill and others who run a few thousand . But for the most part that is all Medicare pays them …they make money on the volume of people they can sign up

so that is how insurance works …the insurers hope less people have claims then they take in
 
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=s2ustBOk0dz6iQoS5zcaUIHYEPDxevl0oi+BjOjfXg7ZekbscaBPbrsrkDptW6iX
Click to expand...
Nine in 10 people with Medicare either had traditional Medicare along with some type of supplemental coverage (51%), including Medigap, employer-sponsored insurance, and Medicaid, or were enrolled in Medicare Advantage (39%) in 2018 (Figure 1). But 1 in 10 Medicare beneficiaries (10%) – 5.6 million people – were covered under traditional Medicare with no supplemental coverage, which places them at greater risk of incurring high medical expenses or foregoing medical care due to costs. Under traditional Medicare, beneficiaries without supplemental coverage in 2021 would pay a deductible of $1,484 for an inpatient hospitalization plus daily copayments for extended hospital and skilled nursing facility stays, and a separate deductible of $203 plus 20% coinsurance for most physician and other outpatient services, including for drugs administered by physicians for cancer and other serious medical conditions.
KathyAnn said:
Yes but if the government wasn't pouring all this money into the insurance companies, they might be able to provide better medicare benefits and then it wouldn't cost so much for the senior.

There's a MA plan where I live that gives you the part b premium back, only has a $1,900 max out of pocket, gives around $50 a month for over the counter supplies, gym membership, transportation, etc. Only catch is that it is a HMO so limited number of doctors. You have to know the government is paying them very well that the ins companies can provide all that and still make a hefty profit.
Click to expand...
That is the same with MA plans. I live in a small city that has two hospitals and two large clinics and both of them are in network which means our MA plan with BC/BS costs us only $5 for a office visit, $40 for a specialist. $90 for emergency visit.

I think a supplement policy is a must for many reasons.

My wife went to the ER and the bill was $3,876.87. She paid $90.
 
Our Advantage plan works really good.

Yesterday we received a bill for $90.00 copay from the hospital for my wifes issue on Dec.25th 2022.

We choose the advantage plan which has zero copay for everything except emergency room visits. We knew that so the $90.00 is no surprise. What is surprising is the charges for all that was done amounting to $42,229.69. The issue was resolved that same day.
 
A friend of mine with a MA plan got sick in Hawaii on vacation and her plan wouldn’t cover her to see any doctor. Another friend of mine started having her oxygen levels drop in the 80’s and it took 4 months bugging them for appointments, waiting for tests until she finally got the care she needed. She has a serious lung disease diagnosed 5 years ago and they kept trying to tell her that she had allergies or asthma despite the previous diagnosis.

She was house bound because she was so winded she could barely walk. She is lucky she survived their incompetence and now finally is on oxygen and is starting to feel better. She ended up in the ER a few times who put her on oxygen and stabilized her and then sent her home with nothing and told her to see her doctor. It’s a serious condition to have your oxygen level drop below 90.,
 
we got a bill for 225k for when my wife and i were hospitalized for weeks with covid .

that wasn’t even for intensive care .

we have govt medicare and a HIGH DEDUCTIBLE F plan ….

we paid about 800 for the two of us and that was mostly for ambulance rides for the two of us coming and going
 
That article which is from the Year 2022 sounds like it is a study or survey that is predicting what people will do.
When this year's enrollment period came around, we thought about Medicare Advantage Plans. I called and spoke with Medicare.
Based upon what we were told and what we learned, we decided to stick with our original Medicare.
 

You must log in or register to reply here.

Back
Top