Medicare Advantage Plan...Yes or No?

Stephanie

New Member
The process for picking a health insurance plan can be overwhelming. How do you know if you’re picking the correct plan? Will the ‘cheaper’ monthly premium cause issues when you’re trying to seek care? What if you need physical therapy, will it cover that? When people are selecting their insurance plans, they need to balance out the monthly premium compared to what their potential out of pocket costs could be.

I have first hand experienced this working in aging services. I work in a facility where we primarily serve seniors who fall in the low-income bracket. Many of these seniors have opted for a Medicare Advantage plan because of their limited financial resources each month. A Medicare Advantage plan are sometimes called “Part C” or “MA Plans,” and are offered by private companies approved by Medicare. Medicare pays these companies to cover Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage (Medicare, 2015).

Medicare Advantage plans have several positives that draw the consumer in. Some of them are: convenient coverage plans (all your coverage is through one plan), personalized plan structure (many different plans are offered that you can tailor to your individual situation), cost saving opportunities & coordinated medical care (Lockett, 2019). Some disadvantages are: limited service providers, overwhelming number of plans offered (making a decision could be difficult), additional costs for coverage & state-specific coverage (Lockett, 2019).

I personally don’t believe that Medicare Advantage plans really serve individuals better; especially the elderly clients. The residents that I have known to select an advantage plan is because they don’t pay a monthly premium. Which is very attractive, especially to a senior that has low income. Where I have seen a gap widen is when this resident needed outpatient physical therapy services. The resident had to pay a $35 co-pay for each therapy visit. This amount alone in one month is more costly than if they would have decided to keep their traditional Medicare plan. So while it may seem like an advantage plan is a good choice in the short term it does provide significant financial challenges when the person does seek care.
 

I have had a Medicare Advantage plan since I was eligible, quite a few years, very satisfied. I don’t want to mention it’s name but it was operated by a large non profit hospital system. I thought the copays were very reasonable and actually lowered over the years. Just this past January I switched to the BCBS MAP because the hands on care in the old plan had gotten poorer in quality as many providers moved away or retired and in the last 2 years prior had some unpleasant experiences and felt like I was being “processed “ rather than cared for. Putting more $ into bricks and mortar than they knew how to staff. My BCBS plan actually costs less, no monthly premium, zero copays for many meds and primary care visits, and so far very satisfied with providers, especially the way they are managing care during the pandemic. I feel I’m a good judge of quality for my situation because I’ve worked in health admin in both inpatient and outpatient settings in areas of standards compliance. Have had quite a bit of PT with the old plan, (joint replacements) & never more than $20 an hour. Same now with the BCBS PLAN.
One disadvantage to just being on traditional Medicare here & some places is that providers may have a quota on how many traditional Medicare patients they will accept, partly due to lags in reimbursement. Many MAPs also offer free side benefits like the Silver Sneakers gym membership program. Spent many free hours swimming laps etc in a nice health club.
 

terry123

Well-known Member
Location
Houston, Tx.
I have a Humana PPO advantage plan that has worked well for me. This week I will have in home PT and OT and will not have a co-pay. I have not been here in awhile. I had gall bladder surgery and a problem with BP meds. Trying to get better now at home.
 

Aunt Bea

SF VIP
Location
Near Mount Pilot
I have a BCBS PPO with zero premium and it's as good as the underlying Medicare program.

BCBS is coordinating my care with Medicare for a fee paid to them by the government and working to control costs by negotiating with various healthcare providers.

BCBS isn't really insuring much of anything in the traditional sense.
 

Knight

Senior Member
I think health has a lot to do with choice. For my wife & me medicare advantage works. We both need cholesterol meds due to hereditary cause. That's the extent of meds so the $6.00 X 2 cost every 3 months means nothing. Blood work every 6 months & scheduled Doc visit following the blood work zero cost. I understand we are exceptional as a couple but no magic pills, diet & exercise was & still is our priority once I retired.
 

terry123

Well-known Member
Location
Houston, Tx.
I also would add that my plan covers all the meds I take and thy are free with a 90 day supply. For short term meds I can use cvs or walgreens and they are free also after using the plan benefits. The only thing I have paid a copay for was a small order of xanax (sic) to help me sleep. I had to cut the smallest dose in half as a whole one was too much for me. The doctor said okay. I only had to use them for a couple of nights as I started sleeping better. He only prescribed 10 and cutting them in half gave me 20 so I have some if I have the problem again.
 


Top