WSJ article was mostly about patients in recovery care after surgery. Apparently their need for assistance was longer than allowed by Advantage but they extended coverage by switching to Supplemental.
You would hope social workers are available to advise if that happens to you or me.
Well, these offices aren’t rejecting Medicare per se. They’re adopting a business model that works on a flat fee, capitation model, where needed services are provided for that fee. This works fine with patients whose needs are minimal or non existent even. Money for nothing, in effect. It works nicely…even if a bunch of MA recipients do exceed their alloted Medicare share with whatever ails them…provided a number of things are in place. Namely a sufficient number of patients with employer provided plans with a generous enough level of reimbursement to offset these heavy users. Subsidize their choice of MA, in fact. As insurance reimbursement is reduced to lower and lower levels, obviously that subsidy is going to fall short at some point.
Since it’s becoming apparent that more and more MA users are finding themselves SOOL when they find themselves in need of more than simply the basics, I can only surmise that the tipping point has already been reached and passed.
I’ve suggested for a number of years that there should be a set of primary care practices that provided the sketchy service that MA beneficiaries are knowingly purchasing for themselves (only fair after all, right?) I didn’t really expect it to come to pass.
Problem is though that, “if you need to”, implies that someone is doing so after they’ve gotten to the point where their medical issues are no longer being addressed by second tier care. That supplemental is by then likely to require medical underwriting and I can tell you that even a few of the commonplace conditions that might make a person dissatisfied with their previously satisfactory MA plan is going to bump those premiums up big time. Not just wiping out any savings accrued so far but making just the premiums unaffordable.
Odds are it will cost you a lot. Your reversion later to Medicare needs a supplemental with it. If you are not grandfathered in it will cost you and not fully cover you.
This is indeed the risk of Medicare Advantage. You can pay me now or pay me later–if your number comes up. But of course we hope that does not happen.
The choices are easy if you guess right. And as always insurance is eager to sell insurance for stuff that does not happen. That makes it affordable.
And if appropriate options are still available.
For some time, readers of this forum have had the opportunity to read (and also ignore) reports of increasing numbers of hospitals that are no longer participating with MA plans. Ignoring this when information on the issue is readily available is surely willful ignorance.
That’s only if you’re in Medicare Advantage. With regular Medicare, your piece of a $1 MM hospital bill for a stay of less than 60 days is capped at $1,632 in 2024.
intercst
Don’t you live in Missouri?
There are only four states, New York, Connecticut, Massachusetts and Maine where you can switch out of MA and still buy a Medigap plan without medical underwriting.
Or do you have some kind of former employer-paid retiree health insurance that allows the switch?
intercst
Yes, I live in Missouri. No I know nothing about switching. This all news to me.
Best to learn about this when you are healthy. Believe me, the worst time to get blindsided is when you suddenly find that you are sick.
Wendy
I don’t think Wendy said she had to pay the $150K for her surgery, but I could be wrong.
DB2
I am from CT. I did not know it was limited to the four states.
But the statement is partially false. The cost of the gap plan in CT will rise. The selections offered to new enrollees rise in price each year. You would not be more or less grandfathered in on a lower cost basis which also will rise with inflation.
I have heard the gap plans are covering less. The deductible is no longer covered. God knows what else is not covered any longer. This might be changing every few years as well. Again you need to be grandfathered in.
I don’t think that’s true. Connecticut is “community rating” state. That means everyone pays the same price, no matter what their health.
Here’s the three methods Insurance companies use to set Medigap premiums:
This is the least common method, and all members pay the same premium regardless of age, gender, or location. Premiums may increase due to inflation or other factors, but for the whole group at the same time.
Premiums are based on the age of the policyholder when they purchase the policy. Premiums are lower for younger buyers and do not increase with age, but may increase due to inflation or other factors.
Premiums are based on the policyholder’s current age, so they increase as the policyholder gets older. Premiums are lower for younger buyers but increase as they get older, and may eventually become the most expensive. Attained-age rating is the most common method used by carriers.
Washington State uses issue-age rating. I pay $48/month and so does everyone else from age 65 to 100+ (assuming they bought the policy the year they turned age 65.)
An attained-age state probably charges a 65-yr-old $35/month for the policy I have and someone 100 years old would be paying double that, about $70/month.
The other nice thing about Washington State is that I can switch from one Medigap insurer to another at any time, as long as I buy the same high deductible Plan G policy. So if my current insurer jacks premiums, and is no longer the low cost provider, I’m immediately switching to the insurer that is.
intercst
Insurance companies have runoff accounts. Meaning what was offered as a plan 5 or 10 years ago is not offered now. The state locks down what happens with those runoff accounts policy wise. The new policies are relatively more expensive and cover less.
But yes that is for everyone.
The groups are pools of people that have the same terms in the policy. There are almost a dozen medigap groups every year offered. There are differences in all of that between the plans/groups.
My dad got me up to speed on this. As a doctor he has been keenly aware of the differences. As a finance person I am interested in how the insurers in CT work.
That’s right. My insurance covered everything after the deductible and copay. At the time I had private insurance.
Wendy
Please keep us posted on your adventures this time around.
DB2