to find the originating source that Raw Story "borrowed" from. Usually I just bypass Raw Story, and Google to find the article.

I appreciate you adding the link.

I went back to traditional Medicare after a little bit of time on a Medicare advantage plan years ago. And it sucks. Going back to Medicare has been a breeze. I have to pay a little for doctors visits, but when I get the bill, not when I go in. And doctors are so used to medicare, they know just how much they are going to get paid. Advantage comes and goes the raises premium. The plan I had was dropped by my doctor. A year or so after I dropped it. The way they just called it a Medicare plan makes it sound like the government is screwing the old people. And they get away with it over and over, it’s bullshit.

Which is why they’re labeled Medicare Part C. The reality, of course is far different, given how they are run. That’s why I’m going with Original Medicare when I turn 65 next month.

The only thing they have to do with Medicare is they take your Medicare money and make more money to give to their stockholders. When Medicare wants to raise rates, it takes an act of Congress.

drug plan. A lot of folks can't afford a supplement or drug plan. Besides Dr. Oz will let us know the changes.

And if you can’t afford the actual prescriptions, there are programs to help, and if you can’t afford it after that you should be able to qualify for Medicaid.
But above all, everyone at every I come level should avoid Medicare Advantage plans.

It is still too high, but it much better than it was before.

myself and my wife. We needed to use some savings, but I absolutely do not regret having only real Medicare. We have never even had a supplement plan. Our supplement plan is a savings account and some investments.

That's free and automatic if you are eligible. You get it when you enroll in Part B.

Of course, this is what everyone should have. Not just seniors. Everyone in the country.

It's so good that when I go for physical therapy, for example, I feel guilty watching everybody else sit at the windows and write out their co-pay checks.

So I haven't started Medicare Part B yet but will soon. Looking forward to that plus TFL. Plus my regular health insurance for everyone else.

If you are retiring from a company that offers a medicare supplement plan then that is usually the way to go. Most state and federal retirees are offered a medicare supplement plan. Otherwise, choose carefully when you are first eligible. Plans that are rated as "Issue Age" plans are normally best. They will not increase just because you get older. The majority of the plans offered are "Age Attained" and they will end up being the most expensive as you get older. They will increase as you age and due to medical cost inflation. If you want to change your supplement plan later, after you are first eligible, you can be subject to medical underwriting. and can be denied. Part D prescription drug plans can be changed every year as needed if your drugs change.

Hospital is Part A, Medical is part B, prescription drug insurance is Part D, and Medicare Advantage is Part C

Sorry if that's a stupid question. Just wondering then what stops Blue Cross or Bob's Excellent Insurance Co. from getting the gvt to label them Medicare Part W, or some such.

Just like Medicare C was passed in 1997 by both branches of Congress. It passed the House 346-85 and the Senate 85-15. Signed into law on Aug. 5, 1997 by President Clinton.

Every private insurer meeting the requirement of the law can call their plan Medicare C. In fact, the Federal Government on the official Medicare website lists all the available Medicare C plans by region and insurer. You can even enroll in them from there.

I didn't know any of that

are Medicare Advantage plans. You can look at Medicare.gov and see which Medicare Part C plans are offered in your area. (https://www.medicare.gov/plan-compare/#/?year=2025&lang=en)

Part W would need to be authorized by Congress before anyone could claim to be Medicare Part W.

I am SO glad my husband and I didn't get tricked into signing up for one of those plans.

In my 33 years of regular Medicare experience (first with older spouse) they mistakenly refused to pay for an ambulance bill (resolved) and a pre- surgery leg ultrasound for a clot patient ( never resolved). These two cases involved me. There are also frequent incidents of their failure to pay provider line items which are dropped and don’t involve me.

at all. Medicare doesn't pay plenty of times. That gets disguised because Medicare sets the standard. Anything Medicare won't pay for gets buried.

bumbles.

I got fined when I quit Wellcare. They were not providing anything other than a monthly bill. Co-pays were the same before and after. Dafuq???

who are Republicans and care more about their tax dollars than whether old people get health care. The government pays more for "Advantage" plans than for real Medicare. Are your relatives OK with paying more as long as it goes to rich "health care" executives and not poor old people?



https://theconversation.com/taxpayers-spend-22-more-per-patient-to-support-medicare-advantage-the-private-alternative-to-medicare-that-promised-to-cost-less-241997

does the "do not call list still exist? these guys don't seem to care.

Why is that the insurance companies withe Advantage plans are not held to the 80/20 rule?

Rate Review & the 80/20 Rule | HealthCare.gov

for "Medicare" Advantage companies. I'm on the do not call list and I get at least one phone call every single day from one of those companies. And always from a different number so it doesn't help to block the number.

But, fortunately never had to use them. I chose the supplement to cover the 20% out of pocket costs for non-hospital coverage. The supplemental coverage premium cost me approximately $210 per month and the plan would pay for anything Medicare approved. To access Medicare coverage I would first have to pay the annual Medicare deductible in addition to the monthly premiums for both Medicare and the supplemental plan.

I now have a UHC Advantage plan - Medicare Part C (through my employer) and have used it this year and for the first time, for eye surgery in both eyes. The surgery, per eye, cost $18,000, which Medicare capped at $5,000. My out-of-pocket co-pay was $275 per eye, $40 to see the specialist, and roughly $100 total to cover the expensive eye drops. I received free transportation by car to and from the doctor's office and to and from the hospital. There are also other benefits included. It's best to compare what the various plans offer, if you have a choice, to what Medicare alone would offer, if you can pre-plan your needs for the year.

I have no complaints, although as I mentioned, I have had limited experience. What I do know is true Medicare will intervene on behalf of the policy holder if you need their help and you contact them.

We do see quite a few individual testimonials from happy customers. But the disastrous accounts of people being denied, especially in true life/health-threatening circumstances are striking.

Your example makes me wonder if these corporate-based "Advantage" plans aren't a bit more friendly to the customers/patients than the individual plans. I UHC (for example) was covering for a large corporation then it might be a bit more hesitant to deny/delay/defend.

for a number of years.

She had EXCELLENT care, nothing was denied. I understand others have differing experiences, but hers was wonderful.

Unfortunately Sutter Health in Northern CA stopped accepting it so she has something different now.

All this is confusing by design.

confusing by design !!!

She has had it for many years.

She turned 100 on August 31st, 2024.

She has never been denied care for anything.

Best wishes to her!

I might be wrong, but I don't think Kaiser accepts Medicare without an Advantage plan. There was a meme this week showing the insurance companies denial percentages & Kaiser was the lowest at 7% & United the highest at over 30%! But then a few years back Kaiser was one of the companies who's doctors were caught doing Medicare fraud.

colonscopies, etc.

I remember when I first started with Kaiser, the doc said they likely wouldn't approve a med I was taking that cost well over $100/month, compared to the generic which was less than $10. The only real difference was the expensive one was once a day, and the cheap one was twice a day.

Got mad at first, but then tried it. The two a day worked much better than the newer expensive one.

Senior Advantage. They lived into their early nineties and were never denied coverage on anything. My father passed away while in Kaiser hospital and I cannot say enough about the kindness and care shown to him and our family by all the doctors, nurses etc. I thought for sure we would get some kind of bill from Kaiser after he passed. We never did.

UHC will kill you. My wife’s cancer bills are at least $1,500,000. I have paid probably $3,000 total. No pre approvals, no hassles. Unbelievably great. I have dealt with regular insurance nightmares. The minute I could out of the insurance racket I did.

For her, it's secondary insurance for medical/hospital. But she's changing this year only because she needs a surgery and her preferred surgeon is out of their network. So we'll see what 2025 holds.

=============

Things are named in such a way to suggest that you have to do something right now because the enrollment period is closing. None of this is from Real Medicare, its all from the "Advantage" plans - and they all have "Medicare" in the title.

Many of these are for the Part-D (drugs) but still shilling for the corporations.

Medicare "Advantage" (heh) is no fooling
around with in network or out of network
doctors which can be a royal pain.

I am getting four to seven calls a day trying to sell me one of these plans. These plans are so profitable that they can plan people to solicit customers to these plans.

Advantage plans all have networks with copays for essentially everything, and the copays add up. The medical maximum out of pocket limit on every plan helps to offset this, though.

For this year’s Medicare Annual Election Period, which ends today, Advantage plans have considerably reduced benefits, and increased copays and premiums. Some of the Advantage plan premiums are as high as Medigap plans.

Another trend is more and more providers are no longer accepting Advantage plans, largely because of claims issues.

Some Advantage plans, with $0 premiums are a good choice for low income seniors. And since Medigap premiums are based on age, some seniors turn to Advantage in their later years because the Medigap premiums are beyond their means.

Generally, if a senior can afford a Medigap plan, it provides excellent options for medical care.

However, since original Medicare does’t provide prescription drug coverage, a separate, standalone prescription drug plan is required to avoid a lifetime penalty.

Also, dental, vision and hearing coverage need to obtained with separate policies, as well.

There is much room for reform with our entire healthcare industry, Medicare included.

That's why the Republicans want to get rid of it. Watch Dr. Oz try to do this.

In likely every one of the many posts here deriding MA, throughout every year since the introduction of MA, at least one poster has made this claim - sometimes followed with mighty huzzahs from others who've been gaslit to believe this bullshit.

Wanna talk about Medicare denying service or medication? Ask me, a cancer patient still in treatment for the next year and a half who, by the grace of something likely undeserved, is covered by an Advantage plan that never acceded to Medicare's automatic DOC.

This garbage disinfo is what's constantly led low-info voters to support "Medicare for All", because they think it's free free free! It isn't - not by a long stretch - and those who continue to promote this harmful canard either have a nefarious agenda or are as ill-informed as their intended audience.

Is at least 1.5 million. First an operation and 30 days in the hospital- $700,000. Then chemo in the hospital. Another $450,000. Then radiation and now votrient. Everything was covered no hassles with the supplement. It has been great. I know she would be dead with MA.

says you need. They have detailed coverage policie for all kinds of procedure, tests, etc.


Original Medicare pretty much follows a "pay and chase" scheme. They'll pay most claims upon submission -- but do deny some on frontend -- but periodically audit doctors who show higher utilization rates than the typical physician in that specialty. If the records don't support the care billed, they recoup the money, but from the doctors. If the doc knew what he or his billing service was doing, they might be charged with fraud.

This is why you see Medicare pursuing a doctor years after the service was billed for $21 million in services that were never performed. The "pay and chase" lets a lot of improper claims through.

Advantage plans, are more likely to deny suspected improper claims up front than through audits years later. Over 80% of initial denials by MA are overturned when the doctor provides additional information like, "Oh, chit, we forgot to mention that the patient developed pneumonia just before the typical discharge date, please allow the additional days."

Many of the denials are partial denials, Doctor asked for 14 days of therapy, but we are only approving 10 days at this point and will reconsider additional days if patient is making progress. Original Medicare's payment policy might also deny claims after the typical, standard of care, period. If you read, UHC, Aetna, Cigna, etc., coverage policies, they mostly follow CMS/Medicare policies word for word. Whether those policies are applied correctly is another matter, but that's true under original Medicare too.
Believe it or not, doctors do cheat.

I've seen cases where a doctor might order an expensive test 1 time for every 100 patients when the patient has to be referred to another facility for the test (facility bills and profits in that case). Then, when the doc buys similar testing equipment for their office, thus being able to profit from it personally, the utilization rate jumps 400%. What that tells me is that the test wasn't needed that often, until the doc could profit off it.

I've asked doctors who billed a high paying code -- when they only performed a lower paying code -- why they chose the higher paying code? The answer from a supposedly intelligent person was, "Because I looked down the list of codes and the code I billed paid the most."

Admittedly, the rules are confusing, but that’s true under original Medicare too.

If you don't believe providers cheat Medicare, read this from the HHS OIG.

https://oig.hhs.gov/fraud/enforcement/

Jaw surgery which would have left her without a chin. I had to pay to rebuild her jaw out of pocket. The last year I paid for insurance for my wife the premiums were $ 832 a month with a $7,000 deductible. I priced out every scenario and you are totally screwed if you have to buy insurance. The minute I could get off of this crap I did.
My wife’s cancer bills are at least 1.5 million. I have never had one issue with Medicare with a supplement. She would be dead if she was on advantage.

with trump and Dr. Oz. Don't be in denial.

She was pushed into it by my deceased father's retirement plan. First, the healthcare system with mom's doctors dropped Aetna for over a year, because Aetna wouldn't reimburse for care. Then, when mom was hospitalized and needed rehab, Aetna refused to approve it. Mom desperately needed to stay in a facility for a few weeks. She couldn't go home to her apartment and I couldn't care for her. She had dementia, hoarding, and many health issues. She was in a wheelchair. Her doctors fought and fought with Aetna. I was prepared to pay $10k in cash for mom's rehab - I actually had the certified check until, at the very last minute, Aetna relented.

A few years later when mom was dying I saw how Aetna refused, over and over, to pay mom's bills. Hospice fought with them and we didn't owe the money, but I saw the records. It was disgraceful, and what a waste of money to have to keep filing and filing.

My employer's retirement plan tried to push me into Medicare Advantage but I insisted on traditional Medicare. I had to read the fine print and call the plan to insist.

My wife was pushed into UnitedHealthcare Medicare Advantage by her retirement plan. It's a racket.

and insist on patients being in a Medicare Advantage plan.

Now you have.

Your doctor who you have been going to accepts it. Our’s did.

When the time came for her to go on Medicare, they told her that they would only keep seeing her if she signe on to one of two specific Medicare Advantage plans.

He is the one percentile. Too bad your Doctor sucks. He is really be an asshole to you and his other patients. Obviously, he put’s his money over your health.

referred by my dentist did not accept Medicare. Consequently, my secondary insurance did not cover charges or even a copay. And even though my dentist had referred me to the specialist for a related disorder, my dental insurance declined compensation for the treatment code provided by the oral surgeon. I'm fortunate to afford insurance over and above Medicare, but it is by no means "bulletproof".

When I was turning 65, my doctor's office told me that they didn't accept Medicare. In my case, I had been using my doctor for a number of years and I spoke to her regarding this.

She informed me that they were not accepting any new patients but because I had been a patient for a long time, they would continue with me.

It's real and it is happening.

Last edited Sun Dec 8, 2024, 03:57 AM - Edit history (1)

seriously

BTW - if a doctor is pimping Advantage plans, THEY LIKELY BEING COMPENSATED FOR DOING SO

it seemed clear that original Medicare plus a Medigap supplement was the way to go, rather than Medicare Advantage.

I also suspect that the Medicare Advantage industry hoped to be able to dominate to the point of driving original Medicare out of action, at which point Medicare Advantage cos. would be free to cr*ppify their coverage to the max. I.e., so long as they continue to have to compete with original Medicare, that can't be too obviously too much worse.

(Which is why we really needed a public option health insurance alternative for non-seniors.)

would be great, but it has virtually no chance until we have Presidency and HUGE majorities in House and Senate. Don't see that happening.

Believe it or not, those who choose MA aren't a stupid as some folks think.

and for some relatively healthy insureds, they may be a good deal; but the Advantage cos. probably wouldn't be in the business if their plans were actually a better deal for most insureds in the long run.

Back when I researched it, I understood too that once you chose an Advantage plan, you would have no option to get back on original Medicare if Advantage wasn't working out for you. I'm not sure if that restriction still exists; maybe someone else here knows.

it would be a moot question.

I think there are 4 states where Mdigap is guaranteed, but the premiums are a bit more because of it.

Just a couple of months ago millions of Americans who had MA plans were dropped because the CEO said those plans were not profitable enough for the company. They can do this at any moment and then when people try to get another plan or get Original Medicare they will find they are not insurable due to pre-existing conditions or because they have so many health issues they will pay exorbitant premiums.

original Medicare, get a Part D plan, and a Medigap without underwriting.

https://cahealthadvocates.org/medicare-advantage/when-medicare-advantage-plans-terminate-coverage/


If that is too expensive, you have guaranteed right to choose another MA plan.

and get kicked in the teeth AGAIN at any moment.

Because American seniors want to be anxious and live in fear!

etc.

If you prefer original Medicare, great. But you are in the minority.

Have the right to underwrite. Essentially, you are screwed.

I'm pretty sure I know why, but there are some fucktards out there who simply get their jollies messing with vulnerable people.

is that insurance companies spend so much money on soliciting customers. Not just in ubiquitous TV ads but salespeople who cold call potential customers. They would not be expending the resources unless they expected a windfall in return. Health insurance companies make money by denying claims and coverage.

gave some subsidies for Medigap and drugs, people wouldn't be forced into MA plans.

Biden or Harris seldom mentioned improvements to Medicare (although the Part D cap is a big deal). The reason is, they knew it was a loser.

According to Gallup 53% prefer private insurance to government insurance. I don't fall in that group, but I get why they feel that way,

You make all same assertions like a right winger. Call in it government insurance is the dead giveaway.

". . . . . . Yet nearly as many, 53%, prefer that the U.S. healthcare system be based on private insurance rather than run by the government."

my friend's brother is on Kaiser in ATL. He needed to go to a rehab facility. They only one he could go to was in Hapeville and he lives in Lawrenceville. That is 50 miles away. MA id fine if you are not sick. The minute you really have problems you are screwed. My wife has cancer. If she was on MA she would be dead today.

MA denying cancer care. Maybe you have some.

her first bill was $700,000 her secon d bill was over $500k and there is no way they would have approved her radiation. now she is on Votrient.

You still didn't answer driving 50 miles to Hapeville for rehab.

to write off 80% or so as insurance/Medicare adjustables. Yes, they would have approved her radiation.

One reason we will likely never have universal healthcare, especially MFA, is that lawmakers would prefer patients gripe at insurance companies rather than them.for "inconveniences" like a 10 day stay in a rehab center in Hapeville. I actually found Kaiser had much better quality of care than a bunch of independently practicing doctors who failed to coordinate care. YMMV

What's the matter with Hapeville, anyway?

But if original Medicare works for you, great. Let others choose what works for them. As of last year, 51% of Medicare beneficiaries chose Med Advantage Plans.

to drive 50 miles for rehab? I can't believe you defend MA. How about when they had to move my daughters jaw back and the result was she was to be left without a chin. I had to pay to give her a chin out of pocket. Is that OK with you also?

switch this year?

Were you insured by Kaiser too? Doctors screw up under any plan out there.

My daughter also could not be covered for a year due to a pre-existing condition of acid reflex. I have been buying insurance since 2001. I know all the crap that this industry does to people.
The last year I paid for insurance my monthly for my wife was $832 per month ith a $7,000 deductible. That is $17,000 before I would get any coverage. They get you no matter what. Want a lower deductible you just pay the exact same amount after it is all said and done.

I was very active in the ediscovery of Blue Cross in the class action matter. I called all 38 blues and actually brought in 5 blues for ediscovery. That matter was started in 2013 and even though they were found guilty no one has been paid. It was a 2.67 billion dollar judgeeent and policy holders have been waiting 11 years for a payout. I actually have 3 claims in on that matter.

AND YOU DEFEND THIS INDUSTRY.

You can buy insurance without big deductibles, but I know it’s costly. I assume your employer chose that cruddy insurance for you. Should blame them too.

In any event, I definitely support universal healthcare, but bad outcomes will still happen.

Still not a reason to shoot someone in the back, especially 11 years after your issue l

has nothing to do with it. It shows how be roken our healyhcare is. and you still defned this system.

on top of Part B for Medicare Supplement. You pay through the nose for that plan, regardless of what alphabet designation they give you and choosing your own doctors, and you don't get vision or dental. Forget it. I currently pay just $10.50 a month for mine on top of Part B. I will be damned if I am going to pay double and be forced to take Medicare Supplement.

There is lots of misinfo here and in other places about Medicare Advantage. It has served me well. I recently injured my leg, and while I had to choose from a list of providers, I wound up having to pay just $270 total for the MRI and all the rest covered.
My HSA paid that off. Most people here simply don't understand that private industry does the processing of claims, not the government, regardless of whether you choose Medicare Advantage or Medicare Supp.

Not get cancer.

If you got cancer or some other catastrophic illness?

Her bills are at least 1.5 million and I have paid maybe $2,000.

Greatest insurance ever. I use Mutual of Omaha for my supplement. I have never had a problem No pre authorizations. No questions. Mutual of Omaha is the cheapest for a supplement. AARP for dental- covere implants and VSP for vision. If you can afford it you will never regret it.

do you understand that?

A good case can be made for using original Medicare without any medigap supplement. This link makes that case.
https://www.huffpost.com/entry/medicare-supplemental-policies_b_3901861
I am not giving advice, just providing food for thought.

paid very little out of pocket for the surgery and therapy combined bill. My brother, on the other hand, has put off knee replacement because of the high co-pay his Medicare Advantage plan requires and recently had to cough up $30 co-pays for PE for another issue. My husband has complicated medical issues that require seeing a specialist and we end up paying is far less than any premium for a plan in addition to regular Medicare. I've been on it 10 years and he's been on it 12 years, so it's not a fluke.

imho!

It burns me up every time I get my "permission" letter telling me that my up-coming test has their OK.
As bad as I hate to, I'm going to go back to "AARP" otherwise known as United Healthcare. At least I
won't have to check the "in-network" business anymore and I won't be eaten up with co-pays. Last yr I
had a problem with carpal tunnel in my hand. After it was over, I needed physical therapy. Well, forget
that! No way I can pay a co-pay for physical therapy for 3-6 weeks 3 times a week. I have a little numb-
ness in three fingers of my hand, but nothing like immediately after surgery. So I'm ok.
And the way I handle the never-ending calls is I don't answer, then block & delete them.
Another thing I'm pissed about is not giving me my Medicare co-pay back which is deducted from my
SS every month. That is out-right theft if you ask me.

I have to get off here cause my kitty is raising hell to get fed. It's like I haven't fed her
in days when it's only been a few hours!

I opted for original Medicare and a supplement plan and have had great care with a variety of specialists. MA plans much cheaper per month here in Minnesota and many people choose them for that reason and they are marketed with perks to be attractive to potential users. Don’t be fooled though, like one of my relatives is, they limit care and doctors to keep their costs under control and have no reason to see you as a person with medical needs.

I briefly sold Med Advantage plans for a company.

Everything in this post is accurate.

The insurance companies make their money when utilization is low.

They can control utilization by slow rolling or simply denying claims.

Don’t sign up for it.

As long as Medicare has approved the treatment. They don’t get to decide not to pay their portion.

And why don't they have it? For us it just seemed like the natural thing to do. The insurance we'd had all along became our backup insurance.

I think.

Maybe things have changed in recent years?