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Originally Posted by CritterLover
I was told initially than the plans pay for more of the things that they provide as "standard" care, and Medicare does not, so the issue seems to be whether or not, relative to MY specific health needs, United Healthcare Medicare Advantage will work for ME, and I've found that it will. It's clear that it doesn't work for some, but it feels like lots of folks think that they are the only group of doctors around. I felt no pressure to join the villages health, but that it was one choice. What am I missing?
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The way these plans work, based on my understanding of them through my own research, is that the government pays the medicare C insurance company a fixed amount of money per year to provide healthcare to you. I think it is around $10,000 per year. You still pay the government your medicare premium each month. The government is not in the business of making a profit. So they probably calculated what the average cost is for a medicare eligible person ($10,000?). Based on that average cost they pay the insurance company a flat fee of $10,000?. The insurance company is in the business to make a profit. So the insurance company wants to be sure that, on average, the customer, you, does not cost $10,000, or even close to $10,000 per year. They can do this by limiting the doctors/specialists you are allowed to see, or they can change your copays, or your deductibles, limit drug choices, etc. Now, on the surface, do you think you're going to get better overall healthcare deal with the profit driven insurance healthcare providing company or the non-profit government medicare system? If you think the insurance company that is paid a flat fee from the government will do a better job in your interest, then go with the insurance company. If not, then you need to look outside TVHC if you are close to 65.