Having just switched to UHC MA from Plan F, could you please elaborate on just how this happens? The max out of pocket expense on option 1 is $4400/yr. and $1900/yr. on option 2, exclusive of drug cost, which is identical to plan F. There are co-pays on MA, but they are $15 and $30 in general, so $16,500 in 4 weeks is unlikely in co-pays. Did you include the cost of very expensive tier 5 drugs that you received in the first 4 weeks, in which case the cost would have been the same on plan F? Did the cost of drugs push you into the catastrophic phase and therefore the main cost fell on the MA plan? Was there a bone marrow transplant in the first 4 weeks? And finally, did you choose to utilize an out of network provider without prior approval? Since the formulary and terms of coverage are virtually identical in the 2 plans, the main difference is the network restriction.

No offense, but I'd really like to know the basis upon which you came up with these 7 "talking points"

1. Don't you think "preventative medicine" benefits older seniors as well? Even the government concurs with this, hence all their chronic care management, Optum QA criteria and PQRI initiatives. Like most physicians, the doctors of TVH are well trained in treating chronic and serious illness, in fact, it is the preventative medicine issues that in general are newer to us.

2. The provider network can, and frequently does change somewhat every year in ALL insurance plans. The insurance company can decide to drop certain providers, and the providers can opt out of participation in an insurance plan, just as patients have the option to change insurers. So what. Most of the insurers changes are QA driven, profit being a secondary motive in that decision.

3. True, AFTER the first year it is harder to change back to supplemental policy, there may be underwriting criteria and there may be a premium increase--but it's not "whatever they want to charge". But why would someone really need to change back? If you get "seriously ill" , there are more than enough in network physicians to treat you. If you have a NEED for care that cannot be provided in network, 99.5% of the time the insurer will approve the out of network provider. The main problem is when someone WANTS, not NEEDS out of network care, with exception of certain states such as California

4. Yes, we will all die, and yes the bill can be expensive. What is your point---it is the coverage that counts, not the raw bill, and your exposure is limited under either plan

5. Aha! Now we come to the crux of your philosophy---you used that most vulgar word to the far left---PROFIT. Of course, when it comes to health care administration, insurers "profits" are far, far less than government waste. As far as single payer government health insurance goes, I'll take a pass on VA medicine for all.

6. Actually, your Medicare card and supplement will probably COST the average patient about $2000/yr. MORE than the MA plan. If you are seriously ill, it may save you a few thousand. IF you CHOOSE to go out of network without approval, then it will save you a fortune, but then that would be on you, not the insurer.

7. I agree with that adage, but if you look at the plans it detail, you will find it does not apply here.

I agree!

Question remains---On what basis do you "agree".... I disagree, but have plenty of facts and experience for my opinion. You are certainly entitled to yours, but all I can suggest is to get the FACTS directly from a source---UHC or SHINE, after all, I could be wrong.......

My opinion is right for me based on my personal experience and of course, as you pointed out, your opinion is right for you based on your experience. Shine is an excellent point to start a search for health insurance details if, you have no health insurance knowledge. UHC representatives will only help you to understand how their product can work for you.

Please don't take my opinion personally. It is just my opinion.

I have a Medicare Advantage plan through Care Plus, and I'm very satisfied with it. I told my primary care physician that I was pleased with the plan, and he said "You should be pleased with it, you're very healthy." He told me that people with serious health issues would find major restrictions on their healthcare choices in any Medicare Advantage plan. His advice to me was to continue with Care Plus, but if any health issues should arise, change to original Medicare with a supplement plan at the next annual enrollment period. For me, I think that was good advice.

Having gone through the process (MA back to Medicare and supplement), you may be in for a shock. We got lucky and were able to change back during the first year with no penalty, however this is what was told to me: (if you want to go back to Medicare)
1. You may/will be subjected to health questions.
2. Based on your answers to the above questions, you may/will be denied coverage for a period of time for specific health issues, or subjected to higher premiums (both Medicare and supplemental).
3. I do not recall if you could be completely denied getting back to Medicare based on the above questions.

If you are considering this, I would call Medicare ( and or SHINE) and get info specific for your situation.

Also, ALL of this is subject to major changes with the new administration after January 20th.......

The above information is over 1 year old, and things may have changed.

I really do not understand the thrust of the question. They are talking points and relate to the subject at hand. What does " basis " have to do with it ? They either are factual representations or falsehoods. If falsehoods, go on record and correct them. I will not be offended.

1. I think preventative medicine has a prominent place in healthcare and do not think I intimated otherwise. I merely offered an opinion to the effect The Villages Healthcare system is emphasizing same in conjunction with its efforts to attract young healthy seniors to sign up for its Advantage product. This statement was intended as an opening for the rest of my post. Everything you added was absolutely correct but I saw no need to provider a " primer " to define " preventative medicine ".

2. Here I do think you are incorrect. The provider network provided by Medicare is all encompassing and probably includes 99 % of all physicians practicing clinical medicine in the United States and pretty much with few exceptions most medical institutions of note. The institutions opting out can agree however to except the Medicare reimbursement scheme voluntarily and many do so. Physicians can opt out but most that do are mental healthcare specialists. It is estimated that 42% of them have done so. Furthermore, any insurance company which provides Medicare Supplement policies must honor the claims of any medical service provider if Medicare has first paid the claim.

Medicare Advantage insurers on the other hand can as you indicated change their provider networks once each year. Medicare Supplement insurers have no say in the matter. The " so what " comment minimizes the importance in some cases of maintaining a trusted doctor patient relationship.

3. Okay you got me. I obviously misspoke and any re-pricing does have to be approved buy the state insurance departments. I am still under the impression however that once you opt out of Medicare Supplement insurance the insurance company can refuse to take you back if they feel you are medically not insurable. Welcome to the world of paying 20% of your medical expenses just at the point in time you are hard pressed to afford them. There are a couple of other posts dealing with why you might want to go back on this thread and I think they stand for themselves. Do you really believe all medical care is equal ? Personally I want the best for both my loved ones and myself.

4. I thought the point was to continue the post. If you think it superfluous, so be it.

5.Ahem ! I do not think you got me. I was a senior manager of a very specialized commercial insurer ( nothing to do with health insurance ) that for a period of time was the most profitable insurer of its type in the entire world. I, like the people at United Healthcare, was not dumb and did everything in my power to maximize " profits ". I am not going to get into politics with you since this is not the place to do so, but you might be very surprised. The " crux of my philosophy " indeed ! And you did offend me!

6. To quote your post " If you are seriously ill, it may save you a few thousand ". My response is simply a few hundred thousand is the more likely outcome.

7. I'll stand by the adage and its application.

Never mind. I took it out. (I have got to stop writing posts about insurance.)

But I do think there are lots of things to think about here in this thread. But I need to shut up now. I already said my piece.

Actually, a good debate. I re-read my point 5 and I agree it was offensive. My only excuse is that after a year of campaigning by politicians advocating "free" health care, "free" college tuition, and "free" whatever (and sadly there are voters out there that are stupid enough to believe that anything is "free"), as well as telling us America is bad because of capitalism and corporations are bad because they make a profit I was oversensitive to the issue. My sincere apologies.

I still would like to know how anyone on the UHC MA plan can rack up hundreds of thousands of uncovered bills, UNLESS they CHOOSE to go out of network without prior approval.

Village Heath with Tricare
 

Interesting thread. I have original Medicare with Tricare as a supplement. You are all correct that it is fantastic IF you can find the correct physicians and their staff can figure out how to bill Tricare. The issue finding medical care points you to the Medicare website which is WORTHLESS often out of date or the doctors no longer take Medicare, incorrect contact information, etc. I have resorted to word of mouth recommendations with various results, some good, some bad. A common thread is over crowding, poor administration and lousy scheduling procedures. One can count on showing up on time, waiting at least 30-45 minutes to be seen and only a few minutes with a physician or PA. We came from Colorado with Kaiser HMO and I was never delayed and billing was always correct to Tricare. Never payed a cent with a major surgery and follow up radiation. All the docs had my complete history and I could email each one or get refills of scripts over the phone. This place is in the dark ages. JMHO Just wondering if The Villages Health will take Tricare secondary and handle the bills??