Medicare Advantage or the Original Medicare?

[Dutch_12078]

5 hours ago, 2gypsies said:

Don't shoot the messenger!  I was trying to find a reason why the poster's daughter said doctors don't like Advantage programs since he hasn't returned to reply.  BTW.... Kirk's link from 'Value Penguin' also states they may received some compensation.

The site I referenced sells all kinds of insurance... Supplement and Advantage.  

Again, here is a 'possible' reason that the poster's daughter made her statement.

 

"If you ask your doctor how they feel about Medicare Advantage plans, the answer may surprise you. The average physician is not a fan of Medicare Advantage because these plans put the patients’ financial risk in the hands of the doctor.

The Medicare Advantage plan carrier will pay the doctor a set amount of money upfront based on the patient’s diagnosis. So, the only way the physician will make a profit is if they stay under budget. If they don’t say under budget, they end up losing money. Meaning, you may not receive the full extent of care.

Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services."

Again.... this is from the link that sells Advantage plans.

Not all the plans are a one size fits all.  I agree with you that everyone needs to investigate which one is best for them.

 

I'm not trying to shoot the messenger, just refuting the message. Fortunately, our PCP doesn't gear our treatments to what makes the most money for her. As part of a non-profit hospital practice, she's paid a salary. Every provider signs a contract with the various insurance companies whose patients they accept. If they don't like the payment terms of the contract, then that's on them, not the patients for choosing that company's coverage.

[mike5511]

On 11/15/2022 at 7:06 PM, Dutch_12078 said:

Does she say they also don't like Medicare itself? Advantage plans cover everything Medicare does plus more...

Well nobody likes Medicare......but the providers hate Medicare Advantage even more. It doesn't cover as good as Medicare and a good supplement. We have a cousin that sells Medicare Advantage plans. I've heard all the arguments I care to hear about it so I won't engage here in one here. Suffice it to say, my daughter has my back better than anybody else in the world and she said "don't change to it!" I trust her advice. FWIW

Edited November 20, 2022 by mike5511

[Kirk W]

Our primary care physician's group practice does not accept new Medicare patients at times, other times they do, I'm not sure what deternines when but suspect that it is the number of them. They do keep patients that become Medicare covered but they do not accept Medicare Advantage, or at least they didn't at the time we began to go there. Both of us have at times been referred to specialist physicians but I don't know if they accept Advantage. 

[Randyretired]

Like others here have stated we have used our Advantage plan in 5 different hospitals in AZ, a couple in CA and a few here in CO.  Our plan is different than some but we have never been turned away. Many want to lump all Medicare Advantage plans together without understanding there are significant differences in the plans.  Our Advantage is better than any supplement plan I know of.  Our maximum Medicare covered health care is $150 a year.  Plus like many Advantage plans it has some eye and hearing coverage and a few other things. The stigma against Medicare Advantage is wide spread and I believe it is caused by some poor plans leaving a bad taste for some patients and medical providers.  Not all Medicare Advantage plans are the same!  I don't recommend them for everyone but for some they are a viable cost effective plan.  

[Dutch_12078]

9 hours ago, mike5511 said:

Well nobody likes Medicare......but the providers hate Medicare Advantage even more. It doesn't cover as good as Medicare and a good supplement. We have a cousin that sells Medicare Advantage plans. I've heard all the arguments I care to hear about it so I won't engage here in one here. Suffice it to say, my daughter has my back better than anybody else in the world and she said "don't change to it!" I trust her advice. FWIW

Don't supplements just pay the amount that Medicare doesn't cover (20%?) that otherwise would be paid by you?  Medicare Advantage plans pay the providers what ever amounts are included in the contracts the providers agreed to. Do supplements include any of the additional coverage that Medicare doesn't cover, like the annual physicals, eye care, hearing testing, dental coverage, and fitness programs that many Advantage plans include? I'm not arguing, just trying to understand why providers would prefer Medicare's fixed rates versus the negotiable rates that Advantage plans pay. With Medicare and a supplement, it seems they get paid the same with or without the supplement. What am I missing? 

[durangodon]

8 hours ago, Dutch_12078 said:

Don't supplements just pay the amount that Medicare doesn't cover (20%?) that otherwise would be paid by you?  Medicare Advantage plans pay the providers what ever amounts are included in the contracts the providers agreed to. Do supplements include any of the additional coverage that Medicare doesn't cover, like the annual physicals, eye care, hearing testing, dental coverage, and fitness programs that many Advantage plans include? I'm not arguing, just trying to understand why providers would prefer Medicare's fixed rates versus the negotiable rates that Advantage plans pay. With Medicare and a supplement, it seems they get paid the same with or without the supplement. What am I missing? 

I think you have a pretty good understanding.  I think the choice of Medicare type should probably be based on one's personal health, lifestyle, risk tolerance, and which plans are available to the individual. 

I'm not an authority on it, but I will point out a couple of things.  Regular Medicare does pay for eye care.  They don't pay for refraction, so doctors usually charge separate for that (I pay $45 for refraction when I want/need it).  I've been to the ophthalmologist an average of three times per year since I've been on Medicare and had multiple surgeries.  Medicare and my supplement paid for all of it, except for refraction.

I've also been to an ENT several times, one year for extensive testing, yearly for checkups and wax removal.  Never paid a cent for any of it.  Hearing tests were included.

I had open heart surgery under Medicare.  Bills came to over $450,000.  I didn't pay a cent.

I have seriously considered switching to an Advantage plan as my supplement premiums have risen over the years (now $159 month).  I have two reasons for hesitation.

The first is that my overall cost exposure would go up.  My maximum out of pocket costs right now are the total of my premiums.  The Advantage plans I've seen are somewhat higher.  The older I get, the closer these two seem to come together, though.

The second reason is all of the Advantage plans available to me have limited networks, usually based on my geography. I can see how this could be a problem for me.  For example, my brother is on an Advantage plan with an extensive medical group down in the Houston, TX area.  When he developed prostate cancer and needed daily treatments for two months, he had to drive 2 hours each way every day to a treatment center in his network.  He probably passed up twenty or more locations which could have done the treatment under regular Medicare and been much closer to home. 

In conclusion, I don't think there is any simple answer for most people.  That's why I highly recommend using someone who is trained and experienced in the field to help choose a plan.

 

[Dutch_12078]

I very much agree that everyone needs to assess their own needs and budget when choosing a plan, either with professional help or extensive research on their own. Are none of the PPO Advantage plans like those offered by United Healthcare available in your area?

[Kirk W]

48 minutes ago, durangodon said:

I don't think there is any simple answer for most people. 

15 minutes ago, Dutch_12078 said:

I very much agree that everyone needs to assess their own needs and budget when choosing a plan, either with professional help or extensive research on their own.

There is the key. The problem with the posts about how well what others have works is that no 2 people have the exact same situations. Whether you look at Advantage or Medigap policies, they are not all the same. 

Regular Medicare does pay for medical issues with eyes, but not for glasses and normal vision care. It does pay for cataract surgery and things of that nature.  

[durangodon]

2 hours ago, Kirk W said:

Regular Medicare does pay for medical issues with eyes, but not for glasses and normal vision care.

Not exactly correct.  It does pay for normal vision care, just not for refraction.  You can go once a year and be dilated and have your eyes checked for health.  The exam includes looking for glaucoma, macular degeneration, and other conditions.  I consider that normal vision care.

Although regular Medicare does not normally include eyeglasses, it will pay for eyeglasses following certain procedures, including cataract surgery.

[Kirk W]

51 minutes ago, durangodon said:

It does pay for normal vision care, just not for refraction. 

But it does not pay for the normal vision check used to prescribe glasses or the glasses themselves. At least it didn't for us and the supplement plan G doesn't either. 

Edited November 21, 2022 by Kirk W

[Dutch_12078]

4 hours ago, Kirk W said:

There is the key. The problem with the posts about how well what others have works is that no 2 people have the exact same situations. Whether you look at Advantage or Medigap policies, they are not all the same. 

Regular Medicare does pay for medical issues with eyes, but not for glasses and normal vision care. It does pay for cataract surgery and things of that nature.  

Yes on the eye care. I should have been more specific that some Advantage plans include glasses or contacts, as well as routine eye care and of course more serious issues like cataracts, glaucoma, etc.

[sandsys]

19 minutes ago, Dutch_12078 said:

Yes on the eye care. I should have been more specific that some Advantage plans include glasses or contacts, as well as routine eye care and of course more serious issues like cataracts, glaucoma, etc.

My Advantage plan covers all of those.

Linda

[2gypsies]

Medicare does cover refractions and all costs associated with eye issues if checking or treating things such as macular degeneration, cataracts, diabetes, glaucoma, etc.

[durangodon]

3 hours ago, Kirk W said:

But it does not pay for the normal vision check used to prescribe glasses or the glasses themselves. At least it didn't for us and the supplement plan G doesn't either. 

That's what refraction is.

[durangodon]

1 hour ago, 2gypsies said:

Medicare does cover refractions and all costs associated with eye issues if checking or treating things such as macular degeneration, cataracts, diabetes, glaucoma, etc.

Yes, it's part of the diagnostic regimen.  They won't pay for refraction to prescribe glasses or contacts though.  I should have been more clear.  Thanks.

[Dutch_12078]

5 hours ago, sandsys said:

My Advantage plan covers all of those.

Linda

So does mine, Linda.

[mike5511]

On 11/20/2022 at 9:59 PM, Dutch_12078 said:

Don't supplements just pay the amount that Medicare doesn't cover (20%?) that otherwise would be paid by you?  Medicare Advantage plans pay the providers what ever amounts are included in the contracts the providers agreed to. Do supplements include any of the additional coverage that Medicare doesn't cover, like the annual physicals, eye care, hearing testing, dental coverage, and fitness programs that many Advantage plans include? I'm not arguing, just trying to understand why providers would prefer Medicare's fixed rates versus the negotiable rates that Advantage plans pay. With Medicare and a supplement, it seems they get paid the same with or without the supplement. What am I missing? 

With my supplement, I don't have any copays or deductibles. I never pay anything as long as it is medicare approved. I forget the reasons she gave for not getting advantage. It had to do with them not paying or covering what medicare and a good supplement will. I've been told by providers I have the best supplement you can get and not to ever switch it. My supplement is from my former employer and they are always searching and comparing to give us the best insurance they can.

[Dutch_12078]

8 minutes ago, mike5511 said:

With my supplement, I don't have any copays or deductibles. I never pay anything as long as it is medicare approved. I forget the reasons she gave for not getting advantage. It had to do with them not paying or covering what medicare and a good supplement will. I've been told by providers I have the best supplement you can get and not to ever switch it. My supplement is from my former employer and they are always searching and comparing to give us the best insurance they can.

If your former employer is paying for your supplement, that's great. The fact is though, Advantage plans cover things Medicare doesn't, and with the zero additional premium plans, my wife and I pay less in co-pays per year than the premiums on any supplement. The majority of our doctor visits are with our PCP, and there's no co-pay. Specialists are $40 per visit, but those visits are usually no more than 3 or 4 a year, with most once a year.

[lappir]

I'm new to Medicare and this is my first open enrollment period. 

I paid for my BC/BS policy for many years out of my pocket. Did not have an employer subsidized policy since  becoming a "Travel" nurse in the late 80's. Thankfully me health stayed very good and I didn't need to use the policy, but the rate continued raise every year from the people that did use their "insurance" all the time. I also did not start collecting Social Security when I became eligible for Medicare, I send them a check every three months and paid my "Drug" plan up for a year. 

I'm currently only on meds for Blood pressure and cholesterol. I guess with the BC/BS it was much less expensive to fill the prescriptions, but the cost of the "Plan" decrease covers that money with more left over, so I call that a win. At my last visit with my PCP I inquired if I needed an "Advantage" plan and for my health history they said no. As a health care professional, I also believe it would be a waste of money at least at this time. Will I be able to get an "Advantage" plan in the future? Who knows. That is the only thing that slightly bothers me. The rule that within 6 months of your ability to obtain Medicare you can also choose an Advantage plan and have guaranteed acceptance. After that time you many not be allowed to diminish potential costs by enrolling late, and you can only do it once a year. 

I'm certainly tired of all the phone calls I'm getting during the Open Enrollment period and the fact that everyone ASSUMES a Phone number is also an open invitation to TEXT MESSAGE it is beyond me. 

That's my comment and rant. 

 

Rod 

[Kirk W]

2 hours ago, lappir said:

Will I be able to get an "Advantage" plan in the future? Who knows. That is the only thing that slightly bothers me. The rule that within 6 months of your ability to obtain Medicare you can also choose an Advantage plan and have guaranteed acceptance. After that time you many not be allowed to diminish potential costs by enrolling late, and you can only do it once a year. 

That isn't nearly the problem that many of the commercials make it out to be. We have now been on Medicare for 15 years and we have changed plans several times. Because my former employer supplies us with an HRA that pays pretty much everything "out of pocket" including premiums for our supplements and part D, we continue to stay with standard Medicare and a Medigap policy as well as part D for each of us. While I have very little by way of health issues at 80 years old, my wife has a long history of issues and so sees various specialists, in addition to her primary care physician. She currently has 5 specialists that she sees at least semiannually. She has had 4 outpatient procedures this plan year. During the open enrollment period it is actually quite easy to change plans and we are changing part D carriers, starting Jan. 1. We have both changed our supplement insurance plans (based mostly on premium cost) 3 or 5 times. The only catch to those changes is that you do go through an underwriting investigation by the new carrier but even with Pam's history, we have never been declined and you don't leave the current carrier until the new one has accepted you. The statements about how hard it is to change are just part of the marketing pressure that the Advantage plan marketers are blowing way out of proportion. The fact is that most advertising of Advantage plans is designed to take advantage of older people and to frighten them into buying what the company is selling. The following comes form Medicare.Gov.

Quote

You can join, switch, or drop a Medicare Health Plan

 or a Medicare Advantage Plan (Part C)  with or without drug coverage during these times:

• Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
• Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
• Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.

 

Edited November 24, 2022 by Kirk W

[Dutch_12078]

4 hours ago, lappir said:

I'm new to Medicare and this is my first open enrollment period. 

I paid for my BC/BS policy for many years out of my pocket. Did not have an employer subsidized policy since  becoming a "Travel" nurse in the late 80's. Thankfully me health stayed very good and I didn't need to use the policy, but the rate continued raise every year from the people that did use their "insurance" all the time. I also did not start collecting Social Security when I became eligible for Medicare, I send them a check every three months and paid my "Drug" plan up for a year. 

I'm currently only on meds for Blood pressure and cholesterol. I guess with the BC/BS it was much less expensive to fill the prescriptions, but the cost of the "Plan" decrease covers that money with more left over, so I call that a win. At my last visit with my PCP I inquired if I needed an "Advantage" plan and for my health history they said no. As a health care professional, I also believe it would be a waste of money at least at this time. Will I be able to get an "Advantage" plan in the future? Who knows. That is the only thing that slightly bothers me. The rule that within 6 months of your ability to obtain Medicare you can also choose an Advantage plan and have guaranteed acceptance. After that time you many not be allowed to diminish potential costs by enrolling late, and you can only do it once a year. 

I'm certainly tired of all the phone calls I'm getting during the Open Enrollment period and the fact that everyone ASSUMES a Phone number is also an open invitation to TEXT MESSAGE it is beyond me. 

That's my comment and rant. 

 

Rod 

Given the number of zero additional premium Advantage plans available, I don't think cost should be an issue, so there's no "waste of money". And there are benefits to most Advantage plans over original Medicare even if you're quite healthy. Annual physicals for example, are not covered by Medicare beyond a very basic "Wellness Visit". Most Advantage plans do include annual physicals though, including EKG's, blood tests, and other tests that may be indicated by your health status. Given the zero cost, having an Advantage plan could be worthwhile if for no other reason than having it available "just in case".

[docj]

I don't think either group here is going to convince members of the other group to change their enrollment.  It boils down to how much risk avoidance one wishes to accept.  After last year when we made an advantageous change of Medicare Plan F Supplement, I am quite content to pay the premiums for that plan knowing that I won't have ANY other medical costs other than prescription drugs and eyeglasses.   I bought my own hearing aids this year but I'm confident that what I purchased wouldn't have been allowable under most Advantage plans.  The same is true of our eyeglasses, you're not going to find an Advantage plan that is going to fully cover progressive bifocals with high index Transitions photochromic lenses.   

The bottom line is that you can't get something for nothing.  The managed care insurance industry lobbied Congress to create what we now call Plan C Medicare.  But we all know that insurance companies aren't altruistic enterprises.  They are in the business to make a profit, so don't think they really have your best interests at heart.  It's all about the bottom line iMHO.

Edited November 25, 2022 by docj

[Kirk W]

12 hours ago, docj said:

The bottom line is that you can't get something for nothing.  The managed care insurance industry lobbied Congress to create what we now call Plan C Medicare.  But we all know that insurance companies aren't altruistic enterprises.  They are in the business to make a profit, so don't think they really have your best interests at heart.  It's all about the bottom line iMHO.

Exactly!

[whj469]

I have never had better healthcare insurance they my current Kelsey Seybold Advantage plan. It is much better then what I played $930 per month seven years ago before I retired. That was with United Healthcare. I was the CEO for a company with 700 employees and I was responsible for their healthcare insurance. United Healthcare was so bad the I got rid of them and self funded our plan for $230 less per month per employee. My Advantage plan covers us for emergency care in the entire US and most of the rest of the world.

[Randyretired]

On 11/24/2022 at 6:42 PM, docj said:

I don't think either group here is going to convince members of the other group to change their enrollment.  It boils down to how much risk avoidance one wishes to accept.  After last year when we made an advantageous change of Medicare Plan F Supplement, I am quite content to pay the premiums for that plan knowing that I won't have ANY other medical costs other than prescription drugs and eyeglasses.   I bought my own hearing aids this year but I'm confident that what I purchased wouldn't have been allowable under most Advantage plans.  The same is true of our eyeglasses, you're not going to find an Advantage plan that is going to fully cover progressive bifocals with high index Transitions photochromic lenses.   

The bottom line is that you can't get something for nothing.  The managed care insurance industry lobbied Congress to create what we now call Plan C Medicare.  But we all know that insurance companies aren't altruistic enterprises.  They are in the business to make a profit, so don't think they really have your best interests at heart.  It's all about the bottom line iMHO.

If you are happy with your supplement and the premiums are not a burden why change.  I don't know how other plans work but our former employer Advantage plan works for us.  They won't fully cover eye glasses but they do reimburse us $200 after we send in the receipt.  They also reimbursed me $750 towards my hearing aids. They don't care where we buy.  Our yearly medical expenses do vary as we have a copay of $10 for specialists.  Every thing else is covered.  Our max out of pocket is $150 with no deductible but we haven't hit it.  We are happy with our plan and like you we don't plan to change.

Edited November 26, 2022 by Randyretired