Medicare advantage plans

Mrleft8

Super Anarchist
27,335
4,023
Suwanee River
Are they worth it? You see these ads on TV saying you may be eligible for$0 per month.
When I look up plans I'm seeing much higher numbers for out of pocket etc.
It looks just like the reverse mortgage scam to me,but while asking about whether my wife's insurance covered Dental (She has some extensive work to be done) They asked if she had a supplemental plan.... No... "Then it's not covered"
I look at the supplemental plns.... They don't cover it either, except for the charging you $455 for having the plan that doesn't cover you..... I must be missing something.
 

Foreverslow

Super Anarchist
Find an independent medicare insurance broker that's local to you and get them to explain the benefits of both the advantage plans and a medicare supplement plans.

Ask your over 65 friends for broker recommendations.
^

^ THIS

Depending upon what illnesses you have, and drugs and treatments you need, a professional broker can craft a plan that meets your budget.

also note the undersecretary from Medicare sent a warning shot to all these companies last week as they were playing fast and loose with the truth in their advertisements. Sure you can get free dental, or vision, or rides to the hospital, or low/no copayments, or get money back. But you cannot get all of these at the same time.

an insurance broker who specialized in this stuff is the way to go and costs you nothing.
 

boomer

Super Anarchist
16,691
1,714
PNW
Went with an insurance broker with my wife who's a year older. Not to hard to figure out. My wife for her first couple years used United Healthcare, where you can choose to use your own Doctor. However after a year or so and seeing the level of care I received from Kaiser Permanente, she choose to switch to Kaiser as well.

Whomever you choose, no need to go for the higher dollar premium, because most everything is covered with the $28-30 a month premium with a $5 copay for general medical needs, and about a $5000 to a 10% detuctible for certain high priced items such as a prosthetic, free vision exams other then a nominal $5 copay, one set of glasses and lenses a year.

Most but not all needs are a $5-$10 copay, all vaccines free. Kaiser has their own pharmacy - All meds about 1/4 the price of generic brands. Your choice on choosing a dental plan from $90 - $150 or not and pay all dental bills yourself -it's usually a wash.

Kaiser paid for all but 10% of my $67,000 prosthetic. Kaiser pays for one new prosthetic every three years. They pay for all new prosthetic sockets no matter how much my stump changes - every month or every three months. Most stumps continue to atrophy - my stump has stayed the same for over three years now, due to several workouts a day - or strong enough to push my prosthetic guy on his butt, when he pushes on the back of my stump to test my strength.

If you don't have Kaiser available, United Healthcare is a good choice nationwide.

Set yourself for an automatic register every year - and your done.

All in all it's pretty nice, and much better then I expected. I could go through the VA and Tricare like many of my old Seabee mates do, and still use my own Doctor - but I like the level of care I get from Kaiser - my Doctor has even called me on my Sunday mornings.
 
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Mrleft8

Super Anarchist
27,335
4,023
Suwanee River
Went with an insurance broker with my wife who's a year older. Not to hard to figure out. My wife for her first couple years used United Healthcare, where you can choose to use your own Doctor. However after a year or so and seeing the level of care I received from Kaiser Permanente, she choose to switch to Kaiser as well.

Whomever you choose, no need to go for the higher dollar premium, because most everything is covered with the $28-30 a month premium with a $5 copay for general medical needs, and about a $5000 to a 10% detuctible for certain high priced items such as a prosthetic, free vision exams other then a nominal $5 copay, one set of glasses and lenses a year.

Most but not all needs are a $5-$10 copay, all vaccines free. Kaiser has their own pharmacy - All meds about 1/4 the price of generic brands. Your choice on choosing a dental plan from $90 - $150 or not and pay all dental bills yourself -it's usually a wash.

Kaiser paid for all but 10% of my $67,000 prosthetic. Kaiser pays for one new prosthetic every three years. They pay for all new prosthetic sockets no matter how much my stump changes - every month or every three months. Most stumps continue to atrophy - my stump has stayed the same for over three years now, due to several workouts a day - or strong enough to push my prosthetic guy on his butt, when he pushes on the back of my stump to test my strength.

If you don't have Kaiser available, United Healthcare is a good choice nationwide.

Set yourself for an automatic register every year - and your done.

All in all it's pretty nice, and much better then I expected. I could go through the VA and Tricare like many of my old Seabee mates do, and still use my own Doctor - but I like the level of care I get from Kaiser - my Doctor has even called me on my Sunday mornings - he didn't have to do that, but he did.
The big deal is the dental coverage at this point....
None of the sites that I've visited have been clear on what is, and what is not covered, and what the co-pays are. It's all very cloudy, and to me, looks like scam city.

I'll ask a couple of people , but I'm fairly new to Florida, and my experience here has been that if someone can fuck you in the ear, they will.
 

boomer

Super Anarchist
16,691
1,714
PNW
A specialized insurance broker who deals solely with Advantage programs will help you for a nominal amount or no fee - your choice.
 

boomer

Super Anarchist
16,691
1,714
PNW
The other part of finding which provider and plan works the best for you geographically. If one wishes to keep their own Doctor, ask your Doctor which top three providers they use and work with the most, choose from those top three - one can then choose which plan from most costly with the lowest deductible, to the least costly and has copays which are nominal without a broker, by reviewing the plans online.

If one want's a broker to explain what the different providers cover and the cost - then get a broker - all of which is available online - and once one has signed with a provider, there is no need for a broker.
 

Mrleft8

Super Anarchist
27,335
4,023
Suwanee River
Thanks for the advice.
I'm not used to not having a network of peers in my geographical area.... Even trying to buy lumber was a trial in the early days.
When you spend the better part of 50 years in one place, or go to other places where you have a support network, it's easy street. Moving to an alien land cold, is truly difficult.
And yes, North Florida is an alien land to a guy who grew up in New England, had a group of friends in NoCal, and knew half the people on the Caribbean island he moved to from years of extended visits there....
This is a strange land.... Very strange.
 

Quickstep192

Anarchist
908
188
Chesapeake
I just got done going through this. Seemed to me that the advantage plans work if the docs you like are "in-network", but if you want to pick your docs, you'll want to go with a supplement plan.

All the dental plans I looked into require you to use in-network dentists, or you're rolling the dice on what you pay. If anyone knows of a dental plan that works differently, please let us all know about it.

I have neighbors who sing the praises of Kaiser like Boomer does. I wish there were a way to try it without being able to quickly switch to my current doc if it didn't work out.
 

Bump-n-Grind

Get off my lawn.
14,946
3,772
Chesapeake Bay/Vail
The big deal is the dental coverage at this point....
None of the sites that I've visited have been clear on what is, and what is not covered, and what the co-pays are. It's all very cloudy, and to me, looks like scam city.

I'll ask a couple of people , but I'm fairly new to Florida, and my experience here has been that if someone can fuck you in the ear, they will.
with dental there's also probably a waiting period before certain things are covered.
 

boomer

Super Anarchist
16,691
1,714
PNW
We stayed with our dentist, and pay for our dental needs out of pocket. However if teeth have to be re-crowned due to receeding gums (common at our age), then paying into a dental plan would be a prudent move. If one doesn't have any crowns, with healthy gums and teeth, paying for cleaning and checkups is less then paying for premiums.
 

Point Break

Super Anarchist
26,570
4,354
Long Beach, California
I chose traditional part A&B with a gap and D with Anthem. I don’t like networks and even if your doc is in this month they may leave the network next month. Lots of them do. If all you want/need is someone to look in your ear and prescribe an antibiotic supplemental plans are fine and less expensive. If you have docs you want to see without a hassle……you may not like it.
 

Foreverslow

Super Anarchist
fyi for dental alternatives check with your dentist what they offer.
Mine has his own plan for 370 bucks a year.
Includes 2 cleanings/exams along with any other work needed during the year and no co pays.
Offers it only for clients who have healthy mouths to begin with so some meth head with a mouth full of rot and missing teeth will not get the offer.
For me it was cheaper alternative than to use a Medicare Advantage policy with dental included.
 

Blue Crab

benthivore
16,495
2,709
Outer Banks
There's a larger picture here that I don't quite get yet but it appears that going with an "Advantage" plan obviously transfers health care decision making from the current centralized non profit situation to private for profit groups.

That this transfer is all lipstick and eye shadowed no cost, low cost, with additional dental and vision and whatnot isn't actually how the world works.

If the goal of many of us is single payer med for all, this transfer of power and records away from centralized govt run to private ins industry seems seriously counter-productive.

I'd be interested in hearing @BeSafe's and others' analysis.
 

Olsonist

Disgusting Liberal Elitist
29,980
4,537
New Oak City
Are they worth it? You see these ads on TV saying you may be eligible for$0 per month.
When I look up plans I'm seeing much higher numbers for out of pocket etc.
It looks just like the reverse mortgage scam to me,but while asking about whether my wife's insurance covered Dental (She has some extensive work to be done) They asked if she had a supplemental plan.... No... "Then it's not covered"
I look at the supplemental plns.... They don't cover it either, except for the charging you $455 for having the plan that doesn't cover you..... I must be missing something.

No, Medicare Advantage plans are definitely NOT free. You still pay the Part B premium, about $170/mo (usually deducted from your Social Security). But then if anything happens, anything, you pay copays, coinsurance, ... up to a rather large out of pocket max. Moreover everything is always subject to preauthorization by the insurance company and these insurance companies make bank off Medicare Advantage, off of you. BTW, once you go on MA it's very very difficult to switch back to Traditional Medicare. You're fucked for life.

At the complete other end of the spectrum is Traditional Medicare Plan G, maybe $200/mo plus the Part B premium. But then there are no copays, coinsurance, ... other than the $230 Part B yearly deductible. There's no preauthorizations and no referrals either. AARP/UHC has some discounts for vision (EyeMed) and dental (Dentegra) and a health club membership. You'll need a Part D plan which Biden substantially improved this year.

G is more expensive up front $170 + $200 vs $170 but G tightly brackets your Medicare costs. Medicare Advantage seems cheaper up front but with a big exposure in the bad years along with a profit making insurance company fucking you over at every step with preauthorizations, .... Do you really want to spend your out years arguing with insurance companies? As my orthopedic surgeon said, insurance companies are in the business of not providing health care.

You might want to check Marvin Musick on Youtube. Also Stepanie Abt.


My sister the doctor, she and her husband are on G. I'll be going on G as well.
 
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Blue Crab

benthivore
16,495
2,709
Outer Banks
Thanks Cap. Good read.

As a sidebar for vets, I've been using VA as my "gap" coverage. And with the increasing community services, VA paying for a visit to a provider in your area, and of your choice -- at least so far -- has been working out for me. This is a great development over the old way of having to travel to a regional hospital and getting travel pay for the excursion. I knew VA would eventually figure that out. I've been banging that drum for years.
 

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