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So, so sorry this happened to your friend. I know of someone who had a failed kidney transplant and has been on dialysis 3x week for at least fourteen years. He is now 73 years old. Granted he prefers sitting in his chair to walking these days but, up until the last few years, he did well enough. Drove himself to dialysis - may still do. He's always had a Medigap.
Advantage plan performance seems to vary widely by state and carrier. We've had enough sad tales on this board on Advantage that I agree with you - if one can afford a Medigap supplement, it is the best option.
In your friend's case, freedom to choose a different doctor might have made all the difference. Medigaps provide that freedom. Advantage does not.
My sister in Wisconsin has had an advantage plan for years and couldn't be happier. But no way that I want to trade my medicare/medigap for one of them.
Being that time of year, we have been inundated with mail telling us how great the advantage plans are. Always, on the first page in huge letters are $0 monthly premiums. That is the hook.
My wife has been having immunotherapy infusions at the cancer center here that cost $1600 per month. Medicare and her medigap pay every penny. I can only imagine what kind of a hassle it would be to get an advantage plan to cover the cost.
Are you saying someone with disabilities, and under 65 (me) should not get an Advantage plan? There are no Medigap plans for me in my area.
People under age-65 have very limited and expensive options. Medigaps don't even exist in some states for them. Yours is apparently one of them. You have no choice but Advantage at this time. Even if you did, the Medigap would cost at least $300/mo., possibly more.
Last edited by Ariadne22; 10-06-2019 at 04:17 PM..
My wife has been having immunotherapy infusions at the cancer center here that cost $1600 per month. Medicare and her medigap pay every penny. I can only imagine what kind of a hassle it would be to get an advantage plan to cover the cost.
Exactly. Imagine if her Advantage doctors were required to prescribe ineffective medication under the step therapy outlined above. What a nightmare.
Reminds me of a story here in WI a few years ago about a Medicare patient who was being treated with a very effective experimental drug. She moved into a different Medicare region and could not get regional Medicare approval for that drug until it was too late - even though the other Medicare region had approved it. Her cancer had been in remission, tumors were diminishing in size. Once the drug was stopped cancer reasserted itself. By the time approval came forth it was too late for the better drug to be effective. This was not an Advantage issue per se - but the principle is the same.
Exactly. Imagine if her Advantage doctors were required to prescribe ineffective medication under the step therapy outlined above. What a nightmare.
Reminds me of a story here in WI a few years ago about a Medicare patient who was being treated with a very effective experimental drug. She moved into a different Medicare region and could not get regional Medicare approval for that drug until it was too late - even though the other Medicare region had approved it. Her cancer had been in remission, tumors were diminishing in size. Once the drug was stopped cancer reasserted itself. By the time approval came forth it was too late for the better drug to be effective. This was not an Advantage issue per se - but the principle is the same.
Insurer oversight - avoid it if you can.
One last story as to why we have regular medicare/supplement. My wife had to have bone spurs removed from her spine. The neurosurgeon asked who our insurance company was so that they could get it approved. When my wife said regular medicare with a supplement, his response was "Never mind; when do you want to schedule the surgery"?
One last story as to why we have regular medicare/supplement. My wife had to have bone spurs removed from her spine. The neurosurgeon asked who our insurance company was so that they could get it approved. When my wife said regular medicare with a supplement, his response was "Never mind; when do you want to schedule the surgery"?
Thanks. I get bombarded with advantage plan info every day. Even my own PCP suggests I get an advantage plan.
Here's another one, posted the other day on another thread:
Quote:
Originally Posted by Vision67
My experience: At 65 we went on a Medicare Advantage plan and initially, it was wonderful.
Their clinic and pharmacy were nearby and they were convenient and we enjoyed the additional perks like free vision exams.
But then, at age 68, my wife started to have big medical problems. We went through a year with many clinical visits and tests with high co-pays. That was endurable until they started pushing back. They denied a cat scan request from her doctor. They were very nasty about appeals. They even outsourced the decision to a firm that would not talk to us or our doctor.
That was resolved when, after 5 weeks of enduring lots of abdominal pain, she ended up in crisis in the ER and that doc just did the cat scan without asking for authorization. He discovered the root cause of her distress and we got it fixed.
Since then we switched to original Medicare with a "G" supplement from AARP/United Health.
Luckily, she was able to get in. At first, I thought she would be rejected.
When I added up the co-pays from that year, they exceeded the amount of yearly premiums for the G plan.
Bottom line: A Medicare Advantage plan is swell until it isn't.
People under age-65 have very limited and expensive options. Medigaps don't even exist in some states for them. Yours is apparently one of them. You have no choice but Advantage at this time. Even if you did, the Medigap would cost at least $300/mo., possibly more.
What about just going A,B,D and skip the Advantage plan? At the moment I don't go to the doctor often. If something serious comes up, though, which way is better? I only ask here because of the warning in the OP about Advantage plans.
I will try to research more myself, but just curious about your view.
My senior friend had an Advantage Plan here in Las Vegas. Briefly, I wanted to state what happened to him as I think it’s important for others considering Advantage Plans.
Tim had a $0 monthly Medicare Advantage Plan through Blue Cross Anthem that was administered by Caremore.
About 9 months ago his kidneys began failing and it was pretty obvious by his skin tone and lack of strength, fatigue, etc. that he would need dialysis. Under his Advantage plan he had to see his family Caremore doctor first. Then he was referred to a Caremore nephrologist who began treating him with drugs to assist his conditions and additional tests to monitor his kidney function - which was deteriorating. BTW, he had to wait several weeks for each test and appointment.
It was finally determined he needed dialysis. Now another process began - vein mapping, more medication, etc. and all the while his condition worsened as he waited weeks between appointments and procedures.
He eventually went to the ER where he was admitted and they began dialysis. He also had developed pneumonia and a blood clot. After a few days he was released to a rehab center/rest home where he stayed for about a week - his condition worsened and he was readmitted to the hospital. The care at this rehab center appeared to be less than dismal.
At the hospital, his doctor recommended hospice. He declined and was sent to a different rehab center. At this time he was finally receiving dialysis three times a week and appeared to be improving.
He called me and said the pneumonia had returned and would I please contact his doctor to request antibiotics since the rehab nurse would not administer any and he didn't know his doctor's phone number. I had to look up his doctor’s number and was able to call but only got the answering service who would not help as I was not a family member - then I visited Tim. As a non medical person I could easily see the obvious signs of pneumonia. I called his caremore doctor again and got through to the answering service - explained/pleaded the issue and convinced them to contact the doctor.
Six days later they called me back and said they had to examine him first so were sending someone out to the rehab center to see if he needed antibiotics. At this time I told them not to bother as he was back in the hospital on full life support.
They left him on life support until his wife authorized the removal of all artificial aids. They administered morphine and he died 30 minutes later on October 1st, 2019.
I’m advising those dear to me to avoid the Medicare Advantage Plans. Ask yourself what’s more important - your money or your life? Insurers make more profit on advantage plans. Do you notice all the advertisements to convince you to join. Usually, when everyone is trying to convince you to proceed in one direction, it’s time to question it. If you don’t have the money for Medicare and a supplemental the Advantage Plan may be your only option. They used to be called HMO’s but changed the name to Medicare Advantage a few years back and increased enrollment followed.
But if you can afford it, my advice is go with the straight medicare Part A,B D, etc. Spend the money for choice. You might get really sick some day and if you do - access to a quality doctor will be much more important than a few dollars saved, silver slippers classes and a health club membership.
This has been my direct experience and I may not have all the facts. Arm yourself with knowledge and make the right decisions.
Im sorry about what happened to your friend but Orginal Medicare+ medigap+ part D also will not pay for everything. That from personal experience. They can leave you with thousands of dollars in bills. Bottom line- They too are an ins co.
Im sorry about what happened to your friend but Orginal Medicare+ medigap+ part D also will not pay for everything. That from personal experience. They can leave you with thousands of dollars in bills. Bottom line- They too are an ins co.
I understand that, but you generally get better care with a supplement unless you buy a crappy one. My husband has a medicare advantage plan (he signed up for it against my advice) About 5 years ago he had a benign salivary gland tumor. His primary care physician referred him to an ENT After waiting for two months for plan approval he gets a letter from UHC that the referral was denied and instead they referred him to an oral surgeon in San Francisco, mind you - at the time we lived in Reno which is about a 4 hour drive to San Francisco (in good weather). He called Anthem and they said "We decided you need to see an oral surgeon but we don't have a local one in our network and we're not required to". He called medicare and they confirmed that CMS gives Advantage insurers exceptions to the requirement that specialists have to be within a reasonable distance from the patient, Oral surgeons are one of those specialties that don't have to be local.
He went back to his PCP, by this time his mouth was so swollen he could barely swallow. His PCP sent him to the ER, the ER doc said it was an emergency and sent him to see an ENT, UHC grumbled but approved the referral when the ENT doc told them that he either had to remove the tumor or hospitalize him in case it blocked his airway.
And you know what? After that my husband still has an advantage plan! Money's not an issue but for some reason getting a health plan with no monthly premium really appeals to him /sigh
Im sorry about what happened to your friend but Orginal Medicare+ medigap+ part D also will not pay for everything. That from personal experience. They can leave you with thousands of dollars in bills. Bottom line- They too are an ins co.
Trust me sir when you are critically ill - I'd much rather have thousands of dollars in bills and still be alive to worry about them as opposed to no medical bills and possibly dead. What is a person's health worth? Different people have different answers. When it comes to health, to me it's more important than some money or bills.
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