It's whole lot of bafflegab going on in these parts.
Medicare with Medigap or Medicare Advantage?
- Thread starter ZZman
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Yeah, you know, you must know me by now, misinformation drives me crazy and I don’t know why, but maybe just because I care about people.
I don’t even push Medigap or advantage plans. I just hate that some people make a decision to choose one without factual information to rely on.
It’s no secret I love advantage c as long as I can keep my out-of-pocket low. I realize in some states that could be a challenge I think.
At the same time, I have a sibling with a Medigap and they love that too.
Choices are wonderful and if you get severely ill, with either plan, you will be taken care of
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Medicare Advantage is great as long as you don't need healthcare. As soon as you need it, your health care will be managed and you may be denied care - doctors, procedures, tests.
Stick with traditional Medicare with supplemental coverage for the out of pocket portion.
This is really an insurance thread...isn't it? And like all insurance threads-there are far too many variables for anyone to advise the OP. Medicare Advantage Plans are very "state specific". For example-In my state whether you have traditional Medicare-or an Advantage Plan-you are going to end up with the same medical group/hospitals, so there is zero advantage to going traditional Medicare.
There is a ton of misinformation based on old standards on this thread. For example-for the vast majority of plans you do NOT NEED a Doctors referral for a specialist.
He needs a good agent.
There is a ton of misinformation based on old standards on this thread. For example-for the vast majority of plans you do NOT NEED a Doctors referral for a specialist.
He needs a good agent.
false
That response was below you. Just because I don't have a need for an Advantage plan doesn't mean I haven't looked into it. The sales tactics that resemble timeshare sales approaches should alert you to the fact there are unscrupulous operators in the field.
I find your and Alarmguy's position unconscionable. Just because you both have good Advantage plans that work for you doesn't mean they are universal.
A simple internet search on "bad Medicare Advantage" will give you a good idea of the pros and cons, and some of the horror stories associated with problematic Advantage providers.
Here is the best source of all for those who like to learn and read, they might know more than an agent. I spent months, literally on this site and the site of the ins companies before I choose and even then, I had the option to go to traditional for up to a year if I didnt like it.
If your handy you dont have to rely on anyone, all the information is there. Make sure you can afford the max out of pocket and health care networks and doctors you would go to, other than that, not much more to it.
Welcome to Medicare
The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.
Your post is spot on though as far as the health network and referral BS
Also many Advantage C plans have better out of the country emergency coverage than traditional medigap and medicare by itself has no out of country coverage.
Of course the info is there for anyone. My agent only does Advantage Plans-and has been doing so for over 20 years. Call me lazy-he gets paid from the Advantage Plans, and that doesn't affect my rate, and he can immediately answer my questions. So-I don't have to run down the answers-he is a great resource.Here is the best source of all for those who like to learn and read, they might know more than an agent. I spent months, literally on this site and the site of the ins companies before I choose and even then, I had the option to go to traditional for up to a year if I didnt like it.
If your handy you dont have to rely on anyone, all the information is there. Make sure you can afford the max out of pocket and health care networks and doctors you would go to, other than that, not much more to it.
Welcome to Medicare
The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.medicare.gov
Your post is spot on though as far as the health network and referral BS
Also many Advantage C plans have better out of the country emergency coverage than traditional medigap and medicare by itself has no out of country coverage.
Never once I have been denied HC with Advantage.
Were you denied?
I never said you didn't look into it, it's just that you wrote a very specific failure number. You have to admit you are criticizing something about which you simply have no direct knowledge. Not one person I know with an Advantage plan has a complete failure. I bet there are some states with lousy companies selling Advantage plans, just as there are people with gripes with medigap plans. And I have never said anything bad about medigap plans.
Never once have I said they are universal for all. I continue to recommend to do what fits best.
The point remains: People criticizing Advantage are not showing they have DIRECT knowledge. If you do, I'm all ears, I'm open minded.
Yea-but how many people go online and post how happy they are? You know I had open heart surgery and it cost $300,000 and my advantage plan paid most of it?
Not many.....
Agree. I think that the max I would pay for an extended hospital stay is like $5,000.00 Not chump change to be sure....but a lot better than what it would cost without the Advantage plan.
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I haven't but worked at a hospital where I dealt with denials every day. If you are healthy then these are good plans. The moment you need real HC then you are on your own. Mainly, inpatient stays, behavioral health counseling, radiology, some lab tests, skilled nursing services after inpatient stay, or surgery, are always denied.
They take the goal of "keeping people out of hospitals" very seriously.
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There have even been congressional hearings about it recently. It's not false.
There is a congressional hearing about everything, people whine and hearings are held. Last thing I want is congress to get any more involved. This is congress main responsibility = http://usdebtclock.org
BTW - there are congressional hearings on traditional medicare too, no one and I repeat no one is denied valid medical treatment. If they are there is a simple, streamlined process online or phone call or mail to appeal the decision.
I know my wife was denied with her non medicare standard corporate insurance that most working people in here have for a procedure until certain requirements were met even though the insurance company her company used last year approved her.
I was denied medical treatment years back from my traditional corporate health insurance policy too, until certain requirements were met and at the time I was upset as they were looking for cancer.
This stuff is laughable when I read about the evil Medicare Advantage C plans...
Here is a shocker for those who think otherwise, When you are denied a treatment is it because the insurer believes it does not meet medicare requirements. Even traditional medicare denies treatment just like any insurance on planet earth. I think some people think if you have traditional medicare you doctor is given a green light to do anything he/she wants and can charge for it. *LOL*
Advantage C by law covers EVERYTHING that traditional medicare covers. If you think an error was made, they will look it over.
Traditional Medicare is the same, no different, if you dont meet the criteria you will be denied. If you think an error was made you can also file an appeal.
For the doubters, this is for ALL Medicare plans = https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
BTW- pay for whatever you want to buy! If it worth it to you for some reason, pay hundreds of dollars per month more for insurance you think is better. I have no problem with that. I have siblings that go that route too. They love, other than paying the premiums not having medical bills. Nothing wrong with that.
Only have a problem with false information or information leading people to believe they are left in the streets dying because of denied treatment. I actually wish so many people were not signing up for Advantage C plans, we have crossed the 50% line and now 51% of the population is signing on to them. Over time it might be less incentive for all the perks.
I get full coverage and after all the perks my premiums are $0.00
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Read this:
Hospitals are dropping Medicare Advantage plans left and right
Hospitals nationwide are dropping Medicare Advantage plans due to excessive prior authorization denial rates and slow payments from insurers. Scripps and St. Ch
and?Read this:
Hospitals are dropping Medicare Advantage plans left and right
Hospitals nationwide are dropping Medicare Advantage plans due to excessive prior authorization denial rates and slow payments from insurers. Scripps and St. Chwww.beckershospitalreview.com
6,129 hospitals in the USA and 13 are mentioned here. Even if it was 3000 what is the fear? Switch plans or go back to traditional medicare and pay hundreds more dollars a month and be glad for the savings you had at the time. No big deal, though granted for some it is so I would suggest those people skip Advantage C plans and pay hundreds more a month, then they dont have to think about the possibility, even though chances are 100 times greater that some other life altering event will happen in their life other then switch companies. I switch for fun, whoever puts more money in my pocket wins!
I am sure that you do know, hospitals drop and add insurance networks all the time and if the switch makes you unhappy, you can change plans. Simple stuff. You have more protections then when you are working and have company provided health insurance, your stuck with company provided health insurance, happened to my wife a few times.
There is a story for everyone and any service, it's called life, deal with it. With medicare you have more protections than any other form of health insurance. Its really stupid simple.
It's all on line, and I dont want to keep providing links. *LOL* If you dont like what you have, go to another plan!
The links below are from the AARP because I dont want to bother going through hour worth of documents on my medicare portal
Can I Change Medicare Advantage Plans at Any Time?
You have 2 open enrollment periods and a few exceptions
www.aarp.org
When to Get Medicare Supplement Insurance or Medigap
The best time to buy a Medicare supplement policy, or Medigap, is when you have what are called guaranteed protections. Learn more about Medigap.
www.aarp.org
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AS you know, I love the Advantage C plans but that is one place where you would lose because traditional Medicare is pretty much $0.00 for the hospital and with Medigap G or N plus D again, pretty much $0.00
With that said, for your entire life you are paying an extra $200, $300, $400 a month PLUS the mandatory (currently $175 a month) for that coverage with traditional Medicare and Medigap and Drug Coverage (it goes up with age) vs only that mandatory $175 a month for Advantage C
Now if you are someone constantly in the Hospital year after year only that person can figure out if it is worth that, it is a big expense $400 to $600 a month (total) plus pay their own dentist, eye care etc etc
I always said, choice is good, love it. More choice once you retire than you ever had with company paid insurance.
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I think there are some folks who run standard Medicare and Medicare Advantage together in their minds and thoughts.
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