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Post by yogibearbull on Oct 3, 2023 16:21:44 GMT
Medicare Advantage is growing fast. It has reached about 50% of eligible Medicare people in 2023.
The cost advantage and convenience probably come from consolidation of Medicare Parts A, B, D services Plus some additional services (eyecare, dental, etc). Any provider that accepts original Medicare should also accept Medicare Advantage. There are MA-HMOs (with limitations but lower costs) and MA-PPOs (practically can go anywhere).
Overseas coverage is another issue. But I don't think that one can just get supplemental/Medigap insurance and prescription Part D without Medicare B - that has to be paid regardless. Discontinuation of Medicare may cause future problems when back in the US. Reinstatement may require medical underwriting and also permanent penalties. Medicare wasn't designs for ON/OFF/ON.
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Post by anovice on Oct 3, 2023 16:24:48 GMT
People with Supplemental insurance + part D are paying more and thus should theoretically get better service / convenience. If there is no discernible benefit to this extra cost, given there are so many insurance companies offering this insurance, the premiums would have been competed down to a nominal amount. I used to think I would go with Medicare Advantage plan. I am not so sure anymore. What still bothers me is charging a part B premium to people who live overseas where Medicare does not cover. Is this one that falls under the tyranny of the majority or is there a coherent (no B.S.) policy reason for it? "I used to think I would go with Medicare Advantage plan. I am not so sure anymore." There are good reasons to go with a Medicare Advantage plan. If you live in/near a city with good healthcare and your desired hospital/doctors are in network with that Medicare Advantage plan, there might not be any reason to go with a Medigap plan. Also, Medicare Advantage plans usually include dental, vision, and prescription, so there is generally better value.
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Post by anitya on Oct 3, 2023 19:17:38 GMT
People with Supplemental insurance + part D are paying more and thus should theoretically get better service / convenience. If there is no discernible benefit to this extra cost, given there are so many insurance companies offering this insurance, the premiums would have been competed down to a nominal amount. I used to think I would go with Medicare Advantage plan. I am not so sure anymore. What still bothers me is charging a part B premium to people who live overseas where Medicare does not cover. Is this one that falls under the tyranny of the majority or is there a coherent (no B.S.) policy reason for it? "I used to think I would go with Medicare Advantage plan. I am not so sure anymore." There are good reasons to go with a Medicare Advantage plan. If you live in/near a city with good healthcare and your desired hospital/doctors are in network with that Medicare Advantage plan, there might not be any reason to go with a Medigap plan. Also, Medicare Advantage plans usually include dental, vision, and prescription, so there is generally better value. You are right. It is location specific. I did not mean to apply my observations universally. I hope Medicare Advantage will evolve and become more widely underwritten and accepted by the time I am eligible for it. (I have a personal HMO plan and when I really needed the service for the first time recently, I was not impressed and made me think may be I should pay $300 per month more and move to a type of PPO plan I used to have when I had employer's self insured plan. That caused me to have doubts about Medicare Advantage plan. As I get older, I will need more service and good service is quality of life. I see so many older folks getting stressed about their medical service - sort of counter intuitive - the quality of medical service they receive causes them to be more sick and age faster.)
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Post by anitya on Oct 3, 2023 19:22:08 GMT
"Overseas coverage is another issue. But I don't think that one can just get supplemental/Medigap insurance and prescription Part D without Medicare B - that has to be paid regardless. Discontinuation of Medicare may cause future problems when back in the US. Reinstatement may require medical underwriting and also permanent penalties. Medicare wasn't designs for ON/OFF/ON." I know those are the rules. I think it is unfair to people like chang. The libertarian in me was complaining about the rules - it was not Tao of me to do it.
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Post by bb2 on Oct 3, 2023 19:28:00 GMT
You guys are correct about the importance of location. My local Kaiser Advantage has good grades, 4.5* I think. And even within the Bay Area, location is important. So, say you're in Oakland, You might not go with Kaiser but in Walnut Creek, Kaiser is fine. Grand Rapids Michigan has an excellent medical presence and it's highly ranked as a destination and old folks homes are relatively cheap in the area.
Has anyone switched from Advantage to regular Medicare? As I undersatnd it. insurance cannot reject you at your original signup at 65 but afterwards can.
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Post by habsui on Oct 3, 2023 19:37:50 GMT
"Overseas coverage is another issue. But I don't think that one can just get supplemental/Medigap insurance and prescription Part D without Medicare B - that has to be paid regardless. Discontinuation of Medicare may cause future problems when back in the US. Reinstatement may require medical underwriting and also permanent penalties. Medicare wasn't designs for ON/OFF/ON." I know those are the rules. I think it is unfair to people like chang. The libertarian in me was complaining about the rules - it was not Tao of me to do it. No, it's not unfair. Medicare is tied to the US healthcare system. No need to pay for foreign systems. Note that I'm originally from Switzerland and live there about 3 months each year, so I'm aware of needing insurance in foreign countries.
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Post by anitya on Oct 3, 2023 19:49:15 GMT
"Overseas coverage is another issue. But I don't think that one can just get supplemental/Medigap insurance and prescription Part D without Medicare B - that has to be paid regardless. Discontinuation of Medicare may cause future problems when back in the US. Reinstatement may require medical underwriting and also permanent penalties. Medicare wasn't designs for ON/OFF/ON." I know those are the rules. I think it is unfair to people like chang . The libertarian in me was complaining about the rules - it was not Tao of me to do it. No, it's not unfair. Medicare is tied to the US healthcare system. No need to pay for foreign systems. Note that I'm originally from Switzerland and live there about 3 months each year, so I'm aware of needing insurance in foreign countries. chang does not live in the US, though he is originally from the US. I will let chang share his information. No one is asking Medicare to pay for foreign HC systems. What was being questioned is the policy of charging Medicare premiums to people like @chang. Anyway, it does not matter to me - and in any case, not a useful discussion for the forum. BTW, my parents live 7-8 months a year outside the US and I am perfectly fine them paying for Medicare and carrying US supplemental insurance; they use the medical services in the US and pay for services outside the US.
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Post by anovice on Oct 3, 2023 19:52:25 GMT
"I used to think I would go with Medicare Advantage plan. I am not so sure anymore." There are good reasons to go with a Medicare Advantage plan. If you live in/near a city with good healthcare and your desired hospital/doctors are in network with that Medicare Advantage plan, there might not be any reason to go with a Medigap plan. Also, Medicare Advantage plans usually include dental, vision, and prescription, so there is generally better value. You are right. It is location specific. I did not mean to apply my observations universally. I hope Medicare Advantage will evolve and become more widely underwritten and accepted by the time I am eligible for it. (I have a personal HMO plan and when I really needed the service for the first time recently, I was not impressed and made me think may be I should pay $300 per month more and move to a type of PPO plan I used to have when I had employer's self insured plan. That caused me to have doubts about Medicare Advantage plan. As I get older, I will need more service and good service is quality of life. I see so many older folks getting stressed about their medical service - sort of counter intuitive - the quality of medical service they receive causes them to be more sick and age faster.) "I hope Medicare Advantage will evolve and become more widely underwritten and accepted by the time I am eligible for it." As yogibearbull pointed out, Medicare Advantage is growing fast. While I have not seen recent numbers, it would not surprise me if more Medicare eligible people have a Medicare Advantage plan than Medigap. The insurance companies know exactly how to package and market these plans; with the features, functions, and benefits to mirror your HMO or PPO with your employer. A natural transition. That said, while I reside in a mid to big market with outstanding healthcare, I have a Medigap plan. The primary reason is that I do not know where I will reside in the future and in most states, insurance companies require you to go through medical underwriting to switch and, I do not know what will be with my health. Also, while dental and vision (and a gym membership) are nice benefits with Medicare Advantage, I am far more concerned with the medical side and portability.
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Post by anitya on Oct 3, 2023 21:12:17 GMT
You guys are correct about the importance of location. My local Kaiser Advantage has good grades, 4.5* I think. And even within the Bay Area, location is important. So, say you're in Oakland, You might not go with Kaiser but in Walnut Creek, Kaiser is fine. Grand Rapids Michigan has an excellent medical presence and it's highly ranked as a destination and old folks homes are relatively cheap in the area. Has anyone switched from Advantage to regular Medicare? As I undersatnd it. insurance cannot reject you at your original signup at 65 but afterwards can. How easy is it to switch from one Kaiser location to another? One of my neighbors had Kaiser through his work and he was telling me that Kaiser makes it impossible to switch between PCPs. I am presuming you can switch PCPs if you go to a different location, even though your home address has not changed. Do you just google or yelp to figure out which Kaiser location is better or is there a better trick to this? For my next year enrollment, I was thinking of switching to Kaiser but if switching PCPs is tricky, I may have to think again. (I am not inclined to save a few hundred dollars (vs PPO) and not get service when I need it.) (South Bay also has a different HMO system called Valley Health, which allows you to switch between locations but the locations that have better service are impossible to get in for new patients.)
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Post by nobhead on Oct 3, 2023 21:22:42 GMT
I also am keeping my Medigap plan. I just visited the largest orthopedic clinic in my area and saw that they no longer accept some Medicare Advantage plans. You never know from year to year when an Advantage plan will not be honored by your preferred provider.
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Post by anovice on Oct 4, 2023 9:27:18 GMT
"Overseas coverage is another issue. But I don't think that one can just get supplemental/Medigap insurance and prescription Part D without Medicare B - that has to be paid regardless. Discontinuation of Medicare may cause future problems when back in the US. Reinstatement may require medical underwriting and also permanent penalties. Medicare wasn't designs for ON/OFF/ON." I know those are the rules. I think it is unfair to people like chang . The libertarian in me was complaining about the rules - it was not Tao of me to do it. No, it's not unfair. Medicare is tied to the US healthcare system. No need to pay for foreign systems. Note that I'm originally from Switzerland and live there about 3 months each year, so I'm aware of needing insurance in foreign countries. I am not certain why Medicare does not typically cover medical care that you receive outside of the United States, other than CMS probably does not want to administer it. Afterall, TRICARE works overseas.
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Post by FD1000 on Oct 4, 2023 23:25:52 GMT
I have original Medicare. I couldn't find a worthy insurance to cover dental+vision and I made many calls and research. One day a health care broker called me and told he has one. I didn't believe him, but I bought anyway since I could cancel any time. It turned out, we come out paying nothing because the the benefits are more than the monthly pay. This guy also explained to me that he is the best solver in healthcare and there is a solution for the Advantage short fall of $7-8K in certain situations that you pay out of pocket. He sell a $10K insurance for these situations that costs about $30 monthly. This way you come way ahead + no worries of out of pocket short fall.
I know it costs me about $200 more monthly for original Medicare but it's worth it for my piece of mind. I still don't get why most MDs accept Medicare at all, when they pay so much lower.
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Post by Chahta on Oct 5, 2023 0:00:29 GMT
"I still don't get why most MDs accept Medicare at all, when they pay so much lower."
Because it is not always about the money.
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Post by anitya on Oct 5, 2023 0:07:50 GMT
What is Advantage shortfall of $7_8k? Do you mean deductibles and co-pays?
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Post by archer on Oct 5, 2023 0:52:22 GMT
I think the reason medicare is accepted even though though it pays less is because at least it pays. Medical providers make money off of non medicare patients, and also make a little more, even if not as much, off of medicare. The insurance industry and medicare combined is their source of income. They know how to work with it and be successful if they want to go that route. Some don't want the hassle. I'm sure it is a lot of extra administrative work.
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Post by Chahta on Oct 5, 2023 1:20:40 GMT
I think the reason medicare is accepted even though though it pays less is because at least it pays. Medical providers make money off of non medicare patients, and also make a little more, even if not as much, off of medicare. The insurance industry and medicare combined is their source of income. They know how to work with it and be successful if they want to go that route. Some don't want the hassle. I'm sure it is a lot of extra administrative work. I have posted about this before. There is a new Biden program called Direct Contracting Entity (DCE). It turns original Medicare into something similar to an Advantage plan. An insurance company gets a portion of the normal monthly Medicare cost spent for an enrollee. The insurance company handles claims with doctors. In return for a doctor group subscribing, they get a monthly amount for that patient, whether they see the patient or not. This smooths out the operating costs of the doctor. The insurance company can keep up to 40% of the amount paid by Medicare to them as profit. All in the spirit of the government trying to lower Medicare costs. As usual insurance companies make out. I found out about DCEs because my doctor group enrolled and I received a letter from the insurance company notifying me. GGRRRRRR. Here is sales pitch to doctors to join a DCE: blog.hint.com/medicare-direct-contracting-youHere is a description: www.cascadiadaily.com/news/2022/feb/03/there-goes-your-medicare-the-danger-of-dces/
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Post by FD1000 on Oct 5, 2023 3:57:25 GMT
"What is Advantage shortfall of $7_8k? Do you mean deductibles and co-pays?" ( link) quote: "In 2023, the out-of-pocket limit for Medicare Advantage plans may not exceed $8,300 for in-network services and $12,450 for in-network and out-of-network services combined. These out-of-pocket limits apply to Part A and B services only, and do not apply to Part D spending, for which there is a separate out-of-pocket threshold of $7,400 in 2023, above which enrollees pay 5% of costs. (The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated starting in 2024 as part of the Inflation Reduction Act). Whether a plan has only an in-network cap or a cap for in- and out-of-network services depends on the type of plan. HMOs generally only cover services provided by in-network providers, whereas PPOs also cover services delivered by out-of-network providers but charge enrollees higher cost sharing for this care. The size of Medicare Advantage provider networks for physicians and hospitals vary greatly both across counties and across plans in the same county.
In 2023, the weighted average out-of-pocket limit for Medicare Advantage enrollees is $4,835 for in-network services and $8,659 for in-network and out-of-network services combined. For enrollees in HMOs, the average out-of-pocket (in-network) limit is $4,033 (Figure 3). Enrollees in HMOs are generally responsible for 100% of costs incurred for out-of-network care. However, HMO point of sale (POS) plans allow out-of-network care for certain services, though it typically costs more than in-network coverage. For local and regional PPO enrollees, the average out-of-pocket limit for both in-network and out-of-network services is $8,605, and $9,643, respectively."FD: Original Medicare doesn't have out-of-pocket maximums. So, when you are younger, age 65-70-75 and don't need services, it looks great. As you age and turned 75+, you need a lot more services. You will pay more using advantage + you will fight your advantage insurance, you must go thru, to approve your procedures and services. BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more. That's what scares me the most. If you can change back and forth, we all would use advantage, and after we get really sick, change to original Medicare.
So, someone who doesn't have money must use advantage. The ones who have, can make a choice. ==============="Medical providers make money off of non medicare patients, and also make a little more, even if not as much, off of medicare."
FD: Medicare pays a lot less than private insurance for younger people thru their employer. (link) "Private insurance payment rates were between 1.6 and 2.5 times higher than Medicare rates, with some variation among the ten DRGs included in our analysis". As the population get older, the number of accepting MDs for Medicare should go lower. In fact I already know several specialists MDs best in their field that don't accept Medicare and they told me it's because of the low pay. Another tactic by MDs could be to accept limited number of Medicare patients to convey their LIMITED good will. This will create longer waiting line for Medicare patients who need a lot more services than younger people. In the last several years more stand alone MDs joined big companies and now being asked to generate more money (= more procedures) and spend less time with their patients.
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Post by Deleted on Oct 5, 2023 5:10:51 GMT
The MOOP for my UHC MA plan is $750 (company subsidized). I'm 81 yo. Recently had a meniscus tear that required two specialist visits, xrays and mri at a cost of $100 with no questions asked. I agree that local makes a difference and I live in a great medical region. I just have not experienced any issue with MA nor have any of my friends.
FD: "BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more." What LT are you referring to?
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Post by anovice on Oct 5, 2023 12:28:10 GMT
"I still don't get why most MDs accept Medicare at all, when they pay so much lower."
One of a number of reasons is access to 66 million people who are enrolled in Medicare.
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Post by Chahta on Oct 5, 2023 12:49:37 GMT
FD1000 , "BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more." Where do you get that? Medicare does not charge you anything, other than premiums for Part B (based on IRMAA), in addition to the yearly deductible. Medicare always has to accept you if you qualify ,be it Part A, B, C or D. It's called open enrollment.
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Post by yogibearbull on Oct 5, 2023 13:00:41 GMT
Medical billing is a joke.
A $100 bill is reduced to $25-30 by the insurance (regular or Medicare). Then, we may be responsible for 10-25% of that (so, just $2.50-$7.50). For this reason, I never pay "a portion upfront", not I leave my credit card on file with ANY doctor - I have almost walked out of some scheduled procedures over this, but I prevailed with "MY personal policy" of not leaving my card info with them for security reasons.
But those not covered by ANY insurance are screwed - they don't get that insurance discount.
What is even crazier is that some suburban doctors think that they really deserve that $100, and there are rich folks who may be willing to pay those. Not me.
But most doctors are fine with discounted bills of $25-30 (vs $100 that involves game playing). It's a sure thing; they don't have to deal with skipped payments or bounced checks.
I even know of some doctors (in Chicago area) who charge their private-pay patients about 1/3 rd of that they normally bill the insurance. But the patient has to tell them AHEAD, whether private-pay or through insurance. Is it legal? No, but I am not going to report these well-meaning doctors.
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Post by anovice on Oct 5, 2023 13:01:04 GMT
"Despite questions about whether lower fees in Medicare relative to private insurance may discourage physicians from seeing Medicare patients, very few physicians are choosing to opt out of Medicare, which could be explained by several factors. The aging of the U.S population, and consequently, the increase in number of Medicare beneficiaries, means that for many physicians, older adults with Medicare coverage account for a relatively large share of their patient population and revenues. For these physicians, the loss of revenue resulting from opting out of Medicare would be substantial, notwithstanding the difference in payment rates between Medicare and private insurance or self-pay. Other factors, such as physician-level characteristics (e.g., years of practice and age), practice-level characteristics (e.g., solo versus group practices), and patient-level factors (e.g., average income of individuals in an area) may also play a role in physician decision-making." www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/
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Post by FD1000 on Oct 5, 2023 13:06:55 GMT
FD1000 , "BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more." Where do you get that? Medicare does not charge you anything, other than premiums for Part B, in adddition to the yearly deductible. Medicare always has to accept you if you qualify ,be it Part A, B, C or D. I'm talking about being on Advantage, then getting really sick, and now want to go with Original Medicare + Medigap. Pre-existing conditions are the main reason you could be denied a Medigap plan. Even if you could get Medigap after years of being on Advantage, you will pay a lot more.
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Post by Chahta on Oct 5, 2023 13:07:31 GMT
Medical billing is a joke. A $100 bill is reduced to $25-30 by the insurance (regular or Medicare). Then, we may be responsible for 10-25% of that (so, just $2.50-$7.50). For this reason, I never pay "a portion upfront", not I leave my credit card on file with ANY doctor - I have almost walked out of some scheduled procedures over this, but I prevailed with "MY personal policy" of not leaving my card info with them for security reasons. But those not covered by ANY insurance are screwed - they don't get that insurance discount. What is even crazier is that some suburban doctors think that they really deserve that $100, and there are rich folks who may be willing to pay those. Not me. But most doctors are fine with discounted bills of $25-30 (vs $100 that involves game playing). It's a sure thing; they don't have to deal with skipped payments or bounced checks. I even know of some doctors (in Chicago area) who charge their private-pay patients about 1/3 rd of that they normally bill the insurance. But the patient has to tell them AHEAD, whether private-pay or through insurance. Is it legal? No, but I am not going to report these well-meaning doctors. Medical care is a business, after all. This is why we see so many PAs and NPs instead of DRs. They leverage their time to make a profit.
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Post by anovice on Oct 5, 2023 13:09:54 GMT
FD1000 , "BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more." Where do you get that? Medicare does not charge you anything, other than premiums for Part B (based on IRMAA), in addition to the yearly deductible. Medicare always has to accept you if you qualify ,be it Part A, B, C or D. It's called open enrollment. Chahta, it seems to me that what FD1000 is trying to communicate is that if you are on a Medicare Advantage plan and try to switch to Medigap when you are really sick and need long term treatment, you will not be able to get a Medigap plan or if you are, it will be costly.
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Post by Chahta on Oct 5, 2023 13:13:21 GMT
FD1000 , "BTW, when you get really sick and need LT treatment, original Medicare will not accept you or will charge you a lot more." Where do you get that? Medicare does not charge you anything, other than premiums for Part B, in addition to the yearly deductible. Medicare always has to accept you if you qualify ,be it Part A, B, C or D. I'm talking about being on Advantage, then getting really sick, and now want to go with Original Medicare + Medigap. Pre-existing conditions are the main reason you could be denied a Medigap plan. Even if you could get Medigap after years of being on Advantage, you will pay a lot more. OK. Depends on which state you live in. CA does not have underwriting, but TN does. I was almost required to pay triple premium for my supplemental plan G due to a one-time prescription several years ago. Insurance Cos. can only check 2 years back. It is ALWAYS worth it to go to a specialty broker to buy your supplemental plan. They know how to maneuver the system. You need to be aware of "open enrollment". For CA: "During open enrollment, companies must sell you one of the required Medigap policies at the best price for your age, without a health screening (also known as medical underwriting). However, companies may impose a waiting period for pre-existing conditions."
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Post by Deleted on Oct 5, 2023 22:44:31 GMT
What long term care does one get with medigap that medicare advantage doesn't provide? If I get really sick why would I want to go back to original medicare from MA?
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Post by gman57 on Oct 5, 2023 23:04:49 GMT
What long term care does one get with medigap that medicare advantage doesn't provide? If I get really sick why would I want to go back to original medicare from MA? The main advantage is if you have a critical condition you have more options for care. More doctors/hospitals/clinics take original Medicare than MA plans. You can go just about anyplace in the country for care like a hospital that only specializes in your condition. Something you probably can't do with most MA plans.
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Post by liftlock on Oct 6, 2023 0:37:05 GMT
What long term care does one get with medigap that medicare advantage doesn't provide? If I get really sick why would I want to go back to original medicare from MA? The main advantage is if you have a critical condition you have more options for care. More doctors/hospitals/clinics take original Medicare than MA plans. You can go just about anyplace in the country for care like a hospital that only specializes in your condition. Something you probably can't do with most MA plans. People “should know what they’re giving up,” said David B. Honig, a health care lawyer. People signing up for Medicare Advantage are surrendering their right to have a doctor determine what is medically necessary, he said, rather than have the insurer decide. www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.htmlPost hospital rehab care is one example of this. Advantage plans control how long a patient can stay in a Rehab facility versus with Traditional Medicare the doctor and patient decide. It is worth remembering that health care insurers operate with a profit motive. They are incented by Medicare to offer Advantage plans as a means to control health care costs. With Traditional Medicare the costs are controlled by what Medicare allows without involvement of an insurer with a profit motive. With an Advantage plan, one has to pick wisely.
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Post by gman57 on Oct 6, 2023 0:53:53 GMT
The main advantage is if you have a critical condition you have more options for care. More doctors/hospitals/clinics take original Medicare than MA plans. You can go just about anyplace in the country for care like a hospital that only specializes in your condition. Something you probably can't do with most MA plans. People “should know what they’re giving up,” said David B. Honig, a health care lawyer. People signing up for Medicare Advantage are surrendering their right to have a doctor determine what is medically necessary, he said, rather than have the insurer decide. www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.htmlPost hospital rehab care is one example of this. Advantage plans control how long a patient can stay in a Rehab facility versus with Traditional Medicare the doctor and patient decide. It is worth remembering that health care insurers operate with a profit motive. They are incented by Medicare to offer Advantage plans as a means to control health care costs. With Traditional Medicare the costs are controlled by what Medicare allows without involvement of an insurer with a profit motive. With an Advantage plan, one has to pick wisely. True... I still feel the biggest reason to go with original Medicare is location, location, location. I live (and am going to stay) where there are abundant medical care facilities and I might come here for specialized care anyway. If I didn't live close to several large medical facilities or I lived in a rural location with limited options I would have definitely picked original Medicare rather than an MA plan.
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