[Rainger99]

Originally Posted by LuvtheVillages

I like not needing a referral to see a specialist if I feel something needs attention.

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

[tophcfa]

Originally Posted by Rainger99

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor. You can talk with friends and family for references, coupled with your own research, and make an appointment with the doctor you feel is the best for your health issue at hand. As long as the doctor accepts traditional Medicare, which is just about everyone, you’re good to go. Plus, you never have to worry about them being out of network. You can’t just order your own MRI if you injure your knee, but you can determine who is the best orthopedic doctor specializing in knees and make an appointment to see him/her, and if they feel it’s necessary they can order it.

[Rainger99]

Originally Posted by tophcfa

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor. You can talk with friends and family for references, coupled with your own research, and make an appointment with the doctor you feel is the best for your health issue at hand. As long as the doctor accepts traditional Medicare, which is just about everyone, you’re good to go. Plus, you never have to worry about them being out of network. You can’t just order your own MRI if you injure your knee, but you can determine who is the best orthopedic doctor specializing in knees and make an appointment to see him/her, and if they feel it’s necessary they can order it.

I can sort of see the MRI. But if you go to a specialist and they don’t think the MRI is necessary but you do, are you out of luck?

How about the other appointments? Can you make them without any problem?

For example, years ago I severely sprained my ankle. Sometimes my ankle still bothers me. I don’t know if that is caused by the original injury or just old age. I would like to see a specialist but with MA, my doctor won’t refer me for a specialist.

I have a lot more aches and pains than when I was younger. It would be nice to see a specialist every time one acts up.

It would be great to be my own primary care physician so that I could take charge of my health care.

[sdeikenberry]

Originally Posted by Bemabound

TM does not cover out of country needs. TM consistently reduces what they cover, especially for quality rehabilitation - which is a high need in elderly populations. TM does not meet criteria to retain certain retiree federal health care benefits, but MA does. MA have some plans which reduce TM premium costs. MA - PPO plans let you see docs in other areas of the country (TM does but the clinic may cap their new pts, unlikely for MA to be capped). Many reasons to go with MA depending on your specific health needs.

A supplemental plan along with TM covers all of the above concerns. Advantage plans are geared towards profit in spite of the sales hype…patient care does suffer. No way do you want someone weighing the cost of your care over what’s best for you.

[dewilson58]

Originally Posted by Rainger99

.......................

For those with MA, at what point would you drop it because there is no advantage.

Never was an advantage.

[Lynnesail]

In addition to that, if you should get some rare tumor or disease..places like Mayo do not take advantage plans.

[bowlingal]

I have traditional Medicare and would NEVER switch to Medicare Advantage. I can go anywhere in the US, all lab fees are covered, no deductible, no referrals, no charges whatsoever. Yes, I have a supplement, but that monthly payment enables me to sleep at night and not have to worry about charges occurring if I get sick, car accident, cancer, surgery. That to me is worth every single penny.

[MX rider]

We're on UHC Advantage and are happy with it. They have a large nationwide network and we use the wellness benefits, as well as the dental and vision. Choice is a good thing.

We did our research and even talked with people on our plan. SHINE also said it was a good option for us.
Medicare is not a one size fits all. It's about what works best for you.

[Rwirish]

My MA provides all the above.

[tacostello]

Happy Traveler - thanks for sharing your specifics. Very helpful.
One question - have your supplemental premiums increased over time?
And I'll look into Well Care - and Part D $$.

[tophcfa]

Originally Posted by Rainger99

I can sort of see the MRI. But if you go to a specialist and they don’t think the MRI is necessary but you do, are you out of luck?

How about the other appointments? Can you make them without any problem?

For example, years ago I severely sprained my ankle. Sometimes my ankle still bothers me. I don’t know if that is caused by the original injury or just old age. I would like to see a specialist but with MA, my doctor won’t refer me for a specialist.

I have a lot more aches and pains than when I was younger. It would be nice to see a specialist every time one acts up.

It would be great to be my own primary care physician so that I could take charge of my health care.

Yes, you can make an appointment with any specialist that accepts traditional Medicare. You can’t order your own imaging or other diagnostic tests, that’s up to the specialist. If you’re unhappy with the treatment from a specialist, you can make your own appointment with a different one for a second opinion.

[oneclickplus]

Originally Posted by LuvtheVillages

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

I just wanted to "second" your statement. I have exactly the same position. I'm not lured by "free this and free that" with MA plans. It's not free if you give up something (autonomy to make decisions about when / where of care when needed).

[RoboVil]

Originally Posted by Rainger99

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

You normally cannot drop Advantage plans. You can always change from traditional Medicare to an Advantage plan but not vice versa. Advantage plans are great until you need an expensive treatment and then the insurance companies will delay the treatment using prior authorization delays or denials. With traditional Medicare there is no prior authorization and you get your treatment right away.

[RoboVil]

Originally Posted by LuvtheVillages

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

Don't ever leave traditional Medicare. Your life may depend upon it.

[RoboVil]

Originally Posted by Rainger99

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

If you have chest pain and want to be examined by a cardiologist you just call the office and make an appointment. No referrals needed.