[RRGuyNJ]

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.

[CoachKandSportsguy]

Just a moment...

key statement:

She added that the company has also already repriced its ACA plans to account for the higher costs.

analysts have forecasted / predicted the increases will be greater than 20% my comments to regain the profitability growth needed for corporate bonus plans. . and to keep their jobs with the stock market price trend. .

But remember, the out of pocket costs if you get approved has a limit with most MA plans, and medicare does not, so be sure to include a medigap plan for the out of pocket costs which can soar with a prolonged stay in the hospital. .

[kingofbeer]

Originally Posted by RRGuyNJ

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.

Holy smokes. I assume that Medicare supplements might have an out of pocket limit.

[retiredguy123]

Originally Posted by RRGuyNJ

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.

I thought that the ACA required all health insurance plans to have unlimited coverage upper limits. That is, there can be no lifetime cap on coverage. A plan can have an annual catastrophic limit, but no lifetime coverage limit.

[LuvtheVillages]

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?

Yes, within the Medicare guidelines.
Yes for cardiologist.
Yes for neurologist.
I think the colonoscopy guideline is every 5 years.
I think the skin check guideline is once per year.
For lab work you need an order from a doctor. Go to the appropriate doc first.

[retiredguy123]

Originally Posted by kingofbeer

Holy smokes. I assume that Medicare supplements might have an out of pocket limit.

As I understand it, if you don't have a supplement plan, you are responsible for 20 percent of all health care costs under Medicare Part B, with no limit, and about $1,500(?) copay per hospital stay under Medicare Part A. If you have a supplement, the supplement will pay the 20 percent Part B cost and the Part A hospital copays.

[SoCalGal]

Originally Posted by tophcfa

Medicare Advantage plans don’t suit my wife and my needs, but that doesn’t mean they don’t work for others.

For me, Medicare Advantage works beyond satisfaction. I'm facing a life-threatening illness. I've seen more medical specialists in the past year than in my previous 74 years combined. The medication alone costs $16,000/month; I haven't paid a dime. Without exception, the specialists I've seen are highly qualified. After exhaustive analysis, I would have selected the specialists assigned to me. I feel blessed to have MA coverage.

[SoCalGal]

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.

People who think this believe that the "gatekeeper" system--where you see your primary care doctor who refers you to a specialist within the system--is filled with incompetent specialists who couldn't otherwise attract patients. I live in a large metropolitan area. I get exposed to the cream of the crop. If, for some reason, an assigned specialist doesn't click, I simply ask for another referral. Has happened to me once, and it was no big deal.

[SoCalGal]

Originally Posted by CrazyTiki

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests.

I have Medicare Advantage through Aetna. Aetna hasn't denied a single test or procedure since I've been under its coverage for 13 months.

[HappyTraveler]

Originally Posted by 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 $$.

I think you meant this comment for someone else. I didn't describe any of my specifics.

[BrianL99]

Choice A:

The government will provide you with reasonably priced healthcare. You can see most any doctor you want, at any time, without our approval. We'll pay for any recognized treatment you want, for any ailment you have. For about $150/month, you can buy additional coverage that will cover most deductibles and ancillary costs.

Choice B.

A private, profit-making company will manage your healthcare, within the bounds of what they think is reasonable, to insure they make a profit. They'll give you a free gym membership (that everyone wants, of course) and maybe 2 dental cleanings. In exchange, you save about $100/month on medical cost. In exchange for that $100, most Dr visits will be handled by a nurse or PA. You can't see any other Doctor, unless the Nurse/PA/Dr says you absolutely need to. If you need any special procedures or treatments, send them a message and they'll let you know if it fits into their business/profit model.

For the price of Cable TV, you can get the best healthcare available in the world or you can opt to save yourself $150/month.

Tough choice.

[kingofbeer]

Originally Posted by BrianL99

Choice A:

The government will provide you with reasonably priced healthcare. You can see most any doctor you want, at any time, without our approval. We'll pay for any recognized treatment you want, for any ailment you have. For about $150/month, you can buy additional coverage that will cover most deductibles and ancillary costs.

Choice B.

A private, profit-making company will manage your healthcare, within the bounds of what they think is reasonable, to insure they make a profit. They'll give you a free gym membership (that everyone wants, of course) and maybe 2 dental cleanings. In exchange, you save about $100/month on medical cost. In exchange for that $100, most Dr visits will be handled by a nurse or PA. You can't see any other Doctor, unless the Nurse/PA/Dr says you absolutely need to. If you need any special procedures or treatments, send them a message and they'll let you know if it fits into their business/profit model.

For the price of Cable TV, you can get the best healthcare available in the world or you can opt to save yourself $150/month.

Tough choice.

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium

[jminnis]

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?

MA is being hugely over-billed. If someone wants to look at government benefit cheats, start there.....

[retiredguy123]

Originally Posted by kingofbeer

Supplement plans IMHO are for those with chronic illness. Heart disease, high blood pressure, overweight, etc. I assume they do not have to be medically underwritten. If you are in good health, Medicare Advantage is fine
The medicare supplement plans start at $150 per month. Plus you may need to purchase a drug plan too.
Florida Blue for example Monthly Cost $178-$660
Doesn't include:
$185.00 Standard Part B premium

The Part B premium is $185 per month, unless you are under IRMAA, in which case the monthly premium can be more than $600 for the exact same coverage.

[Pat2015]

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?

You have to go through your primary care doctor and they get referrals sent out for you for specialists and tests that are required.