General Discussion

dlk

(12,468 posts)

24. Advantage plans have networks, either HMO's or PPO's

Reply to justaprogressive (Original post)

Sat Dec 7, 2024, 01:58 PM

Dec 7

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.

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Highlight:

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