I thought I'd post the comparison I mentioned down below in the previous MA post in case anyone cares to read it over.

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JoeM

Keep in mind, plans vary from location to location; not just state to state.
Scaled version (if it helps);

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A deeper look into Medicare Advantage plans.

[i]Utilization of Medicare Advantage has grown steadily since it was launched. According to health policy experts, that’s largely because private insurers invest in marketing tactics to draw people to their plans, highlighting perks like extra benefits that aren’t covered by Medicare and an annual cap on out-of-pocket costs. More than 40 percent of Medicare recipients now receive their coverage through Medicare Advantage.

For insurers, meanwhile, the business is increasingly lucrative.

“One of the reasons why they are so focused on Medicare Advantage is they are finding that the commercial insurance market, private side, is not growing,” said Potter, the former insurance executive. “It hasn't been growing for years. The unsustainable increase in premiums year after year and their constant shifting of out-of-pocket costs, is making health insurance unaffordable for businesses, so there is no growth there.”

Ahead of the current open enrollment period for Medicare plans, which began on October 15, major insurers including UnitedHealth Group, Humana, and Aetna announced new expansions into the Medicare Advantage space...

...The returns are so high in part because Medicare Advantage providers have devised ways to spend less on their customers than traditional Medicare. “They've figured out how to game the system in ways that enable them to make outsized profits,” said Potter.

One stratagem is that Medicare Advantage, unlike traditional Medicare, is allowed to require prior authorization for procedures. And high denial rates can deter people from seeking care in the first place, which saves insurers money. The federal Health and Human Services Department has found that “there are persistent problems related to denials of care and payment in Medicare Advantage,” and that in most cases when denials are appealed, insurers overturn their own denials.[/i]

Medicare Advantage (excepting Kaiser) is set up as a win-win situation for healthy people that don't need much care, and the perpetrators, er, purveyors of the programs. People that need actually need care, if they get let in, will be bounced after a year if they get a significant portion of the care that they need. If you go the supplement route, you may not be able to easily option up to a better supplement, unless you have a "life change event", such as moving, marriage, divorce/death of spouse, or if the plan you have materially changes, and a few others. That mean taking the plan that makes the most sense up front; you can option down pretty much anytime (which means paying more for the OOP's when you get care).

MA's gatekeepers will drive you bonkers as soon as you need something approved. As noted, it's a boon for the healthy, and definitely the companies that underwrite them, and usually the mega HMO's that are contracted with. A HMO in Podunksville could get hammered if a few patients that need a bunch of expensive treatments slip thru the cracks, but they're also not likely to provide those $0 premiums that are advertised, because the numbers game doesn't work there.

Play Medicare roulette carefully!
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Part of the confusion with this chart (at least for me) is when they say "Original Medicare", do they mean Part A only or part A and B? I think of Original Medicare as just Part A, which I thought pretty much covered only hospitalization.

MA plans are mostly (not all) HMO plans so as other posted you've got to get everything pre-authorized via a gatekeeper who has a substantial financial incentive to deny you more expensive treatment.

Plus the ridiculously high out-of-pocket maximums compared to standardized Medigap plans.

Here were I eligible for Medicare I'd pick Plan G - high deductible (G-HD) given the premium cost difference of Plan G vs. Plan G-HD in my area.

And the cheapest Plan D I could find as placeholder until I needed expensive drugs.



Edited 3 time(s). Last edit at 10/20/2021 04:21PM by Bill in NC.

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wurm
Part of the confusion with this chart (at least for me) is when they say "Original Medicare", do they mean Part A only or part A and B? I think of Original Medicare as just Part A, which I thought pretty much covered only hospitalization.

They mention Original Medicare and then mention Medigap and Part D when they discuss possible extra costs. Medigap and Supplemental insurance is the same thing. Depending on the procedure they are discussing they refer to the different parts that make up Original Medicare.

So in Original Medicare you have:
Part A - hospital
Part B - doctors
Medigap or Supplimental - Extra insurance that covers things not covered by Part A and B
Part D - prescriptions

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JoeM

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Buzz
People that need actually need care, if they get let in, will be bounced after a year if they get a significant portion of the care that they need.

Buzz, you said that before. You're wrong. It's actually against the law for a Medicare Advantage company to terminate your coverage because of utilization.

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AllGold

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Buzz
People that need actually need care, if they get let in, will be bounced after a year if they get a significant portion of the care that they need.

Buzz, you said that before. You're wrong. It's actually against the law for a Medicare Advantage company to terminate your coverage because of utilization.

Totally right, AllGold. There are very narrow situations in which a beneficiary can be involuntarily removed from a plan. The absolute most common reasons on the Part D side are premium nonpayment and loss of eligibility (moving out of the plan boundaries, for example). I’d imagine on the MA side the most frequent reasons are the same. Anything outside statutorily defined situations, CMS itself has to approve a plan “kicking someone out”. In over a decade in the industry, I’ve seen only one person at the point of potentially being removed (for significant and prolonged verbal abuse of plan staff), and even that person was allowed by CMS to stay with restrictions. Medicare is way different than any other plan type, the law restricts plan actions and there is a ton of oversight.

Is there anyway to up load a pdf on here?
I have a comparison of 2021 vs. 2022 of my
2022 AARP Medicare Advantage Plan 1 (HMO-POS)

I don't have to have referrals for specialists.

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Grateful11




Edited 1 time(s). Last edit at 10/20/2021 09:38PM by Grateful11.

We have Medicare Advantage through United Health Care (UHC). We don't need referrals to see anybody and the primary difference is that seeing our in-network primary physician is $5 while seeing an out-of-network primary is $25. But, virtually all other costs are the same in and out of network (except outpatient diagnostic tests [20% vs. 50%] and prosthetic devices [20% vs. 50%]). It turns out that there are no primary physicians in our town that are in network that we care to see so we're using the group that we've used for 40 years. It costs nothing for our annual physicals and we might need to see a primary once every 2 years or so (other than for annual physicals) and just pay the extra $20 for that.

As Buzz said, it's a really good deal for us because we're healthy. My university system has an arrangement with a company that provides overall evaluations of the various Medicare options. With our medical history they've recommended this particular UHC Medicare Advantage program since we went on Medicare. If I input a variety of (fake) medical problems, it shifts to other MA program as those fake problems get more significant and eventually shifts to recommending traditional Medicare along with supplement plans. Those are much more expensive that what we're paying. So we'll stay with what we have and re-evaluate every year.

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Grateful11
Is there anyway to up load a pdf on here?

No, but open the pdf in Preview and Save As… a jpg. Then upload the jpg in Control Center located at the top of any topic and click on the Edit My Files link.

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Speedy

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Grateful11
Is there anyway to up load a pdf on here?

No, but open the pdf in Preview and Save As… a jpg. Then upload the jpg in Control Center located at the top of any topic and click on the Edit My Files link.

I done that but it only saves the first page and not like all 6.

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Grateful11

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Grateful11

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Speedy

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Grateful11
Is there anyway to up load a pdf on here?

No, but open the pdf in Preview and Save As… a jpg. Then upload the jpg in Control Center located at the top of any topic and click on the Edit My Files link.

I done that but it only saves the first page and not like all 6.

Jpg, pdf, it shouldn’t matter:

[forums.macresource.com]

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Saint Cloud, Minnesota, where the weather is wonderful even when it isn't.