wurm's post about everybody hating Medicare is timely for me. I've been a member of Kaiser since it took over Group Health co-op in 2017 which was founded in Washington state in 1945. Group Health was an HMO that I was happy with since they allowed me great leeway in getting care out of network. Just as I knew would happen, the change created more bureaucratic morass at all levels as managing and controlling took precedence over providing options for its patients.

For the last three months I've been going round and round with appeals to Kaiser/Medicare Advantage getting coverage to see my oncologist. Kaiser had approved coverage for this doc for over a year, but have denied further treatment from him. Now I'm torn between staying with Advantage and trying to find the rare doc (probably non-existent) who can continue with my unorthodox (successful so far) treatment and leaving Advantage but having to seek out docs who take Medicare.

I don't quite understand the ramifications of using Medicare-only docs. I won't have to stay within the Advantage networks, but I will have to see docs that take Medicare. My current oncologist does take Medicare, so the switch would mean I could get coverage to see him, but be limited to Medicare docs.

Would I be THAT limited? Of the docs I see in network for mundane health issues, whom seem just fine, would they likely accept just Medicare ?

Sorry this got so long.

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Wouldn’t Medicare have to approve of your “unorthodox” treatment before they pay for it as well?

I’m in a rural area of Arkansas, but I have never run across a doctor, clinic, or hospital that didn’t take Medicare. I have conventional Medicare.

My husband was dropped by one doctor, an orthopedist, who did not take Medicare, when he turned 65.
He has seen I don’t know how many doctors over the almost ten years he has been on Medicare, so only one not taking Medicare seems like a pretty good percentage.

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Roswell, GA (Atlanta suburb)

Don’t forget about nursing and convalescent homes and services. Many do NOT take Advantage plans.
Those that do may not be up to your standards or may not have beds/rooms available when you need them.

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PeterW
Wouldn’t Medicare have to approve of your “unorthodox” treatment before they pay for it as well?

I agree. Doubtful that any insurance company will pay for an "unorthodox" treatment.

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"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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DeusxMac
Don’t forget about nursing and convalescent homes and services. Many do NOT take Advantage plans.
Those that do may not be up to your standards or may not have beds/rooms available when you need them.

Moving into or out of a SNF/LTC or other applicable institution qualifies for a special enrollment/plan change. That can mean switching to a different MA or switching back to Original Medicare (or other potential changes).

[www.medicare.gov]

My doctor said it’s hard for him to refer patients to specialists if the patient is in an Advantage plan.

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PeterW
Wouldn’t Medicare have to approve of your “unorthodox” treatment before they pay for it as well?

Perhaps unorthodox wasn't a good choice of words. It might be better described as not having a lot of studies behind it compared to the more mainstream treatments. The weird thing is that it was covered for a year in the Advantage plan, but now isn't covered.

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Dennis S
I’m in a rural area of Arkansas, but I have never run across a doctor, clinic, or hospital that didn’t take Medicare. I have conventional Medicare.

That's good to know.

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Edited 1 time(s). Last edit at 10/19/2021 06:09PM by lost in space.

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lost in space

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PeterW
Wouldn’t Medicare have to approve of your “unorthodox” treatment before they pay for it as well?

Perhaps unorthodox wasn't a good choice of words. It might be better described as not having a lot of studies behind it compared to the more mainstream treatments. The weird thing is that it was covered for a year in the Advantage plan, but now isn't covered.

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Dennis S
I’m in a rural area of Arkansas, but I have never run across a doctor, clinic, or hospital that didn’t take Medicare. I have conventional Medicare.

That's good to know.

I surmise that in this poor region, even doctors will take every little bit of profit they can take, where in prosperous areas, their time is better spent on more profitable patients.



Edited 1 time(s). Last edit at 10/19/2021 06:18PM by Dennis S.

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TL

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DeusxMac
Don’t forget about nursing and convalescent homes and services. Many do NOT take Advantage plans.
Those that do may not be up to your standards or may not have beds/rooms available when you need them.

Moving into or out of a SNF/LTC or other applicable institution qualifies for a special enrollment/plan change. That can mean switching to a different MA or switching back to Original Medicare (or other potential changes).

[www.medicare.gov]

I’m not seeing transfer from a hospital to a rehabilitation center covered by your link.

Sorry, that sounds like a real mess. In the other thread you said you're on a retiree plan. You often have better benefits on those plans than the general public can get so be very careful with your decision to drop that plan. Maybe HR or the benefits department at your former employer can help with getting approval to continue seeing your doc.

Another option might be to get Kaiser to give you a referral to a different doc who uses the same treatment method--unless Kaiser's beef is the treatment method not the doc.

Otherwise, I suggest you go to medicare.gov and use the plan finder to see what is available in your area. Then go directly to the web sites of a couple of the insurance companies that come up at the top of the list and use their "find a doctor" to see if your oncologist is in network.

There are a couple other possibilities but I don't have time to get into them just yet.

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DeusxMac

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TL

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DeusxMac
Don’t forget about nursing and convalescent homes and services. Many do NOT take Advantage plans.
Those that do may not be up to your standards or may not have beds/rooms available when you need them.

Moving into or out of a SNF/LTC or other applicable institution qualifies for a special enrollment/plan change. That can mean switching to a different MA or switching back to Original Medicare (or other potential changes).

[www.medicare.gov]

I’m not seeing transfer from a hospital to a rehabilitation center covered by your link.

Also don't forget in most states you have to medially qualify to switch back from MA to standardized Medigap plans.

Here I'd pick G-HD as my Medigap plan were I eligible for Medicare.



Edited 2 time(s). Last edit at 10/20/2021 04:11PM by Bill in NC.

Those who arrive at age 65 with pre-existing health issues should probably avoid the Advantage programs if they can afford to do so … some retiree plans expire after a number of years. While they tend to be outstanding in terms of coverage, they can be very expensive to continue with once the former employer stops paying for them.