For All You Eldergays On Medicare Advantage Plans...

I don't have Advantage but it seems sketchy to me. For $30 more you get all sorts of increased coverage that your Part B $165 premium doesn't provide? Then why doesn't the government do that?

This is going to become a huge issue the more we hear about public/private partnerships (PPPs).

Private will profit, public will suffer. Corruption is built into the system.

OMG OP DONT DO IT. YOU’LL REGRET IT EVERY LAST DAY OF YOUR LIFE ON THIS STINKING EARTH!

I have the Kaiser Permanente Medicare Advantage Plan, and it's been a lifesaver. I live in a fairly rural community, and KP has become a one-stop shop for all my medical needs. If my local KP can't handle a situation, they send you to another KP location about 100 miles away, and they pay you your transportation and hotel fees! And when I travel to other states, I can use the KP facilities there as well. Recently, I was in San Francisco and came down with what I thought was Covid. It was not, but I got the care and attention I needed.

What's the premium R3?

I'd rather have traditional Medicare, but I couldn't afford the medigap and part D premiums at the time. And now it's too late because I missed the 6-month window where the medigap plans have to take you no matter what.

I chose a MA plan with no premium that's run by a local hospital. They have excellent customer service. I don't have to play touch-tone bingo, I am automatically connected to a live person who is a native English speaker. I just made sure my local hospitals and urgent care are in their network.

Our accountant told us to stick with original Medicare. The companies selling the supplements are limited to what thy can be reimbursed by Medicare. What does that mean? It means when they are having a cash crunch or a crummy qtr they slow down or stop payments to providers. Guess who gets stuck with paying the balance - you.

I found a pretty good Medicare Advantage plan in California called Alignment Health MyCal Plus.

*No premium due beyond the ~ $170 taken out for Medicare.

*No problems with drug payments (ADAP covers the $180 for hiv meds not covered, plus takes care of my other meds)

*Pays for gym membership at YMCA (tbh, most other MA plans do this).

*No copays for first 5 days in hospital and only $100/day for next 5 days, unlimited days a/o co-pay

Kaiser is very highly rated for MA plans but folks new to their model may chafe at their restrictions.

(FYI, people under 65 using Medicare ( e.g. SSDI) aren’t able to buy Medigap plans.)

*No premium due beyond the ~ $170 taken out for Medicare.

R7 Those numbers don't make sense. Why would you get more coverage than Medicare provides at no additional cost?

[quote] FYI, people under 65 using Medicare ( e.g. SSDI) aren’t able to buy Medigap plans.

R7 No, it depends on which state a person lives in and what medical conditions they have.

I’m begging you not to do it

I didn't sign up for Part B when I became eligible because as a retired Federal employee, I get to keep my regular employer-sponsored health insurance for life, and I didn't see any point in paying two premiums for not much more coverage. I have Kaiser for my regular insurance and all part B and/or the advantage plan would do is reduce or eliminate some copays, and it just didn't seem worth it. Also, because of my income, I'd have to pay much more than the regular part B premium. So since I don't have part B, I'm not eligible for Medicare Advantage and I can just say "fuck you, Joe Namath."

That said -- there are now Medicare Advantage plans that will subsidize some of your part B premium. These weren't available when I retired.

Thanks for the Medicare for Blue Cross Blue Shield. For a hip that finally healed. We thank you so much.

[quote] Those numbers don't make sense. Why would you get more coverage than Medicare provides at no additional cost?

R8 1) Restricted network of clinicians and hospitals (who might get paid less than those that take patients that are on original/traditional Medicare); 2) Greater amount of rejections to cover expensive procedures (do a Google search if you want details).

Yes R8, you don’t get something for nothing in the business side of medicine.

Also, R8, MA plans now cost taxpayers more than original Medicare does per patient. So the government has once again socialized payments to businesses.

Don't get lulled into a false sense of security with what you think is a great MA plan. You may be going alone perfectly fine, but then one day if something really serious happens such as a really bad cancer, or the need for a heart, kidney or liver transplant and you find out your MA plan refuses to cover it or will only cover a much smaller percentage of it than traditional Medicare would.

Of course you can play Russian roulette with is and win. You can go through life with no serious health issues until you die. But how many people enjoy that type of life? Not many.

[quote] The Office of the Inspector General (OIG) released a study in April 20222 that was initiated due to the following reasons: “A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations (MAOs) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits… CMS annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment.”

I’ll just leave this here.

My mom had Tufts Medicare Advantage plan in Boston. She paid for doctor visits, the ER ($25) and that was really it. Hospital stays, rehab, physical therapy cost nothing beyond her monthly payment of $200. (Not talking about meds, just the rest.) That was 5+ years ago, though. The only problem was after the late 2010s, it stopped covering all hospitals, just Tufts-related hospitals, due to the state govt. breaking up monopolies.

People who get on these scam plans because they offer coverages (eye care, dental care, etc at no additional charge) that traditional Medicare does not offer fail to stop and think. These additional coverages cost money and that MA plan has got to find a way to recoup those costs and the only way they can is by denying coverage or reducing payments on things that Medicare covers with no problem.

People should always remember, NOTHING IS FREE! Somehow, some way, they're going to get their money back.