Medicare advantage plans to good to be true..
Posted 04-13-2021 at 07:33 PM by jdhpa
Quote:
Originally Posted by Ariadne22
Yes, if there wasn't a catch, everyone would be signing up. In a nutshell, the primary catches are lack of provider flexibility and onerous oversight on medical procedures - discussed in the links at the end of this post.
The Advantage plan UHC agent is discussing pays the Part B Medicare premium. Not all plans offer this benefit, but some do. You should know, Advantage plans are huge cash cows for the private insurer which receives an average stipend of about $10k a year (varies by region) from Medicare for each enrollee to pay for Medicare services. Advantage plans use significantly more oversight on benefits administered - i.e, approvals etc. - in order to remain profitable because Medicare is no longer paying for the services - United Healthcare is. Essentially, you are divorced from Medicare when you enroll in Advantage plan.
Further, there are extra costs with Advantage - usually copays to see a specialist, copays for a variety of services, etc. Because this is a PPO, you can see other Medicare providers, but if they are out-of-network, those copays can often be higher. Because of the copays, all Advantage plans have maximum annual out-of-pocket limits which can be as high as $7,000 or more should you encounter serious health issues. The plans are "free" until they aren't.
If you currently have original Medicare without any supplement, you have an unlimited exposure on the 20% Medicare won't pay, which can become problematic should you encounter a serious medical issue. For that reason, most Medicare recipients either purchase a Medigap supplement or enroll in Advantage.
For in-depth discussion in the differences, pricing, etc., the following links cover the issue in detail.
Read all the links in this post:
https://www.city-data.com/forum/59629701-post2.html
And, then, read this thread for additional discussion:
https://www.city-data.com/forum/heal...l#post59629701
The Advantage plan UHC agent is discussing pays the Part B Medicare premium. Not all plans offer this benefit, but some do. You should know, Advantage plans are huge cash cows for the private insurer which receives an average stipend of about $10k a year (varies by region) from Medicare for each enrollee to pay for Medicare services. Advantage plans use significantly more oversight on benefits administered - i.e, approvals etc. - in order to remain profitable because Medicare is no longer paying for the services - United Healthcare is. Essentially, you are divorced from Medicare when you enroll in Advantage plan.
Further, there are extra costs with Advantage - usually copays to see a specialist, copays for a variety of services, etc. Because this is a PPO, you can see other Medicare providers, but if they are out-of-network, those copays can often be higher. Because of the copays, all Advantage plans have maximum annual out-of-pocket limits which can be as high as $7,000 or more should you encounter serious health issues. The plans are "free" until they aren't.
If you currently have original Medicare without any supplement, you have an unlimited exposure on the 20% Medicare won't pay, which can become problematic should you encounter a serious medical issue. For that reason, most Medicare recipients either purchase a Medigap supplement or enroll in Advantage.
For in-depth discussion in the differences, pricing, etc., the following links cover the issue in detail.
Read all the links in this post:
https://www.city-data.com/forum/59629701-post2.html
And, then, read this thread for additional discussion:
https://www.city-data.com/forum/heal...l#post59629701
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