[golfing eagles]

Originally Posted by MX rider

Very well said! We're on UHC Advantage and like it.

Yes, there will always be "horror stories" as you pointed out. But MA plans vary, and some are better than others for sure. People need to do the research and make an informed decison.

Having a choice is a good thing, one size does not fit all.
Over 50% of new medicare enrollees chose MA plans. If they were so bad they wouldn't be so popular.

Btw, we really like the wellness and vision benefits. We get free membership to Genesis gym as a side benefit. Very nice place. My wife takes 2 fitness classes a day there 6 days a week.

Yes, there are some side benefits as well. The gym I was paying $70/month for is now free. I just got eyeglasses for free.

But the real debate on this thread is access to care and insurance denials. I have Florida Blue MA and even Shands and Moffit are in network. The concept that we are all sacrificing our health to line the pockets of insurance company CEOs is absurd and delusional. Bottom line---most people in America don't want to be "denied" anything, even though they freely chose to save $200/month by choosing an advantage plan. No, these plans are not for everyone----If you already have multiple medical problems with established relationships with specialists who are not in network----skip to traditional Medicare. If you have some rare condition that might require travel to a nationally recognized center, advantage is not for you either. But if you are relatively healthy these plans are just fine, and the chances of developing a condition that would cause you a problem with insurance are quite low---unless you are one of the whiners who specifically want to see the doctor that your barber's cousin in Atlanta likes.

Now, if we're looking for something to bankrupt advantage plans of drive the cost up, consider all the ads for so-called "Medicare advantage dual coverage plans" These are not just health insurance plans. They are for those with both Medicare and Medicaid, and now forgive the $174 /month premium for part B, and pay for "rent, groceries, and utilities". This is nothing more than Robin Hood backdoor welfare on the backs of taxpayers hidden under the guise of "Medicare Advantage"---that's the real deceit, and not by CEOs

Lastly, if you want a "horror" story, my wife's late husband had UHC The Villages Medicare Advantage plan and developed a rare form of myelodysplasia requiring bone marrow transplants that was not on the approved "list of treatments" at the time and could only be done at Moffit, which wasn't in that network. However, with a knowledge of how to navigate the system (she's a nurse with Master's in both nursing and healthcare administration), he got all the treatment he needed at Moffit, but unfortunately was unsuccessful.

[golfing eagles]

Originally Posted by retiredguy123

I mostly agree, but paying bonuses to employees will be wasting even more money. Medicare fraud and abuse are so rampant, that reporting it will do nothing. The people in charge know it exists, but they just don't care. I laugh every time I see a TV ad asking for the public to report Medicare fraud. This is just a publicity stunt to make people think the Government is trying to reduce fraud. If you report it, they already know about it, but they have no way to stop it anyway.

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)

[Susan1717]

I have a MA PPO and have been extremely happy. I’ve never had a problem even when I travel.

[M2inOR]

This is a thread for residents of The Villages, but not one mention of Villages Health.

We have Villages Health and the United HealthCare (UHC) Medicare Advantage Plan. Villages Health only accepts UHC, Florida Blue, and Humana.

The federal government gives a lump sum for each Medicare Advantage subscriber to UHC and other insurance companies.

Villages Health gets a portion of that from UHC, Florida Blue, and Humana. This lets Villages Health build a team of PCP and other staff to service it's members.

Many of the other Medicare Advantage plans DO NOT pass along enough of the federal dollars.

Villages Health selects only certain specialists to service their members, considering their reputation and other factors. Not all specialists qualify to be within the Villages Health network.

We've been a member of Kaiser Permanente HMO for all our adult life before moving to The Villages. We never had any issues being handled within their network. Same has been true being under the Medicare Advantage plan with UHC/Villages Health.

I might suggest that many of the Medicare Advantage problems are with other providers here.

Many retired employees have "free" healthcare from lesser Medicare Advantage providers that Villages Health does not accept. It could be that those companies don't comply with Villages Health expectations or requirements for services and billings.

Your experieces might be different. We are very happy with UHC and Villages Health Their combined network has been excellent for us.

[opinionist]

My mother had traditional Medicare, but the system failed badly. She had dementia when she fell and broke her hip. She spent 3 days at the hospital before being transferred to a rehab facility, but she was not officially in the hospital for three days. Medicare refused to pay anything for rehab, and her secondary insurance refused to pay anything because of the decision by Medicare. If ever a patient needed a rehab facility, it was my mother. I was forced to pay out of pocket for a month of rehab, and that would not occur with Medicare Advantage.

[CoachKandSportsguy]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

We have friends with denials from MA and Private insurance, had to go to medicare.

The typical MA denial is post injury/operation rehab . . . rehab has a long tail of expenses.

[BOWRUNNER]

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

I've been inroad to Medicare Advantage for 16 years, works for me

[MX rider]

Originally Posted by CoachKandSportsguy

We have friends with denials from MA and Private insurance, had to go to medicare.

The typical MA denial is post injury/operation rehab . . . rehab has a long tail of expenses.

We're on UHC Advantage and like it. I had a compound fracture of my tib and fib, and also broke my ankle in a dirt bike wreck about a year ago. I got great care through the surgery and rehab, and I'm now 100%. After care was very good and everywhere I needed to go here in Indiana took UHC. No denials or pre approval.

We were in TV all winter, and there were plenty of choices for me there as well if I needed anything.
Btw, medicare is not without denials.

[Wondering]

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

This topic was on Next Door and comments from people who are on a Medicare Advantage Plan total disagree with your analysis. I have never been denied procedures, that my doctor prescribe. It's a lot cheaper than standard Medicare, when you have to purchase a supplemental program to cover costs. In addition, I receive money back from my SS assessment for Medicare. Your source sites two experts who disagree on the topic. The source who is positive on Medicare Advantage made more sense and has better arguments to support its' existence.

[Michael 61]

Reading these threads you have “die hards” supporting traditional Medicare and those that champion Medicare advantage plans. For those under 65, this is a major decision you will have to eventually make. Research is key. Everyone’s personal situation is unique, and one’s health history needs to be taken into consideration. Someone who is very healthy, and goes to the doctor just once a year for their annual checkup will probably rave about how much they love their advantage plan. When it comes to quality health care, cost (though important) should not be the over-riding decision as to which way to go. I personally would want to talk to people well into their 80s, who have multiple health issues going on, who have had multiple hospital stays and rehab, and ask them how their coverage and the plan they selected has worked out for them.

[MrFlorida]

UHC Advantage plan works for me.

[Dusty_Star]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

No. But it was kind of you to ask.

[golfing eagles]

Originally Posted by opinionist

My mother had traditional Medicare, but the system failed badly. She had dementia when she fell and broke her hip. She spent 3 days at the hospital before being transferred to a rehab facility, but she was not officially in the hospital for three days. Medicare refused to pay anything for rehab, and her secondary insurance refused to pay anything because of the decision by Medicare. If ever a patient needed a rehab facility, it was my mother. I was forced to pay out of pocket for a month of rehab, and that would not occur with Medicare Advantage.

This was always an uphill battle with Medicare. For some reason the policy was a patient needed three days in the hospital prior to transfer to a skilled nursing facility for Medicare to pay. This was a catch 22 when there was no need for a patient to stay 3 days----without medical necessity they wouldn't pay the hospital and without 3 days inpatient they wouldn't pay the nursing home/rehab. It was always a conflict between utilization reviewers and discharge planners. Stupid rule IMHO since the inpatient days cost more than nursing home days.

[gatorbill1]

Probably same amount of problems with regular Medicare. A lot more people are happy with MA plans than not

[Sandy and Ed]

Originally Posted by CoachKandSportsguy

We have friends with denials from MA and Private insurance, had to go to medicare.

The typical MA denial is post injury/operation rehab . . . rehab has a long tail of expenses.

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?