Medicare or Medicare Advantage: Will Doctors take new Patients? (Congress: insurance, deductible)

[mborner]

Originally Posted by ysr_racer

So you're not 65 yet, but you're an expert on Advantage Plans?

My Advantage Plan offers everything I need.(For now)

No, I'm 60, But I have done extensive research on the subject because I WANT TO BE PREPARED and informed about medicare. In most cases, you get just one shot to make the most important medical decision of your life. Get it wrong and you'll regret it for the rest of your life because it'll be too late to change.

I want all of my medical decisions and recommendations made by me and my Dr., not by some insurance company. If my Dr. says it's necessary, I don't need some private, for profit insurance company telling me "no it's not". I want the freedom to go anywhere in the country I want, without referrals. I'm willing to pay a premium for that luxury, the luxury of having the most comprehensive medical coverage that money can buy. It doesn't get better than original Medicare with a Plan G. (unless you already have Plan F)

Advantage plans are great until you need them or something catastrophic happens. If you remain healthy your entire senior life, they're great, but if you need them, the horror stories are endless.

It's great that you like your plan, I just hope you stay healthy enough that you don't have to rely on them when you REALLY need them.

I just don't want my healthcare in the hands of a for profit insurance company who's profits are derived through denial of care.

[john3232]

Originally Posted by mborner

No, I'm 60, But I have done extensive research on the subject because I WANT TO BE PREPARED and informed about medicare. In most cases, you get just one shot to make the most important medical decision of your life. Get it wrong and you'll regret it for the rest of your life because it'll be too late to change.

I want all of my medical decisions and recommendations made by me and my Dr., not by some insurance company. If my Dr. says it's necessary, I don't need some private, for profit insurance company telling me "no it's not". I want the freedom to go anywhere in the country I want, without referrals. I'm willing to pay a premium for that luxury, the luxury of having the most comprehensive medical coverage that money can buy. It doesn't get better than original Medicare with a Plan G. (unless you already have Plan F)

Advantage plans are great until you need them or something catastrophic happens. If you remain healthy your entire senior life, they're great, but if you need them, the horror stories are endless.

It's great that you like your plan, I just hope you stay healthy enough that you don't have to rely on them when you REALLY need them.

I just don't want my healthcare in the hands of a for profit insurance company who's profits are derived through denial of care.

I spent much of my adult life on a national health insurance plan while outside the US. A couple of years after returning to the States I started looking into Medicare/supplemental plans which were confusing.

Medicare advantage seemed straightforward, but there’s the HMO. My mother’s health plan had the HMO which could be a hassle.

When I joined Medicare in 2023 I went with United Health Care Plan G (F is only longer available) as well as a drug plan. Thus far I'm very happy with the coverage.
https://www.city-data.com/forum/65818419-post216.html.

[mborner]

One of thousands of (Dis)Advantage plans and how dangerous they are.


https://www.youtube.com/watch?v=qpJitNsXcao

[Ex New Yorker]

Originally Posted by mborner

No, I'm 60, But I have done extensive research on the subject because I WANT TO BE PREPARED and informed about medicare. In most cases, you get just one shot to make the most important medical decision of your life. Get it wrong and you'll regret it for the rest of your life because it'll be too late to change.

I want all of my medical decisions and recommendations made by me and my Dr., not by some insurance company. If my Dr. says it's necessary, I don't need some private, for profit insurance company telling me "no it's not". I want the freedom to go anywhere in the country I want, without referrals. I'm willing to pay a premium for that luxury, the luxury of having the most comprehensive medical coverage that money can buy. It doesn't get better than original Medicare with a Plan G. (unless you already have Plan F)

Advantage plans are great until you need them or something catastrophic happens. If you remain healthy your entire senior life, they're great, but if you need them, the horror stories are endless.

It's great that you like your plan, I just hope you stay healthy enough that you don't have to rely on them when you REALLY need them.

I just don't want my healthcare in the hands of a for profit insurance company who's profits are derived through denial of care.

Congratulations! You did the right thing in planning ahead.
Myself I went to an insurance broker who explained everything in English and set me up with Plan B, G and D. Plan F is no longer available. He told me to avoid advantage plans like the plague. My neighbor went to a different broker and was told just the same.

[pathrunner]

Originally Posted by mborner

When I turn 65, I will do everything in my power to avoid Advantage plans like the plague. Nothing but trouble. I'll be sticking with original Medicare with a supplement. To answer the OP's question, if you're sticking to original Medicare, there are no issues. You can go anywhere, without issue. Be careful with (Dis)advantage plans, though. You get get stuck for life on a very, very bad plan. Contrary to popular belief, they are NOT free.

Amen to this. When I return to PHX soon, I will be going to Mayo for my critical care treatment (pulmonology). Back to Cigna for the regular stuff (my former clinics and PCP, that I really liked).

People have to educate themselves about Advantage. I had 3 surgeries back in 2011 at Scottsdale Shea (now Honor Health Scottsdale Shea). I was brand new to Advantage and did not know that almost every single damn thing was "out of network." I ended up over $100K in debt for my 20%. Very hard lesson to learn. It turns out that most places are "out of network" when you have Advantage (I'm talking critical care specialists and major surgery at a hospital, i.e. lungs and hip replacements).

Research everything and if you choose Advantage, make sure that you know before you go whether it is "in network" or "out of network."

[MN-Born-n-Raised]

@mborner. Thanks for sharing. I had no idea. I repped you accordingly.

I'm not on Medicare yet. But I will study it before I do. Google: "Advantage Care Plans and nightmare". You will have a couple hundred websites to read all about it. Here is one: https://www.nbcnews.com/health/rejec...als-rcna121012


"They don’t want to reimburse for anything — deny, deny, deny,” Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans. “They are taking over Medicare and they are taking advantage of elderly patients.”

Since I am a small business owner, I have to go on the ACA exchange or "Obama Care". I picked United Healthcare. It was "name brand" but THE absolute worst possible healthcare someone could ever possibly pick! (Strong enough?) As in, the doctors on the list were not accurate, you could only get ONE location for prescriptions which was CVS. ONE, not even two on the list. ONE! WTF????

Now, that is not to say United Healthcare is awful. But the plans that someone beat the crap out of premium wise is going to give you that level of service. Letter grade F-. This was last year and UHC had just got back into the ACA. When they launched it and I signed up in October (starting Jan 1), we asked for the list of their doctors. UHC didn't have that list until literally, a week before it started (Jan 1). And it was a PDF and a scanned list from who-knows-when. When we called them back asking if that was some sort of mistake, "they were working on it". And every doctor we called was wrong and they didn't know why they put their name on the UHC list. It was an absolute nightmare. Basically, they took my money before they set-up shop. It took two months of basically no healthcare to get out of that nightmare (via a loophole). But officially, I would of had to keep that plan the entire year. No healthcare for $1400 a month. And if you think you are going to fight the insurance companies, good luck! Pick wisely!!!!!

I dropped them after 2 months and switched to Ambetter (using a loophole). What a breath of fresh air in comparison.
The message is, to pick your path wisely. Don't assume a name-brand Medicare Advantage plan won't be a nightmare.

[pathrunner]

MN, from your post history it is obvious that you have plenty of disposable income. Just go with a Medicare Supplemental Plan and call it a day. If you want to spend thousands and possibly tens of thousands out of your disposable income and something terrible happened (illness, accident injury, etc.) while on Medicare Advantage, then.... why?

[john3232]

With regards to supplemental plans, it's my understanding they are the same regardles of insurance company. Plan F is ideal but it's no longer available for those new to Medicare. Plan G is the next best thing. I pay $126 a month with a $226 yearly deductible.

I went to a gastrologist earlier in the year and had extensive testing done. I also found a primary care physician and discovered my cholesterol was way too high. (246) so...I needed to change my diet. And I went to a local Urgent Care when I noticed a small infection on my foot. Other than the $226 deductible and monthly premium I have paid nothing. Getting a drug plan is also a must

The gastrologist initially told me to take three Budesonide capsules a day. (Today I take one every three days.)

When I went to my local Walgreens to pick up my prescription, I was charged $68 which I thought was a lot until I saw the actual cost: $1700 and change. Budesonide is a tier 4 drug. Year to date my drug cost $276 / $4,660 total

Medicare Supplement Plan G remain the same regardless of your insurance company (as mandated by the government), some states the premium you pay may vary according to a number of factors, including age, location, gender, and overall health.
https://www.cigna.com/medicare/shop-...aign_ID=CSBORG

[mborner]

Originally Posted by pathrunner

MN, from your post history it is obvious that you have plenty of disposable income. Just go with a Medicare Supplemental Plan and call it a day. If you want to spend thousands and possibly tens of thousands out of your disposable income and something terrible happened (illness, accident injury, etc.) while on Medicare Advantage, then.... why?

I'm guessing it's because he's not 65 yet, and therefore, not eligible. that's why he's on ACA.

[pathrunner]

Originally Posted by john3232

With regards to supplemental plans, it's my understanding they are the same regardles of insurance company. Plan F is ideal but it's no longer available for those new to Medicare. Plan G is the next best thing. I pay $126 a month with a $226 yearly deductible.

I went to a gastrologist earlier in the year and had extensive testing done. I also found a primary care physician and discovered my cholesterol was way too high. (246) so...I needed to change my diet. And I went to a local Urgent Care when I noticed a small infection on my foot. Other than the $226 deductible and monthly premium I have paid nothing. Getting a drug plan is also a must.

The gastrologist initially told me to take three Budesonide capsules a day. (Today I take one every three days.)

When I went to my local Walgreens to pick up my prescription, I was charged $68 which I thought was a lot until I saw the actual cost: $1700 and change. Budesonide is a tier 4 drug. Year to date my drug cost $276 / $4,660 total

Each state sets its own prices. Your plan is an Arizona plan. My plan is a California plan. I pay $266/yr. for the deductible. My monthly payment is $226.

Part D (prescriptions) has a factor entitled "Extra Help." I doubt from what I've seen of your posting history that you would qualify for "Extra Help" but you can look into it. I pay as low as $0.43 and as high as $7 but it's usually $4. Occasionally Medicare Part D, and even Extra Help will not cover a prescription. In my case it was a sodium solution for a nebulizer.