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What is the best plan and why? Do most people use the standard medicare plan or do they do the HMO plan? Whats the difference? How is the cost determined for each plan?
This is all new to me.
I think you mean Medicare. Medicaid is health insurance for the poor.
I think it depends on what kind of HMO plans are available in your area. My mother is very happy on the Kaiser one. There are political issues with the costs the Medicare HMO plans are costing and some in Congress are questioning whether it should be continued.
With the Medicare HMO plans, they take your Medicare payments (not sure about all the letters) and give you the HMO services instead. You are then limited to the HMO and its rules.
Thanks. After doing a quick search, Yes, it was Medicare Im talking about. So how is the prices determined? I guess it varies by state?
Im trying to get this figured out for a family member and Im just in the learning stage. And I thought my college Trigonometry class was confusing. lol.
How is HMOs that are making tens of billions of dollars in clear profit annually per HMO in Florida alone saving Medicaid MONEY? The best plan for the Medicaid program is MEDICAID that is not hijacked by scams that have infected the Medicaid PROGRAM.
The reason for privatizing Medicaid in the first place were the people working for Medicaid did not want to answer the phones from the providers such as doctors, clinics, hospitals and the recipients of Medicaid you know the beneficiaries? By force to make the HMO scams (Mandatory) is pure extortion that stand in the recipient’s way of the benefits.
Other words they are lazy and it has came at a very high price (BILLIONS) even TRILLIONS. I would rather see the money stay in the Medicaid Program to do what it was intended to do and this is to provide the supreme medical services for the most powerful nation on earth; American. Most HMOs companies come from India and they won’t even eat a cow roaming in the street and they are starving.
And for the misinformed Medicaid is not just for the poor. It was designed for the child that was born disable and/or persons that have become disabled that are adults. Example: a man, woman or child that had a stroke and has to wait for a favorable decision from a federal law judge that may take years in most cases and for the adults Medicaid is the only option. Because while they wait Medicaid by a disability is all you will get. Since SSA (Social Security Administration) will tell the disabled person you have not been working for years since your disability and you do not have enough quarters for SSDI. So you end up with SSI and its benefit Medicaid, housing (HUD), Food Stamps, etc.
Last edited by themissresearcher; 03-02-2009 at 02:54 PM..
Reason: needed more truth
Hi,
That depends upon your situation and what you want.
The HMO usually has a more expensive premium but has lower costs for many procedures.With the HMO you need to see your primary doctor first (and pay the co-pay) to get a referral to see a specialist. With the PPO a referral is not needed.With an HMO you must see a doctor in the network. With the PPO you can go outside the network but your co-pays will be higher.
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The real difference is choice and how HMO 's operate. You have complete choice of hospitals and physicans with regular medicare. Its limited with a HMO. Also HMO have doctors that work for them. Often they will assign one that will come in and make many of the decisions on what care you will receive regradless of the primary physican.That is how they manage cost.If you go out of netwrok with a PPO they can charge you the full price after the PPO pays them a reduced price for going out of network since they have no contract with them you own the remainder of the bill. Recently I saw a bill of a friends that was 40'000 for hospital. The PPO contract agreed price was 2500 with the patient paying 500. If it had been out of network the 2500 payment would have been reduced by 20% and the rermanider of the 40'000 would have been owed by the friend; since the hospital had no contract to charge 2500 for those services. Also at times certain hospitals are in network but labs and pathology are not;you get hit for full price minus the lower PPO out of network payment for those services.If you can afford regualr medicare IMO its the best.then a PPO becaue of more choice tha HMO. Then HMO. Regualr really comes in when you have a serious problem that requires you be brought to another area medical specaility center that is not in your PPO or HMO network.
Not all HMO/PPOs are created equal. Many that offer the Medicare Advantage plan do NOT require you see your primary care doctor first for a referral. The last three plans I've had let me see any specalist that's on the plan without a referral. I usually go to my primary care doctor first because he specializes in over-50 medicine and knows everybody and can give me guidance in choosing between specialists available to me. And his office staff is extremely good at getting appointments.
One thing you do need to be on the lookout for is plans that let the doctor or hospital bill you for "excess" fees that Medicare or the Advantage plan doesn't cover. That can be a real shocker. Some plans cover all tests, Xrays and diagnostics. Others use a percentage. A percentage of an MRI or CAT scan can be prohibitive, at least on my budget. Getting those covered 100% was important for me.
I also make sure than any plan I'm on lets me go to University of Tennessee Medical Center if I need to. In addition to being a level 1 trauma unit, it's a teaching hospital that has a lot of specialties, particularly for Geriatric care. I also made sure the plan gave me access to the big Orthopedic center -- the same one that handles University of Tennessee players. As bones start wearing out, I'm spending a lot more time at Ortho doctors.
Selecting the right Medicare plan is very, very important and something people need to really spend some time on understanding what's offered and carefully reading the fine print. Your quality of life depends on it as well as the length of your life.
So far this year, I've seen my primary doctor twice: once for my regular yearly blood tests and prescription renewal and once to get some back Xrays done for a Chiropractor. (Medicare will pay for a Chiropractor but not for Xrays he takes.) Had those done at a new state-of-the-art hospital which sends them digitally to my doctor. I've seen a knee specialist and had a bunch of xrays taken. I was hoping I could get those shots that are advertised on TV. They said my knees were too far gone but did give me Cortisone shots which helped a lot. Also seeing a Kidney specialist because of what may be a false reading caused by medication but my doctor wants to make sure.
Total out of pocket cost to me: $0
Zilch. Nada. Nothing. No copay.
One of many reasons I moved to Knoxville was the quality and availability of good medical care. If your back or knees are hurting, it can be very painful to have to go far to get treatment.
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Florida Medicaid HMO Scam Question
