yup

But they pay no attention. They collect the free shoes and gym membership up front…..so crazy!

I do understand how they hook people of modest means but I cannot STAND seeing those same people pimping for these scams, UGH

Until you're 65, you have no idea how confusing and byzantine signing up for Medicare is. I was unemployed last year when I turned 65 and literally could not afford a supplemental plan, which I was told was absolutely neccesary because Medicare doesn't have an annual limit on deductibles and copayments. If you get a long term illness you can end up bankrupt. Medicare Advantage was hundreds of dollars cheaper a month than those 'medigap' plans, has deductible & copay annual limits, covers dental and eye care, and yes gym memberships. I fret all the time that it's "too good to be true". Either way you just don't want to get sick in America. I wish we could fix this. I wish there was a single Medicare option for everyone, I really do. Access to healthcare is abysmal. Oh yeah, my primary care office stopped taking Medicare patients unless they also have a supplemental plan.

I DO KNOW

yes they are doing EVERYTHING they can to entice people onto MA - per Project 2025, MA will be the DEFAULT for those new to Medicare

when enough people are moved, Medicare will cease to exist - THAT is why they are pushed so heavily - it will eventually ALL be turned over to private insurance and then GOOD LUCK to any non-rich senior trying to get health insurance.....that is a republican WET DREAM

the money lost to the MA con could easily be used to improved Medicare but THAT is not their goal

Yeah, okay. So you know how hard it is to navigate then. I literally had the choice of only medicare A&B or MA and hopefully never needing insurance for anything serious. I 100% agree with what you are saying but some choices can't realistically be made on principle. Even without trump both parties seem mostly set on this path. It's infuriating.

I really never have seen much push back from Dems regarding the quandary and confusion seniors experience with Medicare and now repukes are set to get all they want - it is very infuriating indeed.

Based on whether they have a supplement plan or not. Option it of Medicare patients is an all or nothing decision. In other words, they must take all Medicare patients, or none. They cannot pick and choose certain patients, it groups of patients.

If you went with MA, and can now afford a supplement plan, you have the option to switch within a year of choosing MA.

It is absolutely a Byzantine mess of misinformation, hidden information, etc. I went through that nightmare a few years ago, and had to do it on an accelerated basis. I had intended to work for a few more years, but retired unexpectedly about a month and a half after my 65th birthday.

And if you think just signing up at 65 is a nightmare, try signing up within the original enrollment period but using a special enrollment period to make sure you have continuous coverage. (If you sign up after your birthday, there is a delayed start, but if you sign up during a special enrollment period coverage can start immediately. But if you are still in the original enrollment period you can't use the special enrollment period to get immediate coverage. If my birthday had been 5 days later, I would have been forced to have a gap in coverage . . . While under care for an aggressive cancer. No one I spoke with believed I could get immediate coverage, despite what the law says, so I just had to cross my fingers and prepare for a fight. Fortunately, I was right and the experts were all wrong.)

I wouldn't put it past these private insurers kicking out insurers to saving $10 billion.

and DR OZ will be doing EVERYTHING he can to push people into these scams

I'd go after the $10 Billion they owe and kick them out of the program.

no one will do anything about it, that's why they keep getting worse and worse

She passed away in 2023 from cancer. She was approved for every treatment her doctors prescribed.
She lived longer than expected with stage-4 cancer of lungs & brain due to amazing treatments she received.

but the ENTIRE GOAL of MA it to eventually GET RID OF MEDICARE

my sympathy to you for your loss

I am on the same MA plan and I have experienced no problems so far.
I am still wondering if some were forced out of the plan or left voluntarily.

the worst. It is listed on the stock exchange, meaning its main fiduciary is to the shareholders not to the subscribers. The compensation of the CEO is $23 million. I have never understood why is AARP pushing it.

Both our carriers are Advantage but they are not for profit and have been paying all claims.

No monthly premiums, a $250 debit card every year for out of pocket vision+hearing+dentist expense, $240/year for OTC medications & nutritional supplements. With HMO, almost all medical services at doctor's office are free. My prescriptions from Humana mail order are also free for 90 day supply.

but....

the ENTIRE PURPOSE of "Advantage" plans is to entice or force people into the for-profit healthcare at which time MEDICARE WILL CEASE TO EXIST

She lives in a small community and the insurer decided that it would no longer cover anyone in the area. She is now trying to sign up for original Medicare. Insurance companies are not trustworthy and they will have no requirements to cover anyone medical care under Trump.

My theory is, it has nothing to do with an area, rather how many old people live in that area.
This is a federal program, so insurance companies should not cancel anyone unless lack of payment.
That's the way I see it.

parts A,B,D. However she can be denied medigap plans for pre-existing conditions.

Then it was horrible. She had a stroke and it was just as bad as the stories you hear about regular people fighting their private insurance plans for necessary coverage. They booted her prematurely from her nursing home rehab, when she was in no shape to come home. I tried to see about switching to traditional Medicare the next enrollment period, but was told she would either be denied or the premiums would be exorbitant. If you sign up for traditional Medicare when you are first eligible, they apparently can't deny you this way.

My mom's last few months were spent with me being forced to provide inadequate care due to her Medicare Advantage plan skimping on coverage and then me trying to (unsuccessfully) find a way to get her back into traditional Medicare so she could get the care she needed.

DO NOT GET SUCKERED INTO MEDICARE ADVANTAGE PLANS.

...the Medicare supplement needed to use traditional Medicare and she wouldn't have been able to afford the out-of-pocket costs with traditional Medicare without such secondary insurance.

She was basically stuck with her Medicare Advantage plan, which was all too happy to have her tossed out of the rehab center. The rehab center told me that Medicare Advantage plans are much worse than traditional Medicare when it comes to a situation where someone needs a longer stay in a rehab facility.

Many of us warn people that MA can both not pay for your care because of 'reasons', and worse, just kick you out. And then you are in a truly shitty situation where medigap plans, for unfathomable reasons (i.e. abject corruption) are excluded from the ACA prohibition on pre-existing condition exclusions.

But always it is 'my plan is great I get shitty dental that covers almost nothing and shitty eyecare that covers even less and a shitty gym membership I never use'.

It is the same ideological delusions we see every time we discuss universal healthcare.

For profit insurance systems generate profits by not paying for your healthcare. Their only purpose is to extract money from the medicare revenue stream.

And you want a supplement the insurance companies have the right to underwrite you.

I didn't see that you already answered the question I had.

It's a scandal that these private insurers are allowed to use the word "Medicare" in their name.

now they will make MA scams THE DEFAULT for people new to Medicare, and DR. OZ pimps for MA heavily too

Again I say, "Thanks, Oprah."

We ll have to suffer because of their adoration of all things Trump.

Another example of how there is no free lunch. All those extra benefits that MA plans provide to entice people to sign up must be paid for. Looks as if they are being paid for by denial of coverage of life saving care later.

but that heavy advertising bill must be paid as well.

all they are doing is skimming money

The GOP tries to end Medicare.

without medicare i would be bankrupt, homeless, or more likely dead.

Been incredibly expensive—all covered by Medicare and his supplemental plan.

a session of chemo was over 14k. that is every 2 weeks. for almost 2 years.

considering the probability that environmental toxins dumped into the water/air/food contribute, i think corporate america should shut up and pay their taxes.

THAT IS PURE CORPORATE GREED

Many other "developed" countries have systems that provide checks on overcharging. They aren't the same in every country, and there are some problems in all systems, but they are far more effective than is ours at controlling costs while providing benefits.

T. R. Reid's book "The Healing of America" is a really good resource on this subject though it's a bit out of date now.

The second time was a brutal "always fatal" (99.99% of the time, anyway--she was that one in ten thousand that survived it), form that was luckily caught early. As a German citizen, living in Germany, her work insurance covered it the first time, and the German version of COBRA covered it the second time, as she had no health insurance for that period (age 60-65) between her early retirement and her German version of Medicare kicking in at age 65. Some people like to perpetuate the myth that everyone in Europe has "free" uninterrupted health insurance, which is either wrong (if you really didn't know) or a lie (if you did know). But at least there is the fact that the German "COBRA," if you can afford it (it was between €550 and €600 a month at the time, which was 8 years ago, when she was 64), really does cover everything, which, in her case, included five weeks of hospital care, a brutal operation, 84 biopsies, follow up, and 4 weeks in a cancer patient recovery spa, which is considered an integral part of cancer care in Germany.

I mean, once you've had cancer, let alone twice, you're never completely free of knowing it can strike again, but it diminishes your quality of life if you let the fear consume you. Fortunately, she hasn't. Here, at age 70, six years after defeating "the Murderer," you wouldn't know what she has gone through.

When the surgeon that operated on her to remove "the Murderer" saw her a month later, he said he frankly couldn't believe he was looking at the same patient that he operated on for almost six hours just four weeks prior. We celebrated 50 years together this past summer. At times, it has been a bumpy ride along the way, but we have beaten every scare that fate has tossed our way so far. We realize that we have been more fortunate than most, and that nothing lasts forever.

heart surgery and gone through cancer surgery and treatment 4 times it’s hard to say the least. I was forced into bankruptcy at one point because of the edicts of our conservative provincial government (Alberta, Canada) who was being funded by your Ralf Reed republican asshole.

I’ve had heart surgery, but the minimally invasive kind, namely angioplasty and stentosis. Nothing like open heart. And four cancer surgeries? The two my wife had were brutal enough.

Health care isn’t free in Germany, but when she took early retirement after a thyroid operation at age 60, she was uninsured until age 65. I was able to afford her COBRA-like insurance for the five years in-between, which is why her month-long treatment for The Murderer didn’t wipe us out. Medical care at that level is cheaper in Germany than in the USA, but the bill would still have been several hundred thiusand dollars. Since she is a social worker by profession, she knew the ins and outs of the system here, having helped guide people through it her whole professional life.

I had no idea Ralph Reed was plying his evil trade in Canada. After his dubious (to put it in the politest of terms) “Chistian Coalition” antics, I thought he had faded away and decided to do something useful with himself. I was obviously being too optimistic.

government didn’t care, I went bankrupt to save my life and my family. I know I am a Canadian but please don’t let your fucked up people scrue you over

While there are fucked up people here, too, Ralph Reed would be tossed out on his ear as soon as his tourist stay expired.

east are not so and their medical edicts follow the federal governments guidelines totally. We had an NDP government for 4 years and that improved healthcare here but we are back to Conservatives so we’ll see. So far our system is still operating under the NDP line and so I have been 100% covered (I have had to have 6 surgeries in this past year).

I was diagnosed in my 30s. Without Medicare, I would be dead.

That said, the nationalized health care in certain nations would be even better for me because my eligibility for health care wouldn't be means tested. Because of the vagaries of my situation, I have to be either destitute or extravagantly wealthy to have health care in America. Something in between won't cut it.

isn't that part of capitalism?

It is economic activity that adds little or no value but instead uses its control of assets (medicare revenue in this case) to extract as much value as they can from that asset.

UGH

And even if they can switch, if they are sick they would probably fail underwriting.

If they move to a guarantee issue state to switch, that’s a big deal or if their M. A. Plan is cancelled they are free to get a supplement.

Anyway nobody should be surprised that for profit private M.A. plans are denying care but I always feel bad for those who have no choice/money. When you are dealing with serious health issues it is hard to deal with their BS.

Are switching to original Medicare, a govt plan.

https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan#:~:text=If%20you%20joined%20a%20Medicare,Medicare%20Part%20A%20%26%20Part%20B.

So they return to standard MC A and B but without a supplement to fill in the gaps in coverage?

Wow. People must be really desperate to do that.

I’m lucky. I live in a guarantee issue state. I’m using Medicare Advantage now (which we both know is private although some people insist it is not), but I have no intention of staying on it.

In a year or 2 I’ll change back to straight MC and get a supplement. I’m not going to allow them to deny me care even if it won’t happen for several years. That’s the thing - you never know when that will happen.

I agree, they may have trouble getting one of those . But original Medicare doesn’t require people to undergo screening per the link I provided. Maybe some of these people are able to keep their supplemental plan after they transition to traditional Medicare.

If they are in a guarantee issue state where they can switch out of MC C into standard MC A and B (at specific times of the year, on their birthday or whatever their state allows) they can then get a supplement depending on how those states set it up.

If they aren’t and they leave their advantage plan then they have standard MC A and B and nothing else. Not much of an option.

Guarantee Issue states currently: Connecticut, Maine, Massachusetts, and New York, each with different requirements and allowances.

Medicaid kicks in.

of contention for that.

There is an also a Medicare Savings Program where the state pays for Medicare B and copays (but it isn’t insurance) and some states that have that don’t require an asset test so that is sometimes an option if the income is in range.

I still have half a brain but negotiating this maze every year is insane. I also fear for those who may lose assistance if the new administration really does try to cut programs to pay for their tax cut. Pretty sure that would make us both crazy (or maybe we’re already there!).

I'm trying to do my open enrollment. One medication that I depend on to function is now OOP @ more than $1900.00/mo. I was paying for it @ btwn 500 to 600/month depending on the month already when it was covered. Now, I don't know what I'm going to do. Not one plan covers it this year. I have a call in to my doctor and have not heard back. I'm going to wait one more day and call back. I'm not hopeful.

But you have to be completely uninsured to use it. I don't fit that criteria. I'm hoping for help from my doctor for possible replacement suggestions. But she's so busy I don't know if I'll get any.

It was covered under a special exception and that took us five tries to finally get authorization for it and it was still expensive. My understanding is that it's the only medication that does what it does. But I don't know what comes close.

I'm not hopeful. As a matter of fact, I'm starting to get sad. Which is a place that I really don't want to go.

That is one cruel system, indeed.

medicaid will take your house and anything else of value to recover its costs.

that's another reason he was picked

These plans fall way short. Break a hip...insurance decides. Have a stroke and now you have a weak side, can't swallow and got a new feeding tube....insurance decides. Ultimately most all the seriously ill switch to the traditional plan...than if they exhaust that, end up on Medicaid.

Those medicare B insurance stories are real and witnessed by me this month.

They like to deny care there as well. I tell everyone close to me not to fall into it because you don’t know what you don’t have until you need it

I found the whole sign up process incredibly confusing. My doctors office kind of pushed Medicare Advantage plans.

they are likely being compensated

And making sure that your plan is accepted by your doctors and find out the authorization process.
My personal choice is traditional Medicare.

Seniors will have to select a private Medicare Advantage plan. Once everyone is switched over, the insurance companies running the plans will start denying more and more treatments. If you have money, you'll be able to get care. No money? Too bad.

once everyone is on MA, MEDICARE WILL CEASE TO EXIST

THAT WAS THE PLAN ALL ALONG

I suspect the usual crowd will prey on these souls before death. The clergy, the insurance types, etc.

The question is whether there will be any Social Security benefits. If there are, the premiums for MA plans may still be deducted from your SS. If no Social Security, then there will be nothing but private insurance plans, without being called 'Medicare Advantage'.

republicans do no give a FUCK if *ANYONE* has healthcare

they know who their donors are

for life.

If you join at age 65 or retirement, they cannot discriminate based on pre-existing conditions, after that timeframe they can and will, and the best Medicare supplement plans will likely be unavailable when they would be the most beneficial.

If you join traditional Medicare at that point, you’re stuck paying all or most of the 20%.

I spent 56 days in hospital and have four operations and 4 cardioversions. I also get back $100.00 from Part B.

Medicare Advantage or a supplemental plan?

1) Get Sick
2) Die Faster.

Nothing else is considered.

After 100 days, Medicare is done. Medigap will pick up that $204 if you have a Medigap policy, but after 100 days they are done too, unless you purchased expensive nursing home insurance.

https://www.medicare.gov/coverage/skilled-nursing-facility-care


And, nursing homes and rehab facilities aren't covered if docs don't think you will improve. Even under traditional Medicare, Hospitals and Nursing Homes will kick you out when they believe a Medicare audit would deny the care after the fact, which happens frequently if you've worked in a hospital or been hospitalized.

Denials are probably more under MA for most people, but many people cannot afford a Medigap policy and Part D plan. It's a trade off. And, we are likely stuck with it.

Heck, even ACA relies on private health plans.

We need to write our representatives to change the tax code so that premium payments should be used to adjust income in a similar way that contributions to IRA and 401K are. I did some years back, never even got an acknowledgment. Will have to do it again

paying for coverage getting some credit.

I can't afford it. You have to buy young to be affordable.

have no pre-existing conditions.

is unlikely. There are 4 or so states that reqiure guaranteed issue on medigap, but the policies are more expensive in that state (though probably worth it).

Last edited Tue Nov 19, 2024, 10:21 PM - Edit history (1)

"If you switch from a Medicare Advantage plan back to Original Medicare, you can qualify for a Medigap policy; you typically have a 63-day window after leaving your Medicare Advantage plan to enroll in a Medigap policy without medical underwriting."

https://tinyurl.com/294apapu edit - I have been corrected. I guess I need to stop always believing my AI bot.

with a few exceptions.

You may have a guaranteed [Medigap] issue right if:

--You, through no fault of your own, lost a group health plan (GHP) that covered your Medicare cost-sharing (meaning it paid secondary to Medicare)

--You joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months

--Or, your previous Medigap policy, Medicare Advantage Plan, or PACE program ends its coverage or commits fraud

There are no rules preventing someone with preexisting conditions from enrolling in Medicare after Advantage.

You might be thinking about gap coverage, which is private insurance. It can be hard to buy after being on Advantage.

Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months. A prior or pre-existing condition is a condition or illness you were diagnosed with or were treated for before new health care coverage began.

Where you can get back on regular Medicare.

- if you are in a guarantee issue state they allow you to switch back to regular Medicare at specific times (Conn, ME, MA, and NY). Supplement prices in these states are higher because you are allowed to leave your advantage plan (you can switch every year) and the prices are community based - the same for 65 or 85. So a plan N could easily be $200/month. In other states the supplement is much less because if you don’t switch from advantage back to a supplement in the first 12 months you are out of luck.

- if you move out of the area maybe!

Supplements can be tricky and since different states have different rules, the preexisting conditions may not be covered for 6 months or you may fail the underwriting questions.

Criminies, a friggin PhD is needed to make sense of all these rules.

Healthcare doesn't "cost taxpayers." The taxpayers and the patients are the same people.

I thought once someone signed up for Advantage they could never go to the heritage Medicare plan?

When Can I Switch to Original Medicare?
The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked. The second way to leave your Medicare Advantage plan is if you’ve had it for less than one year (that is: you’re entitled to a “trial right”).

Medicare Annual Election (“Medicare Open Enrollment”) and Medicare Advantage Open Enrollment Periods
You can break up with your Medicare Advantage plan from October 15 through December 7, and again from January 1 through March 31, in favor of Original Medicare.

Medicare Annual Election Period (AEP)
Also known as Medicare open enrollment, AEP lasts from October 15 through December 7. If you choose to change from one Medicare Advantage plan to a different one, or if you want to disenroll from your Medicare Advantage plan during this time completely, the cancellation will take effect on January 1.

https://medicareguide.com/medicare-advantage-to-original-medicare-165588

in fact virtually no one that sick would pass underwriting. Note: There are 4 states where medigap is guaranteed issue. NY is one. And there a few other guaranteed issue like if you drop out of MA in the first year.

But (aside from a few states), there is no guarantee you will be issued a Medigap plan if you switch back to Medicare (to help you avoid the uncapped 20% copay) . In most states, they don't have to issue you a Medigap policy. In most states, even if they choose to issue you a Medigap plan, they can charge you whatever they feel like as a premium.

As an example, my daughters billed expenses are $200,000/year. If she were forced into this option, her 20% share would be $40,000 (since there is no cap on out-of-pocket expenses). (There would be some write-down to permitted Medicare costs - I don't have access to the Medicare allowed costs for her care, since she isn't on Medicare.)

“Free” shoes are not an MA benefit. They are provided under Regular Medicare to some diabetes patients. However, the payment rate is so low that many simply can’t access them and those who can have to fight for appropriate shoes. I know one person who has diabetes and foot deformities from birth who waited 4 (Four) months for a right shoe because her feet were different sizes. She was homebound and unable to walk during that time, which is very dangerous for a diabetic. She ended up accepting a right shoe too large because she was afraid of going back on insulin! She is now at risk of amputation. The whole thing is a Potemkin Village, looks great from a distance, but up close, the rot is evident. I could go on, but will simply recall what we said when fighting for the ACA. “The only people satisfied with their health care are the healthy.”

The reference may have been to some so-called "Silver Sneakers" fitness club memberships that come with some plans.

Some plan premiums are now higher than premiums Medicare Supplement plans, and all of the Advantage plans have networks, either as HMO's or PPO's, unlike a Medicare Supplement plan, where a retiree can choose any provider that accepts Medicare, across the US, and there are no referral or prior authorization requirements.

about how much medical costs are when we get old. So fucking what?!!! That's how life works and it should be expected and paid for with regular Medicare, period. If that means money has to be cut somewhere else, then do it.