General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region Forums1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage
https://nebraskaexaminer.com/2024/10/23/1-million-patients-lose-coverage-as-insurers-hospitals-drop-medicare-advantage/
By: Anna Claire Vollers - October 23, 2024 5:00 am
HUNTSVILLE, Ala. Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as Medicares open enrollment period begins.
Libby, a retired middle school librarian, has what she considers good health insurance through the state employee health plan. Andrew has insurance through his job as a university professor and plans to join Libbys insurance when he retires next year.
But this year, a few days before open enrollment began, a letter arrived from UnitedHealthcare, informing the Potters that the regions largest hospital system would no longer be considered in-network for Libbys Medicare Advantage plan.
The Potters spent the next couple of weeks worried and unsure what to do. It seemed incredible that 14 area hospitals, including the areas only Level 1 trauma center, could suddenly become much, much more expensive.
FULL story at link above.
Andrew and Libby Potter look over the letter they received in October, telling them that their regions largest hospital system would no longer be considered in-network for Libbys Medicare Advantage policy. The Potters live in Huntsville, Ala., where Libby is a retired middle school librarian and Andrew is a professor at a state university. (Anna Claire Vollers/Stateline)
wryter2000
(47,247 posts)They should take Medicare out of the name.
I would imagine any university would offer the retired professor health insurance. I hope he can include his wife.
Bmoboy
(392 posts)Instead of almost automatic coverage by traditional Medicare, the Advantage plans insert processing that either delays or denies coverage based on vague internal "rules."
Patients end up paying more out of pocket. The "special" coverages they offer - dental, vision, transportation - have limited benefits hidden behind a wall of long wait times for limited providers.
Wonder Why
(4,506 posts)coverage runs until the end of the current year. Since you didn't provide a link to your source, was that the case? If so, those people will have to pick traditional Medicare or another Medicare Disadvantage program.
moonscape
(5,258 posts)will have to go through underwriting if they want a MediGap plan. Unless they are in perfect health, theyll have a hard time
Silent Type
(6,038 posts)can likely afford original Medicare, but sounds like they are not thrilled about it.
buzzycrumbhunger
(871 posts)Im a. pharmacy tech and lots of docs and hospitals dont even take it anymore because it sucks. They lure you in with $0 copays! but the truth is very little qualifies and you still need Medicare drug and other components to get things like hospital and other coverageand even then that wont even cover things 100%. The cost is ridiculous as it is, especially when so many people are scraping by on Social Security at the same time.
Then people are forced to hope that theres some patient assistance program for special medswhich points out another fact, that Big Pharma has a sweet deal going on when they can charge $8000, $30,000, even $80,000 a month for specialty medications and when no insurance will cover that, the doc can do a prior authorization, the drug manufacturer can find a copay assistance plan where they sell the drug at a vastly reduced price
and then claim the thousands of dollars as a write-off.
I dont know how we qualify as a first-world country when there are over 30 who actually cover healthcare, paid family leave, weeks of vacation, higher education, etc. and we offer almost none of that.
Ms. Toad
(35,304 posts)buzzycrumbhunger
(871 posts)There are some medications, however, that do have patient assistance foundations that dont seem to fall under that. Weve just started doing a med for eye mites (apparently, this is an epidemic, especially in retirement communities, and this stuff is crazy expensive) and the only questions are whether their insurance covers it, marital status, SSN(s), and many get a $0 copay. Ill have to ask our insurance specialist about the particulars. It may be that we have to bypass Medicare and they use the cash price to determine eligibility.
Ms. Toad
(35,304 posts)My daughter had one medication that wasn't covered by insurance and tried to get into their patient assistance program. Not only was there a waiting list - but periodically they would also shut off access to the waiting list.
Most are insurance supplement programs - so you have to have insurance, but any government program (Medicare, Medicaid, TriX, etc.) are excluded.
tavernier
(13,164 posts)However this is what has worked best for me.
Its up to you to research carefully. Be careful with catch words like Advantage, etc. They arent always as clear as how they sound.
Drummer1
(62 posts)...Medicare Supplement Insurance as well as Medicare Prescription Drug Plans. It ain't cheap but it beats getting fucked over by Medicare Advantage horseshit.
dpibel
(3,182 posts)If it's such horseshit, why aren't there millions of people complaining about it?
Every once in a while, someone comes up with a story about someone (usually a cousin of a friend of a friend) who had some horrible experience with their ripoff Advantage plan.
But with 32.8 million people enrolled there should be thousands and thousands of horror stories.
And I just don't see them.
Lots of "Oh, you just watch out. Pretty soon it will bite you!" warnings.
But really no meaningful number of stories from the bitten.
This particular story? Some people will have to change their insurer.
Anyone who spent any time working in the private sector knows that changing your insurer is part of the gig. Whoever gives the best quote this year, that's who you're insured by.