[golfing eagles]

Originally Posted by Sabella

Wait till you get older and as we get older and we age, it’s sad to say but we do get sicker and more medical issues. Your advantage plan might be great now, but as I said, as you get older and you have more issues you’re going to regret that you didn’t stick with original Medicare.

And just what are those "issues", specifically, that you feel will be a problem with an Advantage plan as opposed to Medicare with a supplement? The only one I can think of is electing to have a procedure out of network that is also available in network----and that choice would be on the insured.

[CoachKandSportsguy]

Originally Posted by golfing eagles

And just what are those "issues", specifically, that you feel will be a problem with an Advantage plan as opposed to Medicare with a supplement? The only one I can think of is electing to have a procedure out of network that is also available in network----and that choice would be on the insured.

The biggest issue with advantage plans are rehab issues.
From people who have had those plans, they are fine, until post op rehab starts, then they have issues. And this is from a career nurse who worked in both clinical and administrative, both non profit and profit. . who has ****loads of questionable MD and insurance observed experiences.

[golfing eagles]

Originally Posted by CoachKandSportsguy

The biggest issue with advantage plans are rehab issues.
From people who have had those plans, they are fine, until post op rehab starts, then they have issues. And this is from a career nurse who worked in both clinical and administrative, both non profit and profit. . who has ****loads of questionable MD and insurance observed experiences.

My late wife had an advantage plan and had we had no issues with a rehab stay at Freedom Point of about 3 weeks.

[kendi]

Originally Posted by Dkintzer

As a licensed nurse in FL, I’ll tell you what we tell our 65+ patients…go to Welcome to Medicare | Medicare. They have a questionnaire that you will plug in your meds, diagnoses, where you live, etc & come up with multiple options for you. There are companies who are reputable & get paid by the insurance companies when they get a referral, not you, but don’t push 1 insurance over another. I just have not dealt with them in this area, only in Jacksonville. Hope this helps.

This is what we did and it was helpful to a point. My main concern was getting coverage for my $17,000 per month tier 5 specialty drug. The sight gave me pharmacies for my specific medication in my area and what I would be paying only to find out later that none of these pharmacies can actually get my meds. Even their specialty drug department couldn’t get it. Very misleading and frustrating.

Via benefits provided me with the best plan D options to go with and explained each in detail. Then finally the insurance carrier I chose gave me the info I needed as to how and where to get my meds

The process took a lot of research, calls and actually walking into various pharmacies before I finally was able to get the issue solved. I’d be up a creek if I had relied solely on the information provided by the government on this website you suggest.

[kendi]

Originally Posted by golfing eagles

My late wife had an advantage plan and had we had no issues with a rehab stay at Freedom Point of about 3 weeks.

I know people who did have issues there. Probably depends on the specific situation.

[CoachKandSportsguy]

Originally Posted by golfing eagles

My late wife had an advantage plan and had we had no issues with a rehab stay at Freedom Point of about 3 weeks.

sample 1, you know better than that for statistics.
Also well documented with studies in MA I have a source with multiple samples in multiple settings. . and have posted independently documented issues in MA from actual practitioners, which is resulting in proposed state level intervention.

Also have an admin insider (CoachK who is in charge of all hospital system regulatory reporting) with MA data samples, causing many hospital issues.

checkmate

[kendi]

Originally Posted by golfing eagles

And just what are those "issues", specifically, that you feel will be a problem with an Advantage plan as opposed to Medicare with a supplement? The only one I can think of is electing to have a procedure out of network that is also available in network----and that choice would be on the insured.

Premature death is one such problem. A friend couldn’t get the proper care needed because the advantage plan would not pay for the medical facility she needed to go to to get the specialty care needed. This person died as a result.

On the upside, a relative of mine with lots of medical issues has an advantage plan that has been great for her. She lives in a state where the healthcare is excellent and the hospital system she is in is covered by her plan. And this system provides top notch care for just about any condition you can think of.

[golfing eagles]

Originally Posted by kendi

Premature death is one such problem. A friend couldn’t get the proper care needed because the advantage plan would not pay for the medical facility she needed to go to to get the specialty care needed. This person died as a result.

On the upside, a relative of mine with lots of medical issues has an advantage plan that has been great for her. She lives in a state where the healthcare is excellent and the hospital system she is in is covered by her plan. And this system provides top notch care for just about any condition you can think of.

A lot of assumption there. Depends on her illness, its severity, the definition of the care she would have gotten at the "medical facility she "needed" to go to" vs the care provided in-network and that her death was a direct result of not being at one specific facility as opposed to the underlying pathology. Sorry for your loss, but it may be a case of post hoc ergo propter hoc.

[golfing eagles]

Originally Posted by CoachKandSportsguy

sample 1, you know better than that for statistics.
Also well documented with studies in MA I have a source with multiple samples in multiple settings. . and have posted independently documented issues in MA from actual practitioners, which is resulting in proposed state level intervention.

Also have an admin insider (CoachK who is in charge of all hospital system regulatory reporting) with MA data samples, causing many hospital issues.

checkmate

And as chairman of QA, I would have been in charge of the work CoachK did.

un-checkmate

[rsmurano]

Advantage plans are the worst, I don’t care which 1 you pick. They are ran by insurance companies and the way they make money is to deny service, I read they deny service almost 70% of the time. Congress is looking at this because Medicare does not deny any service. The insurance companies hope you stop at this point and not get the help done, so they save. You can get your Dr to fight them and maybe they will cave in but a lot of the time they don’t. So you have to ask yourself, if Medicare doesn’t deny you medical service, why should an advantage plan deny you?
There are many other benefits that a plan g/n/or any other supplement plan out there provides over an advantage plan.

[mrf6969]

We got fed up and kicked Dis-Advantage down the road. Go get peace of mind by losing the brain damage when you get into Medicare Supplement G.

[Stu from NYC]

We have had an advantage plan for the 4 1/2 years we have been here and working very well for us.

Does help that personal physician does a very good job for us in getting approvals

[golfing eagles]

Originally Posted by rsmurano

Advantage plans are the worst, I don’t care which 1 you pick. They are ran by insurance companies and the way they make money is to deny service, I read they deny service almost 70% of the time. Congress is looking at this because Medicare does not deny any service. The insurance companies hope you stop at this point and not get the help done, so they save. You can get your Dr to fight them and maybe they will cave in but a lot of the time they don’t. So you have to ask yourself, if Medicare doesn’t deny you medical service, why should an advantage plan deny you?
There are many other benefits that a plan g/n/or any other supplement plan out there provides over an advantage plan.

And to quote Luke Skywalker from Star Wars ep.8, "Everything in that post is wrong"

Medicare doesn't deny any service???? I wish. Unfortunately we had several FTEs just to fight Medicare denials. I can't count the number of times I had to personally speak with the physician at the Medicare intermediary to get a simple CT or MRI for a patient that needed it.

They don't cave in if the physician fights for it???? Maybe I'm lucky, but I ran 100% at getting Medicare to approve once I spoke with them.

Advantage plans "deny service"???? No, they limit choices by restricting services to networks. These networks are generally large and diverse enough to handle 99.9% of patient needs.

Deny 70% of the time? I would guesstimate, based on 35+ years' experience that it is about 5-10%--but even that percentage is huge given the volume of orders.

And finally, you should realize that when Medicare denies a service, both advantage plans and supplemental plans alike will deny service as well. The best way to fight either is to have the physician make the necessary phone call. Unfortunately, most doctors these days seem more interested in maximizing billing and consider following up on denials as a waste of time.

And finally, from a patient's perspective, my late wife had an advantage plan----ZERO denials
My current wife has an advantage plan---ZERO denials
I have an advantage plan---ZERO denials

Now, does anyone think that with my knowledge and experience I would sign up for a plan that is "the worst"????? There are some cost saving with and advantage plan, but trust me, I couldn't care less about that.

Those that are critical of advantage plans have either experienced or more likely heard of the one-off problems. Americans, (me included) are generally whiners who want what they want when they want it. Many will sign up for an advantage plan for the monetary savings and then scream bloody murder when they can't see the Chief of Cardiology at Massachusetts General Hospital. But if anyone can't find a physician among the 175,000 that are in the Florida Blue network I can't help them

Of course, these plans aren't for everyone. If you have significant chronic health conditions and are already seeing specialists that would fall out of network, go with a traditional supplement. But if you are relatively healthy, the chances of getting a condition that cannot be adequately handled with a BC/BS or UHC network are quite small

[maistocars]

May want to get off Advantage and go on on a Supplemental. Best decision I ever made. No issues with docs. Up to you.....

[keepsake]

The timeline with Devoted since 12/31/2023 has deceptive procedures in the experience.
Receipts and claims were submitted by US mail on January 8th, 2024.
We learned from a devoted rep later on that the claim was in-fact received and denied but "member had no way to be notified"
That was total B.S. Claim went in US mail, denial notice should be in US mail. Devoted never did that until April.
Turns out fine print in EOC had 3/31/2024 as last date to file a claim.
So Devoted INTENTIONALLY kept member in the dark until 2nd quarter.
This is not an appeal issue IT IS A FRAUD issue and Devoted has to be held accountable.
Amount for both me and wife is $ 560
$ 560 that we would never have spent if the benefit wasn't out there.