How Does Medicare Advantage work for you as a full-timer?

FWIW, some health associations are denying Medicare Advantage Plans as insurance. They say there are too many claim denials, and getting paid is can be a real hassle. That's what I have read anyway.
 
And some Medicare Advantage Plans are also denying coverage so specific physicians and practices - that from my physician's office during last physical. A number of their patients received letters that coverage was no longer available my doc.
 
From my understanding, some doctors are not happy that the Advantage Plan companies seem to be doing the diagnosing, by denying procedures prescribed by the doctors.

Kind of sounds like Grand Design denying roof repair claims put forth by the repairers. :)
 
We live in a rural Tx county so the MC Advantage choices are limited but we have Cigna Advantage simply because they pay way better than any other on my Wife's Parkinson's Meds( unbelievably expensive) , over 3 times as much as other plans.
She has used the emergency room in Arkansas once when we were at the family hideaway and if I remember right it was only $100 out of pocket
 
Oh boy this can vary widely depending on where you live all based on your zip code. Medicare or not - one type of policy/plan may not work for someone else or may not be available where they live.

We use an AARP Medicare advantage plan that is a POS (Point Of Service) type of plan for the last 3 years. It covers us no matter where we travel but it pays more if you use an in network provider. I was in the hospital twice last year, both times over a week stay, different hospitals, different parts of Texas. Also I had to go to several specialist to diagnose what was wrong. Our plan work out great and we have had no problems with doctors, specialist, hospitals or providers, even my ambulance ride to one of the hospital.

In total with our plan for 2024 we paid $2,159 out of pocket which includes two different hospital stays (different hospitals one week each), hospital emergency rooms, one urgent care facility, colonoscopies, endoscopies, pancreatic scans, thyroid scans, MRI's, primary care doctors, 3 different gastroenterologist, one endocrinologist, one standby surgeon, a couple different anesthesiologists, hospital attending doctors, drugs, eye glasses, dentist treatments/ procedures and other things I have forgotten right now.

Yes there are good points and some not so good points to our plan but it fits us pretty well no matter where we travel in the US. We always return to Texas once a year for our annual physicals and primary care dr visits and bloodwork. It has Medicare parts A and B, plus drug coverage, eye coverage, dentist coverage, $100 / quarter allowance for OTC stuff, and we have used them all this last year, and not just in our primary care location. We have also had prescriptions refilled all over the country at Walgreens, CVS and HEB food stores.
Now It doesn't help much with some of Tami's asthma inhalers like tier 3 drugs, but then again neither does any other plan.

Again this type of plan may not work for everyone. Its not traditional Medicare parts A, B, D plus a supplemental, G, H, etc) but its not an HMO advantage plan either. Everyone has to look at what plans are available in their zip code, pick what fits your situation best. How's your health, how much can you afford out of pocket, what drugs are you taking, etc, etc.
 
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@Steven@1478
Steven, I took the liberty of editing you post and spelling out POS just in case folks misinterpret that abbreviation (like I did at first - I had to read whether you were positive or not on the review).... :cool:;)

I'm of the same mind set as you - this can vary all over the place depending on the Medicare Advantage plan one chooses. We have one administered by United Health Care but it is specific to IBM retirees; so far it works very well.

When I first went on Medicare I chose a Florida Blue Medicare plan and immediately discovered it didn't work well except if FL. I changed it immediately in favor of an AARP Plan F that was available at the time.

I think one should worry as much about dental as medical. That one can be a bugger to figure out.
 
My medicare advisor recently told me that if you are financially secure, then a supplement is the way to go because there are no pre-approvals and you can see any doctor, anywhere. Downside is it is more expensive per month versus an advantage plan. Supplements are managed by medicare and not the individual insurance companies. Doctors typically don't get paid easily by advantage plans because those are administered by the individual insurance companies and each has their own set of coding. It is usually a coding issue which causes delays in payment. That is one reason why some doctors and hospitals drop insurance companies. Supplement plans have one set of codes used by Medicare so simpler to deal with for docs. For those of us who travel a lot, the supplement plan is probably the way to go if you can afford it.

The Federal Government does seem to want to get out of the insurance business and would rather see advantage plans and not supplements. With the new administration, there could be a move to beef up advantage plans so coverage is closer to a supplement. Will have to see.

Those that are 65+ know this, but for the younger people, if you sign up for a supplement, you can move to an advantage plan without any medical information or pre-existing condition info required. If you sign up for an advantage plan, you can move to a supplement in the first year without issue. However, after one year, you need to fill out a medical questionnaire and you can be denied coverage under a supplement.

I strongly recommend consulting a medicare advisor in your primary area. They aren't selling insurance and there is no cost to you. They will help you enroll in the right plan based on your situation. They get paid by Medicare to help you enroll. And they get paid more if you enroll in an advantage plan versus a supplement, just FYI.

The last thing and an important thing to mention about Medicare is the monthly cost and how that is calculated. When you get close to retirement and go to retirement seminars, they talk all about Social Security but not so much about Medicare. Your cost for Medicare not including any supplements or other plans is based on your MAGI (modified adjusted gross income) from your two years prior income tax return. Right now the baseline cost is $185 per month per person (there are no family plans on Medicare). There is a table to figure out your penalty if you make more than the minimum level which right now is $206K filing jointly. Unlike Social Security benefits, Medicare costs do count withdrawals from 401Ks/IRAs/etc as income as part of MAGI which can be a big surprise!
 
@Steven@1478
Steven, I took the liberty of editing you post and spelling out POS just in case folks misinterpret that abbreviation (like I did at first - I had to read whether you were positive or not on the review).... :cool:;)

I'm of the same mind set as you - this can vary all over the place depending on the Medicare Advantage plan one chooses. We have one administered by United Health Care but it is specific to IBM retirees; so far it works very well.

When I first went on Medicare I chose a Florida Blue Medicare plan and immediately discovered it didn't work well except if FL. I changed it immediately in favor of an AARP Plan F that was available at the time.

I think one should worry as much about dental as medical. That one can be a bugger to figure out.
Oh yes thank you, not the other meaning. Yes, dental is important as well as eyesight. They told Tami she has to watch for glaucoma.

It gets really frustrating reviewing the new year changes, drugs plans, max out of pocket and such as you may not know what you'll be facing healthcare wise in the coming year and you don't know how well your plan will work until you try to use it.
 
There are pitfalls like if you use traditional Medicare you need to select a drug plan even though you might not use it. If you don't get Medicare drug coverage when you're first eligible, you may have to pay a late enrollment penalty if you join a plan later. Using the ACA and plans for those policies is just as confusing.
Its a good idea to get help sorting through the health care plan quagmire and I would say be careful using advice from an agent that is paid for an insurance company. They may steer you to a policy they get the most commision on but may not be as good for you.
 

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