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Why does everyone (here) hate Medicare Advantage plans?
Posted by: wurm
Date: October 19, 2021 02:17PM
I'm on my way to an eye appointment now, so I won't be able to read these replies until later.

In reading through past threads here, it sure seems like there's no love for Medicare Advantage plans, but that's what I'm leaning toward rather than Medigap plus Prescription Drug plan. Unless I'm really missing something, it seems to make the most sense for me. All my doctors are In-Network for the plans I'm considering, my two prescriptions are generic, so basically free.

True, no one can predict the future. But a $0 premium is pretty attractive. (Yes, I know that's in addition to the medicare Part B cost $146.50). A $20-$40 co-pay for a doctor visit every few months is more manageable for me than a couple hundred dollars more in a monthly premium.

I'm obviously missing something, so let's hear it. It may not change my mind...but it might. Thanks.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: DavidS
Date: October 19, 2021 02:35PM
While I am too young to take Advantage of such a plan (pun intended), my patients love their Medicare Advantage plan. I found out today that starting in January, they will be able to get a Healthy Food Card allowing them to buy $150/quarter ($600/year) of eligible healthy food items (fresh fruit/vegetables, lean meats, cereals, etc.) as an added benefit.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: freeradical
Date: October 19, 2021 02:37PM
Quote
DavidS
While I am too young to take Advantage of such a plan (pun intended), my patients love their Medicare Advantage plan. I found out today that starting in January, they will be able to get a Healthy Food Card allowing them to buy $150/quarter ($600/year) of eligible healthy food items (fresh fruit/vegetables, lean meats, cereals, etc.) as an added benefit.

You can't buy bacon with that card?
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: lost in space
Date: October 19, 2021 02:41PM
I'd been happy with my Advantage plan as long as I was getting care from within the approved network. It's been a royal PITA getting to see specialists outside the network, where I have to get referrals approved. I saw a specialist for a year through referrals, but trying to get a new referral to see him has been denied, even after repeated appeals. I'm about to jump ship. One downside is that once I leave Advantage, I won't be able to get back in if I ever want to go back.



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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: DavidS
Date: October 19, 2021 02:44PM
Quote
freeradical
Quote
DavidS
While I am too young to take Advantage of such a plan (pun intended), my patients love their Medicare Advantage plan. I found out today that starting in January, they will be able to get a Healthy Food Card allowing them to buy $150/quarter ($600/year) of eligible healthy food items (fresh fruit/vegetables, lean meats, cereals, etc.) as an added benefit.

You can't buy bacon with that card?

Only the extra-lean, healthy type of bacon.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: vision63
Date: October 19, 2021 02:55PM
Quote
DavidS
Quote
freeradical
Quote
DavidS
While I am too young to take Advantage of such a plan (pun intended), my patients love their Medicare Advantage plan. I found out today that starting in January, they will be able to get a Healthy Food Card allowing them to buy $150/quarter ($600/year) of eligible healthy food items (fresh fruit/vegetables, lean meats, cereals, etc.) as an added benefit.

You can't buy bacon with that card?

Only the extra-lean, healthy type of bacon.

Maybe vegan Skittles.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: AllGold
Date: October 19, 2021 03:01PM
I think Medicare Advantage has been vastly improved over the last few years. If you'd asked five years ago, I would have said don't get MA. The networks were often terrible and the out-of-pocket costs were high and the premiums were also high. Now I lean to MA because everything has been improved so much. You rarely have problems with the network and the OOP costs and premiums have come down significantly. MA also offers a lot of extras these days that weren't included years ago. The only downside to MA is hospital inpatient copays are still pretty high. You just have to be aware of that and sock away some of that money you're saving on premiums in case you have to be hospitalized.

It also depends on where you live. Historically, places with lots of Medicare recipients like Florida have been good for MA and (relatively speaking) bad for Med Supp. In non-snowbird areas it was the other way around.

Quote
lost in space
One downside is that once I leave Advantage, I won't be able to get back in if I ever want to go back.

That's incorrect.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: Buzz
Date: October 19, 2021 03:26PM
Check out the deductibles for those plans, and the 20% co-pay on potentially expensive procedures. Those Advantage plans are also HMO's, so you need everything run thru your gatekeeper physician. Remember, it's the HMO that is paying your Medicare premium for you so that you have that $0 premium. The HMO gets a dollar amount from Medicare for each person that signs up, and that money goes into a bucket for all the HMO patients' care. Whatever doesn't go for patient care gets divvied up amongst the docs and administrators. The HMO's also take out some reinsurance for catastrophic cases.

It's a numbers management game, and some patients may dovetail perfectly into the model, whereas others may not be a good fit. My FIL was kicked out of his plan, primarily because his daughter and DIL that live closest to him were such PITA proactive advocates for his care, that the HMO couldn't let him fall thru the cracks, and they had to provide him the care that he needed; hence the boot at the earliest opportunity. Many of those plans also don't travel well, so you should check into what really happens if you need care out of state. They may claim to be good all over the country, but there will likely be massive gaps in coverage, because what they really have is reciprocal agreements w/ other HMO's, and if you need care where there is no reciprocity, you end up in a quagmire of red tape trying to get care coordinated.

If you're a good fit, go for it. We pay for the best Part B PPO plan available, that also covers deductibles and co-pays, and we don't have to deal w/ any gate-keeping for desired care. No hassles w/ travel. The Rx plans do take an extra bit of homework (as can be attested to in some of Rhonda's recent threads here), though if you're lucky enough to not need any pricey prescriptions, or anything that isn't part of your HMO's formulary, you're golden. Navigating the Medicare labyrinth can be daunting.

My Rx plan is $24/mo., and Mrs. Buzz's is $17/mo. in addition to our Part B supplement cost. She takes a half-dozen meds regularly, and I have a couple dozen. She has one med that is a poor fit, so she uses Good Rx for it, while two of my meds don't fit well, one gets Good Rx'ed, and the other I get from Canada. That keeps our Rx costs as manageable as possible. Your HMO will send you out on your own to find prescriptions that aren't on their formulary, and the HMO formularies are stripped down to the basics. Again, if your Rx needs fit, great, if not, it's Good Rx or Canada.

If you're as good as fit as it seems, those Advantage plans may be mutually rewarding.... they're looking for as many customers as possible that don't use/need/want much care. You are their ideal target.... until you really need healthcare services.
Good luck.
==
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: MrNoBody
Date: October 19, 2021 03:28PM
I'm losing my Advantage plan 01/01/22. In doing my research, just
using parts A&B; my doctor will only charge me $28/visit vs the $10
co-pay I now have. So, 4 visits a year will be $112 vs $280 (premium
+ co-pay) I now pay. Part D Drug Plan is $121.20/yr; premium + Tier 1
generic drugs.
Dr. visits + Drugs = $233.20

I could get a different Advantage plan (w/ drugs) as an alternative and
still use my doctor for $28/visit. Still have to explore that option.



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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: Numo
Date: October 19, 2021 04:16PM
Quote
AllGold
I think Medicare Advantage has been vastly improved over the last few years. If you'd asked five years ago, I would have said don't get MA. The networks were often terrible and the out-of-pocket costs were high and the premiums were also high. Now I lean to MA because everything has been improved so much. You rarely have problems with the network and the OOP costs and premiums have come down significantly. MA also offers a lot of extras these days that weren't included years ago. The only downside to MA is hospital inpatient copays are still pretty high. You just have to be aware of that and sock away some of that money you're saving on premiums in case you have to be hospitalized.

It also depends on where you live. Historically, places with lots of Medicare recipients like Florida have been good for MA and (relatively speaking) bad for Med Supp. In non-snowbird areas it was the other way around.

Quote
lost in space
One downside is that once I leave Advantage, I won't be able to get back in if I ever want to go back.

That's incorrect.

Isn’t it the opposite?
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: wurm
Date: October 19, 2021 04:34PM
Thank you all for your thoughts. I feel a little better about it now. Coincidentally, I had an appointment with my dermatologist last Monday, my ophthalmologist today and I'm seeing my cardiologist next Monday. I've asked them all their opinions about MA plans while I'm there and that I'm going to be moving off private insurance. So far, they've all said it should be fine and they have no problems with them, as long as I stick with a "name brand". insurer. smiling smiley As it happens, the ones in the running for me are Blue Cross/Blue Shield and Tufts, which they said should be fine. We'll see what the cardiologist says.

FWIW, the one I'm leaning toward is a PPO vs an HMO, only because I supposedly won't need referrals for specialists in-network, which mine are.

Oh, and the best news of all is that I finally saw on the MyMedicare page that I am enrolled in Part B as of 11/1, so that's a relief, as I wouldn't have even been able to get MA without that.

Thanks again.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: TL
Date: October 19, 2021 05:29PM
Quote
lost in space
One downside is that once I leave Advantage, I won't be able to get back in if I ever want to go back.

Incorrect. See [www.medicare.gov] -

Quote
medicare.gov

What can I do?

Change from Original Medicare to a Medicare Advantage Plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
Join a Medicare drug plan.
Switch from one Medicare drug plan to another Medicare drug plan.
Drop your Medicare drug coverage completely.
When?

October 15–December 7

Your coverage will start January 1.

The exception would be if your MA is through your (former) employer as part of retiree benefits. In that case, you may not be able to rejoin THAT SPECIFIC retiree plan, but would be able to join another MA not sponsored by your employer.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: davester
Date: October 19, 2021 05:34PM
There seems to be an unspoken and incorrect premise to this discussion, i.e. that Medicare Advantage plans are similar in some way. They're not. Advantage is just a general framework in which a bunch of different companies sell a bunch of very different products. I'll be going on to Kaiser Permanente Advantage soon. It is nothing like the plans sold by various other insurance companies.



"In science it often happens that scientists say, 'You know that's a really good argument; my position is mistaken,' and then they would actually change their minds and you never hear that old view from them again. They really do it. It doesn't happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion." (1987) -- Carl Sagan
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: TL
Date: October 19, 2021 05:34PM
Wurm by your mention of Tufts I suppose you are in Mass. you might consider talking to
A counselor with SHINE if you need any personalized assistance with plan changes. They are State Health Insurance Assistance Program counselors dedicated to offering neutral advise on enrollment, claims issues, and basically all things Medicare.
[www.mass.gov]
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: wurm
Date: October 19, 2021 06:13PM
Quote
TL
Wurm by your mention of Tufts I suppose you are in Mass. you might consider talking to
A counselor with SHINE if you need any personalized assistance with plan changes. They are State Health Insurance Assistance Program counselors dedicated to offering neutral advise on enrollment, claims issues, and basically all things Medicare.
[www.mass.gov]

Thanks, TL. Yes, I'm in Massachusetts, and yes, I already had a sit-down with a SHINE rep. Very informative.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: lost in space
Date: October 19, 2021 06:15PM
Quote
AllGold

Quote
lost in space
One downside is that once I leave Advantage, I won't be able to get back in if I ever want to go back.

That's incorrect.

Thank you for the correction. I have so much of this stuff careening around my brain right now. It's actually a retired state employee benefit program that I would lose access to.

Back to regular programming.



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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: DeusxMac
Date: October 19, 2021 07:26PM
Quote
AllGold
It also depends on where you live. Historically, places with lots of Medicare recipients like Florida have been good for MA and (relatively speaking) bad for Med Supp. In non-snowbird areas it was the other way around.

My post from January 2020…

Anecdotal, but when my 93-year-old father needed to go to a rehab facility [IN FLORIDA] after surgery, his Advantage plan had extremely limited options. The majority of the facilities in his area wouldn't accept patients with Medicare Advantage plans, so we had to settle for the least-bad of the few that would.

The social worker at the surgical hospital had nothing good to say about Advantage plans, and said she would ensure that her father did not get one when he became eligible for Medicare.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: Buzz
Date: October 19, 2021 08:12PM
Quote
davester
There seems to be an unspoken and incorrect premise to this discussion, i.e. that Medicare Advantage plans are similar in some way. They're not. Advantage is just a general framework in which a bunch of different companies sell a bunch of very different products. I'll be going on to Kaiser Permanente Advantage soon. It is nothing like the plans sold by various other insurance companies.

I thought about mentioning Kaiser before, they're a vastly different (better) animal than they used to be years ago. Since they are so different, I thought it might be confusing. Kaiser is now modeled after the Apple ecosystem, but for healthcare.

DM's example illustrates the pitfalls of where an Advantage Plan is not advantageous.
==
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: testcase
Date: October 19, 2021 08:30PM
I’m leery of ANYTHING that has to be shilled for on virtually EVERY channel, multiple times each hour. If it really was good, it would sell itself. old fogey smiley
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: DavidS
Date: October 19, 2021 08:48PM
As a Permanente physician, I’m proud of Kaiser’s Medicare Senior Advantage plan. It is rated Medicare 5 Stars in every area where we exist. That is the highest rating possible and based on quality of healthcare from many metrics that are tracked, plus patient satisfaction scores. No other insurance company can make that claim. This also allows us to enroll patients year round, not just during the Medicare open enrollment period.

Quote
Buzz
Quote
davester
There seems to be an unspoken and incorrect premise to this discussion, i.e. that Medicare Advantage plans are similar in some way. They're not. Advantage is just a general framework in which a bunch of different companies sell a bunch of very different products. I'll be going on to Kaiser Permanente Advantage soon. It is nothing like the plans sold by various other insurance companies.

I thought about mentioning Kaiser before, they're a vastly different (better) animal than they used to be years ago. Since they are so different, I thought it might be confusing. Kaiser is now modeled after the Apple ecosystem, but for healthcare.

DM's example illustrates the pitfalls of where an Advantage Plan is not advantageous.
==



Edited 1 time(s). Last edit at 10/19/2021 08:48PM by DavidS.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: JoeM
Date: October 19, 2021 08:52PM
Quote
DeusxMac
Quote
AllGold
It also depends on where you live. Historically, places with lots of Medicare recipients like Florida have been good for MA and (relatively speaking) bad for Med Supp. In non-snowbird areas it was the other way around.

My post from January 2020…

Anecdotal, but when my 93-year-old father needed to go to a rehab facility [IN FLORIDA] after surgery, his Advantage plan had extremely limited options. The majority of the facilities in his area wouldn't accept patients with Medicare Advantage plans, so we had to settle for the least-bad of the few that would.

The social worker at the surgical hospital had nothing good to say about Advantage plans, and said she would ensure that her father did not get one when he became eligible for Medicare.

My understanding with MA when I started Medicare 3 years ago was it was a cheap option with extras thrown in if money is a concern but potentially problematic if your potential health doo doo hits the fan. Out of pocket costs can be very high with severe illness and choice of doctors or care in your network might not include top specialists or facilities. Out of state or country coverage can be limited as well. I stayed clear of it up to this point and probably will continue to avoid switching.



JoeM
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: GGD
Date: October 19, 2021 09:43PM
For me it boils down to what is accepted at the medical center I use mostly. There is exactly one Medicare Advantage plan that they accept (they run the plan) and it's unclear if their hospital accepts it.

Quote

Medicare Advantage HMO plans

SHC Advantage
Stanford Health Care physicians are in-network with Stanford Health Care Advantage (SHC Advantage). Your assigned PCP/medical group must refer and authorize treatment at Stanford Health Care.

While standard medicare is pretty clearly accepted for everything.

Quote

Medicare Fee-For-Service

Stanford Health Care accepts Medicare Fee-For-Service for all hospital and physician services.

[stanfordhealthcare.org]

They're pretty much the most expensive provider in the area, and pretty much NO affordable care act plan still has them "in-network", but early on they were for a year or two until networks changed.

Getting care there at standard Medicare's rates is a bargain, and I've been subsidizing that for decades with the high costs I've been paying for service even after insurance over the years.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: lost in space
Date: October 19, 2021 09:46PM
Quote
DavidS
As a Permanente physician, I’m proud of Kaiser’s Medicare Senior Advantage plan. It is rated Medicare 5 Stars in every area where we exist. That is the highest rating possible and based on quality of healthcare from many metrics that are tracked, plus patient satisfaction scores. No other insurance company can make that claim. This also allows us to enroll patients year round, not just during the Medicare open enrollment period.

I've had the best care from Kaiser Advantage, from the people in the trenches. The problems start when the beaurocracy gets in the way.



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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: JoeM
Date: October 19, 2021 10:33PM
FYI, if you have access to the AARP Bulletin, the current issue has a good focus article on MA in general and a comparison of the pros and cons of MA vs regular Medicare.



JoeM
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: AllGold
Date: October 20, 2021 02:42AM
Quick post earlier and I didn't get into any detail but I should have mentioned that Medicare Advantage is not all the same. Every single MA plan is different. In fact, almost all insurance companies which offer MA have multiple plans. Some have a dozen or so different plans. And the plans are region-specific. Not only can you not get the same plan in a different state, but in many cases you can't get the same plan in different parts of the same state. There are also different types of MA plans. The most common are HMO, HMO-POS and PPO. There are also PFFS (Private Fee For Service), SNP, MSA and Cost plans.

To be clear, Medicare Supplement plans (F and G) give you better coverage with no network hassles than any Medicare Advantage plan. Another thing that's nice about supplement plans is they are standardized; unlike MA plans, a supplement Plan G is a Plan G--exactly the same (except for price) no matter which company you buy it from or where you live. But you will pay a lot more for a Med Supp than most MA (inexplicably, there are some MA plans which are hella expensive), and you still have to buy a stand-alone Part D drug plan. Med Supp starts at approximately $100/month when you're 65 (price varies widely in different areas and states) and generally increases in cost as you get older, plus it increases to cover the increased claims costs. By the time you turn 80, expect to pay around $300/month.

So that $0 premium Medicare Advantage plan doesn't seem so bad as long as you realize you have to apply some of that $1200-$3600 annual premium savings to your higher out-of-pocket costs.
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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: MrNoBody
Date: October 20, 2021 05:51AM
Quote
testcase
I’m leery of ANYTHING that has to be shilled for on virtually EVERY channel, multiple times each hour.
If it really was good, it would sell itself. old fogey smiley
Except those commercials are not from the Insurance Provider, they are
brokers (referral agents) who are paid a bounty for every client they recruit.
The bounty (commission) is paid by CMS, another example of lawmakers
making a govt. program a cashcow for a select group of individuals.
...follow the money...



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Re: Why does everyone (here) hate Medicare Advantage plans?
Posted by: GGD
Date: October 20, 2021 08:40AM
Quote
AllGold
To be clear, Medicare Supplement plans (F and G) give you better coverage with no network hassles than any Medicare Advantage plan. Another thing that's nice about supplement plans is they are standardized; unlike MA plans, a supplement Plan G is a Plan G--exactly the same (except for price) no matter which company you buy it from or where you live. But you will pay a lot more for a Med Supp than most MA (inexplicably, there are some MA plans which are hella expensive), and you still have to buy a stand-alone Part D drug plan. Med Supp starts at approximately $100/month when you're 65 (price varies widely in different areas and states) and generally increases in cost as you get older, plus it increases to cover the increased claims costs. By the time you turn 80, expect to pay around $300/month.

The other thing about Plans F and G is that there are also "High Deductible" versions of both, with much lower monthly premiums but a higher deductible. So you'll pay your 20% of the medicare billing rates for services for a longer period of time each year, and possibly the entire year if you're health, but you'll know that there's an upper limit to how much you'll pay each year for health insurance and health care.
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