Medicare Advantage Plans - Cautionary Info (medical, hospital, doctor, blood)
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My senior friend had an Advantage Plan here in Las Vegas. Briefly, I wanted to state what happened to him as I think it’s important for others considering Advantage Plans.
Tim had a $0 monthly Medicare Advantage Plan through Blue Cross Anthem that was administered by Caremore.
About 9 months ago his kidneys began failing and it was pretty obvious by his skin tone and lack of strength, fatigue, etc. that he would need dialysis. Under his Advantage plan he had to see his family Caremore doctor first. Then he was referred to a Caremore nephrologist who began treating him with drugs to assist his conditions and additional tests to monitor his kidney function - which was deteriorating. BTW, he had to wait several weeks for each test and appointment.
It was finally determined he needed dialysis. Now another process began - vein mapping, more medication, etc. and all the while his condition worsened as he waited weeks between appointments and procedures.
He eventually went to the ER where he was admitted and they began dialysis. He also had developed pneumonia and a blood clot. After a few days he was released to a rehab center/rest home where he stayed for about a week - his condition worsened and he was readmitted to the hospital. The care at this rehab center appeared to be less than dismal.
At the hospital, his doctor recommended hospice. He declined and was sent to a different rehab center. At this time he was finally receiving dialysis three times a week and appeared to be improving.
He called me and said the pneumonia had returned and would I please contact his doctor to request antibiotics since the rehab nurse would not administer any and he didn't know his doctor's phone number. I had to look up his doctor’s number and was able to call but only got the answering service who would not help as I was not a family member - then I visited Tim. As a non medical person I could easily see the obvious signs of pneumonia. I called his caremore doctor again and got through to the answering service - explained/pleaded the issue and convinced them to contact the doctor.
Six days later they called me back and said they had to examine him first so were sending someone out to the rehab center to see if he needed antibiotics. At this time I told them not to bother as he was back in the hospital on full life support.
They left him on life support until his wife authorized the removal of all artificial aids. They administered morphine and he died 30 minutes later on October 1st, 2019.
I’m advising those dear to me to avoid the Medicare Advantage Plans. Ask yourself what’s more important - your money or your life? Insurers make more profit on advantage plans. Do you notice all the advertisements to convince you to join. Usually, when everyone is trying to convince you to proceed in one direction, it’s time to question it. If you don’t have the money for Medicare and a supplemental the Advantage Plan may be your only option. They used to be called HMO’s but changed the name to Medicare Advantage a few years back and increased enrollment followed.
But if you can afford it, my advice is go with the straight medicare Part A,B D, etc. Spend the money for choice. You might get really sick some day and if you do - access to a quality doctor will be much more important than a few dollars saved, silver slippers classes and a health club membership.
This has been my direct experience and I may not have all the facts. Arm yourself with knowledge and make the right decisions.
My senior friend had an Advantage Plan here in Las Vegas. Briefly, I wanted to state what happened to him as I think it’s important for others considering Advantage Plans.
Tim had a $0 monthly Medicare Advantage Plan through Blue Cross Anthem that was administered by Caremore.
About 9 months ago his kidneys began failing and it was pretty obvious by his skin tone and lack of strength, fatigue, etc. that he would need dialysis. Under his Advantage plan he had to see his family Caremore doctor first. Then he was referred to a Caremore nephrologist who began treating him with drugs to assist his conditions and additional tests to monitor his kidney function - which was deteriorating. BTW, he had to wait several weeks for each test and appointment.
It was finally determined he needed dialysis. Now another process began - vein mapping, more medication, etc. and all the while his condition worsened as he waited weeks between appointments and procedures.
He eventually went to the ER where he was admitted and they began dialysis. He also had developed pneumonia and a blood clot. After a few days he was released to a rehab center/rest home where he stayed for about a week - his condition worsened and he was readmitted to the hospital. The care at this rehab center appeared to be less than dismal.
At the hospital, his doctor recommended hospice. He declined and was sent to a different rehab center. At this time he was finally receiving dialysis three times a week and appeared to be improving.
He called me and said the pneumonia had returned and would I please contact his doctor to request antibiotics since the rehab nurse would not administer any and he didn't know his doctor's phone number. I had to look up his doctor’s number and was able to call but only got the answering service who would not help as I was not a family member - then I visited Tim. As a non medical person I could easily see the obvious signs of pneumonia. I called his caremore doctor again and got through to the answering service - explained/pleaded the issue and convinced them to contact the doctor.
Six days later they called me back and said they had to examine him first so were sending someone out to the rehab center to see if he needed antibiotics. At this time I told them not to bother as he was back in the hospital on full life support.
They left him on life support until his wife authorized the removal of all artificial aids. They administered morphine and he died 30 minutes later on October 1st, 2019.
I’m advising those dear to me to avoid the Medicare Advantage Plans. Ask yourself what’s more important - your money or your life? Insurers make more profit on advantage plans. Do you notice all the advertisements to convince you to join. Usually, when everyone is trying to convince you to proceed in one direction, it’s time to question it. If you don’t have the money for Medicare and a supplemental the Advantage Plan may be your only option. They used to be called HMO’s but changed the name to Medicare Advantage a few years back and increased enrollment followed.
But if you can afford it, my advice is go with the straight medicare Part A,B D, etc. Spend the money for choice. You might get really sick some day and if you do - access to a quality doctor will be much more important than a few dollars saved, silver slippers classes and a health club membership.
This has been my direct experience and I may not have all the facts. Arm yourself with knowledge and make the right decisions.
What a tragedy, and the administration seems intent on making Medicare advantage our only option. I was just reading an article today about how medicare advantage plans can now use "step therapy". In case anyone doesn't know what that is, it goes like this. There are 4 drugs for a given disease, and medicare advantage requires that the physician try each drug in order of cost, starting with the cheapest. So if you have stage 4 cancer and your oncologist suggests starting with drug D (the most expensive) because you have a short life expectancy if the cancer isn't controlled, medicare advantage won't pay until drugs A, B, and C are tried and fail...too bad for you if you die before you are allowed the drug that might help you https://www.medscape.com/viewarticle/900503
So, so sorry this happened to your friend. I know of someone who had a failed kidney transplant and has been on dialysis 3x week for at least fourteen years. He is now 73 years old. Granted he prefers sitting in his chair to walking these days but, up until the last few years, he did well enough. Drove himself to dialysis - may still do. He's always had a Medigap.
Advantage plan performance seems to vary widely by state and carrier. We've had enough sad tales on this board on Advantage that I agree with you - if one can afford a Medigap supplement, it is the best option.
In your friend's case, freedom to choose a different doctor might have made all the difference. Medigaps provide that freedom. Advantage does not.
Very sorry for your friend. Too bad those in Congress making all these decisions have no clue as they don't use these Advantage plans. Should be called "dis" Advantage plans.
Ironic part is, these plans do not save the government money - just the opposite - to the point Congress had to enact rules which gradually cut Advantage plan profits. In spite of that, Advantage plans remain huge cash cows for the insurers. Advantage is just another way of directing taxpayer money to private for-profit industries.
Ironic part is, these plans do not save the government money - just the opposite - to the point Congress had to enact rules which gradually cut Advantage plan profits. In spite of that, Advantage plans remain huge cash cows for the insurers. Advantage is just another way of directing taxpayer money to private for-profit industries.
Exactly!
Quote:
For instance, a study published earlier this year by the National Bureau of Economic Research (NBER) found that the revenue MA plans received in 2010 was 30 percent higher than the amount they paid for medical care. According to the study, MA plans likely received about $20 billion in federal payments they did not spend on medical care.
Amy Finkelstein, an economist at the Massachusetts Institute of Technology and one of the study's authors, said, "Our study found that health care spending for enrollees in [MA] plans is 10 to 25 percent lower than for comparable enrollees in traditional Medicare," adding, "Yet government payments to plans is far above their lower health care costs." https://www.advisory.com/daily-brief...08/09/ma-costs
Very sorry for your friend. Too bad those in Congress making all these decisions have no clue as they don't use these Advantage plans. Should be called "dis" Advantage plans.
Congress isn't even making these changes, CMS is doing it with the blessing of the administration. Seema Verma is the one who decided that step therapy can be used by medicare insurance companies, that has the potential of killing people but Congress didn't get to vote on it. Congress doesn't vote on how much the Government will pay providers for medicare advantage plans either, that's done by agreement between the insurer and CMS.
Ironic part is, these plans do not save the government money - just the opposite - to the point Congress had to enact rules which gradually cut Advantage plan profits. In spite of that, Advantage plans remain huge cash cows for the insurers. Advantage is just another way of directing taxpayer money to private for-profit industries.
Are you saying someone with disabilities, and under 65 (me) should not get an Advantage plan? There are no Medigap plans for me in my area.
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