Medicare and Moving In Retirement (claim, pregnancy, patient, Kaiser)

[livecontent]

Originally Posted by wehotex

If you enroll in a medicare advantage, you can forget about choosing your own doctor, specialists or hospitals. you are totally at the mercy of what that HMO wishes to approve.

No, that is wrong and a common misconception because people fail to read their literature. Medicare Advantage is not just HMO and you can have choices of Providers. Medicare Advantage Plans have many options:

Preferred Provider Organizations (PPO)
Health Maintenance Organizations (HMO)
Private Fee for Service (PFFS)
Medical Savings Accounts (MSA)
Special Need Plans (SNP)

I am not going to describe all these plans but read Medicare & You which all Medicare recipients receive.

All these plans have choices for many providers from hospitals, primary care physicians and specialist.

The biggest choice is a PPO plan. If you look at the plans literature, you will see many providers for services, especially in higher population areas that have many doctors and hospitals.

For profit, HMO have multiple hospitals and many doctors on their plans. The most restrictive non-profit, as Kaiser Permanente, which I am a member, has many doctors from primary care to specialists to choose. I have switched primary care doctors as I desire and it takes one phone call. I can self-refer myself to all specialist that I need, without my primary care approval. If I do not like a doctor, I have many choices; and I have changed on the spur of the moment. There are multiple hospital facilities that can you choice for your services.

PFFS plans allow you full choice of primary care or specialist but you are on your own to get a doctor willing to accept the payment as you are not in a contract group.

MSA, SNP are described in the book, so read it. They all provide choices of providers.

It annoys me that people spread this erroneous information about Medicare and have never read their literature that is provided. They do not understand Medigap. They do not understand Medicare Advantage Plans. They make no effort to learn. Information is mailed to you; It is online. It could not be easier. The best advice of I would give to anyone is READ IT.

Livecontent

[Tesaje]

Originally Posted by livecontent

No, that is wrong and a common misconception because people fail to read their literature. Medicare is not just HMO and you can have choices of Providers. Medicare Advantage

For profit, HMO have multiple hospitals and many doctors on their plans. The most restrictive non-profit, as Kaiser Permanente, which I am a member, has many doctors from primary care to specialists to choose. I have switched primary care doctors and I desire and it takes one phone call. I can self-refer myself to all specialist that I need, without my primary care approval. If I do not like a doctor, I have many choices; and I have changed on the spur of the moment. There are multiple hospital facilities that can choice for your services.

This is my mother's experience also with Kaiser Medicare Advantage. She is getting very good care and they were responsive when she didn't care for a doctor.

[Curmudgeon]

Originally Posted by Tesaje

This is my mother's experience also with Kaiser Medicare Advantage. She is getting very good care and they were responsive when she didn't care for a doctor.

That was my wife's mother's experience as well and a big part of why we opted for Kaiser a number of years ago. We've never received anything but the best of care, it provides for one-stop shopping (physician, lab, imaging, pharmacy, specialists, etc.) and they spare no expense on tests and wellness.

The only down-side to our pending move is that Kaiser isn't available in our choice of another state.

[auntbee]

I moved recently. My previous doctor recommended a doctor in my new location. Unfortunately, when I called for an appointment, I was told the new doctor isn't taking any new medicare patients. Since I'm a diabetic and needed a 6 month check up, I had to just pick a doctor out of the phone book. He did nothing except the lab work and listened to my chest. He never even asked me any questions. Now I think I need to find another doctor, but not sure where to begin.

[auntbee]

I forgot to mention that I do have supplemental insurance in addition to Medicare.

[livecontent]

Originally Posted by auntbee

I forgot to mention that I do have supplemental insurance in addition to Medicare.

Medicare Supplement insurance is Medigap or called Medicare Select in some states. It is not the best option and is the initial way to cover the gaps of coverage in Medicare. Today, Medicare encourages people to move away from these plans and to the more expansive and cheaper Medicare Advantage Plans. In fact, there are many Advantage Plans that offer you more coverage without any extra monthly insurance fees.

Medicare Advantage Plans are not Medicare Supplement Insurance. These are labeled as Medicare Part C(it includes Part A and Part B). This is the biggest misunderstanding when discussing Medicare. Of course it does not help when the Feds keep changing terms.

Par D is Prescription Drugs. Part A is Hospital Insurance and Part B is Medical Insurance under original Medicare.

You cannot have a Medicare Supplement Plan (Medigap) and an Medicare Advantage Plan at the same time. It is illegal for a company to sell a Medigap plan to you if you have a Medicare Advantage Plan, unless you are switching back to original Medicare. That tells you that the government does not want to encourage enrollment in these plans. . You can see what the Feds want because the Medicare and You Plan discusses the Medicare Advantage Plans, first and clearly, but puts the Medigap discussion in the back of the book. You also need to order a different publication to get further information. No, there is no conspiracy to give less benefits under Medicare Advantage; it is truly the better plan.

Yes, some of you are going to tell me that the Government is planning to reduce payment to Medicare Advantage Plans and the increase payment to Original Medicare. That is true because they have evaluated payments and determined to better balance the system with limited resources. That does not mean that a Medicare Advantage Plan will become less advantageous than Original Medicare or a Medigap Plan. It just means that the Plans may cost more. You still will have better coverage.

I am no expert on this confusing issue and to get correct and full information, you have to read and get the help cited in the Medicare and You book. Even then, some of the so-called experts give the wrong information, after I double checked their answers. But for me, Kaiser Permanente, Medicare Advantage Plan, has been the easiest and best medical plan, I ever used.

Livecontent

[Curmudgeon]

Originally Posted by auntbee

I moved recently. My previous doctor recommended a doctor in my new location. Unfortunately, when I called for an appointment, I was told the new doctor isn't taking any new medicare patients. Since I'm a diabetic and needed a 6 month check up, I had to just pick a doctor out of the phone book. He did nothing except the lab work and listened to my chest. He never even asked me any questions. Now I think I need to find another doctor, but not sure where to begin.

Friends, neighbors, the local chapter of the Medical Association, church members, if you're so inclined, a senior center, an Area Agency on Aging; any or all should be able to help with referrals.

Although I'm still two years from being on Medicare, one question I've always asked any doctor I've had is whether or not he or she accepts Medicare assignment. My feeling is that if they won't do that for seniors they're probably not patient oriented enough for me. I want them to be my advocate for medical care.

[texdav]

The main disadvantage of the medicare HMOs is they have most of the controiol in majpo0r illnesses. tyhey have their own doctors that can actually come in and take control of what the HMO allows from your physican. It also limite your choice in facilites available and the dsotors have to be a provider.It basically works ok until you have a really serious problem then uit kils chocie really.It is manage carew which bgasiocally limits choice which is why so many after a majpr illness leave it to go bac to regular fee for service medicarewhich offers choice of facilties and providers that can be veverythign in a serious illness.

[Boompa]

I have been on Medicare for ten years and moved four times in that period. I have NEVER had a doctor turn me down because I am on Medicare. Exactly the reverse, Doctors don't make much on Office Visits so they send you for tests and therapy to run up the bill.

[livecontent]

Originally Posted by texdav

The main disadvantage of the medicare HMOs is they have most of the controiol in majpo0r illnesses. tyhey have their own doctors that can actually come in and take control of what the HMO allows from your physican. It also limite your choice in facilites available and the dsotors have to be a provider.It basically works ok until you have a really serious problem then uit kils chocie really.It is manage carew which bgasiocally limits choice which is why so many after a majpr illness leave it to go bac to regular fee for service medicarewhich offers choice of facilties and providers that can be veverythign in a serious illness.

What everyone seems to forget is that Medicare is really an insurance plan with guidelines, rules and restriction. It does not matter if you only have original medicare, a medigap policy, or an advantage plan. All these plans, somehow are govern by a set of rules for treatment, facilities, prescriptions, durable medical equipment, visitations, doctor visits, medical procedures and surgeries.

It is all written down in strict Medical Lingo. If fact, it is so comprehensive that many insurance plans, that are not medicare, use the Medicare Guidelines to manage their own plans.

These guidelines and operating procedures are very specific and define what a plan can do for you. Most times they protect you and mandating correct care. If you do not believe that than read your rights under medicare and the people you can go to immediately to solve disputes.

Yes, many times Medicare restricts care for procedures and prescriptions that are recognized and unsafe and not necessary. Remember the are spending your money and their has to be some rules. Yes, it is not perfect, but there has to be some rules for care, that are professional recognized and resources are limited. Yes, it fails some people because it is hard to define rules and procedures for individuals in a group, with limited resources. Do not tell me that the Physician should be the only controller of care. That is nonsense. Some Physicians are greedy and some physicians are not knowledgeable about all accepted procedures of care and medications.

You want full control over your medical care then get no insurance and pay everything yourself, for all insurance has rules. If you have enough money, you can get everything from everybody. But you can end up like Michael Jackson, where there was nobody to control or say "NO".

Livecontent