One more thing, the wife and I enrolled in MC this past Fall.

I had CFBS thru my office that covered us and my employees.

Since I was a small business, the only thing available was thru the "Affordable Care Act".

I was paying over $1300/month for my self and my wife (over $2600 total), with a $4000 deductible...

My employees cost the same per person... Luckily, they also went on Medicare about a year ago...

Since October, we now pay $174/month each, plus another $225-ish) for AARP UHC.

Our Part D is $0.40 (yes FOURTY CENTS)/month. I pay ZERO for my BP meds (2 low dose diuretics) and $9 and change for my 3 month supply of cholesterol meds. My wife pays a bit more for her cholesterol meds (different meds)...

Since October, I've had a metric ton of tests, scans, etc, a 3 day hospital stay for a GI bleed (all healed), and an Aortic Valve replacement...

Total out of pocket cost? $0.00

Of course, YMMV...

Did you miss the last sentence of my post? ;)

"Now, granted, we've also occasionally had that happen with commercial insurance companies, but it much, much more rare..."

We have had Medicare Advantage plans since we retired over ten years ago. We have used UHC except for one year when we had Aetna, which was pretty good too.We are happy with the plans especially this current one. We have both worked for companies that offered excellent medical insurance and this UHC advantage plan surpasses those employer plans.

Perhaps Advantage plans do not address the needs of people who need expensive medications or have medical conditions that are expensive to deal with.

If you are pretty healthy Advantage plans can work for you. I use Latanoprost eye drops for glaucoma which have a $0 copay. I do not use any other prescription meds. All of my surgeries & hospital bills have been covered. I pay a low co-pay for doctor visits but my PCP is $0 no matter how many times I see her. Gym memberships are $0. There are other freebies. I can't complain.

You can when they run out of money

They won't. Governments love to control people above all else. By limiting choices, they maintain control, so you can bet they will throw whatever money is needed in the direction of advantage plans.

So you can easily go from a traditional Medicare supplement to an Advantage plan without medical underwriting. But not the other way. So one of the best things about the Affordable Care Act (ACA or Obamcare) was the elimination of preexisting conditions. Achieve Medicare age and now preexisting conditions come into play again (unless you live in one of four states where your premiums are higher for this privilege). So many different plans and different rates it is a wonder a person of much below average intelligence can navigate. Plan F is not available to new enrollees. What else will change in the future? If you are currently paying higher rates anticipating future medical needs you are not going to want all the people who savined money on Advantage plans in their healthier younger years to be allowed back to regular Medicare when they get sicker. But hey, things can change at any time.

NRLN President's Forum
Authors Conclude
Medicare Advantage
Should be Abolished

An analysis in the JAMA (Journal of the American Medical Association) Internal Medicine on June 10 concluded: "We think the time has come to declare MA [Medicare Advantage] a failed experiment and abolish it. That would allow redeploying the $88 billion taxpayers will overpay MA this year to upgrade benefits for all Medicare beneficiaries."

The conclusion was based on the high cost of MA compared to traditional Medicare. For example:

Medicare Payment Advisory Commission (MedPAC), the nonpartisan agency reporting to Congress, recently estimated that MA overpayments added $82 billion to taxpayers' costs for Medicare in 2023 and $612 billion between 2007 and 2024. Two insurer strategies drive MA overpayments: diagnosis upcoding and avoiding enrollees who are ill and do not contribute to profits.

Although MA insurers must accept all applicants in counties where they offer a plan, they are also free to withdraw from counties where they are accumulating unprofitable enrollees.

Only 2% of Fee-for-Service (FFS) Medicare expenditures go for overhead. But MA insurers incur extra expenses for television advertisements, health care network management, benefit design, executive salaries, health care utilization review, prior authorization, and shareholder profits, driving their overhead up to 14%.

This is according to a report from Milliman, an international actuarial and consulting firm, on MA financial results for 2022. Milliman estimates applied to subsequent years' payments, MA overhead for 2007 to 2024 totals $592 billion--equivalent to 97% of taxpayers' $612 billion overpayments to them during that period.

The authors closed their analysis stating, "A smarter, thriftier way to expand benefits and lower out-of-pocket costs is possible for all Medicare beneficiaries, but first, we must eliminate MA and double down on traditional Medicare, covering all enrollees in an expanded and improved Medicare program. That would be a good deal for patients and taxpayers."

The NRLN has advocated for 10 years that it is time to end taxpayer rebates to the healthcare insurance industry for MA This year rebate payments will equal 17% of every benefit dollar Medicare pays to private insurers. Private plans hold a 54% share of the Medicare market but Medicare payments per enrollee are 22% higher than we pay for Fee-for-Service (FFS) enrollee. Income taxes paid support 76% of Medicare B and D.

Yet 301 bipartisan members in Congress lobby for more rebates hoping they can eliminate the "third rail" risk and gain votes from 33 million over age 65 retirees in MA in their states. They don't care about the other 27 million seniors back home who don't get over $2,000 a year in rebate paid extra benefits. These 27 million are actually more in need according to MedPAC. Private plan insurers focus on enrolling younger, more healthy retirees.

Congress' own commission, MedPAC, produced a report and charts in 2020 showing members of Congress that 25% of the FFS beneficiaries over age 65 account for 85% of Medicare spending! MedPAC's report states that "Costly beneficiaries tend to be those who have multiple chronic conditions, are using inpatient hospital services, are dually eligible for Medicare and Medicaid, and are in the last year of life."

The NRLN and most Americans support competition from private healthcare plans and the NRLN understands the financial challenges ahead for Medicare and the federal budget. However, we do not support MA taxpayer bonuses and rebate subsidies, or anti-competitive restrictions placed on original Medicare FFS just to preserve the notion that private insurance plans may be more cost effective or provide better care than FFS, when the record shows they are not.

We have repeatedly pointed out to members of Congress that the chronic benefits provided to the 33 million enrollees in MA plans are denied to the 27 million participants in traditional Medicare. If Congress is going to continue funding MA with taxpayer money, those in traditional Medicare should receive the same benefits.

Bill Kadereit, President
National Retiree Legislative Network

I have traditional Medicare and my agent told me to not switch to an Advantage plan because everyone will be required to be on Advantage plans in the future. He said I'd be able to stay on traditional if I kept it. I go to doctors at Moffitt Cancer in Tampa and they do not accept Advantage plans. He thought traditional Medicare was better.

RE: National Retiree Legislative Network

What is missing is how the cancellation of Medicare Advantage and using the funds to "fix" traditional Medicare will actually be accomplished.

The Federal government gives Medicare Advantage providers a fixed amount per year, per client. This enables the provider to have a budget to fund a care team that is at the ready to service it's clients. There are also incentives in place to reward providers for keeping their clients healthier.

Yes, of course there are inefficient providers who don't have any idea how to have a profitable business. No provider can afford to operate a business that continually loses money treating its patients.

Someone complained that their doctors were always changing. You might want to consider using a provider that knows how to better operate their business providing healthcare.

For me, I want the best doctor available to treat me when needed. I don't need to see the same person each and every time. Fortunately for me my PCP is available when I make appointments for the future. And if I need someone ASAP, Villages Health delivers; a simple call tells me where to go if someone is needed immediately. This may be someone on my PCP's team, an urgent care clinic, or an emergency room. Fortunately the latter can be whomever is convenient.

Don't forget, the Federal Government has deep pockets, but the depth is not infinite.

At some point all of these deficits causing more and more borrowing is going to reach a point where nobody is going to want to finance them.

We will probably long gone but this cannot go on forever

Laughing out loud! ACA was supposed fix healthcare. It might have had chance if they would have read it before they passed it. IMO and I can have one IT just MADE it worse…….>

Kickbacks?????

Bottom line: An opinion from someone who probably also has an agenda.

NOT TRUE. Both Moffit and Shands are in network for the Florida Blue advantage plan.

More like the quote from Star wars episode 3------"All those who have power are afraid to lose it"

Switch to Medigap from MA plan
 

I agree no underwriting. But the premiums should be higher compared to those already paying higher Medigap premiums. Maybe a sliding scale based on age.

It does not seem right that some retirees are only given the choice of an Advantage plan. Medical and employer relationship should have been decoupled a long time ago.

Unaffordable Healthcare
 

Ah. The Affordable Care Act which was supposed to make health care affordable. We suffered for many years with the same high premiums but our deductibles were higher. Our employers did not offer healthcare. So basically paying an extra $30K per year and not have anything covered since the deductible was so high. It truly caused us financial distress. Rates are not determined by gender or health status or preexisting conditions - but wait - rates determined by age! And oh my gosh are the rates astronomical the years leading up to Medicare.

Hospitals (and doctors) across the country are dropping access to Medicare Advantage plans and a simple internet search will show that this is true. Virtually all hospitals accept Medigap policy.

The Pharmaceutical companies are way too powerful. The pharmacy benefit managers dictate what drugs go on the formulary and are available to you. So the formulary is based on maximum profit, not the most therapeutic drugs. There are no drugs on my formulary for my condition below tier four. I filed an exception and pre-approval and was granted it. What did that buy me? A chance to pay full price for the drug until my deductible is met and then I can pay half price for it. The half price they quoted me is more than the GoodRx price of $75 and this is a generic.

Remarkable how few people who voted for it took the time to read what they were voting for

You’re forgetting “you have to pass it to find out what’s in it “😂😂😂

When the ACA was first passed, my deductible a $7K/year. And, like you, since my deductible was so high, the only thing covered was my yearly physical and my wife's yearly physical and mammogram... Everything else was "out of pocket"...

Only be choosing a lower coverage level was I able to reduce my deductible to $4K, and keep my premium increase to a less insane amount.


However, my monthly premiums increased...

What other Advantage Plans do they accept?

I'm still ****ed about that comment...:censored::censored::censored:

Depends on one’s income. For some it made healthcare more affordable, but for others it made it significantly more expensive. It’s a zero sum game, one person’s subsidized healthcare premiums are ultimately paid for by others increased premiums or those actually paying income taxes. In a way, it was simply a government mandated redistribution of wealth.

While the ACA is far from perfect, it is much better than the alternative—nothing. The main detractors of the ACA have had 14 years to come up with a “repair and replace” plan and they have never put forward any concrete proposal. The ACA now covers over 40 million Americans, including over 21 million in marketplace plans. There are many challenges with our health care delivery system. These challenges were not caused by the ACA. We really don’t want to go back to the days of pre-existing conditions and catastrophic plans. As an FYI, there is no Pre-existing condition limitation on Medicare Supplemental plans if you sign up at the time of eligibility. No underwriting, no pre-ex. Must issue at age 65.

But when signing up at age 65 and selecting an Advantage plan, it is basically the selection for the rest of your life (you can change within first six months or something like that). But selecting a MediGap plan allows you to switch to Advantage later, but not the other direction. Some states allow the change. A fair number of people don't understand this. Also some people don't know your Medicare premiums can double or more depending on your income. My widowed cousin sold her house and is now stuck paying double for two years - pretty sad.

I have no problem using my MA plan as a snowbird in NY or FL. Spent 4 decades in healthcare and neither is perfect, and both have issues. The biggest problem we had with Medicare, MA, and private insurance was the SLOOWWWW play. It often seems like the deny claims for as long as possible so they can hold onto money longer and gain interest, etc. Then there's the Medicare RAC audits which cover many years, they start out claiming you own a ton of money from overpayments, etc., and if you did your paperwork right, you end up owing little to nothing!!! If you don't keep your paper straight, you pay BIG!!! The main difference between Medicare and MA is Medicare doesn't require preauthorization and MA's sometimes do but they still cover the same things. MA are required to cover whatever Medicare covers, but they through in dental, vision, etc. as inducements. Medicare and MA generally use the same guidelines for what is and is not covered, e.g. if Medicare won't authorize a procedure for something, chances are good MA won't either; that's just the way it works. So, what's the fix? I suspect it'll end up being Case Rate, no more prior authorization, etc., e.g. stage IIB lung cancer and you (hospital, clinic, etc.) get paid $60k and the care which they and the patient pick. I would like to see legislation for prompt pay, but insurance companies have generally shot it down. Slow pay cases should include significant interest as a penalty.

you speak the Truth .... finally someone who remembers

Medicare Advantage steals from us all.
 

Go to this website and see what this group of Doctors think about our current "healthcare" system: Physicians' Proposal - PNHP

I had that very test, MA paid for the test, but I was responsible for 20% of the cost for the “nuclear injection”, which equates to approximately $970.

I chose UHC MA and am very happy with it. I’ve had numerous surgeries and health issues and had no problems with my MA plan. I don’t pay a monthly fee for a supplement. However, with my plan I had to pay a co-pay for the surgi center /hospital. $150 per day. Up to $2400 out of pocket max. A supplement policy would cost me $2400+ per year. I see it as you either pay at the front end with a supplement or the back end with an MA plan. Plus you get some perks, dental, optical, gym membership, Part D meds.

In the original ACA, everyone had to have insurance. There was an individual mandate. If everyone was insured, the burden of those who can't or don't pay for care would have been eliminated. One way or another, we all pay for those who don't have insurance, and in 2010, there was 50 million uninsured Americans.

The individual mandate was thrown out, that took many healthy young people out of the pool and increased costs dramatically.

I can't tell you how many people I have heard complaining about the ACA, while their own kids got to stay on their parents health insurance until they were 26 years old. The number of uninsured Americans has dropped by more than 20 million since 2010.

The biggest reason that it is costly is because there is no pre-existing condition limitation and the people who need care the most are the most likely people to sign up for it. And it required all insurance policies to include certain essential benefits so that insurance companies weren't selling plans to people which were so skinnied down that they didn't pay for much of the care that people needed.

The United States remains the only industrialized democracy in the entire world where health care is a privilege and not a right. We are the only country that ties health insurance to employment. We also spend far more than any other country per capita on health care and our outcomes are not superior.

Saying all of this does not make me a communist or a socialist. The US is the only outlier. Millions of Americans routinely travel to other countries to receive care, the nickname for this is medical tourism.

Many folks think that a government health care system is socialism. But we already have tens of millions of people in a government health care system who are on Medicare and Medicaid, and generally, the folks who are covered are ok with their coverage and don't see themselves as participating in a socialist system. There is no reason that Medicare can't be expanded to cover everyone.

For those who would not want everyone to be covered by Medicare, do you think it's better run by a handful of gigantic for-profit health insurance companies, big pharma advertising all over TV, and conglomerate health care systems buying up individual practices?

MA works great for my mother. She never leaves her home city and is in a medical system that accepts her plan. Not so much for a woman I know who lost her life cause she wasn’t approved for the specialized medical facility she needed in Florida. All depends on what MA plan you get and where you live. As for myself, I stay far away from the MA plans. Don’t want an insurance company making my medical decisions for me.

How is that a problem? That’s chump change compared to what we pay through Obamacare! And the Medicare Supplement benefits blow away the ACA benefits. $3K in premiums per year for outstanding benefits, a national network, and no referrals, absolutely blows away close to $3 k per MONTH for inferior benefits, with a limited local network, needing referrals for everything, and dealing with co-pays and max out of pockets.

Heres what's currently going on with MA plans in Congress. These plans are funded 80% by Federal funds. Congress wants to lower that 80% funding given to insurance companies. When they do lower it you can bet that benefits with MA plans will be lowered. Once on MA plan you cannot change back to Medicare. Do you now get the "hook and bait" that Congress had planned?

Stop the BS. You can always switch back to regular Medicare.

Joining a plan | Medicare

Does the 80 percent include the Medicare Part B premiums paid by the retirees, or do the MA plans also receive those premiums in addition to the 80 percent?

Also, how much does it cost to operate the traditional Medicare program, to include the benefits paid to medical providers, and the salaries and benefits of the Government employees and contractors who manage the program (including lifetime pension and SS monthly payments after they retire)?

You can always ATTEMPT to switch back, with medical underwriting, and you will most likely get rejected if you have a history of expensive health conditions. Insurance isn’t designed to allow people, with minimal health care needs, to get free/inexpensive coverage and then be able to switch to better/more expensive coverage when they get a serious/expensive health condition.