[sallyg]

We'd be broke without our Medicare advantage plan. It has been absolutely problem free great coverage. The best insurance we've ever had.
Not sure what this post is about?? Stirring the pot?

[sallyg]

Originally Posted by PugMom

it works for me. i've been able to get the care i need, when i need it, for what i want. i've never been denied, never had to sacrifice care. i'm leery of some of these stories, -they appear to be looking for some gut reaction, typically in a sensational way.

Agree!

[MSGirl]

Originally Posted by bowlingal

LaLamy, yes it's true. A friend who has Medicre Advantage was denied a nuclear test. If they had a traditional they would have been covered, no problem. So, just because you never heard of it, doesn't make your statement true. The advantage plan is good as long as you don't get sick. But, no one knows when you will get sick.....and you will get sick

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

[Sandy and Ed]

Originally Posted by bowlingal

LaLamy, yes it's true. A friend who has Medicre Advantage was denied a nuclear test. If they had a traditional they would have been covered, no problem. So, just because you never heard of it, doesn't make your statement true. The advantage plan is good as long as you don't get sick. But, no one knows when you will get sick.....and you will get sick

Interesting. I had a lung resection due to cancer. Had follow-up treatments with proton therapy (SBRT) four separate times over the years - latest this past March at Moffitt. Aetna Medicare Advantage paid for it.

[Karmanng]

Originally Posted by GoRedSox!

I don't think that Medicare Advantage is correctly labeled an experiment, they have been around for over 25 years. Over 50% of all Medicare enrollees are on Medicare Advantage Plans. Most people say they are happy with their MA plan, at least as many as say they are happy with traditional Medicare.

ALOT of these plans are going to go away and many hospitals are not taking these plans either...........traditional is the only way to go for sure........at least i know they are not going to change my drs on me when they feel like it !!! That happened many times to my folks.........

[Karmanng]

Originally Posted by MSGirl

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

BUT they slight the ones who dont want to use the Advantage plans either...........

[golfing eagles]

Originally Posted by Sandy and Ed

I have an MRI diagnosed/confirmed impingement on the sciatic nerve at the L4/5 level. I am not a doctor so I just listen to what I am told. Surgery was recommended. Scheduled but my Medicare Advantage would not approve. Wanted me to do Physical Therapy first!! Huh??? Are they nuts, I thought. Ok. Went to PT. Therapist diagnosed Periformis syndrome. Deep massage on my butt cheek located the muscle and was able to relax its hold on my sciatic nerve. Maybe in this case the denial was warranted?? Again I’m no doctor just a cynical patient. You ask a plumber to check your plumbing ….what are the chances he’ll find something wrong?

Unless there is neurologic impairment or severe interference with ADLs, a trial of PT is almost always warranted.

[MSGirl]

Originally Posted by Dusty_Star

Some say that Medicare Advantage is a failed experiment. Patients get delayed & denied care, the taxpayers are paying mightily for the winners: the insurance company executives. They also say it should be discontinued or dramatically reformed.

MA was sold heavily to Congress by insurance company lobbyists on the basis that it would save money over traditional Medicare.

Is Medicare Advantage a Failed Experiment? Experts Debate - MedCity News

Next year, under Part D, the donut hole for prescription drugs is supposed to be eliminated. I heard that there are BIG changes coming to the cost per month for traditional Medicare and Medicare Advantage plans. The actual changes have not been leaked, but we should all know in the coming months.

[Karmanng]

Originally Posted by PugMom

it works for me. i've been able to get the care i need, when i need it, for what i want. i've never been denied, never had to sacrifice care. i'm leery of some of these stories, -they appear to be looking for some gut reaction, typically in a sensational way.

those stories are actually true my parents were on the advantage plans and they changed there drs all the time towards the end......I wont go with that plan just because of that plus you cant go to alot of places either with advantge such as mayo clinic...........most hospitals and drs are actually trying to get out of the ma plans fyi

[Sandy and Ed]

Originally Posted by golfing eagles

Please, please, please make ME the "someone" in power as appointed dictator. I'll fix it in under a year. Of course, I'd also have to disband Congress, rewrite some laws, possibly including the constitution, kill all lobbyists and execute those who propagate ridiculous tripe online. Probably not going to happen

Probably not….but I do like your thinking…even if only in jest. Maybe some one at the “top” of HCFA need to be replaced by someone who would insure oversight and logical procedures and policies. Too many knee jerk decisions

[golfing eagles]

Originally Posted by Karmanng

ALOT of these plans are going to go away and many hospitals are not taking these plans either...........traditional is the only way to go for sure........at least i know they are not going to change my drs on me when they feel like it !!! That happened many times to my folks.........

"A LOT"????? How many??? What percentage of these plans???? Big ones or just Mom and Pop plans????? Where??? What states????

You see, there is "a lot" to "A LOT"

[retiredguy123]

Originally Posted by MSGirl

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

Not just in The Villages. I cannot believe that a doctor anywhere can survive treating patients who are over 65 without accepting any Medicare.

[Sandy and Ed]

Originally Posted by golfing eagles

These numbers are out of date, about 15 years ago, but at the time Medicare budget was $600 billion/year, fraud was estimated at $8 billion/year and the government was spending $12 billion/year to fight it, without success. If that were a private company and you were CEO, what would you do????

The sad part is that it should have only cost 1% of that to find the frauds----just print out a list of the highest Medicare billers that are not institutions and start there. Number one on the list was a Florida solo cardiologist who billed $55 million in one year. Who thinks that was legitimate?????

Really want to cut healthcare cost? Eliminate the continuing practice of defensive medicine that costs over $1 TRILLION/ year by eliminating runaway jury malpractice verdicts (or killing all the lawyers)

There are too too many issues to list here. We’ve been chasing our tails for so long we don’t know where we originally wanted to go

First it was doctors who always sent you for an MRI at a company that they owned under another corporate name.

Therapists milking therapy sessions to the maximum that Medicare would pay

Nursing homes with different wings so facility and sundry expenses for private pay and VA pay could be bundled with Medicare costs

A lot of creative accounting. A lot of organizational gyrations to hide fraud and abuse.

I remember way back in the 80’s (?) when at Senate hearings testimony got uncomfortably close to opening up the nursing home industry to a deep dive investigation on how Medicare was paying non-Medicare related costs. Almost comical to see on tv how the questions were backpedaled. Almost an “aha” moment. No one seemed to want to go there. Lobbyists be dammned

[Terrynmarty]

We have MA BCBS.
Same coverage as MA traditional due to it being from employer.
They changed last year.

Only issue we had was with a breathing doctor husband had.
Because small office, they don’t take MA.
Reason: MA requires more paperwork.

Hmmmm

That made me think MA checks to be sure valid.
The office never forwarded all our records.

Otherwise everywhere we go it has been accepted without question.

[Joe C.]

There's a simple fix for Medicare fraud.
1st offense - $1million fine.
2nd offense - $5million fine and 5 years prison
3rd offense - Seizure of all assets and death penalty.