[PoolBrews]

Originally Posted by villagetinker

If you have been on an Advantage plan for more that 1 year, you can be subjected to underwriting when going back to traditional Medicare. IMHO, I would contact SHINE and have a discussion with them. So, to answer your question it depends on how long you have been in an Advantage plan. We were on for 5o weeks and were able to switch back without any penalty, but we just made it.
SHINE has 800 number and LOCAL meetings in TV, and we have found them to be very helpful. If you get the Daily Sun, the weekly advertisement for healthy living usually has their contact info.

Can you share your reasons for switching back? I'll be going on Medicare next year and want to understand reasons for and against an Advantage plan.

[kendi]

Originally Posted by rsmurano

All advantage plans are very bad. There is a reason why they throw everything under the sun in them to entice you.
You might be healthy now but tomorrow you might not be. If you have been on an advantage plan for over a year, all the supplement plans can refuse you.

Have you investigated any advantage plan? If you have, you would have never joined 1. All advantage plans can refuse medical service because the insurance company are the 1’s that approve medical service to you, not Medicare. Medicare does not refuse any medical service, if a dr thinks you need help, you always get it. Why are advantage plans been talked about in congress for years? Because of the 60% refusal rate of coverage by advantage plans.

Also, your supplement plan covers everything that Medicare covers, there is no right of refusal of medical service from the supplement company.

Also, have you been seeing in the news that more and more hospitals are not accepting advantage plans? Right now your local hospital might cover your advantage plans, but don’t count on it tomorrow. I have Humana prescription plan and the salesman last year tried to get me to get their advantage plan so I asked him a couple of questions: do you refuse medical service even if a dr prescribes it? He said yes they can. A year ago, I had a medical device installed in me and the 1 I picked was $20,000 more than the cheaper device, so I asked the salesman if they would allow me to get their advantage plan device I wanted and he told me they would have recommended the cheaper unit if it did the job. Remember, these are insurance companies that make money when they don’t have to pay out.

What I don’t get is hearing about people taking a cheaper advantage plan that has many deficiencies to save a couple hundred $$$ when getting a much better supplement plan g/n/?? When overall you are saving hundreds of dollars a month compared to what you were paying when you were working with possibly better coverage.

I know someone who died due to her advantage plan denying the specialty facility she needed to go to. Very sad

[MX rider]

Originally Posted by rsmurano

All advantage plans are very bad. There is a reason why they throw everything under the sun in them to entice you.
You might be healthy now but tomorrow you might not be. If you have been on an advantage plan for over a year, all the supplement plans can refuse you.

Have you investigated any advantage plan? If you have, you would have never joined 1. All advantage plans can refuse medical service because the insurance company are the 1’s that approve medical service to you, not Medicare. Medicare does not refuse any medical service, if a dr thinks you need help, you always get it. Why are advantage plans been talked about in congress for years? Because of the 60% refusal rate of coverage by advantage plans.

Also, your supplement plan covers everything that Medicare covers, there is no right of refusal of medical service from the supplement company.

Also, have you been seeing in the news that more and more hospitals are not accepting advantage plans? Right now your local hospital might cover your advantage plans, but don’t count on it tomorrow. I have Humana prescription plan and the salesman last year tried to get me to get their advantage plan so I asked him a couple of questions: do you refuse medical service even if a dr prescribes it? He said yes they can. A year ago, I had a medical device installed in me and the 1 I picked was $20,000 more than the cheaper device, so I asked the salesman if they would allow me to get their advantage plan device I wanted and he told me they would have recommended the cheaper unit if it did the job. Remember, these are insurance companies that make money when they don’t have to pay out.

What I don’t get is hearing about people taking a cheaper advantage plan that has many deficiencies to save a couple hundred $$$ when getting a much better supplement plan g/n/?? When overall you are saving hundreds of dollars a month compared to what you were paying when you were working with possibly better coverage.

I would disagree with you saying "all plans are bad". Like anything, some are better than others.
We did our research and even talked to some people with serious medical issues on our plan, UHC Advantage HMO/POS. We can go anywhere in their large nationwide network, with no pre-approvals needed.

We even checked many specialists, hospitals and doctors and the majority were in the network. We also have used the dental, vision and wellness benefits. We're satisfied with our desision.
Btw, SHINE said it was a good option.

Painting with a broad brush on this is foolish.

[Mrprez]

Originally Posted by MX rider

I would disagree with you saying "all plans are bad". Like anything, some are better than others.
We did our research and even talked to some people with serious medical issues on our plan, UHC Advantage HMO/POS. We can go anywhere in their large nationwide network, with no pre-approvals needed.

We even checked many specialists, hospitals and doctors and the majority were in the network. We also have used the dental, vision and wellness benefits. We're satisfied with our desision.
Btw, SHINE said it was a good option.

Painting with a broad brush on this is foolish.

Agreed, the OP will not get an unbiased opinion here. Best thing is to go talk to the people at SHINE and get the facts.

[Marine1974]

[QUOTE=Rainger99;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?

I have regular Medicare $174 a month taken out of my social security. My supplemental is with AARP United Healthcare $166
Per month . ( up from $146 a month in 2023) . My deductible is $240 for the whole year after that I pay $0 . No referrals needed I can go anywhere. My drug plan Medicare part d premium is $0 some drugs I regularly take our $0 others $15, prescriptions I don’t regularly take range from $15 to ? . I also have VA healthcare but due to my income I’m put in a tier where I pay a copay for primary care $15 specialist $50 but if I see 3 specialist in the same day it’s still one charge of $50!.
I’m on my dentists dental plan $375 a year . 2 cleaning, X-rays free . 20% off other procedures .
Never had Medicare advantage but my wife does . She’s healthy but pays copays .

[LuvNH]

Originally Posted by Mrprez

Agreed, the OP will not get an unbiased opinion here. Best thing is to go talk to the people at SHINE and get the facts.

You NEED professional information which you can get from SHINE. From experience I would tell anyone to buy the best insurance you can afford. Your healthcare needs are not the same at 65 as they will be at 85 .

[RoboVil]

Originally Posted by Rainger99

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.

If you travel within the US at all then regular Medicare has you covered everywhere. With Advantage programs, you could get hit with a big bill if you need care outside of their network. We currently travel outside of TV to visit family and don't have to worry about whether network services are available. Also, join AARP and price their regular Medicare plans (via United Health) and obtain Medigap coverage too. As for pricing, it just depends on what plan you chose and where you live.

[Rainger99]

Everyone says you don’t need referrals for Medicare.

How does that work? If I want an MRI of my knee, I just show up and it is covered?

[sully1]

Switch now while you still can.There is nothing greater than piece of mind. Spend the few extra bucks and be worry free. You can’t take it with you my friend. Did you ever see a hearse with a u- haul trailer behind it?

[biker1]

Radiology typically works by having a Dr. make a referral. I doubt you would find a provider who will entertain a patient calling directly for an MRI. The provider will verify your insurance before any procedure.

Originally Posted by Rainger99

Everyone says you don’t need referrals for Medicare.

How does that work? If I want an MRI of my knee, I just show up and it is covered?

[retiredguy123]

Originally Posted by Rainger99

Everyone says you don’t need referrals for Medicare.

How does that work? If I want an MRI of my knee, I just show up and it is covered?

You can see a specialist, like a dermatologist or a surgeon, "IF" they will see you. But, even some specialists will not see a patient without the patient first seeing a primary care provider. But, Medicare will not require a referral, when some Advantage plans will. For an Xray, like an MRI, you would definitely need an order from a medical doctor or other authorized provider.

[Rainger99]

Originally Posted by biker1

Radiology typically works by having a Dr. make a referral. I doubt you would find a provider who will entertain a patient calling directly for an MRI. The provider will verify your insurance before any procedure.

So if I twist my knee playing pickleball, and I go the ER and ask for an MRI, the doctor has to order it? And he makes the decision to order an x-ray rather than an MRI?

[biker1]

Drs will typically follow a protocol appropriate for the injury. This may involve an x-ray and physical therapy and a subsequent MRI if the problem persists. It depends.

Originally Posted by Rainger99

So if I twist my knee playing pickleball, and I go the ER and ask for an MRI, the doctor has to order it? And he makes the decision to order an x-ray rather than an MRI?

[retiredguy123]

Originally Posted by Rainger99

So if I twist my knee playing pickleball, and I go the ER and ask for an MRI, the doctor has to order it? And he makes the decision to order an x-ray rather than an MRI?

As a patient, you cannot demand an MRI if the doctor disagrees. But, personally, I think the medical profession is pretty stingy when it comes to ordering an MRI. Just my opinion.

[Joeint]

Originally Posted by Rainger99

I don’t need a referral to see a specialist in my UHC advantage plan.

And when I was working and before I had Medicare, I had to get a referral to see a specialist. It wasn’t a problem. My primary care doctor would always refer me.

You may not need a referral but you will definitely need an approval which may or may not happen. You need to get approval for a rehab stay if you need one. (dis)Advantage plans are fine if you're healthy not so much when you get older and need more care.