General Discussion

marybourg

(13,214 posts)

7. Not quite accurate to say that: "(regular) Medicare always pays". Occasionally they don't.

Reply to justaprogressive (Original post)

Sat Dec 7, 2024, 12:07 PM

Dec 7

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.

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The Medicare Advantage trap: What they don't tell you [View all] justaprogressive Dec 7 OP

Thank you for posting this. I tried to read this article on Rawstory but there is a paywall. OMGWTF Dec 7 #1

Try this: Ocelot II Dec 7 #3

I don't particularly like RawStory as a source. Here is the original. ... aggiesal Dec 8 #85

Thank you. I seldom, if ever, click on a Raw Story link, except dmr Dec 8 #99

I don't understand why they are allowed to call it a Medicare plan. It should be called privatized senior insurance. Walleye Dec 7 #2

Technically the Advantage plans offer the same level of service as Original Abnredleg Dec 7 #5

Yep, my advice is stick with it, maybe get a supplement if it looks feasible, but not a Medicare advantage Walleye Dec 7 #6

You will also need a DownriverDem Dec 7 #29

Yep, I'm afraid so Walleye Dec 7 #35

There are some plans with no premiums up front SCantiGOP Dec 7 #63

Out of pocket expenses for plan d are now capped at 2000 Voltaire2 Dec 8 #106

I am 81 and have used only real Medicate, including through cancer treatments for Trust_Reality Dec 7 #8

The problem is Medicare Advantage plans are allowed to interpret and decide - and they have the final say dalton99a Dec 7 #9

Are you eligible for Tricare for Life? COL Mustard Dec 7 #16

I can't say enough good things about the combination of Medicare and Tricare for Life Susan Calvin Dec 7 #74

I'm still working COL Mustard Dec 7 #77

Get a supplemental plan that covers the other 20 percent Desert grandma Dec 8 #90

Because it is literally authorized and governed by Part C of the Medicare statute. Ms. Toad Dec 7 #81

Do any other private insurers get that part C label? leftstreet Dec 11 #148

If Congress passes specific legislation authorizing a Medicare W, and the president signs it, then yes they would. MichMan Dec 11 #154

Thx leftstreet Dec 11 #155

All private insurers whose plans comply with the Medicare Part C rules (as an alternative to original Medicare) Ms. Toad Dec 12 #163

There is coverage as long as you are profitable dalton99a Dec 7 #4

Wow. ShazzieB Dec 7 #67

Not quite accurate to say that: "(regular) Medicare always pays". Occasionally they don't. marybourg Dec 7 #7

It's Not Accurate RobinA Dec 7 #83

Link to Thom Hartmann's original article erronis Dec 7 #10

Thank you for posting the original, Erronis Bumbles Dec 7 #17

Hartmann's post very helpfully supplied by another DUer erronis Dec 7 #18

And we are forced to have it... Quanto Magnus Dec 7 #11

And for people over the holidays meeting relatives markodochartaigh Dec 7 #12

someone has to pay for the 24/7 tv commercials, the annoying calls, and the mailings rampartd Dec 8 #126

80/20 rule kkmarie Dec 8 #130

Maybe there is a loophole markodochartaigh Dec 8 #134

I had a Medicare plan with a UHC supplemental plan for several years Erda Dec 7 #13

Glad you have had a good experience with an "Advantage" plan. erronis Dec 7 #20

My elderly mother had the same BuddhaGirl Dec 7 #23

Miledigap plans are good. That's different from Medicare Advantage. Beck23 Dec 7 #27

bingo.... markie Dec 8 #108

My mother has Humana Advantage. SamKnause Dec 7 #28

100! Wow!! CrispyQ Dec 7 #46

I'm very happy with my Kaiser Advantage plan. CrispyQ Dec 7 #32

Wish I had Kaiser here. When I lived in Atlanta, I had Kaiser. They really pushed you to get preventive exams, vaccines, Silent Type Dec 7 #36

I have Kaiser Senior Advantage and have been happy with it. Both my parents also had Kaiser skylucy Dec 7 #78

Don't get cancer Henry203 Dec 7 #42

My spouse has had a good experience with UHC Advantage thru AARP. Beartracks Dec 7 #60

K&R SheltieLover Dec 7 #14

It's confusing as hell. milestogo Dec 7 #15

No, I get tons of emails from CMS/Medicare to look at my open-enrollment options erronis Dec 7 #21

Another advantage over boonecreek Dec 7 #19

Medicare advantage plans are all scams LetMyPeopleVote Dec 7 #22

Advantage plans have networks, either HMO's or PPO's dlk Dec 7 #24

Original Medicare will not deny treatment Beck23 Dec 7 #25

Absolutely false. See post #26. Silent Type Dec 7 #37

Where the fuck do people get this idea? OilemFirchen Dec 7 #54

My wife's cancer treatment Henry203 Dec 8 #113

First off, Clinton signed legislation for Part C. And it is not true that Medicare pays for anything a doctor Silent Type Dec 7 #26

I started buying insurance in 2001. It was horrific. My daughter had to have extensive Henry203 Dec 7 #47

It's all going to change DownriverDem Dec 7 #30

I had a bad experience with my mom's Medicare Advantage plan with Aetna. yardwork Dec 7 #31

Some doctors don't accept Medicare DavidDvorkin Dec 7 #33

Never heard of any doctor refusing Medicare. Emile Dec 7 #56

My wife's DavidDvorkin Dec 7 #69

If you say so. Emile Dec 7 #75

Normally Henry203 Dec 8 #116

It's the doctor she had been going to for years DavidDvorkin Dec 8 #124

If you look at the stat's Henry203 Dec 8 #128

An oral surgeon Zambero Dec 8 #115

It's a problem. . . . h2ebits Dec 8 #131

99.9% of doctors accept Medicare dalton99a Dec 7 #58

it's the other way around Skittles Dec 8 #103

When I researched it, snot Dec 7 #34

Over half of Medicare eligible beneficiaries choose MA plans, primarily because of cost. I do agree a Public Option Silent Type Dec 7 #38

The Advantage cos. do all they can to make their plans appear attractive, snot Dec 7 #41

So you think 31 million people are stupid? Maybe if original Medicare met their needs, Silent Type Dec 7 #48

Maybe not stupid but ignorant. Brenda Dec 8 #109

Actually, it might be an opportunity if your MA plan is eliminated. Then, you have a guaranteed right to return to Silent Type Dec 8 #132

"Choose another MA plan" Brenda Dec 11 #156

Plenty of people do fine on MA, as DUers have posted, even though cancer, heart disease, Silent Type Dec 11 #157

Insurance companies Henry203 Dec 7 #50

Whoever convinced you of all this was lying. OilemFirchen Dec 7 #57

The first warning about Medicare Advantage misanthrope Dec 8 #100

I think anyone campaigning on eliminating people's MA plans would face a lot of resistance MichMan Dec 7 #45

Totally agree. Maybe someone in Congress will realize that if they put those benefits in original Medicare and Silent Type Dec 7 #52

People are brainwashed Henry203 Dec 8 #117

That's essentially what Gallup called it. But thanks for responding. Silent Type Dec 8 #133

You loved Kaiser? Henry203 Dec 11 #146

Glad your wife has survived. As others here on DU and elsewhere have posted, there ain't much evidence of Silent Type Dec 11 #147

so Henry203 Dec 11 #149

Hospitals and doctors bill those huge amounts to insurance, even Medicare, knowing that they will have Silent Type Dec 11 #150

So it is OK Henry203 Dec 11 #151

If you want quality care from Kaiser, it is. No one makes you sign up. Did your friend Silent Type Dec 11 #158

i was with Blue Cross when this happened Henry203 Dec 11 #159

Got it. In 2013 we didn't have pre-existing condition protection. Sorry about you daughter though. Silent Type Dec 11 #160

Eleven years Henry203 Dec 11 #161

Eat the rich and their enablers... problem solved NotHardly Dec 7 #39

My Medicare Advantage is just fine, thank you. I will be damned if I am going to pay 100, 200 a month more valleyrogue Dec 7 #40

You better Henry203 Dec 7 #51

Can I ask what your maximum annual out of pocket expense is? Sucha NastyWoman Dec 7 #70

Around $400. Henry203 Dec 8 #112

Is that the amount you have ACTUALLY paid in a year or the amount you could POTENTIALLY pay Sucha NastyWoman Dec 8 #119

My wife has cancer Henry203 Dec 8 #121

I thought Medicare Advantage only covered 80% of chemo treatments. Sucha NastyWoman Dec 8 #122

I have Medicare with a supplement Henry203 Dec 8 #123

the entire point of MA is to eventually GET RID OF MEDICARE Skittles Dec 8 #86

You better not get cancer Henry203 Dec 8 #118

Plus Advantage is costing the government more than traditional Medicare surfered Dec 7 #43

Good argument for Original Medicare w/o Supplement OKnow Dec 7 #44

I haven't read the link yet, but I have only regular Medicare and had surgery that required follow-up PE and Vinca Dec 7 #53

I think that dr. is nuts bagimin Dec 7 #80

Totally fed up with the so called "Advantage" Plan ReRe Dec 7 #49

No way am I again having an HMO determine my care. LiberalBrooke Dec 7 #55

The fact that they push this "advantage" so hard indicates how profitable it must be for them. patphil Dec 7 #59

Spot on Picaro Dec 7 #61

If you have original Medicare plus a supplement the insurance company that sold you the supplement MUST PAY their part Sucha NastyWoman Dec 7 #62

What percent of the eligible population does not have original Medicare, with or without a supplement? LAS14 Dec 7 #64

I am on an Advantage Plan. How can I get out and use traditional Medicare? Evolve Dammit Dec 7 #65

In most states you have to be approved to change to a supplement plan Sucha NastyWoman Dec 7 #73

Think I missed this years "enrollment period. December 7. Went with an advantage plan as it is free (no monthly premium) Evolve Dammit Dec 8 #125

You can easily choose original medicare at annual enrollment Desert grandma Dec 8 #97

Thanks for this! ShazzieB Dec 7 #66

My Friend F 72y/o Will Be Retiring Soon And Will Be Looking For A Medicare Plan..... global1 Dec 7 #68

About Medicare and pre-clearance Progressive dog Dec 7 #71

Medicare Advantage started in 1997 Progressive dog Dec 7 #72

Thank you for the correction - Ms. Toad Dec 7 #82

I have had a Kaiser Medicare Advantage plan for the past five years. Never denied anything. Sibelius Fan Dec 7 #76

The coming admin. SayItLoud Dec 7 #79

Look. Morbius Dec 8 #88

correct, their "healthcare plan" is to TURN IT ALL OVER TO PRIVATE INSURERS Skittles Dec 8 #101

Traditional Medicare doesn't include dental or vision coverage GoreWon2000 Dec 8 #84

that's how they entice people into the scams Skittles Dec 8 #87

Dental and Vision are cost prohibitive without insurance GoreWon2000 Dec 8 #89

there are some who don't fall for the scam Skittles Dec 8 #91

You didn't answer my question GoreWon2000 Dec 8 #92

I have extra insurance plans that cover them Skittles Dec 8 #93

You're paying more GoreWon2000 Dec 8 #94

like I said, THAT'S HOW THEY ENTICE PEOPLE Skittles Dec 8 #95

Traditional Medicare never addressed dental and vision coverage GoreWon2000 Dec 8 #96

Even though I pay more monthly for a supplement its more cost effective for me in the long run indigovalley Dec 8 #129

Your supplement is good for people in your situation GoreWon2000 Dec 8 #138

I pay for both Henry203 Dec 8 #120

I don't pay any extra premium for Medicare Asvantage GoreWon2000 Dec 8 #139

THANK YOU so much for this info. nt Raine Dec 8 #98

I knew a lady we rented a home from in 2005. She signed her mom up for that... C Moon Dec 8 #102

If it looks too good to be true...it probably is! PortTack Dec 8 #104

It seems like every other ad on TV is a Medicare Advantage ad. Jeebo Dec 8 #105

they drive me crazy (close to the title of a great 80s song btw) when I watch American streams Celerity Dec 8 #107

not specifically medicare, but.... thought of this markie Dec 8 #110

I have an appointment tomorrow wolfie001 Dec 8 #111

I didn't realize Medicare Advantage was a Bush thing MadameButterfly Dec 8 #114

Medicare C was signed into law by President Clinton in 1997 MichMan Dec 8 #135

I can't find those or the post that said it was signed into law by Bush MadameButterfly Dec 8 #141

Posts # 26 & #72 MichMan Dec 8 #142

I found it. post 85, the Tom Hartman report MadameButterfly Dec 8 #143

Correct, Clinton signed it into law; Bush just changed the name of it after it was already implemented MichMan Dec 8 #144

No thanks to either of them MadameButterfly Dec 8 #145

The commission an agent is paid by the insurance companies for selling a policy can be twice as much Sucha NastyWoman Dec 8 #127

People have a choice to get a MA plan or not MichMan Dec 8 #136

it should be criminal mike_c Dec 8 #137

I have a question - my friend tells me he signed up for a Medicare Advantage plan walkingman Dec 8 #140

🚩 thanks I need to start brushing up on this stuff underpants Dec 11 #152

Medicare Advantage was always a solution looking for a problem. VMA131Marine Dec 11 #153

This is a REALLY excellent thread! A KEEPER, most definitely. calimary Dec 12 #162