Which Medicare Supplement Insurance Plan Do You Have? (Massachusetts, Minnesota, Wisconsin)

[RiverBird]

Originally Posted by Weichert

That they do. But you aren't going to get a Medigap plan from them free.

Correct.

Can someone please explain this in painstaking detail ~ how Advantage actually works (or doesn't):

"The bottom line is this: Medicare Advantage works to your advantage when you are healthy, but if you happen to get sick, the private insurance market will turn its back on you, and traditional Medicare will be there to greet you with open arms–provided we can keep it solvent..."

[Escort Rider]

Originally Posted by newenglandgirl

Correct.

Can someone please explain this in painstaking detail ~ how Advantage actually works (or doesn't):

"The bottom line is this: Medicare Advantage works to your advantage when you are healthy, but if you happen to get sick, the private insurance market will turn its back on you, and traditional Medicare will be there to greet you with open arms–provided we can keep it solvent..."

I don't know where that quote in your post came from, but it is baloney. Medicare Advantage works like this: Medicare pays the plan an annual fee and the plan agrees to take care of you as per the terms and conditions of its contract with Medcare and its disclosures to you. Typically you pay co-pays instead of percentages.

Not all Medicare Advantage Plans are created equal, however. Some are PPO's and some are HMO's. Typically you do have to use doctors and hospitals within their networks. My Kaiser plan, being HUGE, is a little different. Kaiser doctors, including all sorts of specialists, are on salary and they work for Kaiser. Kaiser owns and operates its own HUGE hospitals, many of them teaching hospitals. There are about five of those hospitals in the greater Los Angeles area alone, and several times that many Kaiser doctors' offices each with its own lab and pharmacy.

I have had my Kaiser plan for four and a half years now, since turning 65. It is the only 5-star rated (by Medicare) Advantage Plan in Los Angeles County, and I can see why. I have received excellent and efficient medical care, including hernia surgery three years ago.

[reed303]

Originally Posted by newenglandgirl

Correct.

Can someone please explain this in painstaking detail ~ how Advantage actually works (or doesn't):

Medicare itself explains MA plans here :
How Medicare Advantage Plans work | Medicare.gov

and, in even more detail, starting at page 72 here:
https://www.medicare.gov/pubs/pdf/10050.pdf

[RiverBird]

Originally Posted by Escort Rider

I don't know where that quote in your post came from, but it is baloney.

Originally Posted by newenglandgirl

Can someone please explain this in painstaking detail ~ how Advantage actually works (or doesn't):

"The bottom line is this: Medicare Advantage works to your advantage when you are healthy, but if you happen to get sick, the private insurance market will turn its back on you, and traditional Medicare will be there to greet you with open arms–provided we can keep it solvent..."

Sorry to have forgotten to reference the link - this is a quote from the article posted above by HighCotton.

[RiverBird]

Originally Posted by reed303

Medicare itself explains MA plans here :
How Medicare Advantage Plans work | Medicare.gov

and, in even more detail, starting at page 72 here:
https://www.medicare.gov/pubs/pdf/10050.pdf

Thanks ~ I do have the Medicare booklet. What I was asking for is detailed clarification on what HighCotton's article was saying about Advantage Plans "turning their back on you."

[Ghostly1]

Originally Posted by newenglandgirl

Thanks ~ I do have the Medicare booklet. What I was asking for is detailed clarification on what HighCotton's article was saying about Advantage Plans "turning their back on you."

Whatever it said it was likely Bravo Sierra to some extent. Advantage plans are capitated by Medicare and MUST provide ALL Medicare benefits to their enrollees. For competition purposes, many provide additional benefits - no premiums, eye exams and glasses, prescription benefits, etc.

While there may be some differences of opinion when it comes to determining what's "medically necessary" and what isn't, the plans cannot cherry pick the medical benefits they provide, nor can they lessen benefits for any one person, only a "class" of persons which, in their cases, are just two; Medicare beneficiaries and Medicare disability enrollees.

[in_newengland]

I think I have an Advantage Plan. It's Tuft's HMO and it's what I can afford. Because of somewhat low premiums (around $65/month this year) I have to make up for it in co-payments of $20/$30 and any outpatient surgery has gone up to around $250/day.
Hospitalization is not totally covered either.

Generally I am against HMO's but when I looked in the book, all the doctors I go to are covered--and it's turned out that any specialists I've been referred to have been covered. It charges about $2.00/prescription. I don't take any regular prescriptions but if I need an antibiotic, the coverage is there. It pays me back $150 from joining the Y. This will be my third year on this plan and it's no Cadillac plan but the premiums are affordable for me and so far so good.

The only other decent choice that was affordable to me was by BC and when I compared them it looked like apples and oranges. If I had more money I'd buy better health insurance but even so, it's like buying any insurance: a gamble because we do not possess the ability to see into the future.

[CarolinaWoman]

Originally Posted by highcotton

There are already many doctors or health care providers and also hospitals that do not accept Advantage plan's payment terms and will not agree to treat you. I understand the number of doctors and hospitals unwilling to accept Advantage are growing. When I need health care - I do NOT want that kind of BS and hassle! It sounds like you don't either...

You are right, after I visited my doctor's office I called around to my other doctors and our local hospital. At that time our urologist did accept certain Advantage companies but not all of them. The hospital was attempting to work with the companies for approval.

One thing I don't like about Medicare is the provider billing. I was in the hospital for knee replacement surgery and specifically asked for a copy of the hospital bill. The bill is sent direct to Medicare, they do their thing and then forward the claim to my Medigap company and they do their thing.

Walla, it's over and I received just a statement from Medicare stating this is the amount charged and this is what Medicare allowed in payments. This is followed with a statement from my Medigap company again stating what Medicare paid and this is what Medigap paid. Hey, let me see the actual bill with charges from the hospital, docs and everyone else.

When it's over I didn't owe any money but I still wanted to see the itemized bill. The same thing when hubby had surgery. I called the hospital each week and contacted Medicare to no avail requesting the itemized bill.

I know this sounds crazy and I should be happy. It's like magic, go in have a procedure and no bills piling up in the mailbox. Visit your family doc for a check-up, no bills or statements. I just wanted a copy is all. LOL

[highcotton]

Originally Posted by CarolinaWoman

You are right, after I visited my doctor's office I called around to my other doctors and our local hospital. At that time our urologist did accept certain Advantage companies but not all of them. The hospital was attempting to work with the companies for approval.

One thing I don't like about Medicare is the provider billing. I was in the hospital for knee replacement surgery and specifically asked for a copy of the hospital bill. The bill is sent direct to Medicare, they do their thing and then forward the claim to my Medigap company and they do their thing.

Walla, it's over and I received just a statement from Medicare stating this is the amount charged and this is what Medicare allowed in payments. This is followed with a statement from my Medigap company again stating what Medicare paid and this is what Medigap paid. Hey, let me see the actual bill with charges from the hospital, docs and everyone else.

When it's over I didn't owe any money but I still wanted to see the itemized bill. The same thing when hubby had surgery. I called the hospital each week and contacted Medicare to no avail requesting the itemized bill.

I know this sounds crazy and I should be happy. It's like magic, go in have a procedure and no bills piling up in the mailbox. Visit your family doc for a check-up, no bills or statements. I just wanted a copy is all. LOL

While I wouldn't mind seeing what all was billed and the costs - I would not want to interfere by challenging anything, especially since I'm not an expert in medical/medicine or health care. I would much prefer to know that everything is dealt with directly between the parties that actually performed the health care, and let them workout any differences they may have. The last thing I want is to have to deal with is bureaucratic red tape between doctors and hospitals.

That said, I strongly suspect that the reason you were never given the billing you requested for your procedure is because they don't want you (as a patient and layperson) getting involved or challenging anything. Even if you told them that you wanted a copy of the billing just for your personal use and records - you could always try to get involved by wanting to complain of overcharges or that you never received that second $150 box of Kleenex, billed by hospitals as 'MRS' (Mucus Removal System).

[highcotton]

I'm really surprised that more people have not voted in the poll. The poll question is completely innocuous, and there is no right or wrong choice in the poll. And nobody knows who voted for any particular plan. Maybe there's really not all that many retired people on Medicare that visit this forum.