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I have had a Medicare Advantage Plan for four years and have been very happy with it. The problem with Medicare Advantage Plans is there are limited availability of them in certain areas of the country. The one I am currently with is discontinuing availability in my area come Jan. 1, so I have signed up with another one. I deal with an independent insurance agent in my area who is well versed with what Medicare Advantage Plans are available where I live. I previously had a Plan F Medicare Supplement (if I remember correctly) for a few years after I turned 65 and my premiums kept going up every couple of years as I went into a new age group. When my premium reached $120/month I decided it was time to explore what else was available. The agent with whom I had the Plan F Medicare Supplement Policy did not deal in Medicare Advantage plans and discouraged me from switching to one. I'm very happy that I ignored her advice. I've been paying $34 a month for a pffs--a private-fee-for-service Medicare Advantage Plan but next year on the new plan, I will be paying $0 per month for very similar coverage. That's right. Zero. I am healthy and see my doctor only for the occasional illness and the annual breast exam. I have one generic prescription that costs me $4/mo.
The health care plan that was just passed in the House does away with Medicare Advantage Plans, so what the future hold for them is up in the air right now.
...The health care plan that was just passed in the House does away with Medicare Advantage Plans, so what the future hold for them is up in the air right now.
No, the Medicare Advantage Plans are not going away. The reimbursement rates are being reduced to help fund the whole program and the advantage plans will stay in place. There is nothing wrong in evaluating this program, as it has been determined that the rates were too lucrative for the providers. Yes, some insurance carriers will drop out of the Advantage programs--these carriers only wanted excessive reimbursements at the expense of overall Medicare. We do not have to be held hostage by a bunch of overpaid insurance executives. There will be increased cost or reduced benefits under the medicare advantage plans but more Americans will be covered for health insurance and other benefits will increase. Eventually, these insurance company privateers will have to compete more effectively because of the inclusion of public government funded insurance and loose their cash cow. That is why they are vehemently opposed to the the the Obama Plan.
Under the plan there will be other increased coverages to make up some of the difference. The "Donut Hole" will disappear from the prescription drug program. Medicaid will allow more people to enroll because the income cap will be raised. So, people who cannot well afford the Medicare Advantage Plans may have a choice of a combined Medicare/Medicaid Plan which will cover much more.
I'm glad to hear that Medicare Advantage Plans are not on the chopping block. What the future of Medicare--indeed, the entire health care industry, will be is anybody's guess at this point. By the time both houses of Congress come to some kind of agreement on a bill--assuming the President signs it--what we finally end up with is a big unknown at this point.
I am also very happy with the Medicare Advantage Plans. I am enrolled in the Kaiser Permanente Senior Advantage Plan in the Denver Region. It is interesting to note that this plan has been designated as the Best Medicare Plan in the Nation in the upcoming December Magazine Issue of US News And World ReportsTop Health Insurance Companies - US News Best Health Plans
When our time arrived and we were overwhelmed with all the books, literature and mailings we received. The Medicare Advantage Plan looked wonderful on paper and even calling and speaking with the people at Medicare ... it was the Advantage plan.
Fortunately, I was in our doctor's office prior to finally making a decision and noticed a sign at the front desk ... We Do Not Accept Medicare Advantage Plans and listed all the companies ... this doc has treated our family since 1976! I went back to the lady that handles the insurance claims and asked about the sign. She advised me to call our local hospitals which I did and nope they didn't accepted the Medicare Advantage Plan either. Goodness we would have been stuck for a year if we had purchased the Advantage Plan. We would have been ok as we are healthy but we would have been stuck paying for a plan that no one in our area will accept for payment.
We then decided on the regular old Medicare Part A & B and purchased a Medigap policy from another insurance company. Also got a good Part D Rx policy with the help of MyMedicare.com and have had no problems whatsoever.
Unfortunately there is alot of crap marketing and sales of lousy plans. If a plan is marketed then physicians and hospitals must be under contract to support the plans. What happens is that the contracts change and the patient becomes responsible to verify that the provider is a member of the plan.
That is why Kaiser Permanente is a much better health insurance plan because that plan has their own physician network that works only with the plan. However, it is only in the original HMO model that they market and it is better in California because they own their own hospitals. Kaiser has branched out into other states where the hospitals are contracted and in some plans and areas, Kaiser also contracts with independent physicians.
Here in Colorado, in Denver/Boulder. Kaiser has their own Permanente Medical Group that services only Kaiser Patients in the HMO Medicare Plan. They have their own clinics with x-ray, labs, pharmacy; and it makes it real simple to get care. However, Kaiser does not own their own hospitals and contracts for services. So far, it has worked well for my family and I, for many decades. There is minimal problems with billing and there is no issues of care being refused.
Not all doctors except all Medicare Advantage plans. You've got to check the Providers list for doctors, hospitals, pharmacies that you will be using. You've got to check the drug formularies to see what they cover and what the copay is. And you've got to do this every year. Things change.
The Advantage plans can be great. I'm very happy with mine. But you've got to really read and pay attention to all the literature on each plan. Even do a spread sheet or cards with specific questions and concerns and see how each plan deals with them.
Don't just look at copay for doctors visits, but think of how many times you might see a doctor/specialist and and how much it will cost. Is it better to pay more each month for a smaller co-pay? Can you see specialists without a referral? Same with drugs.
What extras does it offer that might be worth paying more for? Life-Alert/Life-Line? Health Club? Hearing aids? Dental insurance? OTC drugs? There are lots of little things they're throwing in that may make a difference to you. My Advantage program is adding health club membership through a company called Silver & Fit.
Assume nothing. Decide what you need, do the homework and it will pay off.
No, the Medicare Advantage Plans are not going away. The reimbursement rates are being reduced to help fund the whole program and the advantage plans will stay in place. There is nothing wrong in evaluating this program, as it has been determined that the rates were too lucrative for the providers. Yes, some insurance carriers will drop out of the Advantage programs--these carriers only wanted excessive reimbursements at the expense of overall Medicare. We do not have to be held hostage by a bunch of overpaid insurance executives. There will be increased cost or reduced benefits under the medicare advantage plans but more Americans will be covered for health insurance and other benefits will increase. Eventually, these insurance company privateers will have to compete more effectively because of the inclusion of public government funded insurance and loose their cash cow. That is why they are vehemently opposed to the the the Obama Plan.
Under the plan there will be other increased coverages to make up some of the difference. The "Donut Hole" will disappear from the prescription drug program. Medicaid will allow more people to enroll because the income cap will be raised. So, people who cannot well afford the Medicare Advantage Plans may have a choice of a combined Medicare/Medicaid Plan which will cover much more.
Under the palns in both the house and senate advanatage plans will be eqaully paid the same amount as stadard pay for servidce which will mean either the plans drop some coverage or the premumim to those on it goes up quite abit.The disadavantage of the medicaid is that the income levels will be raised and those under the level will not be allowed in to the co-op or the government plan whichever is passed and shifting more burden to the states to cover people. States will have to lower coverage or raise taxes to pay for the large increase on medicaid people.Anytime they say that they are reducing funding that is code for the coverage shifting ;no matter what they say;always has and always will.
Check it very carefully. I've noticed that in some of the cheaper ones they now "Balance Bill" -- the doctor can bill you for more than the insurance company/Medicare pays.
This is the note under Blue Cross/Blue Shields Blue Advantage Gold: Premium and Other Important Information2 General $81.00 monthly plan premium in addition to your monthly Medicare Part B premium. This plan does not allow providers to balance bill (charging more than your cost share amount).$3,400 out-of-pocket limit. This limit includes only Medicare-covered services.
This is the note under Cigna Medicare Access Premium and Other Important Information2 General "$20.00 monthly plan premium in addition to your monthly Medicare Part B premium. Balance billing means that a provider may charge and bill you more than the plan's payment amount for services.
There is a limit on what providers may charge for Medicare-covered services.
Providers may balance bill 0 % to 15 % of the plan payment amount for the following services:"
These notes are from the Official Medicare.gov site. It's in the fine print under the ratings for each plan. Something else to watch out for.
If you choose plan F Medicare Supplement, the plan pays the balance or the overage above what Medicare accepts.
I have had a Medicare Advantage Plan for four years and have been very happy with it. The problem with Medicare Advantage Plans is there are limited availability of them in certain areas of the country. The one I am currently with is discontinuing availability in my area come Jan. 1, so I have signed up with another one. I deal with an independent insurance agent in my area who is well versed with what Medicare Advantage Plans are available where I live. I previously had a Plan F Medicare Supplement (if I remember correctly) for a few years after I turned 65 and my premiums kept going up every couple of years as I went into a new age group. When my premium reached $120/month I decided it was time to explore what else was available. The agent with whom I had the Plan F Medicare Supplement Policy did not deal in Medicare Advantage plans and discouraged me from switching to one. I'm very happy that I ignored her advice. I've been paying $34 a month for a pffs--a private-fee-for-service Medicare Advantage Plan but next year on the new plan, I will be paying $0 per month for very similar coverage. That's right. Zero. I am healthy and see my doctor only for the occasional illness and the annual breast exam. I have one generic prescription that costs me $4/mo.
The health care plan that was just passed in the House does away with Medicare Advantage Plans, so what the future hold for them is up in the air right now.
As long as you have your health you can jump around between the cheaper plans. The real test of a good health insurance plan is how well will the plan protect you in a worst case scenario? Are certain drugs black listed? Are you able to go outside the network and see a specialist out of state if you desire? What are the EXCLUSIONS and LIMITATIONS? What is the "maximum out of pocket responsibility" or is there no STOP-LOSS protection?
A weak plan is a plan where you are saddled with HUGE Co-pays that go on and on with no cap and lots of exclusions and limitations. A strong plan has limited out of pocket costs and good STOP-LOSS protection.
Ask to see a SPECIMEN POLICY of a plan you think you like or, take advantage of the 10-day FREE LOOK period if you decide to get a plan you THINK you are going to like and READ IT during the first 10 days.Then call your agent to ask about any limitations that concern you and cancel the policy and upgrade or change to a different carrier if it turns out to not be what you thought.
Remember you probably won't able to upgrade to the stronger plan if you are in the middle of a claim and find out the plan you switched to to save a few $$ really doesn't protect you very well after all.
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