Biden is Going After Medicare Advantage Plans

[wildhorseluvr]

My insurance broker in central Oregon strongly warned me to never sign up for an Advantage plan, and my agent here said the same thing. That’s for me…may be entirely different situation for someone else. I’m one of those Jolly mentioned with limited knowledge and difficulty understanding the ins and outs. I had a trusted broker for many years who helped me get the best insurance for my needs at the best possible price, and my new insurance guy here spent a long time patiently explaining the differences and helping me make the best decision. 

[solargeek]

Apr 6, 2024 12:04:14 GMT wildhorseluvr said:

My insurance broker in central Oregon strongly warned me to never sign up for an Advantage plan, and my agent here said the same thing. That’s for me…may be entirely different situation for someone else. I’m one of those Jolly mentioned with limited knowledge and difficulty understanding the ins and outs. I had a trusted broker for many years who helped me get the best insurance for my needs at the best possible price, and my new insurance guy here spent a long time patiently explaining the differences and helping me make the best decision. 

We too were warned about Advantage plans especially in Wisconsin which has its own rules – – one of three states that does.

We have seen with my in-laws who have United Healthcare Advantage plan that they ended up paying differentials that are not listed for the nights in the hospital once they pass 6-7 nights. $250 a night kicks in.
They have great drug plans because they use a lot of drugs earlier on. They don’t have vision and they should’ve.

UHC Advantage plans that our contemporary friends have are also as bad as when we were on UHC through my husband’s work. Every chance they could, they denied everything.

You had to fight for over a year to get things paid.
I’m not a fan of the Advantage plan for many reasons but for some people it works great. YMMV

[BrewDaddy]

Now ya'll got me scared of what is to come.....

Started digging into what Oregon does and how it all fits together and am clueless...

Hoping my local Senior Services folks can get me squared away when the time comes.

bd

[arabianknight]

Apr 6, 2024 11:42:49 GMT Jolly said:

The problem I have with all this, is that we're talking mostly seniors here, many with limited medical knowledge, limited insurance knowledge and some with mild cognitive problems. Medicare Advantage is an insurance product and it can be very confusing, even for the best of us.

Or Medicare in General.  That is why I tell anyone that is getting to that age to go see an Independent insurance agent.  Ask Questions there and they can and will answer those questions and or concerned. And one should every few years go in and go over your plan and see if there is another option that may be better for an even lower price. That is what I did and so did my friends when I told them to go see a Insurance agent that is independent and can offer plans from any company, and compare between them all for the best for you at the time. As things change later join life go in and REVIEW what you have and maybe get chances suited better for that stage in life.

[wildhorseluvr]

Apr 6, 2024 17:42:24 GMT BrewDaddy said:

Now ya'll got me scared of what is to come.....

Started digging into what Oregon does and how it all fits together and am clueless...

Hoping my local Senior Services folks can get me squared away when the time comes.

bd

Makes me feel a little better to know smarter minds than mine struggle with understanding this mess too. 😁
Life can get a bit scary when you’re on a fixed income and necessities like food, housing and medical costs are skyrocketing.
I started out here with an agent who was honest and gave good advice, unfortunately he was totally unreliable about keeping appointments, LOL. Found another agent in the next town who is great and managed to explain plans well enough even I understood most of what he was saying. 

My insurance broker in central OR was always keeping an eye on changes and looking for the best plan for me. He would periodically call me in to go over the differences and why changes would be to my advantage. I struggle with things like co-pays and being nickle and dimed to death for every little thing. He found me a plan that cost a bit more monthly but eliminated those hassles for me. 
Another reason to touch bases with your agent on a regular basis is if your health changes or you start adding/changing meds. Just one of my meds is approx. $2k/mo without insurance, about $360 with insurance, and while satisfying the deductible it cost me over $650/mo for a couple months. ☹️Changed my drug plan last fall and the same med now costs me around $200/mo. 

[solargeek]

Hey! I found this really helpful (to me) email I sent a friend when she was determining whether to go with Advantage or Supplement. I have WPS Supplement and am so happy with it. This was in a Medicare document I received. IN each answer, the Supplement situation is first and bolded; then the Advantage plan is underlined and sometimes bolded.

"Pros and cons—determining the best plan between Medicare Advantage and "Medigap" or "Supplemental" plans
Will I still be covered by Original Medicare? With a Medicare supplement plan, you keep your Original Medicare coverage and pay your Part B premium.
With a Medicare Advantage plan, Original Medicare is replaced by coverage from a PRIVATE company; & you still need to pay your Part B premium. [SG here: this means the company can and does CHANGE THE RULES.]

Can my plan be terminated? A Medicare supplement plan cannot terminate your coverage and is guaranteed renewable for life, as long as you pay your premium.
Medicare Advantage plans can change benefits and networks, or even be discontinued, at the end of each year.

Can my plan benefits be reduced by the insurer? As long as you continue to pay the Medicare supplement plan premium, benefits will only change if required by law.
With a Medicare Advantage plan, copays, deductibles, and out-of-pocket limits can change each year.

What service area does the plan cover? With a Medicare supplement plan there is no network, so you can see any health care provider that accepts Medicare in the U.S.

With a Medicare Advantage plan, the plan network is usually limited to certain providers and geography, except in emergencies.

Do I need referrals? No referrals are necessary with a Medicare supplement plan. [SG HERE: this was critical for us to pick our own doctors, not an HMO or assigned doctors}
With a Medicare Advantage plan, referrals can be required for specialists or to get care outside the network.

Does the plan include supplemental benefits? Medicare supplement plans provide coverage in addition to your Original Medicare coverage.
Medicare Advantage plans vary. They must have benefits at least equal to Original Medicare, but they are not required to provide supplemental benefits.

What happens if I move out of state? The Medicare supplement (Medigap) plan moves with you wherever you live in the U.S.
With a Medicare Advantage plan, moving out of the plan’s area can cause loss of coverage.

Does the plan have to cover Wisconsin’s state-mandated benefits? Under a Medicare supplement plan, state-mandated benefits—such as skilled nursing care, home health care, and chiropractic care—are covered.

[SADLY ]With a Medicare Advantage plan, state-mandated benefits are not required to be covered."

[wildhorseluvr]

Thanks for posting that, solargeek.

The insurance broker I had in central OR (retired Marine and personal family friend) was adamant that for my situation I never change to an Advantage plan.
I remember 3 of the issues he pointed out were: Medicare supplement cannot be terminated, no referrals necessary, and goes with me wherever I go. My eldest DD was upset when I ended up in the hospital last fall, thinking I had the Advantage plan and would end up with no coverage in a new state. One quick call to our broker friend confirmed I was covered. 

I also recall something being said about once you got on the Advantage plan you might not be able to switch back to the supplement? Not sure if that’s true now or something they’re trying to put in effect soon.

BTW, at one point after my DH passed, I kept getting billed for a life insurance policy he had taken out on me. Didn’t want/need it but had a lot of trouble cancelling it. Finally managed to do so…or so I thought. With my memory getting scrambled at times, I confused that policy with my Medicare supplement. 😱 Believe me, you do NOT ever want to do that!! Took me many, many long phone calls to Medicare to resolve this and the ONLY reason they let me sign back up again is due to my memory issues and some very serious family medical crises that happened during that time, every one of which had to be documented. They finally made a determination that I could go back on the supplement plan. I hate auto pays but that same day had them set up the auto payment through my bank and told my kids never to cancel it until I’m 6 feet underground, LOL. Not an experience I ever want to repeat, LOL. 

[Tricky Grama]

When we took the advantage plan we were under the impression we could switch anytime we wanted. 'Course ya know we get lied to all the time...

[David!]

Trying to get on original Medicare from Advantage plan usually requires medical underwriting. So by the time someone gets sick it’s usually too late to switch. I think this is why we need to carefully weigh the pros and cons when first getting on Medicare. The agent assured my brother if he got really sick he could just switch to regular Medicare. That proved not to be true. It’s tough to make a decision that will impact the rest of our lives that’s often irreversible. Things like this need to be pondered over a pitcher of margaritas.

[David!]

BrewDaddy , Try 90DaysFromRetirement.com. The guy has many yalltube videos offering the pros and cons of both plans. I’ve spent countless hours over the past 6 months studying this. Good luck!


solargeek, Thanks, that’s a really good comparison in a nutshell. Sent his to several friends who have bones that are reaching 65 soon.

[BrewDaddy]

Thanks David! I'll check it out. bd

[solargeek]

At least in WI you can NEVER go up from an Advantage plan to what I have- Supplement Plan "G". Which is run through a private company and fits the parameters above. I pay more ONLY because I want coverage not offered with Advantage plans- travel, out of state, total free choice over and over for any issue.

Seriously, as far as I was told by the Medicare person and it's the same at least in GA where DS is, YOU cannot step back UP to a private Medicare Supplement once you go with Advantage. SO you are stuck with a lesser plan the rest of your life.

It may well be you can beat my costs but we travel to MKE, MSN, ORD, DC, TN, GA (soon to end as DS and DBIL are moving to the Loop/Chicago in July), and AZ all for family every year. Unless I want to never see them again, I want coverage everywhere I have to go. We (DH and I) are aging (60s) and for sure the worst is yet to come.

[farmrbrown]

Apr 7, 2024 22:02:24 GMT solargeek said:

Seriously, as far as I was told by the Medicare person and it's the same at least in GA where DS is, YOU cannot step back UP to a private Medicare Supplement once you go with Advantage. SO you are stuck with a lesser plan the rest of your life.
.

That's correct. The only way to return is by an appeal, citing extreme circumstances or if you change your mind in the first 90 days of signing up.

www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

[wildhorseluvr]

Tricky Grama, if I’d not been warned to stay away from the advantage plan, I wouldn’t have known either. Just because the advantage plan is not a good one for me doesn’t mean it’s not ok for someone else. 

solargeek, Plan G is what I’m on too. 

[joebill]

I freely admit to being very selfish in my decision to go with regular Medicare and a supplement.

I KNOW that private industry only can and will accept a losing proposition for a very limited time, but the government can and does engage in a lifetime of disgraceful loss if it will buy a few votes. We hardly studied the issue at all.

Called our state farm agent and asked him what their supplement plan covered and he said "whatever Medicare does not cover" and that is how it has been. Price has gone up over the years, of course, but it buys us a lot of security and we never have to wonder how much a hospital bill will add up to......Joe