Medicare advantage plans

[Olsonist]

To be honest, I don't think I'm going to do anything. It all seems like a shell game. Get this plan which will cost you $200 a month, but you may not need it. or try this plan wich will only cost an extra $170 a month, but doesn't cover anything you need. Or stay with part AB and D and keep your fingers crossed.
WTF! Why is this country so far behind Uganda?
Even fucking Grenada has better health care system than the USA.
This is pathetic!

Which fingers need to be crossed?

Traditional Medicare with Parts A+B, an AARP/UHC Plan G Medigap and a Part D drug plan has coverage very similar to a cadillac corporate group benefits plan.

You can try prying my Medicare, UHC and Aetna Silver Script Smart Rx cards out of my cold dead hands.

You want simplicity? Kaiser isn't terrible and it is dead simple. I just think my health outcomes are better if I choose my doctor, the Bay Area has Stanford and UCSF, and then my doctor gets the final say instead of the insurance criminals. I'm willing to pay for that.

 

[Mrleft8]

SSDI Medicare doesn't pay for Dental, Eye care, or hearing, at least not here in Florida.
What do older people need? Dental, eye care, and hearing.
Sure if I need stitches because I cut my finger dicing onions, I'm pretty much covered (Except for the $230 co-pay for the office visit,) The same cut except it was my toe, and I wasn't dicing onions, got stitched up on the friday afternoon before Carnival in Carriacou for $15, (and I got a box full of neosporin, and gauze pads just in case)..... AND a year later the Dr. asked how my toe was. The Dr. here can't remember my name w/o looking at a chart.
The fact is, and this is a fact. The health care system in the USA sucks. It's the most expensive in the world, and our level of care is very low. VERY low.

 

[Olsonist]

SSDI Medicare doesn't pay for Dental, Eye care, or hearing, at least not here in Florida.
What do older people need? Dental, eye care, and hearing.
Sure if I need stitches because I cut my finger dicing onions, I'm pretty much covered (Except for the $230 co-pay for the office visit,) The same cut except it was my toe, and I wasn't dicing onions, got stitched up on the friday afternoon before Carnival in Carriacou for $15, (and I got a box full of neosporin, and gauze pads just in case)..... AND a year later the Dr. asked how my toe was. The Dr. here can't remember my name w/o looking at a chart.
The fact is, and this is a fact. The health care system in the USA sucks. It's the most expensive in the world, and our level of care is very low. VERY low.

With Plan G, that $233 deductible is for the year. After that gets paid then you're good for the whole year even if you have a heart transplant, two knees and both hips, with no copays, no nada.

Yeah, urgent care is cheaper elsewhere.

BTW, if you have Medicare and they accept Medicare then Medicare only pays Medicare assignment and the urgent care facility has to only charge you Medicare assignment for the cut treatment which will probably be less than the $233. Like 98% of docs accept Medicare assignment. Basically, Medicare is doing the price negotiation for you. If you pay cash, it'll probably be more.

Also, Medicare doesn't cover overseas emergency care buy Plan G does, covers 80% after that darned $233 deductible. Kaiser does as well. Yeah, you'll have to file paperwork for these to work.

 

[BeSafe]

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.

To the initial question, No Bargers gave really good advice. Get advice from experts that understand your state.

In answer to the second, "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" - see below for my opinion.

---------------

"Health care" in the US is a broad category that includes a myriad of services and is a hodge-podge of federal, state, and county programs. Historically, these services tended to be provided by charitable institutions, often at the county or city level. As each new layer of government got involved, they each added their own requirements and needs, with no two states being the same. ALL of them are special little flowers. And the Federal level tries to tie them all together.

As a national government, medicine is about probability of outcome and access. How do you get the most people the most care within the limits of a finite system? Edge cases are often long and resource intensive and someone has to make a judgement call as to when enough is enough. The Federal government is ill-equipped to deal with making those choices – there’s just too many people and too many possibilities - and the Feds don’t trust the States to make them. That ship sailed.

The ‘work around’ is to using private companies as surrogates. In essence, corporations like United Health Care are being used as clutch-plate between the citizens and the government. They can cross state borders and make ‘hard choices’ that politicians just can’t make. We pay them to be the bad guy while assuming they’re actually good guys.

How is a program like “Medicare Advantage” able to offer more services than “Medicare Original”? By limiting the edge cases and, hopefully, by being efficient.

If you’re an average person with average medical challenges, the Advantage program is probably better. You get more services for similar costs. Insurance companies love things like broken bones and angioplasties. They’re EASY. Problem exists, accepted treatment applied, go home. Done and done. If you’ve got a complicated history, rare diseases, or non-localized intermittent issues, you require a lot more time with specialists and added administrative costs. Hate to say it, but no one really likes you. The pain in your ass is a pain in their ass. That's where the government carrot and stick comes in - if you're part of the system, you have to take care of those clients too if you want the easy money. That's the core negotiation at the highest levels.

There is a bit of regulatory capture – meaning that health care companies DO make profit from the system. But remember, the reimbursement rate is set by the government. It is symbiotic. The profits are capped. If United Health Care suddenly became Google making 30%, then you bet the reimbursement rates would get adjusted - which can be done retroactively BTW. Don’t embarrass the benefactor. In essence, health care is becoming a utility, just like .. you know, utilities.. and traditional banking.

There’s a reason why people park money in defense and health care during recessions and pull it out during boom cycles. The capture works both ways.

We are basically moving toward “single but not single payer” – American style. Slowly.. painfully.. but moving. There’s going to be 3-5 major players that control 90% of the market. They’ll all work under the same fundamental framework with the same legal requirements – that’s where the governmental exercises control and the oversight will exist. They’re going to get a standardized reimbursement per situation (which caps their profits) and they’re individual success/failure will be squeezed out of efficiency.

In practice, its socialized medicine but its going to have the veneer of capitalism. Rich people will always have their own doctors. And, theoretically, there could be a new "Blue Cross/Blue Shield" enter the market but the barrier for entry is mountainous.

 

[Blue Crab]

So... death panels really are on the horizon.

 

[BeSafe]

So... death panels really are on the horizon.

Yes. "Infinite value of human life" meets "Finite resources of practical existance."

The government only has two tools - limit care or run out the clock. The US does a bit of both but historically leans toward the former. Other countries lean more toward the latter.

 

[Blue Crab]

As noted by Olsonist above, that's probably the best reason for Trad Med and gap coverage: reducing the amount of time wasted on preauthorization and other kinds of wrangling to get needs met. But as we all know advertising works. Many of my non-vet friends have transferred lately to Advantage plans aided by a very forcefully persuasive sales guy in the group blocking for Joe Namath.

 

[Olsonist]

As noted by Olsonist above, that's probably the best reason for Trad Med and gap coverage: reducing the amount of time wasted on preauthorization and other kinds of wrangling to get needs met. But as we all know advertising works. Many of my non-vet friends have transferred lately to Advantage plans aided by a very forcefully persuasive sales guy in the group blocking for Joe Namath.

My twin brother and I did a deep dive on Medicare. We went through the YouTube videos which are excellent, looked at all the quotes, looked at the coverages, .... I know so much more about Medicare than I ever did about Obamacare.

However, my brother went into the room with the UHC salesman and got the hard sell on UHC Medicare Advantage (when he had a question about Plan G). One meeting and it took me a week to talk him off the ledge. A good salesman with a commission on the line can be very persuasive and un-persuading people is hard.

Again, my preference for Plan G is:

1. flexibility - I can pretty much choose any doctor, even Cleveland and Mayo, well except for walled garden Kaiser. It even covers Extra Charges.
2. coverage - anything Medicare covers with no preauthorizations or referrals
3. budgeting - Plan G brackets my health care expenses with no OOP maxes or copays

For me, it's not a close decision. You get one, exactly one, open enrollment period with no consideration of pre-existing conditions. One.

 

[billy backstay]

For me, it's not a close decision. You get one, exactly one, open enrollment period with no consideration of pre-existing conditions. One.

Doesn't one have the option to change every year between October and December? My agent mentioned that I could get Plan G if I wanted to pay for it, but he didn't think it was necessary for my/our needs.

 

[Olsonist]

Doesn't one have the option to change every year between October and December? My agent mentioned that I could get Plan G if I wanted to pay for it, but he didn't think it was necessary for my/our needs.

No. You get one seven month guaranteed issue period, three months before your birth month and three months after. You also get a Trial Year where you can switch back to Traditional Medicare. Otherwise you’ll have to go through medical underwriting when they can refuse you for a bad haircut.

Yeah, you have to pay upfront for Plan G, $123.82/mo for me in CA, but then there are no copays or OOP Maxes afterwards. I think your agent is full of shit and eying a fat Medicare Advantage commission.

Yes, there are open windows when you can switch from like plan to like plan. That’s on a state by state basis. That’s different from switching from MA to Trad. Also Part D drug plans are open enrollment every year. That’s also different.

Look, there’s no way Kaiser makes billions off of Medicare Advantage by fixing market inefficiencies, pays Allison Janey her nickel and still provides care equal to Medicare. That’s free market perpetual motion thinking. Eventually, you’re the inefficiency.

 

[tommays]

No. You get one seven month guaranteed issue period, three months before your birth month and three months after. You also get a Trial Year where you can switch back to Traditional Medicare. Otherwise you’ll have to go through medical underwriting when they can refuse you for a bad haircut.

Yeah, you have to pay upfront for Plan G, $123.82/mo for me in CA, but then there are no copays or OOP Maxes afterwards. I think your agent is full of shit and eying a fat Medicare Advantage commission.

Yes, there are open windows when you can switch from like plan to like plan. That’s on a state by state basis. That’s different from switching from MA to Trad. Also Part D drug plans are open enrollment every year. That’s also different.

Look, there’s no way Kaiser makes billions off of Medicare Advantage by fixing market inefficiencies, pays Allison Janey her nickel and still provides care equal to Medicare. That’s free market perpetual motion thinking. Eventually, you’re the inefficiency.

I made the mistake of saving a bit with a plan N and not G and while its a really good plan I was declined to switch to ANY G due to preexisting conditions

 

[Olsonist]

N has $20 copays and is about $20 cheaper per month than G. G doesn’t have copays and covers Extra Charges (Mayo, Cleveland, some docs charge extra above the standard Medicare Assignment).

You can switch from N to G in Washington State at any time. All of this stuff has to be looked at state by state.

 

[boomer]

Doesn't one have the option to change every year between October and December? My agent mentioned that I could get Plan G if I wanted to pay for it, but he didn't think it was necessary for my/our needs.

Your agent is correct. If you and your wife are healthy with few needed trips to the Doctor with no preexisting conditions, there is absolutely nothing wrong with staying with UHC Advantage, if you wish to switch to a supplemental to save a few bucks, that's OK, too.

Good heath starts at home, with a healthy lifestyle. As MoeAlpha the Navy Doctor would say, the most important person in maintaining your health is you, not your Doctor - that's why he rides his bike and walks as much as he can, and stays active.

Even if one can't ride a bike, stair climb like one once could, or do daily 7-21 minute workouts, just walking and staying active go a long way to maintaining overall health. A good sign of a active person and healthy heart, is how well one can still get it up. If one struggles with getting it up, then exercise or walking can help tremendously with overall health.

Nothing else, a healthy lifestyle - just trying to walk more, don't overeat junk food, and maintain a somewhat active sex life, and dance weekly with one's wife, can go along way to maintaining one's health. The older we get; exercise is medicine and movement is life.

One alternative, is do what Ernest Borgnine does or did on his way to 95 years alive....

 

[Olsonist]

The most important person is you. The second most important person is your primary care physician. Way down the list past your yoga instructor, your bow, your mistress, your dog walker, your drug dealer, … is your Medicare broker. Not on this list at all is Joe Namath or Allison Janey.

If you can combine your bow and your mistress, you’re golden. But I’ve tried this and I believe it is subject to the Pauli exclusion principle.

 

[boomer]

The most important person for me is my wife, then my adult children and their significant others, then my grandkids, then my closest best friends whom I can count on one hand, then my siblings. My dog is in that mix too, as is my wife's dog, somewhere between my wife and my adult children. I do my upmost to maintain my health for all of the above and more. I maintain a good close working relationship with my Doctor - since he's an ex-Navy Doc, that's not hard to do. I also maintain a good working relationship with my nurse, and all healthcare doctors. I also like to have yearly bloodwork done, to monitor my health, and like many, pay attention to what my body is telling me about my health.