Medicare Advantage plans

I have posted here several times about folks being careful about choosing these plans - this article outlines why


https://www.yahoo.com/finance/news/...als-insurers--and-seniors-152214464.html

People who choose an Advantage plan over Medicare had better like it because it can be very difficult to leave the plan and get on Medicare when things go south.

You are totally correct - hard to opt out of those plans if you can at all

You can easily go from an Advantage plan any time you want to, to regular Medicare...it's just you may not, probably not, qualify for a supplement plan, G for instance. Then you are screwed.
Most nursing homes will not allow advantage plans and the resident has to go to regular Medicare A & B.
Go with regular Medicare A & B from the start and you cannot be denied, do not have to qualify, for a plan G and have it for life as long as you make the premiums.

Wife and I on the old F plan which is the best IMO - it is no longer offered but the Plan G you mentioned is the best available now days and is very similar to Plan F

Not sure what you mean on nursing homes? Medicare does not pay for nursing homes - Long term care policies will however

I just dogged a bullet last month and switched from an AP back to traditional Medicare. The underwriting is all done on-line with you answering a lot of questions. Once all questions are answered you hit "Submit" and within 2-3 minutes you'll know if your approved. I'm only 68 and in good health, but in my older years I'm not taking any chances. I watched a few congressional hearings and it's a proven fact that Advantage Plans are a bait & switch scheme and only good till you need them. Once you need them it's wait for approval and get denied.
My insurance agent said he writes 90% traditional Medicare and 10% AP.

I was a health insurance agent for many years. NO WAY would I sell anyone an AP policy

As I recall, the difference is that the F plan absorbs the annual deductible? I chose G because the F premiums added up to slightly more than paying the deductible on G. This was with Cigna, pricing may be different with others.

What it means is most nursing homes when they need to get a resident medical care, they don't want to have to jump thru the advantage hoops(restrictions). With regular A & B any hospital that takes Medicare will take them. Some will not take advantage plans any longer and the list is growing. Certain Advantage plans are nightmares and they choose to not deal with that mess.

Maybe I should not have said "most nursing homes". It is absolutely safe for me to say a hell of a lot of them don't though. Had to go through this recently...twice.

Free Advice on the Internet...take it for what it is worth...

gotcha - thanks for clarification - did not realize some of them won't mess with AP

Hands-on experience shared amongst friends can be a valuable source of information when one is searching. Ultimately, we are responsible for our own decisions, but I always appreciate hearing multiple perspectives.

This.

I sold health insurance for over 40 years and am now retired. I post "free advice" about this stuff on a regular basis in hopes I can help some folks on here

I had an AP because I have VA benefits also and it was saving me $50.00 per month because i didn't need the drug plan. But with all the horrible stories people have gone through with AP's I switched back to traditional MC. I guess now I'm double covered.

Well, I'm just saying with the numerous texts, telephone calls and emails I get each day about Medicare and Medicare Advantage, who knows what to believe. I have been on Medicare and now on Medicare Advantage plan for a couple years...I have never had a single problem and I have some medical issues. All the plans are pretty much self-explanatory and outline the coverage and costs. I didn't say your advice is wrong, or there is anything wrong with suppling the advice, I didn't even know insurance agents could be involved in Medicare Advantage or Medicare, I just thought everyone signed up like me after reading and studying the available plans. Please Carry on.

I get it - go back and read the original article I posted and decide for yourself - you may not have experienced it yet but there are alot of potential holes in AP plans - they are so bad that Congress is discussing doing away with them - the reason every insurance company is promoting them on TV constantly is because they are making a killing off of selling them - they are awesome plans until you really get sick - but what do I know after 40 years ???? Please read below that the article discusses

"Seniors also have a lot at stake. If more hospitals ditch these plans, seniors who rely on that coverage will be forced to pay higher costs or may even be kept from seeing the doctor of their choice. Many have little recourse if they face these challenges."

"It stinks," Mayo said. "You're putting consumers in the middle of these negotiations and they really value being able to know if they're facing out-of-network costs if they do see a provider that's not within their network. So the emotional strain that this takes on the people caught in the middle is the worst."

Just what we need, more Congressional involvement in our healthcare...geeezzzz. I believe most people simply don't involve themselves in what they actually signing up to receive, what their plan covers, what the cost are, how to stay within the guidelines. Like I said, I signed up for a local plan, involving a local hospital system, I read all the ins and outs of the plan, and I haven't experienced any problems. I refuse to sign up for one of the Big-Name Insurance Companies, never experienced one that wanted to fulfill their obligations.

Google Video's on Congressional Hearings on AP plans and have a listen. You may be switching after watching these.

Really? I wouldn't give you two cents for anything happening in Congress today, those people are only about getting re-elected, and I believe anything coming out of their mouths even less.

Enjoy your AP.

Advantage plans are private insurance plans. It is not a "supplement" like a lot of the commercials make it look like(Plan C). You still pay for Medicare B. You either have regular Medicare or you have an AP, cannot have both. They are also just 1 year contracts. If you do nothing they will continue with what you had but your doctors may not be in their network and the embedded drug plan may not cover your drugs anymore. That is why you have to check them out each and every year.

Ditto

Yes, I think you misunderstand my post, I was on regular Medicare then changed to Medicare Advantage. Yes, you have a chance to change plans each year and yes, you need to research what you are getting each year. My plan sends me a document each year before the sign-up period begins outlining what if anything is changing and what costs will be for the new year.

Yes, I think you misunderstand my post, I was on regular Medicare then changed to Medicare Advantage. Yes, you have a chance to change plans each year and yes, you need to research what you are getting each year. [/quote]

I understand, I was just responding to what you said, "I didn't even know insurance agents could be involved in Medicare Advantage or Medicare". I only wanted others to know that agents are involved because AP's are a private insurance product. The way an insurance agent is involved with Medicare is when they help you find a supplement, such as Plan G. An agent has nothing to do with Medicare A & B.
I know you know this, I was only wanting others to know.
I really should have highlighted the part I was responding to, sorry for the confusion.

I understand, I was just responding to what you said, "I didn't even know insurance agents could be involved in Medicare Advantage or Medicare". I only wanted others to know that agents are involved because AP's are a private insurance product. The way an insurance agent is involved with Medicare is when they help you find a supplement, such as Plan G. An agent has nothing to do with Medicare A & B.
I know you know this, I was only wanting others to know.
I really should have highlighted the part I was responding to, sorry for the confusion. [/quote]
No worries.

Advantage Plans are great until you have a serious illness…..there is no free ride for insurance… they are all about treating you with meds and keeping you out of the hospital at all costs, because when you go to the hospital you have now lost them money…..my heart surgeon is one of the best in the country….you would not be able to use his services on an A P …..you are relegated to doctors who need more patients and are willing to be paid less to get them….

I have experienced the same with some of the leading insurance companies over the years, at one time I owed numerous outstanding claims while insured with a leading insurance company, once my lawyer got involved, they changed their tune and paid off the claims. You have to be your own advocate and be persistent. I understand the concern if in fact hospitals are turning people away because of their coverage, I have not experienced such behavior, and I never have trouble with referrals or medications. Insurance companies I have found like to place all the responsibility on the consumer regardless of who is at fault for the screw up. The above instance I stated was caused by the doctor supposedly not "coding the service correctly", the insurance company knew the services were valid, but both placed the responsibility on me to correct the issue. Sounds like some of the issues now happening with Medicare Advantage, also sounds like the problems may not be with Medicare Advantage but maybe the insurance company providing said service.

Medicare Advantage IS an insurance product, NOT a government provided entity. When you choose an AP, the government turns it over to that company and THAT COMPANY makes all decisions concerning your health. In other words, a clown in a cubicle at that insurance company decides what you get and don't get.
What has come to light lately is the fact many AP's are relying on AI to decide what service you receive, such as if they will pay for a hip replacement or make you undergo therapy for a year instead. AI is over riding what your doctor says you need. If AI can replace that clown in the cubicle, guess who profits from that? There is a big stink about this going on right now and are finding out it has been going on longer than a lot have thought.