Medicare or Medicare Advantage: Will Doctors take new Patients? (credit, calculated)
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Wow! I understand now what you went through. Yes, Medicare is complicated and confusing. Congress is trying to remove the word “ Medicare” from Medicare Advantage be cause it is confusing. It’s confusing because it leads beneficiaries to believe that it IS Medicare and it is absolutely not. When you choose a Medicare Advantage plan, you are choosing to go off of Original Medicare and go privatized, managed, for profit care. Basically, Medicare Advantage is inserting a for profit insurance company between you and your doctor. The insurance company decides what you need, not your doctor. Sure, you and your doctor can decide what care you need but if your Advantage plan won’t pay for it, what good is it? If you stay with Original Medicare, there is no insurance company that can get between you and your healthcare provider. You and your Doctor decide what you need and Medicare just pays for it, end of story. You and your doctor decide what is medically necessary. With an Advantage plan, the insurance company decides, and you’d be amazed at what procedures and tests are denied.
Like I mentioned above, I’m only 60 but this could be a life or death decision. I’ve done extensive research because I just want to be informed. I do not want to make the wrong decision and then regret it for the rest of my life.
I’m sorry you’ve been through the confusion that is “Medicare”. It is not simple. So many choices. So many decisions. It requires some education, for sure.
From what I've read just over 40% of those new Medicare join the Advantage plan. My guess is many think, "Oh, one-stop shopping with Medicare. I'll go with that."
I can just imagine speaking with a UHC rep. if I decided after the 6-month window to change from Medicare Advantage to UHC Plan G.
"Let's see here. You recently join Medicare (1/1/23) and in the past 11 months you've been a gastrologist four times. A primary doctor three times and there is also a visit to an Urgent Care.. Sorry, but the $128 quote online is for those new to Medicare, in your case the Plan G monthly premium will be... $525."
So you're not 65 yet, but you're an expert on Advantage Plans?
My Advantage Plan offers everything I need.
What you need to realize that Advantage Programs have the power to deny you services if they so choose. And they deny a whole lot because they need to make money. And it is tough to make money in health insurance when your clientele is people over 65. They will deny your services up front.
Regular Medicare has specific rules for certain things they will cover. If you meet the criteria... they will cover. They won't deny you just because.
Not that regular Medicare doesn't "deny". They just screw the provider instead of the patient. LOL.
Economically, Advantage plans are better up front. There is no question. But the older you get... if you start to get frail. I'd switch to regular Medicare. But if you are say 70 and still going strong... the Advantage plans are fine. But at that age you never know when your health might go awry.
I have insurance through one of my former employer retirement plans. It once was a supplement plan and then they changed it to Advantage - a PPO plan where I can see any dr that takes medicare, anywhere. Most of the cost is paid by ex-employer so I can't beat the cost on my own. But I did not know the relative disadvantages of Advantage when they changed over.
That said, I can't really discern any difference to me. It's way better than the crappy insurance I had when I was working at far less cost. In surveys I have seen almost everyone is satisfied with Medicare and there is no real difference in satisfaction between regular and Advantage programs. But yeah, with Advantage plans you have to be careful because there are a lot of scams. If it sounds to good to be true (free), it is.
Problems start when you need treatment and are told it’s not covered. Or you can only go to this doctor or that hospital.
My mother was a retired San Francisco public school teacher, and her Part B (HMO) was covered by SF (or maybe it was Cal.) But she paid nothing. There were no issues when she lived in SF since Kaiser Permanente was in the HMO.
However, when she moved to San Deigo, she needed to find in-network providers. The same when she moved to Mesa, Az. She didn't want to drive to Phoenix.
I'm fortunate in that I can afford the $360 or so a month to cover my Medicare, UHC Plan G and my Plan D (drug.)
I like to think I'm in good health but if I need extensive medical treatment, I don't want an insurance company telling me what they will or will not cover. Or which doctor/hospital I must go to.
What you need to realize that Advantage Programs have the power to deny you services if they so choose. And they deny a whole lot because they need to make money. And it is tough to make money in health insurance when your clientele is people over 65. They will deny your services up front.
Regular Medicare has specific rules for certain things they will cover. If you meet the criteria... they will cover. They won't deny you just because.
Not that regular Medicare doesn't "deny". They just screw the provider instead of the patient. LOL.
Economically, Advantage plans are better up front. There is no question. But the older you get... if you start to get frail. I'd switch to regular Medicare. But if you are say 70 and still going strong... the Advantage plans are fine. But at that age you never know when your health might go awry.
Attempting to switch from Advantage to original Medicare as you get older can be costly depending on your medical history and current health status.
Quote:
Note, however, that in most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed-issue” rights for Medigap. You generally have guaranteed-issue rights for six months when you are both 65 or older and enrolled in Medicare Part B. Guaranteed-issue rights ensure that you can buy any plan sold in your state, and that you won’t be charged higher premiums based on your health status.
Without guaranteed-issue rights, your insurance company may require medical underwriting before it sells you a plan. During medical underwriting, the insurer looks at your past medical history and current health status. If the company determines the risk of covering you is too high, it can refuse to sell you the plan you want, or it may charge you much higher premiums for the coverage. https://www.ehealthinsurance.com/med...ge-to-medigap/
Attempting to switch from Advantage to original Medicare as you get older can be costly depending on your medical history and current health status.
Yup! Correct. You might pass medical underwriting and have the option for Medigap, or, you might not. I would not want to take that risk, that's why I'm choosing a Medigap plan during my 6 month window, it's guaranteed acceptance.
Medicare (dis)Advantage plans or so popular because, well, let's be real; most of them have a $0 dollar premium and that's very enticing to a fixed income senior. Zero premium doesn't mean your coverage is free. Unfortunately, they're marketed in such a way that makes seniors believe they have free health care coverage. Also, word of mouth plays a big part. Obviously, most seniors don't utilize their benefits to the full extent (otherwise Advantage plans would go broke) and when they're asked by a friend or family member, they say "Oh, I just love my Advantage plan, it's been great!"
What they don't tell you, and you need to ask, is "how often have you used it and what types of serviced did they provide?" If they've had some serious medical issues, they will not be happy with their Advantage plan. Out of pocket costs on Advantage plans can be astronomical. By law there are dollar limits that they can charge but when a medically necessary procedure is denied and you end up paying for it out of your pocket, those dollars do not count toward you maximum out of pocket limit. Say your plan has a maximum out of pocket of $7,000/year and your denied procedure costs $14,000. That's on you. You still haven't met your maximum out of pocket of $7,000 because the procedure you had wasn't covered. The maximum out of pocket is only for covered services that the plan agrees to pay.
Medicare Advantage plans profit by denying services. That's their main driver of profitability. They don't tell you that in those Joe Namath commercials, do they.
All depends on the type of treatment you may need as you get older. If you're in good health an Advantage plan might work but even minor surgery will cost thousands of dollars. You reach eighty and start visiting your doctor more often...good luck.
Quote:
...It’s also worth noting that Medicare Advantage plans—the private-insurance alternative to Original Medicare—sometimes offer coverage that Original Medicare doesn’t. But, as you’ll see below, that coverage may be skimpier than you think because Medicare Advantage benefits aren’t standardized.
“Medicare Advantage plans are required to cover everything Original Medicare covers and nothing more. A supplemental benefit could be robust, or it could be not,” says Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. “We hear from a lot of people who are surprised by what their Medicare Advantage plan doesn’t cover.” https://fortune.com/well/2023/01/26/...-isnt-covered/
This year I had a tooth infection, and the tooth was pulled. I thought my initial Plan G with "wellness" would provide me with a discount. But none of the dentists in my zip code which were supposed to accept my "wellness" coverage did. In fact they had no idea what I was talking about.
In any case I needed the tooth removed, a tooth implant and a new crown. The cost? Just over 5k. Now, the first thing I was told when I arrived for the initial treatment was, “You will need to pay the first of three installments today.”
In other words, no money, no work done.
I expect the same applies to medical treatment. "Excuse me, but your co-pay is $17,863.43. You'll need to pay 1/4 now or we can't move forward."
Yup! Correct. You might pass medical underwriting and have the option for Medigap, or, you might not. I would not want to take that risk, that's why I'm choosing a Medigap plan during my 6 month window, it's guaranteed acceptance.
Medicare (dis)Advantage plans or so popular because, well, let's be real; most of them have a $0 dollar premium and that's very enticing to a fixed income senior. Zero premium doesn't mean your coverage is free. Unfortunately, they're marketed in such a way that makes seniors believe they have free health care coverage. Also, word of mouth plays a big part. Obviously, most seniors don't utilize their benefits to the full extent (otherwise Advantage plans would go broke) and when they're asked by a friend or family member, they say "Oh, I just love my Advantage plan, it's been great!"
What they don't tell you, and you need to ask, is "how often have you used it and what types of serviced did they provide?" If they've had some serious medical issues, they will not be happy with their Advantage plan. Out of pocket costs on Advantage plans can be astronomical. By law there are dollar limits that they can charge but when a medically necessary procedure is denied and you end up paying for it out of your pocket, those dollars do not count toward you maximum out of pocket limit. Say your plan has a maximum out of pocket of $7,000/year and your denied procedure costs $14,000. That's on you. You still haven't met your maximum out of pocket of $7,000 because the procedure you had wasn't covered. The maximum out of pocket is only for covered services that the plan agrees to pay.
Medicare Advantage plans profit by denying services. That's their main driver of profitability. They don't tell you that in those Joe Namath commercials, do they.
Thank you for explaining how disastrous Medicare (dis)Advantage can be for far too many individuals. There are risks in life, and Medicare Advantage is one of the biggest ones for seniors (or those on disability prior to retirement age).
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