Are all Medicare Advantage Plans bad? THE TRUTH!
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- Опубликовано: 12 сен 2024
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I'd love to hear your personal experience with your Medicare Advantage Plan -- please share below!
I'm in 67 I'm in Medicare I pay 174 I don't know even with in in advantage or supplement I'm so confused bc I'm new to this mess pls help
@@lolalucky6373 Rewatch for @0.35- thru1 Minute With advantage plan, you are assessed by a certain group of doctors in either a HMO (Bad) or PPO (not much better). The insurance company is deciding your healthcare needs. They can reject a treatment plan your doctor thinks you need. Advantage plan members can lose coverage anytime they want. With Supplemental, you obviously still would like a PCP, but if you break a bone, you can go directly to an Orthopedist without waiting around for you PCP to 'refer you to someone"
I was on an Advantage plan when my cardiologist's pre-authorization request to perform a heart catheterization was denied. This occurred during the enrollment period and I had already decided to switch back to a supplement plan due to the higher out-of-pocket expense in the event of a catastrophic health event. So I told my cardiologist to schedule the heart cath after Jan1 (about 3 weeks away) when the supplement plan takes effect. The heart cath showed I had two coronary arteries 100% obstructed, and a third that was 85% obstructed! I was immediately scheduled for heart bypass surgery and I am doing great today 3 months later. I tell everyone about my experience and to NOT enroll in an Advantage plan. Advantage plans makes more sense for young healthy people, not aging seniors.
Wow, thanks for sharing this!
Glad you are back on track with the right medicare plan. The plan C or advantage plan is nothing but scam. They take your money but they do not want to treat you properly.
I will NOT be getting an advantage plan due to what my mother experienced this summer. She was on an employer sponsored group advantage plan. However, after breaking her femur bone and hospital stay, she was transferred to a skilled nursing facility. The advantage plan denied her continued rehab stay after 6 weeks, even though her treating doctors stated she wasn't ready to go home and still wasn't weight bearing. It was completely unsafe for her to go home, but the advantage plan didn't care. We switched her back to Original Medicare the following month. Since she never suspended her FEHB supplemental coverage, we mistakenly thought she was simply getting extra benefits on the advantage plan. We learned a very painful lesson that ANY advantage plan, even an FEHB group advantage plan, can and will deny you the care you need all due to profit.
When Advantage plans become the doctor and then ration/deny care for profit, they become my enemy. I would only do Advantage if I had NO other options.
The same happens on a typical HMO / PPO. I've work in the filed of Cardiology as a Cardiac Sonographer for some 20 years. Unfortunately, it's not uncommon to watch a frustrated cardiologist trying to explain to an insurance "doctor" why a procedure is warranted vs not.
A good example happened a few months ago. A young man, 45, arrives at ED with active chest pain, shortness of breath, and non-specific EKG changes and a significant family history of heart disease in a first degree relative. Based on these criteria, our cardiologist recommemded admitting him, performing a cardiac cath to determine if in fact he had significant arterial blockages or not. The insurance company refused. They argued he was too young and wanted him to try medications instead. Our cardiologist had to inform him that he was at a major risk for a future event, and return to the ED if symptoms worsened. Insurance in America...
I would go with G-hd over Advantage. At least you can get your procedure done without fear of being denied. Yes you could be stuck with some of the cost of the procedure but there is a stop loss on the amount. And some hospitals will work with you and discount it down.
I luv my Med Adv plan. Works for me. I signed up with you on April 1st. Thanks Stephanie
Wonderful! You are so welcome!
Thanks for another informative video. One point I'd add is that an advantage of the supplement plans is that, if you start out with one of them, you always have the right to "try out" an Advantage plan in the future, and more importantly, to switch *back* to your supplement plan if you don't care for it - all without medical underwriting.
And btw - it would be great if you did a video on what medical providers are required to tell you as far as exactly which of their recommended procedures, etc. Medicare covers! I've done some research on this and it's very difficult to determine what their obligation is to the patient in this regard. And I've read some about the "ABN" notices, but even that's just not very clear.
We have been with Kaiser North (California) HMO for over 30 years. Our son was born at Kaiser and we have been treated for life threatening illnesses there. After I retired we stayed with them through Covered California (ACA) and will stick with them for Medicare (Kaiser Advantage). The out of pocket max for each of us will be $6K per calendar year. That's a lot of copays and coinsurance!
Wow you have had a total different experience then I have.
@@billjones4986 Have you been a Kaiser North patient?
Dan, you've been lulled into a false sense of security. Comparing an Employer funded plan and an Advantage plan even under the same carrier isn't comparing apples to apples. No two plans are the same. Advantage Plans are terrible as one ages. The quality of care is subpar because a lot of their protocols are outdated and they will often deny many tests and treatments. Same with approving drugs. You won't get approved on the latest and greatest. Sister in Laws Cardiologist told her that he hadn't prescribed the drugs the insurance carrier would approve, after denying the ones he ordered, in over 20 years. Advantage Plan put her in the grave prematurely. The family was constantly challenging denials at almost every visit. Do u want a bean counter guiding your treatments or your Doctors.
@@JohnJohn-wr1jo My experience is different. The only difference between my employer's plan and ACA with is more expensive copays. Now with Medicare my copays will cost less and I will save around $30 a month. I received good care from my cardiologist under both plans and I have no reason to believe that Medicare will be any different. I know several people with serious illnesses who are happy with Kaiser Advantage. I am sorry to hear about your sister-in-law. Which Kaiser did she have?
Kaiser Hawaii is horrible! Providers don't return patient calls in a timely manner, don't keep up on new medications, push for unneeded procedures, etc!
I went with original Medicare plus a supplement plan because after the first trial rights period on an advantage plan, I’m be stuck in one for life because I likely wouldn’t get approved by underwriting. Thank you for listing that as a con, because that’s very important for people to know.
Aren’t certain advantage plans hard to use in rural areas because of very limited provider networks?
Yes, that’s correct.
Excellent video Stephanie. I am learning a lot from your. No one who can afford the original medicare should get the advantage plan. They should change the name of this plan to "Disadvantage plan". Seniors need peace of mind and not need the harassment and the headache when they are sick or they need medical attention.
Yet another informative video! Just one point - if you start on Medicare with a supplement plan, you can always try out an Advantage plan without underwriting - *and* if you change your mind, you can go back to that supplement plan without underwriting. (And this is in all states, afaik).
And btw, I have a request - do you think you could do a video on what a medical provider has to disclose about which services they're recommending for you are covered by Medicare? I've tried to do some research on this and it's just about possible to determine what their obligations are in this respect. I've read about the "ABN" notification, but it's just not clear! And many providers ask you to sign that "financial agreement" document, which I've always felt was like signing a blank check.
Excellent video. You convinced me to stay away from Advantage Plans and stay with my current Plan G (at least in my case). :)
Good overview, however - you left out that when one has a Medicare Advantage plan, one has access to a Case Manager - usually a nurse or social worker to help you with things like navigating the health system, learning how to manage your condition, finding specialists. When an individual is really sick or has a really complicated medical situation - having access to a case manager is like gold. No one talks about this and thus it is not well known. On traditional Medicare, you are completely on your own.
Great point to mention!
What happens when you travel to another part of the country or even outside of the country? Good luck then.
Only problem is that the "Case Manager" works for the insurance company, and at the end of the day is there to represent their interests, not yours.
@@freecycling6687 I get that people don’t trust insurance companies. But I’ve run case management departments for many years. Case managers are very disconnected from the finance department. The job of case manager is to support the member in getting the care and services that the person needs within the available benefits from the type of plan that they purchased. And then if the person needs supports that are not covered by the benefits, the case manager’s job is to help arrange for any available community resources for the member.
I have United Health care and I have nothing but problems, unless you are willing to pay out of pocket for your PCP and Dentistry, you will need to use who they send you to, it was great in the beginning but they change things without warning leaving you liable for anything they decide is out of network
Great video and very educational. Medicare Advantage plans cover what is considered medically necessary. Things like plastic surgery and "upgraded" cataract lenses are not medically necessary and not covered.
How does Medicare work for FERS? Retired federal employees who still have Healthcare through the pension. Should they drop it? Or continue paying the premium plus medicare bill once they reach 65?
If cost is an issue just do HDG. No yearly plan changes (just your part D), networks, or pre-approvals.
Yes, I agree. Our HDG plans are about $40 a month....(Indiana)
I will have an Advantage Plan offered to me by the state of NC. It is a PPO plan that will save my wife and I $7K per year in premiums. In addition the PPO plan has a max out of pocket of $4K per person with a max of $2500 per person on drugs. The Medicare has a max out of pocket of $5900 per year. You would have to purchase an additional drug plan. The plan states that you can see any provider in or out of network, anyone that accepts Medicare and accepts your insurance, and preferably a provider that accepts Medicare assignment.
I know a lot of folk on this plan and they all love it. Have a friend that needed knee replacement with no issues at all with the prior authorizations. My sister has had no issues with her prior authorizations also. It looks like to me it's sorta hit and miss on the authorizations but Humana and the state plan seems to have a good reputation around here. Thank you for your videos. Very informative and helpful. I appreciate it.
There are no excess charges with Medicare Advantage. You don't have to worry about Medicare assignment.
It is my understanding 5 states where no prior approval is needed for Medicare Gap are very expensive. Medicare Gap plan in New York State rates is absurd. We more or less don't have a choice but to go with Medicare Advantage in NY.
The "Gap" plans (aka "supplement", "Medigap") don't have prior approvals, regardless of state. You can visit any doctor, at any location, that accepts Medicare. If the Medigap plans are very expensive in NY state, that's very likely because NY allows you to switch Medigap plans at any time during the year without medical underwriting, which is not the case in most other states. (A handful of others have that law as well, but the list escapes me at the moment.)
Have you looked into high deductible plan G?
@@karenaubin325 But still have to pay a supplement.
Some Medicare Advantage cover Emergency Room care overseas. The Medical City Chain in the Philippines can bill SOME Medicare Supplement & Tricare since they have a Hospital in Guam. Source: Philippine Expat Forums. I will carry both US & Philippine Coverage if I stay in the Philippines after age 65.
Medicare Advantage Plans can be an excellent choice for some people, offering comprehensive coverage and additional benefits. However, they may not be the best fit for everyone, particularly if you have specific healthcare needs or prefer greater flexibility in choosing providers. It’s important to carefully evaluate your health needs, budget, and preferences, and consider consulting with a licensed insurance agent to make an informed decision.
Very good information! Thank you.
Some insurance is better than none. I would have a MAP if that was all I could afford. The really sad part of this saga is that many do not have the mental acuity to make a good decision (It has nothing to do with old age in most cases). I try to tell most of my friends about the hazards of MA plans but many say they like their plan. That's usually because they have not had to use it other than a simple office visit. They are swayed by the "freebies" the MA insurance companies wave in their face like carrots but they never seem to use those freebies. The "free" eyeglass frames offered by their plan that look like vintage1940's don't seem to appeal to them. I appreciate your honest open approach. Keep up the good work.
Great video. People need to understand not all Advantage plans are bad. We and other local friends are using an AARP (highly rated) United plan. We can go anywhere in the country if needed for treatment - United has a huge network of practitioners. Best to get advice instead of winging it - there’s too much to understand and lots of bogus information.
So true - thanks for your input!
I have Medicare disadvantage only because I can't afford the supplement plan plus I am diabetic which would result in denial of coverage. I just wish this stupid country would follow the lead of Canada and the UK.
Just make sure you don't vote for it getting worse like the US did in 2016.
If you don’t mind having an HMO plan, then an Advantage can be right for you…….
Advantage plans are also available as PPOs.
Advantage subscribers generally like their plans until they become ill. Thats usually when the honeymoon is over. The denials can become life threatening the older one gets. Sister in law chose an Advantage Plan due to the cost. She couldnt swing the monthly supp costs and was fine with the plan the first few years. She developed several chronic issues and was stuck with subpar care and treatments for the next five years. Suffered a stroke and was denied acute care rehab. Died in a regular rehab that told her during her evaluation that they couldnt provide the level of care that her doctor ordered so they assisted the family in challenging the Advantage denial. Less than a week after admission she choked on her own vomit and spent almost a month in ICU before she passed. One of the last conversations she had with my wife she mentioned "I hope I dont live to regret this Advantage Plan, or worse die because of it". Unfortunately she realized both.
Wow. Thank you so much for sharing.
I'm so sorry for your loss and that she had to suffer 😢
Thank you!! Perfect timing!! I will be selling Medicare Advantage plans again and I need to know this information to better help my future clients. You look so Radiant and Beautiful!!! And I highly appreciate your transparency and honesty!! 🙂🙂
Glad it was helpful!
Getting my advantage plan saves me around $400 a month. I still have my doctor and dermatologist and some of my meds are free. My BP was $150 now $10. I don't have to pay for part B, so I get full SS.
If moving from traditional Medicare to Advantage later on in life, is this also subject to medical underwriting?
I went with the advantage plan and I'm damn glad I did, the total Hospital costs were over $300,000
Do it yourself a favor and find a internal medicine specialists I found one of the best I've had internal bleeding from eliquis finally I'm off of that for sure your videos are great😅
Great work as always, how does Medicare Advantage differ from private commercial insurance when it comes to Prior Auth?
My husband is turning 65 this June (2024). He is still working and has insurance thru his employer. Do we need to tell Social Security about his plans or just provide proof of insurance when he files for Medicare when he’s done working?
Thank you.
We have Medicare Advantage PPO. What is your thoughts. Thanks.
How is it working for you? I typically always recommend a PPO over an HMO!
Thank you for that info and insight !
Glad it was helpful!
advantage plans don't sound to great, for me
MAP are fine long as your in good health.the extra benefits they brag about are overrated.bottom line best not to use depend on a MAP!
Stay away i have had 4 months of raising my bp and a1c numbers cause they made my medical peps give all money back finally got corrected but oh the stress
Never get one!