Original Medicare vs. Medicare Advantage

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AnnetteLouisan
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Re: Original Medicare vs. Medicare Advantage

Post by AnnetteLouisan »

MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

AnnetteLouisan wrote: Sat Oct 01, 2022 8:35 pm
MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
So you heard it third hand then advised your parents based on that?
By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
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AnnetteLouisan
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Re: Original Medicare vs. Medicare Advantage

Post by AnnetteLouisan »

MGBMartin wrote: Sat Oct 01, 2022 8:42 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:35 pm
MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
So you heard it third hand then advised your parents based on that?
By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
No, I heard it from a trusted friend whose immigrant parents were directly impacted and apparently taken advantage of, left with unaffordable bills after serious health problems and related multiple surgeries. As others noted upthread, you have to take a lot of steps to ensure something that “by law” Medicare Advantage has to do. That’s true btw of many laws - you can sue to get your rights, but will you?

I don’t want my parents to go through that and they can afford original Medicare. My parents get everything covered thank goodness, which made their lives and mine much easier.

Different people have different abilities to obtain their rights. So yes I listen to how policies are actually visited upon people I know.
Northern Flicker
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

chemocean wrote: Sat Oct 01, 2022 6:32 pm
jebmke wrote: Sat Oct 01, 2022 9:33 am
chemocean wrote: Sat Oct 01, 2022 9:29 am Advantage plans are private insurance, so the insurance company is making the decision about treatment. You can appeal, but the first two levels of appeal are within your advantage system. Only at the third level of appeal so you get an impartial Medicare administrative judge. This condition is especially important with skilled nursing after hospitalization . Some insurance companies are notorious for denying further needed skilled nursing after hospitalization. I plan on switching to the Original Medicare during the open season the year before I need skilled nursing after hospitalization
What are the chances that the underwriters would refuse to take you?
None. My understanding is moving to Original Medicare from an advantage plan does not require underwriting. The issue is finding providers that accept Medicare, as I have read in the media.
Parts A, B, and D (hospitalization, out-patient care, and drug plan) do not require it. Getting a supplemental policy does unless you move out of the plan area or the MA provider discontinues your plan.
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

AnnetteLouisan wrote: Sat Oct 01, 2022 8:47 pm
MGBMartin wrote: Sat Oct 01, 2022 8:42 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:35 pm
MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
So you heard it third hand then advised your parents based on that?
By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
No, I heard it from a trusted friend whose immigrant parents were directly impacted and apparently taken advantage of, left with unaffordable bills after serious health problems and related multiple surgeries. As others noted upthread, you have to take a lot of steps to ensure something that “by law” Medicare Advantage has to do. That’s true btw of many laws - you can sue to get your rights, but will you?

I don’t want my parents to go through that and they can afford original Medicare. My parents get everything covered thank goodness, which made their lives and mine much easier.

Different people have different abilities to obtain their rights. So yes I listen to how policies are actually visited upon people I know.
I worked in healthcare for 40 years I’ve seen the good and the bad when it comes to healthcare and insurance.
I’m fortunate enough to live in an area where the Medicare Advantage offerings are vast and many are highly regarded.
What works for some may not work for others and other peoples experiences are just anecdotal to me.
I take your point though as you are just looking out for your parents which is commendable.
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AnnetteLouisan
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Re: Original Medicare vs. Medicare Advantage

Post by AnnetteLouisan »

Thanks. Fair enough. I certainly don’t have 40 years in the medical field or in any field yet. So thank you for encouraging me to explore it further rather than relying on anecdote.
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Re: Original Medicare vs. Medicare Advantage

Post by tj »

MGBMartin wrote: Sat Oct 01, 2022 8:42 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:35 pm
MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
So you heard it third hand then advised your parents based on that?
By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
They are not required by law to consider every participating Medicare hospital and doctor "in network" for the Advantage plan. You need actual Medicare for that.
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Re: Original Medicare vs. Medicare Advantage

Post by rtt22 »

MGBMartin wrote: Sat Oct 01, 2022 8:42 pm By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
What's this pre-authorization thing then? Something like "instead of a hip replacement as the doctor recommends, do physical therapy for 9 months, then we'll re-evaluate".
MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

tj wrote: Sat Oct 01, 2022 9:07 pm
MGBMartin wrote: Sat Oct 01, 2022 8:42 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:35 pm
MGBMartin wrote: Sat Oct 01, 2022 8:26 pm
AnnetteLouisan wrote: Sat Oct 01, 2022 8:01 pm I’ve heard that Advantage is cheaper but much worse and I’ve warned my parents against switching to it.
I’ve heard lots of things but I don’t typically make important decisions on what I hear.
I do research and I advise others to do the same.
I heard it from a friend in my state whose parents switched to Advantage due to cost and then had serious surgeries Advantage didn’t cover. I also think the name is intentionally misleading. That will do as far as I’m concerned. Others can make their own inquiries.
So you heard it third hand then advised your parents based on that?
By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
They are not required by law to consider every participating Medicare hospital and doctor "in network" for the Advantage plan. You need actual Medicare for that.
I didn’t say they did.
I was talking about procedures and treatment etc.
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MGBMartin
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

rtt22 wrote: Sat Oct 01, 2022 9:10 pm
MGBMartin wrote: Sat Oct 01, 2022 8:42 pm By law Medicare Advantage has to cover and pay for everything that original Medicare covers.
What's this pre-authorization thing then? Something like "instead of a hip replacement as the doctor recommends, do physical therapy for 9 months, then we'll re-evaluate".
When I needed to see neurosurgeon last year everybody told me your insurance will make you go to physical therapy first.
When I saw neurosurgeon he told me physical therapy is not an option for you as you need surgery. He told me a pre authorization would not be needed as his findings will be sufficient to satisfy my insurance. I called my insurance to make sure and was told because I had seen a BayCare neurosurgeon his recommendation was sufficient, my insurance is also BayCare. I’ve been told that several times, if I see a BayCare doctor or be seen at a BayCare facility such as Urgent Care then no pre authorizations are needed for the suggested treatment.

I don’t doubt other MA plans work differently especially ones that are not part of of the provider themselves.
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cashmoney
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Re: Original Medicare vs. Medicare Advantage

Post by cashmoney »

Sandtrap wrote: Sat Oct 01, 2022 6:50 pm
fishandgolf wrote: Sat Oct 01, 2022 9:00 am Greetings Fellow BH's:

My mother-in-law (87 years old and very healthy.....with some exceptions) has been on Original Medicare for many years. She's a very active social person and recently several of her "social acquaintances" initiated a discussion on the subject of "Original Medicare vs. Medicare Advantage".

Many of these folks are on "Medicare Advantage Plans" and have been giving her a hard time about the costs she incurs on "Original Medicare" (she can easily afford the cost). They have nearly convinced her that she needs to change her plan......and she's in a serious quandary about doing so and has reached out to us. It's been a long time since my wife and I have researched the pros and cons of each plan. One of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details. I would appreciate it if there are any BH's intimately familiar with this subject and could offer a few pros and cons of each program; it would be very helpful to put my her mind at ease..... :?:
This might be a useful example:

We have "Original Medicare" with Part F Supplemental, plus additional supplementals.
The distinguished "Mayo Medical Centers" take our coverage. They do not take "Medicare Advantage".

Also: "Medicare Advantage is an "HMO" so you have to work with the "network". . . whereas "Original Medicare" is more open and choices and so forth can be to your benefit, sometimes greatly.

"Original Medicare" is federal. . per se. .
"Medicare Advantage" is private. . per se. . (some higher deductables and coverage limits, etc, than "Original". . but. . it depends).

To OP:
*** It is very important that you try to get a good comprehensive look at your present and future health care needs, and then get the plan/s that will fit your best as far as medical coverage, finances, etc.
(what might be excellent for someone in great health and continues that way might be terrible for someone in other circumstances.)

I hope this is helpful
j :D
dislaimer: many ways to do things and opinionizations based on nil to zero to extensive experience. This is only one.

Mayo Clinic in Rochester is in network with UHC Medicare Advantage Plans as of a 1/1/23 .Most UHC MA plans have the National Network feature which allows you go to any in network provider in the country.The Mayo clinic in Jacksonville and has been accepting all the MA PPO plans out of network for a long time ( not sure about the other campuses.) and it wouldn't surprise if all campuses are soon in network with UHC since that's the only MA carrier they have ever contracted with so far. https://newsnetwork.mayoclinic.org/disc ... ationship/

Also Most MA plans do not have medical deductibles like original Medicare
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

There are increasing numbers of providers who will not accept new patients who have original medicare as their coverage. Original medicare supports a de facto nationwide hospital network, but not a de facto nationwide physician network.
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Re: Original Medicare vs. Medicare Advantage

Post by Dottie57 »

Medicare Advantage is funded by the government. Believe the individual covered stops paying for medicare and the Advantage plan receives a dollar amount for eac person who is enrolled in MA. In return the MA plan assumes all responsibility for providing Health Care. For the plan to be profitable care there has to be cost controls.This is similar to HMO’s.

So if you’re healthy, MA s a good deal. I prefer regular regular. Medicare. As I wan to keep my doctors and pharmacy and hospitals.. I also also do. not want to have an incentive to provide the cheapest care or limit care.
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Re: Original Medicare vs. Medicare Advantage

Post by grok87 »

Northern Flicker wrote: Sun Oct 02, 2022 2:51 am There are increasing numbers of providers who will not accept new patients who have original medicare as their coverage. Original medicare supports a de facto nationwide hospital network, but not a de facto nationwide physician network.
interesting point
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Re: Original Medicare vs. Medicare Advantage

Post by vested1 »

I'm always suspicious when something is pushed so aggressively by private companies, as if they are doing so out of altruistic reasons. Who pays for those commercials, and how are they so cost effective? If I ever see Jimmy Walker, Joe Namath, or Tom Selleck pushing MA again it will be too soon. They are why fast forward was invented. I used to wonder why MA providers never had commercials that featured women celebrities, then realized they probably couldn't find any who had the requisite lack of ethics.

My wife and I both have HRA's (Health Reimbursement Accounts) though our separate former employers which reimburse a total $11,200 a year for any health related expense, including Medicare premiums. My former megacorp employer is constantly looking for ways to cut expenses on retirees, including slashing our life insurance across the board this year. Starting last year my former employer offered their hybrid version of MA, which has a premium of $80 a month, but for the privilege of having higher deductibles and less coverage you lose the HRA. Wow, tough decision. I have a nagging feeling that despite their glossy mailings hawking the "advantages" of their version of MA, they aren't doing it for the retiree's benefit.

Both my wife and I are required to go through separate intermediaries every year at open enrollment in order to qualify for the HRA's for both spouses, by choosing either a supplemental plan or Part D. Those agents work for entities that have no financial interest in which plan we choose, neither MA nor supplemental. They get paid the same either way. We have been educated on the disadvantages of MA by those agents when we pressed. They were not eager to share their opinion, but after dealing with numerous issues with other customers, answered our questions.

As others have said, MA is fine depending on where you live, if you are relatively healthy and expect to remain that way until the moment of death, or if you ever want to return to original medicare and happen to have a preexisting condition which could cause you to be denied depending on where you live or certain criteria that you may not qualify for.
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Re: Original Medicare vs. Medicare Advantage

Post by MGBMartin »

My MA company does not advertise on TV or use celebrities to push their plans, at least not that I’ve seen.
I stay away from the companies that advertise on TV constantly. I’ve checked out some of theses and they do not meet my needs.

As for returning to Medicare, you cannot be refused returning to Medicare because of a preexisting condition; getting a Medicare Supplement may be problematic though.
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Re: Original Medicare vs. Medicare Advantage

Post by nisiprius »

I won't make a strong case for traditional Medicare plus supplement ("Medigap") plus Part D, although it's what we've used, but I'll make some points for consideration.

1) Twenty years on employer-sponsored HMOs, all rated very good, they were OK. Fine. No horror stories. But there was aggravation. I had perhaps ten issues* requiring significant hassles and time spent on the phone--all eventually resolved OK.

So far, after about ten years on traditional Medicare and Medigap, I have had no issues and have paid nothing out of pocket. And that includes three hospital admissions and one air ambulance ride.

2) Consider carefully the implications of the Medicare Advantage doctors' network versus traditional Medicare's.

3) Consider carefully the question of whether you can change from Medicare Advantage to traditional Medicare plus Medigap if you find after a few years that you just do not like the Medicare Advantage plan.

This is a real mess, and one of the big reasons we opted for Traditional is that I felt I could not get a straight answer. When asked, representatives rattle off a list of restricted situations in which you have the right to do it (e.g. during the first year). But at the time, the website, the printed materials, and what the representative was telling me were three different things. (The rep was like "oh, really? I don't think it says that. It does? well, it must be out of date or something...")

4) On Medicare Advantage, the quality of the HMO/PPO really matters so you have to dig into reputation and rating and talk to friends. On Traditional Medicare plus Medigap, it doesn't, because the insurer doesn't have any discretion to speak of. It's a mechanical process. The only difference between insurers is the premium.


*Example of what I mean by an "issue." When routine screening colonoscopies were new, I once went back-and-forth for three weeks during which the insurance company told me, every time I called, yes it was covered on my particular plan, while the gastroenterologist's office kept telling me that the same company kept telling them that no, it was not covered on my particular plan. State health insurance ombudsman's office cleared it up. It was covered BTW.
Last edited by nisiprius on Sun Oct 02, 2022 7:02 am, edited 6 times in total.
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

Dottie57 wrote: Sun Oct 02, 2022 5:11 am Medicare Advantage is funded by the government. Believe the individual covered stops paying for medicare and the Advantage plan receives a dollar amount for eac person who is enrolled in MA. In return the MA plan assumes all responsibility for providing Health Care. For the plan to be profitable care there has to be cost controls.This is similar to HMO’s.

So if you’re healthy, MA s a good deal. I prefer regular regular. Medicare. As I wan to keep my doctors and pharmacy and hospitals.. I also also do. not want to have an incentive to provide the cheapest care or limit care.
If you have a Part C Medicare Advantage plan, you still have to pay the $170.10 a month Part B premium (unless are in an Advantage plan that offers a Give Back Benefit in your area).
tunafish
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Re: Original Medicare vs. Medicare Advantage

Post by tunafish »

Northern Flicker wrote: Sun Oct 02, 2022 2:51 am There are increasing numbers of providers who will not accept new patients who have original medicare as their coverage. Original medicare supports a de facto nationwide hospital network, but not a de facto nationwide physician network.
More anecdotal stuff. Here'e mine:

I hear rumors about doctors not accepting Medicare, but only once in my 15 or so years on Medicare+Medigap have I encountered it, and that was with a random specialist, not someone with a world class reputation, etc. I had no trouble finding a replacement specialist. I also have never had a problem with the world class doctors at the Boston hospitals turning me away due to Medicare.

Someone also mentioned prescription plans. I have AARP Plan D and (I hope this isn't jinxing stuff) they have approved every non-formulary med my doctors asked for within a day.
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Re: Original Medicare vs. Medicare Advantage

Post by brian91480 »

uaeebs86 wrote: Sat Oct 01, 2022 9:31 am Clark Howard believes you should never do Medicare Advantage unless you can just not afford the premiums and costs from regular Medicare. He doesn't think the providers will be there for you if you have a major medical issue or need any advanced type of care.
To me... "regular Medicare" includes Part A, Part B, and maybe even Part D.

But everyone ** should ** either buy Part C (Medicare Advantage) or a seperate Medigap policy in addition to regular Medicare. That's how you get an Out Of Pocket Maximum for the year.

If you don't buy the extra Medicare insurance, you're rolling the dice on a major health / financial risk.

-- Brian
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Re: Original Medicare vs. Medicare Advantage

Post by nisiprius »

brian91480 wrote: Sun Oct 02, 2022 7:01 am...To me... "regular Medicare" includes Part A, Part B, and maybe even Part D...
We feel that we need part D for the catastrophic coverage.

Otherwise, part D sucks generally, and it is driving me bananas that e.g. the same medication may cost $60 when bought with insurance at CVS, and $15 when bought without insurance at Costco or through Amazon's mail-order pharmacy.

It is a pet gripe of mine that you have to commit to Part D for a year, but the insurance company only has to commit to the formulary for 60 days.

It's one of the few situations where I do go for e-statements. For heaven's sake, a monthly six-page statement that needs graphic diagrams and maps to chart your progressive adventure through the countries of Deductonia, Initialstan, Doughnutland, etc.
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Re: Original Medicare vs. Medicare Advantage

Post by JoeRetire »

AnnetteLouisan wrote: Sat Oct 01, 2022 8:47 pm I don’t want my parents to go through that and they can afford original Medicare. My parents get everything covered thank goodness, which made their lives and mine much easier.
If you are willing to pay the premiums, Original Medicare with the most expensive Supplements will indeed make things easier, if ease is your primary concern.

For many, a little less easy can save quite a lot of money while still getting terrific service. The out of pocket maximum provides protection in the worst cases.

I would never base my decision on "I heard someone say X was bad", but we each get to choose our own path.
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Re: Original Medicare vs. Medicare Advantage

Post by bradinsky »

Good morning everyone,
I just checked with Medicare.gov as to what premiums, drug & out of pocket costs would be for a Medicare Advantage plan be in my area. Of the first 6, the lowest total was $5823 & the highest was $6841. It moves upward quickly after that.
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Re: Original Medicare vs. Medicare Advantage

Post by Sandtrap »

cashmoney wrote: Sun Oct 02, 2022 1:11 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm
fishandgolf wrote: Sat Oct 01, 2022 9:00 am Greetings Fellow BH's:

My mother-in-law (87 years old and very healthy.....with some exceptions) has been on Original Medicare for many years. She's a very active social person and recently several of her "social acquaintances" initiated a discussion on the subject of "Original Medicare vs. Medicare Advantage".

Many of these folks are on "Medicare Advantage Plans" and have been giving her a hard time about the costs she incurs on "Original Medicare" (she can easily afford the cost). They have nearly convinced her that she needs to change her plan......and she's in a serious quandary about doing so and has reached out to us. It's been a long time since my wife and I have researched the pros and cons of each plan. One of the things that I do remember is that once you enroll in one of the plans, under certain circumstances you can not go back to the other plan....but I don't recall those details. I would appreciate it if there are any BH's intimately familiar with this subject and could offer a few pros and cons of each program; it would be very helpful to put my her mind at ease..... :?:
This might be a useful example:

We have "Original Medicare" with Part F Supplemental, plus additional supplementals.
The distinguished "Mayo Medical Centers" take our coverage. They do not take "Medicare Advantage".

Also: "Medicare Advantage is an "HMO" so you have to work with the "network". . . whereas "Original Medicare" is more open and choices and so forth can be to your benefit, sometimes greatly.

"Original Medicare" is federal. . per se. .
"Medicare Advantage" is private. . per se. . (some higher deductables and coverage limits, etc, than "Original". . but. . it depends).

To OP:
*** It is very important that you try to get a good comprehensive look at your present and future health care needs, and then get the plan/s that will fit your best as far as medical coverage, finances, etc.
(what might be excellent for someone in great health and continues that way might be terrible for someone in other circumstances.)

I hope this is helpful
j :D
dislaimer: many ways to do things and opinionizations based on nil to zero to extensive experience. This is only one.

Mayo Clinic in Rochester is in network with UHC Medicare Advantage Plans as of a 1/1/23 .Most UHC MA plans have the National Network feature which allows you go to any in network provider in the country.The Mayo clinic in Jacksonville and has been accepting all the MA PPO plans out of network for a long time ( not sure about the other campuses.) and it wouldn't surprise if all campuses are soon in network with UHC since that's the only MA carrier they have ever contracted with so far. https://newsnetwork.mayoclinic.org/disc ... ationship/

Also Most MA plans do not have medical deductibles like original Medicare
Good info.
great to know

I've been getting multiple yearly patient notices from the Mayo Center in Scottsdale about "Medicare Advantage". So locations differ, I see. Things are changing.

Sounds like you have good access there. Great.

thanks again,
j :D
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Re: Original Medicare vs. Medicare Advantage

Post by CWRadio »

I have a Transamerica plan G supplement (Medigap). It is a closed policy in my state. No new people can join. The plan uses ATTAINED AGE PRICING.

My concern is since no new people can join a Transamerica plan G the yearly cost of the plan will be higher due to the only people left in the plan are getting older and sicker. Not much I can do except change plan which require medical underwriting.

Pick a plan that will last through retirement and will not close to new customers.
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

CWRadio wrote: Sun Oct 02, 2022 7:44 am I have a Transamerica plan G supplement (Medigap). It is a closed policy in my state. No new people can join. The plan uses ATTAINED AGE PRICING.

My concern is since no new people can join a Transamerica plan G the yearly cost of the plan will be higher due to the only people left in the plan are getting older and sicker. Not much I can do except change plan which require medical underwriting.

Pick a plan that will last through retirement and will not close to new customers.
Paul
It wasn’t just your state. In September 2020, Transamerica stopped issuing new Medigap policies nationwide.

I would call a Medigap broker and see if they know of another insurer where you could pass underwriting with your medical conditions.

On a related note, it is worth mentioning that, in some states, some insurance companies are known for closing a Medigap pool and then starting a new pool with new, younger, healthier participants.

The people in the original pool are left with an older, sicker pool as time goes on, with corresponding increasing rates (especially since the people who can go through medical underwriting leave the pool as rates go up).

Every few years the insurance company then repeats the process.

Mutual of Omaha and Aetna are known for doing this.
tunafish
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Re: Original Medicare vs. Medicare Advantage

Post by tunafish »

ModifiedDuration wrote: Sun Oct 02, 2022 8:00 am
On a related note, it is worth mentioning that, in some states, some insurance companies are known for closing a Medigap pool and then starting a new pool with new, younger, healthier participants.

The people in the original pool are left with an older, sicker pool as time goes on, with corresponding increasing rates (especially since the people who can go through medical underwriting leave the pool as rates go up).

Every few years the insurance company then repeats the process.

Mutual of Omaha and Aetna are known for doing this.
I have AARP Medigap Plan F, which closed awhile ago amid predictions of rising prices due to that reasoning. I just went back and looked at my tax records, and here are the last three years annual premiums. I suspect 2021 went up maybe because of covid:

$3021 for 2020
$3210 for 2021
$3079 for 2022
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Re: Original Medicare vs. Medicare Advantage

Post by jebmke »

nisiprius wrote: Sun Oct 02, 2022 7:10 am
brian91480 wrote: Sun Oct 02, 2022 7:01 am...To me... "regular Medicare" includes Part A, Part B, and maybe even Part D...
We feel that we need part D for the catastrophic coverage.

Otherwise, part D sucks generally, and it is driving me bananas that e.g. the same medication may cost $60 when bought with insurance at CVS, and $15 when bought without insurance at Costco or through Amazon's mail-order pharmacy.

It is a pet gripe of mine that you have to commit to Part D for a year, but the insurance company only has to commit to the formulary for 60 days.

It's one of the few situations where I do go for e-statements. For heaven's sake, a monthly six-page statement that needs graphic diagrams and maps to chart your progressive adventure through the countries of Deductonia, Initialstan, Doughnutland, etc.
Part D is a loser for me. I've thought seriously about dumping it entirely; fortunately I have found a cheapo plan that is essentially insurance insurance to avoid the penalty if I ever wanted to get in late. $10 a month in 2023 - down from $12 :greedy
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bradinsky
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Re: Original Medicare vs. Medicare Advantage

Post by bradinsky »

brian91480 wrote: Sun Oct 02, 2022 7:01 am
uaeebs86 wrote: Sat Oct 01, 2022 9:31 am Clark Howard believes you should never do Medicare Advantage unless you can just not afford the premiums and costs from regular Medicare. He doesn't think the providers will be there for you if you have a major medical issue or need any advanced type of care.
To me... "regular Medicare" includes Part A, Part B, and maybe even Part D.

But everyone ** should ** either buy Part C (Medicare Advantage) or a seperate Medigap policy in addition to regular Medicare. That's how you get an Out Of Pocket Maximum for the year.

If you don't buy the extra Medicare insurance, you're rolling the dice on a major health / financial risk.

-- Brian
Where in this country does “regular Medicare” include part D? I’d be interested.
WillRetire
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Re: Original Medicare vs. Medicare Advantage

Post by WillRetire »

notBobToo wrote: Sat Oct 01, 2022 12:55 pm To the OP, I recommend staying with the Original Medicare. Even if your relative is in one of the areas with good MA coverage (CA, CO, FL, DC, others?), why change if she can afford what she has and is satisfied with what she has?

I was recently notified that starting in 2023, my ex-employer would like all of its Medicare eligible retirees to move to a new group MA program. One can apparently stay with Original Medicare, but would lose the stipend that the company provides to pay for health care costs. (Which currently covers about nine months of Plan G premiums for DW and I.) The notification stated that 99.9% of retirees would continue to have access to their chosen providers. I ran a quick check and found that none of my providers are in network, although both of our prescription sets are fully covered, most at Tier 1 or Tier 2. So good news, bad news I guess. That would be my fear in switching to a MA program -- outside of the geographies that have very good MA coverage.
Interesting coincidence: a good friend of mine is evaluating similar or same options. The 99.9% statement caught my eye too. The actual quote in the plan's brochure, the one my friend is considering, is as follows:
"In fact, 99.9% of UnitedHealthcare Medicare Advantage members continue to have services from their chosen
providers covered."

Now, take a hard read of that statement... 99.9% of UHC MA members
It is not sayingthat 99.9% of all providers, or even all medicare providers, are in network. Just that members continue to have services from their chosen providers. What is a "chosen provider"? Is it a provider the member used before switching plans? Or is it an in-network provider that the member switched to after joining the plan? "Member" means someone who has the plan.

The implication of the statement is: If you like your doctor, you can keep your doctor.
In real life: maybe, maybe not. It is in your best financial interest to use in-network doctors. Even with a PPO, going out of network is fraught with issues like maybe the doctor does not accept the plan (even though they accept medicare), and members get to spend time screening providers.

Read the plan statements very very carefully. MA plans use aggressive marketing techniques to deceive. Buyer beware.
orlandoman
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Re: Original Medicare vs. Medicare Advantage

Post by orlandoman »

The confusing fact in these discussions is that Medicare vs Medicare Advantage is not an apples to apples comparison:
- Original Medicare offers specific unchanging benefits
- Medicare Supplements offer 10 specific plans, each plan is exactly the same i.e. all Plan G's offer the same benefits
- Medicare Advantage plans come in two major groups HMO's & PPO's. MA plans offer the same benefits as Original Medicare, but, they can adjust coverage amounts, deductibles & copay's, etc. The way HMO's & PPO's operate is different and within both HMO & PPO plans there are many different variations & many times extra benefits like dental & vision care. MA plans can make adjustments on a yearly basis.
- MA plans receive a monthly payment for each enrollee from Medicare to cover the expenses of it's members (around $1,200 per month). They are only allowed to make a certain percent of profit and any excess funds has to be used for extra benefits for it's members.
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Re: Original Medicare vs. Medicare Advantage

Post by JoeRetire »

Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
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Re: Original Medicare vs. Medicare Advantage

Post by Farmboyslim83 »

I’m on the east coast, and have a BCBS Medicare Advantage plan. All BCBS plans are in-network, so if a provider in Florida, North Carolina, etc. is in- network for that plan, they are in- network for me, if I need care there. Don’t know many hospitals, Dr’s, etc. that are not in a BCBS network.
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Re: Original Medicare vs. Medicare Advantage

Post by Artful Dodger »

prd1982 wrote: Sat Oct 01, 2022 10:45 am I haven’t switched to Medicare Advantage because I cannot understand the financial side of it. Based on the advertising, insurance companies want you to pick MA vs. a supplement. The MA plans swear they are paid the same amount by the federal government as traditional Medicare. Yet MA plans promise more benefits at a significantly lower cost. I cannot find any explanation as to how they do it. Do they deny service? Do they make it difficult to get service? Do they reimburse medical facilities at a lower rate?
In general, the people who enroll in Medicare Advantage plans tend to be healthier and have lower claims costs than those who enroll in and stay in traditional Medicare. It makes sense, if you’re healthy and don’t expect to be needing more advanced care, you’re more likely to sign up for a plan with less provider choices and more restrictions. If you’re worried about your health, you’re more likely to want the broadest network of providers and least restrictions.

In addition, Medicare pays the MA plans risk adjustment money for members that are higher claims cost enrollees (as well as lower cost members). This helps them manage their loss ratio.

I haven’t seen anything recently, but in the past there were reports MA plans did a better job of identifying provider fraud than traditional Medicare and this helped their claims cost.
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Re: Original Medicare vs. Medicare Advantage

Post by rtt22 »

CWRadio wrote: Sun Oct 02, 2022 7:44 am I have a Transamerica plan G supplement (Medigap). It is a closed policy in my state. No new people can join. The plan uses ATTAINED AGE PRICING.

My concern is since no new people can join a Transamerica plan G the yearly cost of the plan will be higher due to the only people left in the plan are getting older and sicker. Not much I can do except change plan which require medical underwriting.

Pick a plan that will last through retirement and will not close to new customers.
Paul
I did not know that switching from one Plan G (Medicare Supplemental) vendor to another Plan G vendor requires medical underwriting. I thought that switching from a Medicare Advantage plan back to a Plan G plan would require underwriting (state and time frame dependent) but switching from one Plan G vendor to another Plan G vendor also requires underwriting?
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Re: Original Medicare vs. Medicare Advantage

Post by montanagirl »

rtt22 wrote: Sun Oct 02, 2022 9:57 am
CWRadio wrote: Sun Oct 02, 2022 7:44 am I have a Transamerica plan G supplement (Medigap). It is a closed policy in my state. No new people can join. The plan uses ATTAINED AGE PRICING.

My concern is since no new people can join a Transamerica plan G the yearly cost of the plan will be higher due to the only people left in the plan are getting older and sicker. Not much I can do except change plan which require medical underwriting.

Pick a plan that will last through retirement and will not close to new customers.
Paul
I did not know that switching from one Plan G (Medicare Supplemental) vendor to another Plan G vendor requires medical underwriting. I thought that switching from a Medicare Advantage plan back to a Plan G plan would require underwriting (state and time frame dependent) but switching from one Plan G vendor to another Plan G vendor also requires underwriting?

Depends on your state but generally yes. I went through underwriting two years ago to switch plan G insurers.
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Re: Original Medicare vs. Medicare Advantage

Post by ModifiedDuration »

rtt22 wrote: Sun Oct 02, 2022 9:57 am
CWRadio wrote: Sun Oct 02, 2022 7:44 am I have a Transamerica plan G supplement (Medigap). It is a closed policy in my state. No new people can join. The plan uses ATTAINED AGE PRICING.

My concern is since no new people can join a Transamerica plan G the yearly cost of the plan will be higher due to the only people left in the plan are getting older and sicker. Not much I can do except change plan which require medical underwriting.

Pick a plan that will last through retirement and will not close to new customers.
Paul
I did not know that switching from one Plan G (Medicare Supplemental) vendor to another Plan G vendor requires medical underwriting. I thought that switching from a Medicare Advantage plan back to a Plan G plan would require underwriting (state and time frame dependent) but switching from one Plan G vendor to another Plan G vendor also requires underwriting?
It depends on the state.

Some states have very lenient rules regarding switching Medigap policies and going from one insurer to another would not require medical underwriting.

But, in most states you would have to go through medical underwriting to switch your Plan G from one insurer to another, unless you fall under one of the exceptions:

https://www.medicare.gov/supplements-ot ... sue-rights
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Re: Original Medicare vs. Medicare Advantage

Post by Sandtrap »

JoeRetire wrote: Sun Oct 02, 2022 9:15 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
Good point and a substantive input post.

thanks!
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dodecahedron
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Re: Original Medicare vs. Medicare Advantage

Post by dodecahedron »

Artful Dodger wrote: Sun Oct 02, 2022 9:45 am
prd1982 wrote: Sat Oct 01, 2022 10:45 am I haven’t switched to Medicare Advantage because I cannot understand the financial side of it. Based on the advertising, insurance companies want you to pick MA vs. a supplement. The MA plans swear they are paid the same amount by the federal government as traditional Medicare. Yet MA plans promise more benefits at a significantly lower cost. I cannot find any explanation as to how they do it. Do they deny service? Do they make it difficult to get service? Do they reimburse medical facilities at a lower rate?
In general, the people who enroll in Medicare Advantage plans tend to be healthier and have lower claims costs than those who enroll in and stay in traditional Medicare. It makes sense, if you’re healthy and don’t expect to be needing more advanced care, you’re more likely to sign up for a plan with less provider choices and more restrictions. If you’re worried about your health, you’re more likely to want the broadest network of providers and least restrictions.

In addition, Medicare pays the MA plans risk adjustment money for members that are higher claims cost enrollees (as well as lower cost members). This helps them manage their loss ratio.

I haven’t seen anything recently, but in the past there were reports MA plans did a better job of identifying provider fraud than traditional Medicare and this helped their claims cost.
Indeed, studies by Harvard professor Malcolm Sparrow and others have shown that traditional Medicare has approved payments for invoices for services allegedly rendered to patients who were already dead on the date of the purported service and that the alleged services were rendered by physicians who themselves were dead on the date the service was allegedly provided.

That said, Professor Sparrow’s work has also raised some concerns about lack of due diligence measures against fraud by some managed care plans as well as traditional Medicare.
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Re: Original Medicare vs. Medicare Advantage

Post by CWRadio »

Take a look at my posting on how to switch from Medicare Supplement (Medigap) without medical underwriting. Paul
viewtopic.php?t=387082
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Re: Original Medicare vs. Medicare Advantage

Post by pshonore »

Sandtrap wrote: Sun Oct 02, 2022 10:06 am
JoeRetire wrote: Sun Oct 02, 2022 9:15 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
Good point and a substantive input post.

thanks!
j :D
Same experience here with MA plans from Anthem and UHC. In a small state like CT, there are very few if any hospitals or doctors that don't participate. Still pay Part B but $0 deductible and $10 copays for providers, 2K out of pocket max. Rx, Vision and hearing benefits provided as well.
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Re: Original Medicare vs. Medicare Advantage

Post by Broken Man 1999 »

The MA plans are certainly popular in Florida.

https://medicareguide.com/florida-medic ... 0Medicare.

"...In 2021, almost 2.5 million Florida residents enrolled in Medicare Advantage, representing 52% of all eligible beneficiaries. More Medicare-eligible residents of Miami-Dade county chose Medicare Advantage (74%) than anywhere else in Florida, but nearly all counties in the state saw increases in Medicare Advantage enrollment versus Original Medicare..."

My doctors are all in Hillsborough County, Medicare Advantage plan penetration is 57%.

We have used HMOs and PPOs from about the time the plans originated. Currently DW and I have Humana MA PPO. While we can go out of network, we never have needed to go out of network. MegaCorp offers our MA PPO with zero contribution from us as one option for retirees.

DW has never had to change doctors, our daughters joined her doctor when they left their pediatrician. I have never had to change doctors because of my plan, including all my specialists. Unfortunately some are getting older, like me, so I might have to pick new ones in the future.

We can afford any type insurance we desire, but we have continuously received great care with our HMOs and PPOs. I am definitely a high user of medical services, but have no horrible experiences to share about MA plans.

I think MA plans work best in larger communities. The networks can be broader and deeper. Looking in the link I posted at the penetration at the county level shows metro areas with much higher penetration than in the smaller counties.

Every person should actually learn about what Medicare covers, and along with that the ins and outs of your plan.
'
As well, having doctors who are advocates for your care goes a long way when dealing with any type insurance plan you might have.

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Re: Original Medicare vs. Medicare Advantage

Post by cashmoney »

WillRetire wrote: Sun Oct 02, 2022 9:05 am
notBobToo wrote: Sat Oct 01, 2022 12:55 pm To the OP, I recommend staying with the Original Medicare. Even if your relative is in one of the areas with good MA coverage (CA, CO, FL, DC, others?), why change if she can afford what she has and is satisfied with what she has?

I was recently notified that starting in 2023, my ex-employer would like all of its Medicare eligible retirees to move to a new group MA program. One can apparently stay with Original Medicare, but would lose the stipend that the company provides to pay for health care costs. (Which currently covers about nine months of Plan G premiums for DW and I.) The notification stated that 99.9% of retirees would continue to have access to their chosen providers. I ran a quick check and found that none of my providers are in network, although both of our prescription sets are fully covered, most at Tier 1 or Tier 2. So good news, bad news I guess. That would be my fear in switching to a MA program -- outside of the geographies that have very good MA coverage.
Interesting coincidence: a good friend of mine is evaluating similar or same options. The 99.9% statement caught my eye too. The actual quote in the plan's brochure, the one my friend is considering, is as follows:
"In fact, 99.9% of UnitedHealthcare Medicare Advantage members continue to have services from their chosen
providers covered."

Now, take a hard read of that statement... 99.9% of UHC MA members
It is not sayingthat 99.9% of all providers, or even all medicare providers, are in network. Just that members continue to have services from their chosen providers. What is a "chosen provider"? Is it a provider the member used before switching plans? Or is it an in-network provider that the member switched to after joining the plan? "Member" means someone who has the plan.

The implication of the statement is: If you like your doctor, you can keep your doctor.
In real life: maybe, maybe not. It is in your best financial interest to use in-network doctors. Even with a PPO, going out of network is fraught with issues like maybe the doctor does not accept the plan (even though they accept medicare), and members get to spend time screening providers.

Read the plan statements very very carefully. MA plans use aggressive marketing techniques to deceive. Buyer beware.


WillRetire wrote: Sun Oct 02, 2022 9:05 am
notBobToo wrote: Sat Oct 01, 2022 12:55 pm To the OP, I recommend staying with the Original Medicare. Even if your relative is in one of the areas with good MA coverage (CA, CO, FL, DC, others?), why change if she can afford what she has and is satisfied with what she has?

I was recently notified that starting in 2023, my ex-employer would like all of its Medicare eligible retirees to move to a new group MA program. One can apparently stay with Original Medicare, but would lose the stipend that the company provides to pay for health care costs. (Which currently covers about nine months of Plan G premiums for DW and I.) The notification stated that 99.9% of retirees would continue to have access to their chosen providers. I ran a quick check and found that none of my providers are in network, although both of our prescription sets are fully covered, most at Tier 1 or Tier 2. So good news, bad news I guess. That would be my fear in switching to a MA program -- outside of the geographies that have very good MA coverage.
Interesting coincidence: a good friend of mine is evaluating similar or same options. The 99.9% statement caught my eye too. The actual quote in the plan's brochure, the one my friend is considering, is as follows:
"In fact, 99.9% of UnitedHealthcare Medicare Advantage members continue to have services from their chosen
providers covered."

Now, take a hard read of that statement... 99.9% of UHC MA members
It is not sayingthat 99.9% of all providers, or even all medicare providers, are in network. Just that members continue to have services from their chosen providers. What is a "chosen provider"? Is it a provider the member used before switching plans? Or is it an in-network provider that the member switched to after joining the plan? "Member" means someone who has the plan.

The implication of the statement is: If you like your doctor, you can keep your doctor.
In real life: maybe, maybe not. It is in your best financial interest to use in-network doctors. Even with a PPO, going out of network is fraught with issues like maybe the doctor does not accept the plan (even though they accept medicare), and members get to spend time screening providers.

Read the plan statements very very carefully. MA plans use aggressive marketing techniques to deceive. Buyer beware.

Check the benefits outline many of the UHC Group MA PPO plan many have the same cost for in network and out of network however out of network providers can't be forced to accept the plan.This is anecdotal but as a licensed agent doing business with UHC since 2006 with a good sample size of members in Fl for individual MA plans I would guesstimate that well over 90% of the medicare providers here will accept ( in or out of network ) the individual UHC PPO .I would expect this number to be even higher with the UHC Group MA PPO plans that feature the same cost in and out of network.In the area I do most of my business the few and far between providers who won't accept the individual UHC MA PPO out of network are those who don't contract with any UHC plans period and I believe this is mostly do to the fact is they do not want to go through the UHC provider credentialing process.If a provider contracts with any UHC plan ( individual,group,medicaid etc) then are very likely to accept UHC MA PPO plans OON because they are already credentialed and using the UHC claims platform.
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Re: Original Medicare vs. Medicare Advantage

Post by mpnret »

JoeRetire wrote: Sun Oct 02, 2022 9:15 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
Mine is also a PPO. Accepted everywhere Medicare is and it's the best plan I have ever been on. Also free being it's part of a retirement package.
Northern Flicker
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

Dottie57 wrote: Sun Oct 02, 2022 5:11 am Medicare Advantage is funded by the government. Believe the individual covered stops paying for medicare and the Advantage plan receives a dollar amount for eac person who is enrolled in MA. In return the MA plan assumes all responsibility for providing Health Care. For the plan to be profitable care there has to be cost controls.
Two points not mentioned there: 1) many MA providers are non-profit orgs that are not trying to turn a profit (though may have high executive compensation to cover); and 2) Medicare generally pays out a little more per person for MA than for original Medicare. The benefit received by the Medicare system for the additional cost is transferring the actuarial risk to the MA provider.
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Re: Original Medicare vs. Medicare Advantage

Post by orlandoman »

mpnret wrote: Sun Oct 02, 2022 1:29 pm
JoeRetire wrote: Sun Oct 02, 2022 9:15 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
Mine is also a PPO. Accepted everywhere Medicare is and it's the best plan I have ever been on. Also free being it's part of a retirement package.
The , "Accepted everywhere Medicare is ..." is misleading. What that means is that the MA plan will pay as in-network if the physician will accept it. Physicians can take Medicare patients but only take a few or no MA plans. A dermatologist group I visit, takes Medicare but only a few MA plans in fact they stopped taking new patients for the PPO MA plan I belonged to at the time.
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Northern Flicker
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Re: Original Medicare vs. Medicare Advantage

Post by Northern Flicker »

Apparently, there is year-around special enrollment in 5-star MA plans so that if an MA plan degrades, one does not have to wait for open enrollment to switch to a different, 5-star plan.

https://medicareguide.com/switch-5-star ... plan-95744
cashmoney
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Re: Original Medicare vs. Medicare Advantage

Post by cashmoney »

orlandoman wrote: Sun Oct 02, 2022 2:17 pm
mpnret wrote: Sun Oct 02, 2022 1:29 pm
JoeRetire wrote: Sun Oct 02, 2022 9:15 am
Sandtrap wrote: Sat Oct 01, 2022 6:50 pm Also: "Medicare Advantage is an "HMO"
My Medicare Advantage plan is a PPO, not an HMO.
It's virtually identical to the plan I had when I was working - with all the same coverage, same doctors, same hospitals. Just a lot cheaper.
Mine is also a PPO. Accepted everywhere Medicare is and it's the best plan I have ever been on. Also free being it's part of a retirement package.
The , "Accepted everywhere Medicare is ..." is misleading. What that means is that the MA plan will pay as in-network if the physician will accept it. Physicians can take Medicare patients but only take a few or no MA plans. A dermatologist group I visit, takes Medicare but only a few MA plans in fact they stopped taking new patients for the PPO MA plan I belonged to at the time.

Maybe his personal experience has been that he has not been shot down by any medicare provider in or out of the network on his ppo plan which is not unusual.

If a provider is Participating (Contracted) with a MA plan that means they accept the terms and conditions and will file UHC claims however some medicare providers may stop taking new medicare patients altogether regardless of if you have original medicare or a medicare advantage plan.

If a provider is Non Participating( not contracted) with a medicare MA PPO they can choose whether they will ACCEPT plan out of network.Most medicare providers will accept a MA PPO OON especially if they already have a contract with another line of health insurance with the same carrier.ie group,indvidual,medicaid etc.

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Re: Original Medicare vs. Medicare Advantage

Post by Eric »

prd1982 wrote: Sat Oct 01, 2022 10:45 amThe MA plans swear they are paid the same amount by the federal government as traditional Medicare. Yet MA plans promise more benefits at a significantly lower cost. I cannot find any explanation as to how they do it.
The federal government pays more per person enrolled in Medicare Advantage than it does per person enrolled in traditional Medicare. If I recall correctly, at the beginning that disparity was intentional: Legislators wanted to create a Medicare Advantage market so they subsidized it. More recently, insurers may have found other ways to maximize their compensation from Medicare. See discussion from the Kaiser Family Foundation below. Bottom line: "Medicare spent $321 more per person for Medicare Advantage enrollees than it would have spent for the same beneficiaries had they been covered under traditional Medicare in 2019."

https://www.kff.org/medicare/issue-brie ... hallenges/
Chuckles960
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Re: Original Medicare vs. Medicare Advantage

Post by Chuckles960 »

I am exhausted after reading this thread,at least partly because it has all been said before, over and over in this forum.

Yet none of the personal experience reports are worth anything. Everything depends on the particular MA plan, and what services you personally will need in future---which of course you do not know.

It is possible that some MA plans are great, and some insurance companies are ethical. In general, though, the goal is to make a profit. They have a lot of flexibility to make up rules and co-pays and fine print. If the premium is lower, it's all fun and games until you run up against those restrictions.

The advantage of original medicare+F/G is not that it is the cheapest plan,it is that it is the no-worries plan. Medigap plans are also profitable for the insurance companies, or they wouldn't sell them. (On average you would do better by paying what original medicare doesn't pay, which is actually not a whole lot. Medigap plans are easy money for the insurers because they are taking very finite risks.)

If you're rich enough, you don't need to buy freedom from worry; you can pay any expected or unexpected costs. If you are poor enough, you have to go with the cheapest possible plan and deal with the consequences later. For those in the middle, the point of any insurance is transferring risk to the insurer, and Medigap F/G does that completely while MA is a lot of fine print and gotchas. Plus, as already noted, you will be paying for those obnoxious commercials.
Last edited by Chuckles960 on Sun Oct 02, 2022 5:19 pm, edited 1 time in total.
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