Originally Posted by Blueblaze (Post 2447191)

Our current Humana "Giveback" PPO plan is free and even refunds the Social security deduction for Medicare.

Originally Posted by Rainger99 (Post 2447207)

What is your current plan?

Originally Posted by Blueblaze (Post 2447191)

I confess, I don't understand how MA stays in business giving insurance way for free. I suspect it has something to do with those $500 office call visits they bill the gooberment, that used to only cost me $25, back before doctors started billing insurance companies instead of patients. But after paying 3% of my wages for 50 years on a promise to get some back if I lived to 65, I see no reason to shell out $1000/mo of my life savings at the back end of this scam, for the same thing I can get for free.

Originally Posted by Blueblaze (Post 2447191)

Yes, I complain about the lousy primary care doctors that are available here in-network, but I'm not convinced that paying an extra $1000/month between the two of us would improve our choices much in this healthcare desert.....

Originally Posted by Blueblaze (Post 2447191)

I confess, I don't understand how MA stays in business giving insurance way for free. I suspect it has something to do with those $500 office.....

Originally Posted by HappyTraveler (Post 2447243)

Replying to comment #80. Good comment overall.



I am unconvinced of this also. Just because a claim is made with TM that you can choose whatever specialist you want doesn't mean that Doc is taking new patients. Many of the experienced ones aren't; they're full.


If I understand what you're saying here... you mean how does the insurer stay in business? It is as follows (I'm no expert here if anyone wants to provide more detail on this).

The Fed Gov pays insurers approx $1000 monthly for each Advantage plan enrollee they have. So, Humana is getting about $12,000 p/year for you. BCBS gets the same for me. They're insurers so, they know how to manage risk, benefit and P&L. So, they can offer benefits back to enrollees from the money they're taking in every month.

In the plan you chose, they kick back part of the $1000 to you as reimbursement for what you mandatorily pay into Medicare each month ($180 or so). I could have chosen one of those plans but, decided to pick a BCBS plan that, instead of that, offers a generous allowance - $3500 p/yr - that can be used for dental (no implants), vision or hearing -- or any combo of those. I was anticipating dental work this year so....

I'm trying to use some of that this year but, haven't been happy with the periodontal practice I chose. So, am going to go to another one. But, here I can answer the question posed in comment #54 - asking whether others have had treatments denied by an MA insurer. It's a classic example of the devil is in the details.

I had one denied by BCBS related to this dental work. But, guess what? It was the vendors fault, they installed something in the treatment plan that is not covered and that exception (bone grafting, implants) is fully disclosed up-front in the plan so, I don't know why they did that. That part of the authorization was denied, of course. So, it makes you wonder how many of the denials of treatment related to MA plans are actually screw-ups by the med practices? Either erroneously filed outright (like my case) or the wrong procedure codes were used causing a denial. See?

Two more things to add: I do see in the details of the work I want to have done that the insurer isn't going to cover every aspect of the procedure - some aspect codes I would have to pay out-of pocket. So, for the total procedure, I may have to pay for about 40% of it. I don't love that and it feels a little like a bait-and-switch but, I also get that they're not going to let someone just easily blow that $3500 - they want them to have skin in the game and that probably helps keep the medical provider from simply selling a patient on anything to get their piece of that allowance.

Also, the other allowances related to my plan are $135 p/quarter to spend on OTC items (via a loaded debit card), Silver Sneakers membership, regular annual dental care, eye exam and new glasses every year, no cost for Tier 3 and 4 prescriptions. No monthly premium for the plan.

I mention all that because it's not just the lack of paying a monthly premium that is saved, BCBS is actually paying me. If I use all of the allowances provided, it will net me over $4000 p/yr.

Lastly, I would caution anyone, regarding any life issue against making a decision today for a 'maybe' of what might happen a two decades from now. That could cost a boatload of money over time and many things are going to change anyway, that's guaranteed.

Originally Posted by Aces4 (Post 2447246)

Ouch... I hope all those considering signing up for Medicare Advantage read this!

Originally Posted by HappyTraveler (Post 2447224)

He mentions the very name which you posted.
It's probably either the second or third one down, here: https://plans.humana.com/plans
Like with all of them sort by zip code and county for your options.

Originally Posted by Rainger99 (Post 2447291)

There are two that seem to fit his description. I am trying to find out which one he recommends.

HumanaChoice Florida Giveback H5216-452 (PPO)

Humana Full Access Giveback H5216-393 (PPO)

Originally Posted by kingofbeer (Post 2447166)

The best plan with the most coverage.

Originally Posted by HappyTraveler (Post 2447281)

Ouch, I also hope they recognize that you make no argument at all in that obtuse comment.

But, I will point something out from your comment further up;

Indeed, that might be the case....or not.

What people also need to consider is, no matter their insurance plan, whether the surgery or procedure a specialist is recommending is actually needed? It's estimated than 12%+ of surgeries/procedure in the USA every year are unnecessary. That is something like 2.5 million+ people undergoing the knife who don't need to be. Think about that. How many of them died b/c of it? How many suffered adverse outcomes?

I know countless stories of people who later realized they didn't need the surgery they had gotten (me also) and some who realize that they didn't seek less invasive options before agreeing to be cut into. So, the easier it is for many Docs to sell you something, well, that's what they're going to do. KA-CHING!

Originally Posted by kingofbeer (Post 2447165)

It's a stupid rule to charge extra if you have higher income. The medicare premium should be zero for all.

Originally Posted by Aces4 (Post 2447340)

Research regarding your MD may be the answer if you've run into a "cut happy Dr". I am sure I am not the only person not to have Drs. that try to sell me something. I'm talking about tests that could help with the prevention of strokes, heart attacks, aneurysms, etc. for which the elderly have a propensity. Ct scans, MRIs, Doppler ultrasound testing are great tools for diagnosis without a scalpel in sight. As far as the KA-CHING for Drs. treating Medicare patients, have you ever seen a traditional Medicare statement? Yeah, those Drs. are rolling in the dough, lol.

Originally Posted by HappyTraveler (Post 2447355)

Everyone who has reached a mature age has run into "cut happy" Doctors whether they comprehend that or not. (Plenty don't) You can't have upwards of 2.5 million+ unnecessary surgeries/procedures every year in this country without that being the case. It happens in the dentistry and the veterinary realms too. Caveat emptor.

The last couple sentences are a good indicator that you weren't employed in the business arena during your working career. The evaluation criteria you used isn't accurate or complete.

My Mother was on TM for 30 years and she mused to me why her Doc would tell her to come back and see him for some minor thing she went in for. She'd say, "I healed fine and there are no problems so why does he need me to come back?" I replied, "For the billing, so he can fill the calendar and get paid." She'd be in there all of 2 to 3 minutes for the return visit and Medicare got billed. She stopped going back when she knew there was no need. She lived until one week shy of 98.

Originally Posted by CoachKandSportsguy (Post 2447419)

Expect MA price increases coming to your account:

https://www.bizjournals.com/stlouis/...increases.html

when asked about a subscription, just click on the No Thanks link to continue reading. .
Does not discuss your MA plan, just and example of MA companies needing large price increases to maintain solvency. .

good luck to us!

Originally Posted by CoachKandSportsguy (Post 2447419)

Expect MA price increases coming to your account:

https://www.bizjournals.com/stlouis/...increases.html

when asked about a subscription, just click on the No Thanks link to continue reading. .
Does not discuss your MA plan, just and example of MA companies needing large price increases to maintain solvency. .

good luck to us!

Originally Posted by Aces4 (Post 2447365)

Yes, because a Dr was thrilled to make the $3.00 off your mother's visit. It never occurred to you that her Dr. was following up to insure her issue was completely recovered. On the other hand, it does sound like the Drs that the two of you had chosen may not have been vetted by you. :icon_bored:

Hate to disturb your visions but I have worked in healthcare, dentistry, the health insurance and LTDB arena. Why do you think physicians don't want to work in Florida, old people aren't as profitable for them.

Originally Posted by HappyTraveler (Post 2447521)

Doc made more than $3...that is just silliness. He told her to come back for the billing.

I guess you'd also be shocked to hear that the Medical Director at the nursing facility where she later lived for a few years into her 90s isn't primarily there for the patients/residents - he's there for the owners of the facility. And his starting point in making decisions is what benefits them (and his monthly or annual bonus). The real world....

Originally Posted by Aces4 (Post 2447525)

.... traditional Medicare allows VERY little for a brief office visit. The physician has booked time that could have gone to a patient who pays a normal fee plus he has overhead for the medical assistant or nurse, room set up and cleaning afterward, office rent, malpractice insurance, supplies and on and on.

Originally Posted by HappyTraveler (Post 2447542)

Yes, indeed.....you made my point. It's like empty airplane seats are 100% lost revenue for the airline just as the open calendar spots are lost $$ for a Doc.


She chose her Doctor, lived hours away from me and he was otherwise capable. Maybe you would force your parent to do something but, I would not unless it was a danger. I got no indication of that. She solved it by not returning for unneeded follow-ups. (Plus, who says the next Doc wouldn't do the same?)


And I am sorry that you continue to conflate things erroneously. It seems to be a habit and only creates negative interactions and faulty assumptions.

Here's the reality, she DID get pulled from there when I figured out what was going on. While my 3 brothers were clueless about it all and the one that was her caretaker and had all the POAs was largely AWOL. (Note to all: don't ever give one person all the POAs) They overbilled her for 10s of thousands and were feeding her too many sedatives - like they do most of the inmates. He never got the $$ back. It was atrocious.

We can end this here. I'm not interesting in dialoguing with anyone who wantonly conjures and believes things that aren't factual.

Originally Posted by Aces4 (Post 2447587)

Yup, it's ending here. Holding all physicians up to the same light because of bad choices on the patient's end and then concluding Drs. are all getting rich off of traditional Medicare because of an appointed followup office visit doesn't float
the rational boat. :shrug: (BTW, nothing was conflated, comments were based on the information that was provided.)

Originally Posted by Rainger99 (Post 2447291)

There are two that seem to fit his description. I am trying to find out which one he recommends.

HumanaChoice Florida Giveback H5216-452 (PPO)

Humana Full Access Giveback H5216-393 (PPO)

Originally Posted by Blueblaze (Post 2447717)

the various gimmicks United was doing, like free "stuff" from some weird online store that mostly had "stuff" I don't need.

Originally Posted by Blueblaze (Post 2447717)

We're on the 1st one, but that's not a recommendation. You need to do your own research. I'm just saying I don't understand why people defend paying twice what they probably paid for their employer's insurance for a Medicare add-on, after paying 3% of their income for their entire career towards Medicare. The result they get seems no different than what they'd get for free, so far as I can tell.

I chose the "giveback" deal because Humana is the only one offering it, and I'd rather have the money in hand than beg for it through the various gimmicks United was doing, like free "stuff" from some weird online store that mostly had "stuff" I don't need.

I apply that same logic concerning the $1000/mo it would cost for a Medicare supplement. $12K/yr in the bank buys a lot of healthcare that I probably won't even use, anyway. I buy insurance for disasters, not groceries. My "free" MA plan (that I already paid for) pays at least 80% of the disaster costs, and I've saved $12K/yr towards the 20%, in the meantime.

Originally Posted by biker1 (Post 2447846)

I don't know anyone paying $1000/month for a Medicare Supplement. I do know a lot of people, including myself, who are paying less than $200/month. Regarding your "free MA plan", you are still paying the Medicare Part B premium of $185.00/month.

Originally Posted by kingofbeer (Post 2447027)

54% of Medicare beneficiaries are enrolled in Medicare Advantage plans. I enrolled in Medicare Advantage because I wanted to be able to see Villages Health primary doctors. I was not impressed with any local primary doctors who where not part of Villages Health. IHMO, MA is perfect for those without chronic illness or conditions. High blood pressure, obese, heart condition, obese etc. You will see how expensive a gold Medicare supplemental plan is and then you will decide for yourself.

Originally Posted by tophcfa (Post 2447956)

Totally agree, I’m paying less than $200 per month for what I believe is the best Medicare Supplement plan money can buy.

Originally Posted by Rainger99 (Post 2448058)

What is the best Medicare Supplement plan??

Originally Posted by biker1 (Post 2447846)

I don't know anyone paying $1000/month for a Medicare Supplement. I do know a lot of people, including myself, who are paying less than $200/month. Regarding your "free MA plan", you are still paying the Medicare Part B premium of $185.00/month.

Originally Posted by tophcfa (Post 2447956)

Totally agree, I’m paying less than $200 per month for what I believe is the best Medicare Supplement plan money can buy. Perhaps they are confusing Medicare with Obamacare? Last year I was paying over $1,000 per month for a far inferior health care plan through Obamacare.