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Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)
-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Should I switch from Medicare Advantage to regular Medicare? (https://www.talkofthevillages.com/forums/medical-health-discussion-94/should-i-switch-medicare-advantage-regular-medicare-353203/)

Frodo 09-25-2024 06:24 AM
Medicare
 
We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.

Rainger99 09-25-2024 06:35 AM
Quote:
Originally Posted by Frodo (Post 2373382)
We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.
Aren’t Medigap companies a for profit business?

Frodo 09-25-2024 06:49 AM
Medicare
 
We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.

retiredguy123 09-25-2024 06:51 AM
Quote:
Originally Posted by Rainger99 (Post 2373385)
Aren’t Medigap companies a for profit business?
Yes, they are. But, they operate significantly different from advantage plans. Medigap plans are designed by the Government to pay the 20 percent copay that original Medicare doesn't pay. They have very little flexibility when paying claims. Basically, if Medicare covers it, they must pay for it. They cannot deny coverage of a claim approved by Medicare. The only flexibility they have is in how much they charge in premiums. So, they are basically a piggyback plan to Medicare, and they are heavily controlled by the Government.

westernrider75 09-25-2024 07:02 AM
Quote:
Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.
We currently have a supplement which costs us about $250 a month (for both of us) but are considering switching to an advantage to potentially save some dollars. My biggest concern is being able to get necessary services through an advantage plan. For instance, my sister in law has been ha i get back problems for about 6 months. She finally got in with a surgeon who ordered an MRI to try to determine exactly what was happening. It was denied. That would not happen with a supplement.

MX rider 09-25-2024 07:13 AM
Quote:
Originally Posted by Frodo (Post 2373382)
We have to remember that Medicare advantage is a for-profit business. Whenever they can deny you a service they make more money. On the other hand, if you would like to see a specialist and you have regular Medicare you call up and make an appointment. You don't have to go through a thousand steps trying to get approval from your managed care insurance provider.
Obviusly, all MA plans are not the same. Mine doesn't require approvals. This person likes their plan as well. But don't let her facts get in the way of your story.

"I have an advantage plan and I am very pleased. I was recently diagnosed with breast cancer, I have had the best care at MOFFITT. My recent hospital bill was $30,000 and I only had to pay $150. I also had thousands of $$ in bills for tests and procedures prior to surgery and only paid $120.
I have great dental and vision coverage. Florida Blue worked with me to get into doctors ASAP. I have a $20 copay for specialist, but didn’t have to pay a copay at MOFFITT. Just wanted to share a positive view on Advantage plans."

Arlington2 09-25-2024 07:29 AM
Quote:
Originally Posted by westernrider75 (Post 2373398)
...My biggest concern is being able to get necessary services through an advantage plan. For instance, my sister in law has been ha i get back problems for about 6 months. She finally got in with a surgeon who ordered an MRI to try to determine exactly what was happening. It was denied. That would not happen with a supplement.
Many of us would be interested to know the MA plan your sister has. Some MA's seem to be notorious for denials. I have UHC and have had many similar tests with no denials. I do know a person with UHC that had a knee denial, but it turns out it was a problem with the procedure coding. I am 100% pleased with UHC. I believe most Fl Blue folks have the same positive experience.

biker1 09-25-2024 07:30 AM
Which plan do you have (insurance company and plan letter)?


Quote:
Originally Posted by westernrider75 (Post 2373398)
We currently have a supplement which costs us about $250 a month (for both of us) but are considering switching to an advantage to potentially save some dollars. My biggest concern is being able to get necessary services through an advantage plan. For instance, my sister in law has been ha i get back problems for about 6 months. She finally got in with a surgeon who ordered an MRI to try to determine exactly what was happening. It was denied. That would not happen with a supplement.

Emkay56 09-25-2024 09:15 AM
Sounds to me like you have a great advantage plan. I've had an advantage plan since I started Medicare, 3 years... I'm healthy so it works great for me. Why pay $200/mo for a supplement plan? To me it's a no brainer to keep what you have.

Quote:
Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.

Thomy 09-25-2024 11:12 AM
Quote:
Originally Posted by retiredguy123 (Post 2373058)
Not exactly. Medicare can refuse to cover some treatments or drugs.
Rarely....

retiredguy123 09-25-2024 11:25 AM
Quote:
Originally Posted by Thomy (Post 2373469)
Rarely....
That is because most mainstream Medicare providers know in advance what Medicare will and will not cover. But, there are thousands of medical treatments and drugs that Medicare does not cover. For example, many people travel overseas and pay a lot of money for stem cell treatments.

SusanStCatherine 09-25-2024 11:29 AM
Medicare Prescription costs
 
Quote:
Originally Posted by Thomy (Post 2373469)
Rarely....
I'm on just a few prescriptions. One is NP thyroid which has been around since before FDA approval so it is never covered by any insurance. It's rediculous. So I found a mail order pharmacy to minimize my cost to $60 for a 90 day supply.

I'm also on a new generic. It is on a high tier on my part D plan. They want $177/mo through Part D. I got an exception through and it still costs the same and after I meet my deductible then I pay 50% because of the tier. I was able to get it filled at CVS and used a GoodRx coupon which brought the cost down around $70/mo from the start. CVS found me even a better discount than GoodRx. And my doctor did not think they would fill a 90 day supply, but CVS did and that was even less expensive.

I pay $0 for my plan D and what I pay on these two prescriptions do not count toward my $545 deductible. But I probably won't reach that anyway. I looked at all the available part D plans and spending more would make no difference whatsoever due to my particular prescriptions.

Everything depends on your own individual case. Also things can change.

retiredguy123 09-25-2024 11:42 AM
Think about it. If Medicare covered everything, quacks and snake oil salespeople would be coming out of the woodwork to sell treatments and collect money from Medicare.

lawgolfer 09-25-2024 04:18 PM
Quote:
Originally Posted by Rainger99 (Post 2372914)
I am currently on Medicare with a UHC Advantage policy. For the most part, I am satisfied with Advantage but I am interested in possibly switching to a regular Medicare and I am trying to figure out how much that would cost.

Right now, I pay my Medicare premium and there is no deductible. The maximum out of pocket payment is $2700 a year. This is for co-pays. Primary doctor is $0 a visit and specialist is $30 a visit. Dental and Vision are included at no extra cost. I am in network but the network is not limited to Sumter County. It is a nationwide network. I can go to hospitals in New York or Los Angeles or Chicago or Orlando or Tampa. They even have a hospital in Alaska!

Fortunately, I have been healthy and my out of pocket expense has been less than $250 a year.

For those of you with regular Medicare, can you give me a ballpark estimate of how much a Medicare supplement policy costs and how much dental and vision cost? Do you also have a separate drug policy?

And has anyone switched from regular to advantage or from advantage to regular? If so, why did you switch and are you happy with the change? Thanks.
Unless money is a serious problem and the "free" teeth-cleaning and eyeglasses are extremely important to you, switch to regular Medicare as soon as you can and purchase a Supplemental plan from one of the private insurance companies (AARP gets you United Health).

Should you have a serious medical condition, your choice of doctors will be limited to those in the Advantage plan. They may, or may not, be the best available. Getting permission to use a doctor outside the Advantage plan will be as hard as pulling your own teeth.

With regular Medicare, you can be treated by any doctor you choose, provided the doctor accepts Medicare and accepts as payment in full what Medicare and your supplemental insurer pays.

If you don't care who cuts into your chest to place several bypasses on your heart or cuts into your brain to remove a tumor, stay with your Advantage plan.

Rainger99 10-15-2024 07:23 PM
Some Advantage plans being dropped!
 
According to the Wall Street Journal, about 7.1% of Advantage enrollees will have to find another plan next year because theirs is being terminated, up from 0.4% to 1.5% during the past four years.


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