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That's interesting, it makes me think that when you look up a doctor (when you're doctor shopping) and you see "Dr. so-and-so has privileges at these hospitals" I have to wonder if they are then considered "out of network" for billing purposes.
Like I said, when I chose Advantage, I was assisted by a volunteer at the Area Agency on Aging. I wasn't informed (she may not have known) that there are enormous "out of network" charges when enrolled in Advantage. All I knew was that I couldn't afford Supplemental on a disability income. At that time, the cost for Supplemental would have been between $350-400/mo.
Advantage is "free" but there is actually a huge cost for that "free."
And see, even if I had addressed the problem beforehand (I was brand new to Advantage and didn't really know how it works when bam I ended up in the hospital twice, the 2nd time with major surgery), I would not have been able to change it. My pulmonologist was connected to that hospital, and the infectious disease doctor that was called in was out of network. Everything other than the hospital was out of network.
And to add insult to injury, the ER was completely disconnected from the hospital. Unbelievably, they do not share records even though they are in the same damn building and people are admitted from that ER to that hospital. It's madness. But that's our health care system. I'm very grateful to have what I now have. Will never have to deal with that crap ever again.
It is much easier to understand why a specialist might not be considered “in network” by every insurance system
But the idea that an ER which admits patients to a hospital it is based in that is “out of network” is just a financial decision made to reside profits—
It is likely a shell corp owned by the hospital Linder a different name
Might even be leased out to another entity for flat fee or % of overhead even though both are owned by same ultimate corporation——
That is what market-based medicine brings you in America
I'm referring to my MEDICARE premium -- not the Advantage or Medigap premium. I think the Medicare premium goes up from the "regular" $164/month if your income is higher than $97,000. My income in 2022 was WAY higher than that (ONLY because I was paid my regular salary as the retirement incentive PLUS paid another ~$70k for work), but that was an anomaly. This year my income will be actually a bit less than 1/3 of my 2022 income and in 2024 it will be much, much lower.
The Medicare Advantage premium and the Medigap plan premiums DO appear to vary based on one's state.
From what I've been reading, once you're on a Medicare Advantage plan, you MIGHT be required to go through medical underwriting to then switch to a Medigap plan -- so it's not guaranteed or your premium might be sky high. Apparently there are exceptions, e.g. for the first year (that's what I've been referring to), but also if you move and the Advantage plan you were on isn't in that state, or circumstances like that.
(But as I wrote, I find all of this somewhat confusing, so I may be wrong, and if so, I hope someone corrects me!)
Do yourself a big favor. See if your Dr's inc. dentist are accepting the MA plans. Here in De. many do not and you wind up with a bigger nut than you would have with the supplemental plans. We know someone, who is not a close friend friend so the details are a bit thin but she had a MA plan and found that her Dr. did not accept it. She then has some kind of health problem and instead of being able to simply pick a specialist for herself, she had to first find one who accepted her MA plan. Our dentist does not, nor eye Dr.
I've only run into 2 specialists over 7 years now, who will not take you unless you have a referral. One was years ago and I just kept looking (the staffer was a bit rude). The other is a wonderful doctor at UAB (University of Alabama Birmingham) pulmonary clinic who reviewed my records and decided to take my case (the staffer in this case was very helpful in explaining the process of being accepted). He is extremely busy so it has to be that way. I'm really stoked by him and his staff, and I think they operate very well under pressure. I can well understand why he requires an evaluation before accepting a patient.
Quote:
Originally Posted by nuts2uiam
Do yourself a big favor. See if your Dr's inc. dentist are accepting the MA plans. Here in De. many do not and you wind up with a bigger nut than you would have with the supplemental plans. We know someone, who is not a close friend friend so the details are a bit thin but she had a MA plan and found that her Dr. did not accept it. She then has some kind of health problem and instead of being able to simply pick a specialist for herself, she had to first find one who accepted her MA plan. Our dentist does not, nor eye Dr.
And then he has to be "accepting new patients." A lot of the time, they aren't. I've also found that when an office learns that I have full Medicare coverage, they automatically accept me as a patient.
That's interesting, it makes me think that when you look up a doctor (when you're doctor shopping) and you see "Dr. so-and-so has privileges at these hospitals" I have to wonder if they are then considered "out of network" for billing purposes.
Like I said, when I chose Advantage, I was assisted by a volunteer at the Area Agency on Aging. I wasn't informed (she may not have known) that there are enormous "out of network" charges when enrolled in Advantage. All I knew was that I couldn't afford Supplemental on a disability income. At that time, the cost for Supplemental would have been between $350-400/mo.
Advantage is "free" but there is actually a huge cost for that "free."
This boils it down nicely. A good starting point for those beginning the Medicare journey.
I read the link. So, even if one has, say G or G-HD supplement plan - one cannot easily switch to another provider offering the same plan. So, how do people make the decision? Seems like the price offered at enrollment might not reflect the future price - and one provider may start abnormally low but may then jack up the prices by a lot. Alternately, another provider might be somewhat higher at the enrollment time but might have better long-term price path.
So, how do people make reasonable choice? Even looking at the past price rise history, if that were available, might be very misleading. After all, some provider could be holding the line on the price to build up a bigger pool and raise the price when the pool is already big.
Is there data available for one to make assessment by insurer? Are some plans, for instance - the HD plans, less likely to see a price rise since some of their downside is shared by the participant?
I read the link. So, even if one has, say G or G-HD supplement plan - one cannot easily switch to another provider offering the same plan. So, how do people make the decision? Seems like the price offered at enrollment might not reflect the future price - and one provider may start abnormally low but may then jack up the prices by a lot. Alternately, another provider might be somewhat higher at the enrollment time but might have better long-term price path.
So, how do people make reasonable choice? Even looking at the past price rise history, if that were available, might be very misleading. After all, some provider could be holding the line on the price to build up a bigger pool and raise the price when the pool is already big.
Is there data available for one to make assessment by insurer? Are some plans, for instance - the HD plans, less likely to see a price rise since some of their downside is shared by the participant?
Expecting US medical policy to be “reasonable”, “fair”, “easy to comprehend” is just not going to happen
Knowing the ins/outs/policies/practices of various insurance companies is why people use an independent agent to help them shop
Our agent when we switched from my teachers’ retirement ins to Medicare with a Medigap policy (we already had Medicare and the teachers’ ins was our “supplemental” plan) pushed a Cigna full cover plan which was still available at that time—they have been phased out now for new enrollees
But he didn’t push AARP’s United HealthCare which supposedly has lower rates because he said that ALL companies will raise rates—some at different times or for different reasons—so you should always expect your rates to increase over time
This year he helped friend of ours who was on that same Cigna plan as supplement to Medicare get into a new lower price supplement where she has to pay her deductable I think—and she saved enough and has few hospitalization needs—that she did it
But we are in FL now and don’t think he is certified for FL plans—wouldn’t know the ins and outs like TX
I read the link. So, even if one has, say G or G-HD supplement plan - one cannot easily switch to another provider offering the same plan. So, how do people make the decision? Seems like the price offered at enrollment might not reflect the future price - and one provider may start abnormally low but may then jack up the prices by a lot. Alternately, another provider might be somewhat higher at the enrollment time but might have better long-term price path.
So, how do people make reasonable choice? Even looking at the past price rise history, if that were available, might be very misleading. After all, some provider could be holding the line on the price to build up a bigger pool and raise the price when the pool is already big.
Is there data available for one to make assessment by insurer? Are some plans, for instance - the HD plans, less likely to see a price rise since some of their downside is shared by the participant?
You just touched on one of the major potential drawbacks to Medigap plans when one cannot pass underwriting if wanting to switch to another.
Yes, the premium increases can be quite large as one ages. I've seen recommendations to budget for anywhere from 5%-20% for annual increases. It can get to a point where it is either just stick with what you've got and pay the price, or enroll in an Advantage plan. You can have your agent research historic data on annual premium increases for a particular carrier, but still no guarantee what held true in the past will hold true in the future.
As mentioned way upthread, I started Plan G in 2016 at $124/mo California price. It goes up about $20/yr. My current rate is $228/mo. It goes up every September. In 7 years a $100 jump is not outrageous.
I'm sure actuaries are using a program to evaluate health conditions and usage, and probably do adjust each person's rate accordingly. I'm just guessing at that, but it makes sense.
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