Medicare DisAdvantage

Do yourself a favor and read this article before signing up for a Medicare Advantage policy.

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And yet, the TV is now full of adverts of old phartz howling about MA being cut. Once the part C and D handouts to the insurance industry got started, it is going to be nearly impossible to stop them.

Steve

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Thank you for sharing. It was informative to learn of the additional discretion MA plans have that allows them more declinations when compared to traditional supplement plans.

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No matter how you slice it, this is a fundamental problem faced by health insurance of all types. They use statistics to determine how long a given condition should take for recovery and allow patient to return to home.

Human nature is some try to stretch out these times for as long as they can. Being careful about it helps keep insurance rates affordable.

If her circumstances require additional care, someone should help her report same. But is everything covered forever? Never. Long term care insurance should cover it.

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As stated in the article, the problem with the above is that fighting the insurance denial often continues after the patient’s death. She had to pay out of pocket until all her funds were gone, and then go on Medicaid to get the help she needed.

There should be a fiduciary responsibility put on insurers.

DH turns 65 next year and we have started to explore our options. At a seminar we went to, put on by people trying to become our financial advisors and not our Medicare Advantage Co, told us that you can switch back to regular Medicare from MA, but if you had been with MA for IIRC more than a year, you had to undergo underwriting and might be assessed higher rates. Seems as though the MA problems don’t take place until you are pretty infirm, at which time I doubt you could afford the fees assessed from underwriting. We will be sticking with Medicare when the time comes. We will pay for our own gym memberships, thank you.

IP

IP

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The supplemental plans that cover out of pocket costs with traditional Medicare oftentimes have gym membership thrown.

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For anybody that has Sirius/XM radio, there is a great show on the Doctor’s Channel called Healthcare Connect. The show host is an expert at advising health care users how to navigate the byzantine medical industrial complex in America. They have spoken often on the Medicare Advantage pitfalls. Medicare sounds like the way to go.

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Indeed, but for as much as these examples are common knowledge…and frequently discussed on this forum…folk still continue to sign up for these plans. It’s a financial decision for the most part…oftentimes made by folk at a time when they perceive themselves to be in robust good health (as I did this time last year…and still not tempted to switchtoan MA plan) but even when they’re not but presumably have had no problems so far and imagine that situation will continue.

These plans have become increasingly popular and, unless there’s a major change, are set to continue the growth and exert their influence on medical care at time of service. Not just for MA enrollees themselves but for everyone else. The more MA participants there are in the system…especially at primary care level…the more the rest of us with either trad Medicare and/or a group health plan are , in effect, subsidizing the heavy users with increasingly shorter appointment times etc as the MA reimbursement dollar has to stretch to cover MA participants if/when they get sicker. Quite apart from the “doctoring” side, practices have to spend more time on dealing with preapprovals, denials, searching for cheaper alternatives to drugs that are suddenly off formulary (all things that happen with far greater frequency than with traditional plans)

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Listen to the words used in the MA ads. They tell viewers about the “extra benefits you are entitled to”, as if they are somehow being cheated by “big gummit” traditional Medicare and can only get what is due them by going to MA.

Steve

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We went with Plain old Medicare because there’s no list of approved Docs - other than some say upfront that they don’t accept Medicare. We added a supplemental policy (currently from Anthem) to cover unexpected expenses that Medicare doesn’t cover. Seems to work pretty well.

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Another reason why we are going with OM. We are in the process of freeing ourselves up for extensive travel and that seems to be what works best if you are not at home when there is a need for a doctor.

These comments are great, though. We are still in research mode, being slightly over a year from signing up.

IP,
also needing to figure something out for herself for the following 4 years given the loss of DH’s retiree healthcare

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I’d be sure to look at the Marketplace for insurance. Depending on your state, it may or may not be a good source for a policy. But its certainly worth a look. I suspect you won’t qualify for any premium subsidies, although one well-known poster here managed to arrange his affairs so that he qualified for a hefty subsidy in spite of his significant investment portfolio. If you are healthy and can handle a sizeable deductible and co-pay, the bronze level plans can be a good value. One of the biggest things they do is give you the negotiated rates for having insurance rather than starting at the “rack rate” and having to negotiate from there.

There might also be some high-deductible plans that are HSA qualified, allowing you to sock away a few thousand a year for health expenses down the road, with no tax on the earnings of that money when used for medical expenses.

The Marketplace is not going to work for everyone, but I’d at least check to see if it works for you. If nothing else, it’s an easy place to compare some alternatives to what an insurance broker or search engine finds for you.

–Peter

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My wife and I are 60 and retired and have an ACA plan. by keeping our MAGI (Modified Adjusted Gross Income) to around $65k, we get a pretty hefty subsidy and manage a premium on a Bronze plan of around $35/month. A lot of our expenses are out of pocket, but last year our total healthcare expense was under $5k. It’s not all wonderful. We had a somewhat difficult time finding providers that accepted our insurance and were accepting new patients, and because of that we have a longer drive than we’d like. We feel the trade-offs are worth it until we turn 65 and start Medicare.

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@PolymerMom2 -

Your last post was in 2017. Welcome back!!!

'38Packard

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@inparadise - Please. If you do ANYTHING - talk with your local SHINE volunteer about the options. They make what seems complex much more understandable.

Hope this helps.
'38Packard

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Yeah, I got very tired if constantly changing my password to be able to login. I thought I’d check to see if anything had changed. It sure did!

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SHINE? In an effort to please the Gremlins with 20+ characters when I believe you to have the brain cells to understand 6, what is SHINE?

IP

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It is different for each state, but this is what it is in MA.

Please check out the organization in your state.
'38Packard

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Thanks for the suggestion. It’s apparently called VICAP in VA. VICAP - Medicare / Prescriptions

IP

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Great! I’m hoping if you do contact them, that you have as good an experience as I’ve had with ours!

'38Packard

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