Medicare or Medicare Advantage: Will Doctors take new Patients?

[mborner]

Oh, boy! This does not look good.


https://www.youtube.com/watch?v=TItK8aCrWWY

[mborner]

Originally Posted by john3232

Yes, and the commercials with Joe Namath are great. It's not surprising Medicare Advantage has 50% of the market. Get great health coverage and extra benefits all for the low price of $12 a month or better yet...free!

Medicare Advantage - the name itself is very deceptive and shouldn't be allowed but my guess is political donations will ensure the name stays.

Yea, Joe Namath, JJ Walker, William Shatner, to name just a few.

As we speak, congress is trying to get the word "Medicare" removed from Advantage plans because it's misleading to seniors.



https://www.fiercehealthcare.com/pay...dvantages-name


https://pocan.house.gov/media-center...ne-alternative

[pathrunner]

I just spoke with my Supplement Plan servicer. Rates do not go down from state to state. That was an error on the part of my agent 5 years ago when I moved to New Mexico. I ended up staying with my existing plan because while the rate would significantly go down - according to her, which was apparently incorrect - she advised me not to do it because New Mexico has a health care crisis and it's difficult to get the plan serviced. (Shortage of PCP's and specialists. I found out that it is true about New Mexico's healthcare situation.) It's also not true that the plan becomes inadequately serviced. By law, servicers have to cover what the plan provides.

So just to clarify, is not true that rates go down with an existing Supplement policy when one moves across state lines.

My agent is in Florida, which is an issues-related state. It's the exception rather than the norm. So the agent was misinformed that my plan would cost less. All I can do is change my address when moving across state lines.

I can change providers and I'm not willing to do that - yet. I like my supplement servicer (Loyal American in Austin TX) and actually just signed up yesterday with their new dental plan that didn't exist when I signed up for Plan G. I'll cover that in a separate post on here.

[Ponderosa]

Doing a little research on the MA vs standard Medicare prior authorization problems commented on in this thread, I discovered that new regulations to address this issue become effective 1/1/2024. In a nutshell, MA programs will now be required to provide the same medically necessary procedures, prescriptions, and care as would be authorized in traditional Medicare.

Prior Authorization and Medical Necessity Determinations
CMS finalized several updates designed to curtail improper MA plan prior authorization processes and ensure MA beneficiaries receive timely and appropriate access to medically necessary care. Specifically, the agency stipulates that MA plans may only utilize prior authorization processes to confirm whether a patient’s care is medically necessary, addressing concerns that plans were creating non-clinical barriers to care in their programs.

Additionally, the final rule requires that MA plans adhere to traditional Medicare coverage policies when making a medical necessity determination and cannot utilize alternative criteria to deny coverage of an item or service that would be approved under CMS rules. In response to hospital and health system advocacy, the final rule also explicitly clarifies that MA plans must adhere to the “Two-Midnight Rule” under traditional Medicare, which requires that an MA plan provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care that crosses two-midnights.

emphasis added

There are also new regs about misleading advertising...

https://www.aha.org/special-bulletin...advantage-rule

[john3232]

I follow this fellow who released the below video a month ago.

This article (which is difficult for me to understand) was posted 4/23.
https://www.aha.org/special-bulletin...advantage-rule

So, I'm going to assume this gent is up on any changes to Medicare Advantage next year.

https://www.youtube.com/watch?v=ifkUn3NOT9w&t=270s

[mborner]

Originally Posted by john3232

I follow this fellow who released the below video a month ago.

This article (which is difficult for me to understand) was posted 4/23.
https://www.aha.org/special-bulletin...advantage-rule

So, I'm going to assume this gent is up on any changes to Medicare Advantage next year.

https://www.youtube.com/watch?v=ifkUn3NOT9w&t=270s

Yea, I've seen many, many of his videos. He's a fast talker, for sure. He knows what he's talking about, although, he has has had some mis-leading information in the past.



I like this guy.

He is on top of everything Medicare, including congress rulings, fraud, deceptive practices, mis-leading advertising, etc.

If it's Medicare in the news, I doubt you'll hear about it before he does.


https://www.youtube.com/watch?v=IuoexB3d_jU&t=178s

[john3232]

Originally Posted by mborner

Yea, I've seen many, many of his videos. He's a fast talker, for sure. He knows what he's talking about, although, he has has had some mis-leading information in the past.

Can you recall what he said which was misleading?

Also thanks for the link you posted.

[mborner]

Originally Posted by john3232

Can you recall what he said which was misleading?

Also thanks for the link you posted.

Sure.

In one of his videos he talks about excess charges with regard to plan N. Plan N does not cover excess charges and he makes it sound as if excess charges are common and can be expensive. The reality is, very few people on plan N ever pay excess charges because excess charges are all but dead. In the past, if an individual did pay excess charges, they were relatively small dollar amounts.




https://www.youtube.com/watch?v=is637v8OKQ0


Here is a good video of the reality of excess charges.




https://www.youtube.com/watch?v=eh_RFjGpVo4&t=1198s

[john3232]

Originally Posted by mborner

Sure.

In one of his videos he talks about excess charges with regard to plan N. Plan N does not cover excess charges and he makes it sound as if excess charges are common and can be expensive. The reality is, very few people on plan N ever pay excess charges because excess charges are all but dead. In the past, if an individual did pay excess charges, they were relatively small dollar amounts.

What's important to me is there’s no guarantee we won't see an increase in excess charges over time. All depends on your comfort level, which he (the guy in my video) likes to stress no matter which plan you choose.

Personally, I expect health care costs to rise in the coming years and this includes the excess charges in Plan N.

[john3232]

Are you a Plan G or a Plan N personality. Medigap G - peace of mind or Medigap N - responsible saver. Depends on the individual.

https://www.youtube.com/watch?v=EaO_P7ttfqg