Medicare doesn't require preauthorization, Advantage plans often do. Medicare doesn't generally tell providers what to do by virtue of what they'll pay for. e.g. If we want to do 28 radiation treatments for breast cancer, an Advantage plan may say they'll only pay for 15 treatments hypofractionated. If we want to do 45 radiation treatments for prostate cancer, an Advantage plan may only authorize 28 treatments. No, the insurance companies (private and Advantage) can't practice medicine, but they can tell you what they'll pay for, which can drive the treatment offered. Medicare doesn't have dental, vision, or hearing coverage, but Advantage does. Advantage plans are PPOs or HMOs, so you have to be in network, and as a snowbird do you want to be in network at TV or your other home? See an advisor BEFORE you chose. Rusty Nelson (TV local) did a series of 3 YouTube videos with an insurance advisor/consultant that I found very informative. Between private insurance and Medicare, Medicare always pays less. Some insurance companies pay a percentage of billed (e.g. 50%), so in order to get what Medicare pays, they have to bill twice as much, but usually they bill much more to private insurance because they'll pay more than Medicare and percent of billed is usually a lot lower. I'll probably stay straight Medicare once I retire and keep my PCP and specialists here and just use clinics at/around TV.
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