[MX rider]

[QUOTE=rsmurano;2340733]I would never never go the Advantage plan route. If you are thinking about going this route, make sure you check these things out 1st:
1) something like 70% of medical procedures are not approved by the advantage provider. Since these policies are usually ran by insurance companies, they don’t approve medical procedures to save money. If you don’t believe this, check it out, and also look into why congress is looking into this. Why? Because Medicare doesn’t need approvals for medical procedures, so why do advantage plans?
2) I will always pay less with a supplement. No copays, $200 year deductible
3) once you are in the Advantage plan, you might never get into a supplement plan in the future. If you have any medical issues within the last 2 years, the supplement plans will not accept you. But when you turn 65, any plan has to accept you.

My insurance broker told me: if you can afford the supplement plan cost, keep it, this is the gold standard for Medicare coverage.


Not all advantage plans are created equal. You're painting with a broad brush.

After much research we went with UHC and are happy with it. We talked with SHINE and they said it was a good option. We also spoke to some people on this plan with major health issues and they were happy with it as well.

They have a very large nationwide network, so it travels with us. Not every single hospital takes it, but all the ones we checked with here in Indiana did. Many Florida hospitals take UHC.

When it comes to medicare, having options is a good thing. It's not a one size fits all.
Bottom line, do the research.

[Marine1974]

I have traditional Medicare and a supplemental insurer United healthcare. I have an annual $240 deductible after that I pay $0 . I can pick and choose my doctors.
I pay $339 a month total premium’s .

[Jameson]

MX Rider said "When it comes to medicare, having options is a good thing. It's not a one size fits all.
Bottom line, do the research."

That's the best advice. We all have different needs. Also trust no one especially agents pushing medicare plans. They get paid to sign people up and also get recurring compensation (varies with the plans) in subsequent years even when you don't change plans. They typically don't disclose that. Also I've been to a hospitals where they were saying they were full with no free beds. A couple times I asked about an entire wing of a given floor being dark and shut down and I was told they were simply short staffed. They had "beds". Most of that is their own fault forcing employees out the door during COVID and they are still trying to recover.

[Marine1974]

Originally Posted by ithos

It is only going to get worse.

To the casual observer in The Villages, it is apparent that many retirees do not put a high priority on proper diet and exercise. So when their health starts to deteriorate they figure it is now the government's job to shell out whatever money is required to pay for their medical expenses.

This wouldn't have been a problem in the 60s and 70s when medical care was far less advanced. But obviously things are much different now. Yes you paid Medicare taxes but it wasn't near enough.

Social Security and Medicare finances look grim as overall debt piles up - The Washington Post

https://www.usnews.com/news/best-cou...%20among%20men.

What do you mean by we haven’t paid enough ?

Medicare is funded by a combination of sources, including:
General revenues: Contributions from the government
Payroll taxes: Paid by both employers and workers
Beneficiary premiums: Monthly payments for coverage
Other sources: Taxes on Social Security benefits, state payments, and interest
My taxes on my social security payments up to 85% also pay for Medicare . I’m being taxed on money I contributed.

[CoachKandSportsguy]

Originally Posted by Jameson

They had "beds". Most of that is their own fault forcing employees out the door during COVID and they are still trying to recover.

its a very ignorant statement to say that hospitals forced employees out the door during code without understand the financial risk of a federal requirement.

Maybe you might want to talk with a medical staff recruiter. CoachK's best friend is one as well as she was director of HR staffing along time ago. Currently the pickings are very slim, just like plumbers and electricians . . some hospitals have internal applicant exams for nursing positions to verify beyond licensing. . . many cannot pass the job related exam.

Being a hospital, like any industry, requires certain industry standards, and one of which is following CMS federal rules for reimbursements. The choice was getting reimbursed for their operations which is not all covered by insurance by following rules, or suffer financial losses by not following rules. As a operations owner, which would you choose?

Your comment is based upon incomplete sympathy news without any background knowledge or financial responsibility for continuing operations.

[Cathyand Bob]

Excellent article! All need to learn about how complicated/ unnecessary this gob of spaghetti is.
It's satisfying to know that there are "overlookers" to try to make changes.

[Zenmama18]

Originally Posted by Carla B

I first heard of Medicare Advantage programs back in the 1980's. Someone I casually worked for explained to me that he had recently enrolled in senior healthcare through Humana.

The way it worked, he explained, was that Social Security transferred his monthly Medicare premium to Humana in exchange for covering his healthcare needs, even prescriptions and eyeglasses, and what a great deal that was. At that time I was too young to worry about such concerns. But it did make a huge impression on me when he told me a few months later that the Humana program had gone insolvent and he was back to searching for doctors.

From then on, I took notice of company after company advertising their Advantage program and going out of business not long after.
When we reached the time where we had to make a choice, I voted in favor of paying for Medigap as long as possible, even if we had to give up such niceties as eating out a couple times a week. My husband agreed, since he had a history of unusual health concerns and preferred choosing his own doctors.

So, here we are some years later, mostly eating at home but still able to pay Medigap premiums, even though insurance companies have figured out how they can profit from Advantage programs.

We went with traditional Medicare and a Medigap because when my husband enrolled, two of his doctors didn't take any Medicare Advantage plans, just traditional. He didn't want to leave a doctor who had helped keep him alive for 10+ years. We checked on the State of Florida Office of Insurance Regulation (OIR) website for the least expensive "G" plan and signed up. Rates go up every year of course, but are still manageable for us.

[OrangeBlossomBaby]

Originally Posted by Badger 2006

I have Florida Blue Advantage PPO and referrals are not needed for In-Network (Less expensive) or Out-of-Network (More expensive). There can be significant differences between HMO and PPO Advantage Plans.

Yeah that's what I thought. Maybe certain procedures need pre-approvals, but as far as I could tell, Advantage PPOs work just like other normal PPOs outside the Medicare system, but come with more perks (like gym memberships and allowance toward eyeglass costs) because they're Advantage.

[OrangeBlossomBaby]

Originally Posted by rsmurano

I would never never go the Advantage plan route. If you are thinking about going this route, make sure you check these things out 1st:
1) something like 70% of medical procedures are not approved by the advantage provider. Since these policies are usually ran by insurance companies, they don’t approve medical procedures to save money. If you don’t believe this, check it out, and also look into why congress is looking into this. Why? Because Medicare doesn’t need approvals for medical procedures, so why do advantage plans?
2) I will always pay less with a supplement. No copays, $200 year deductible
3) once you are in the Advantage plan, you might never get into a supplement plan in the future. If you have any medical issues within the last 2 years, the supplement plans will not accept you. But when you turn 65, any plan has to accept you.

My insurance broker told me: if you can afford the supplement plan cost, keep it, this is the gold standard for Medicare coverage.
I agree!

The operative phrase is bolded and underlined. Many of us can't afford that. And some of us are healthy enough and not "at risk" patients, that there's really no advantage to paying extra every month for the "possibility" of needing care that we probably won't need for another 10 years, if ever.

[psoccermom]

Originally Posted by rsmurano

I would never never go the Advantage plan route. If you are thinking about going this route, make sure you check these things out 1st:
1) something like 70% of medical procedures are not approved by the advantage provider. Since these policies are usually ran by insurance companies, they don’t approve medical procedures to save money. If you don’t believe this, check it out, and also look into why congress is looking into this. Why? Because Medicare doesn’t need approvals for medical procedures, so why do advantage plans?
2) I will always pay less with a supplement. No copays, $200 year deductible
3) once you are in the Advantage plan, you might never get into a supplement plan in the future. If you have any medical issues within the last 2 years, the supplement plans will not accept you. But when you turn 65, any plan has to accept you.

My insurance broker told me: if you can afford the supplement plan cost, keep it, this is the gold standard for Medicare coverage.
I agree!

#1 is not true. I have an advantage plan and have cancer. I have never been denied anything.

[bowlingal]

Advantage plans are good.....until you need medical care. Then, they suck

[MplsPete]

Originally Posted by rsmurano

..:1) something like 70% of medical procedures are not approved by the advantage provider. Since these policies are usually ran by insurance companies, they don’t approve medical procedures to save money. If you don’t believe this, check it out, and also look into why congress is looking into this. Why? Because Medicare doesn’t need approvals for medical procedures, so why do advantage plans?...

I tried to "check it out," and I couldn't find a source for your 70% claim, or anything close.

[CoachKandSportsguy]

Reform of 'prior authorization' rules crucial to patient care - CommonWealth Beacon

The link will ask you to sign up, but ignore it. the quote below is just one section of the article.
The point is that its not necessarily the non-profit hospital healthcare system which is the issue, but the for profit insurance healthcare part of the system which is making a mess of patients' experience in many cases. .


A 2021 McKinsey & Company study estimates that about one-quarter of the $4 trillion spent on health care annually in the United States – $950 billion – is administrative. Recognizing some administrative spending is necessary, the report identifies simplification opportunities that could deliver $265 billion in annual savings from roughly 30 interventions, including prior authorization reforms.

[CoachKandSportsguy]

Originally Posted by OrangeBlossomBaby

The operative phrase is bolded and underlined. Many of us can't afford that. And some of us are healthy enough and not "at risk" patients, that there's really no advantage to paying extra every month for the "possibility" of needing care that we probably won't need for another 10 years, if ever.

the future is too uncertain for those statements to be true in 10 years. .
good luck with that. .

[Michael 61]

Originally Posted by rsmurano

I would never never go the Advantage plan route. If you are thinking about going this route, make sure you check these things out 1st:
1) something like 70% of medical procedures are not approved by the advantage provider. Since these policies are usually ran by insurance companies, they don’t approve medical procedures to save money. If you don’t believe this, check it out, and also look into why congress is looking into this. Why? Because Medicare doesn’t need approvals for medical procedures, so why do advantage plans?
2) I will always pay less with a supplement. No copays, $200 year deductible
3) once you are in the Advantage plan, you might never get into a supplement plan in the future. If you have any medical issues within the last 2 years, the supplement plans will not accept you. But when you turn 65, any plan has to accept you.

My insurance broker told me: if you can afford the supplement plan cost, keep it, this is the gold standard for Medicare coverage.
I agree!

Well said. This should be a big red flag to the many Villagers who are not yet 65. I’m still several years away from Medicare age, but plan to transition to traditional Medicare at age 65, and stay clear of advantage plans. I’m amazed at how many people I run into here at The Villages who are under 65 like myself, but are still rather clueless about the differences between traditional Medicare and the advantage plans. They see these slick ads for advantage plans and all the “freebies”, and assume that is the way to go. For those still under 65, it’s imperative you do your homework, so you can make the proper decision as to what is best for you once you turn 65. I have heard too many stories how people loved their advantage plans until they got quite a bit into their 70s, and their health took a turn for the worst, and they wished then they had traditional Medicare.