Medicare Advantage - Don't do it

[Chrispy]

It's really hard to find a medical doctor who doesn't participate in Medicare except maybe Pediatrics. Not supporting Medicare as a doctor lessens your client base dramatically. You may find a few doctors that are concierge based doctors but it's pretty rare and I avoid them.

Not just participation particularly, but at what rate. I don't currently pay an additional premium myself for reasonable coverage, altho is being diminished by the idiotic drumphy administration.

 

[Talisman]

Nothing comes for free. Countries with national health care pay for it in higher taxes.
So far the majority of US citizens have supported the idea of some form of private healthcare, though seniors and the disabled get Medicare which covers some if not all costs.
Let's not get political here or the thread will be closed. This thread is for the discussion of US Medicare and it's Advantage options.

You're right, but it was a social rather than political consideration.
Last note and I'll close.
Clearly, nothing is free, and in Italy the tax burden is higher even to cover these services, but part of what I pay extra covers the healthcare costs of even a homeless person, and ultimately, I'm better off this way; there are some things that shouldn't depend on my bank account.
(N.B., this also avoids speculative paradoxes like clinics charging €618,000 to remove a flap of skin in a day hospital.)
End OT. Sorry.

 

[Power Pop 23]

You remind me that we are doing that as well as paying for Insurance! The office apparently was losing money. So to stay with our current doctor, both my wife and I had to sign up to this subscription plan. I think it is $300 a year or something like it per person.

It had a nice effect of a lot of patients leaving so appointments now are indeed quick! That wasn't a promised benefit but turned out that way.

A key attraction of the plan was a promise of a limit on the number of patients eligible for the service.

 

[Pareto Pragmatic]

OMG, Amir after all your time and position at Microsoft you didn't come away with some sort of medical insurance?
I guess not but that sucks,

A few companies offer something to retirees, far fewer than in the past. More common for some benefits post 65 years old on top of Medicare, but a few do have something for early retirement. Very few.

But separation, just leaving a job, that's a different story. Usually, that means cutting all ties and obligations.

Personally, I have a benefit of my employment contract that says upon retirement I can convert unused sick leave to pay, then use that to pay for the employer health plan. But I can't take it as cash. So that's nice for me. That's more a deferred compensation plan than them paying for health insurance. It's also a very defined amount, not an unknown amount going forward, so they can do the bookkeeping pretty easily in terms of long term obligations.

 

[Petrushka]

Actually, it's more nuanced than that.
1. While Medicare might not pay for hearing aids it's not unusual for a supplement plan to add hearing aid coverage. And if you have a physical ear issue like a broken eardrum Medicare will cover it.
2. While Medicare doesn't cover glasses, they will cover an annual eye exam without eyeglass prescription should you have a medical issue like glaucoma or a mole (possible cancer) inside the eye or other eye issues.
Eye glasses and hearing aids have become a commodity that's typically pretty easy to source.

I agree that glasses and hearing aids from Costco are a lot cheaper than insurance premiums.

I haven’t mentioned I also have VA, which I don’t us much, but which would cover catastrophic expenses. It paid 100 percent of a trip to the emergency room.

One thing not mentioned is, many doctors like Medicare, because it pays right away, unlike insurance companies.

I think the main problem is that medical need is kid of dubious. A provider can always find just one more service you might need. Countries that have free healthcare ration it.

 

[amper42]

I don't have first hand knowledge about "rationing" care in countries where healthcare is a right.

I do have first hand knowledge of some US Health insurer's delaying treatment authorization or outright denying coverage as a normal practice. Reports of this activity are easy to find. Many times it gets reported by a local news station before the heath coverage is magically approved. Greed now leads to AI systems developed simply to deny pre-authorizations in a more efficient way. Health Insurance companies no longer need to look for workers who are willing to disapprove needed treatment plans. The computer now does the job for them - along with strategically delaying responses to appeals to the point where the treatment is less impactful.

My advice, is stay away from Medicare DisAdvantage plans. If you don't play the game, you won't be impacted by the greed.
Healthcare should be a helping hand. Not an action primarily designed to empty the patients wallet in the most efficient way possible.

 

[Power Pop 23]

A self-directed plan of diet and exercise can be a relatively cheap ($), health care supplement plan.

Consider the 'advantage' of better knowing what you eat by keeping a diary of the amounts of foods eaten over a typical 3-day period.

 

[Doodski]

A self-directed plan of diet and exercise can be a relatively cheap ($), health care supplement plan.

Consider the 'advantage' of better knowing what you eat by keeping a diary of the amounts of foods eaten over a typical 3-day period.

My doctor said my health issues are worse than ever due in part to weight issues. I was ~175-185 pounds at 6 feet height all my life until ~7 years ago when I started gaining weight. I went to 338 pounds and felt that very much after ~300 pounds. It wasn't much of a bad feeling until ~300+ pounds. So.. I stopped eating all the beef and pork roasts that I love so much, no more nanaimo bars, no more cookies, no more peach pie from Walmart that I love, no more cheese everyday, no more sausages, no more of those extra large $1 Walmart chocolate bar snacks on the way home from Walmart shopping trips and no more anything like that. During the late summer for ~6 weeks strawberries where on sale so I went outside everyday for ~5-9 hours per day and ate only strawberries and yogurt everyday as much as I wanted and lost ~42 pounds doing that. It was incredible. Since that time I only eat Shreddies with orange juice, canned beans, use butter for my food still, 4 eggs/day, 2% milk, a small bowl of Knorr Sidekicks pasta/day, canned tuna and those packaged Asian noodles with the favor packet and oil etc if I get the munchies. I am still loosing weight and am down to ~280 pounds. By this time next year I will be at ~180ish pounds again. I went for blood tests last week and the doctor said I am doing very well, everything is right in the middle where it should be , blood pressure 120 over 80. He was very impressed that I lost so much weight and he himself will be eating strawberries and yogurt now too to deal with his weight issue. So he enthusiastically shook my hand and he seemed even more pleased than myself. I feel wayyyy better than at ~338 pounds. I have a lot of clothes now. From buying big and tall clothes and now buying reduced size clothing now as I decrease in weight I had to buy more clothes hangers and make extra space on the clothes racks. I expect I will be giving away clothing in awhile...LoL... I am advised when I lose more weight and increase my core strength that I will alleviate the tailbone arthritis pain and hips arthritis pain and it will again be much better and I will have fewer medical care needs too. So I will reduce load and expenses onto the medical care system.

 

[emmodad]

My doctor ... [ snip ]

The Dood abides...

Good on ya: discipline that should give you more years in which to look back on the 338 number in the rearview

 

[xanalog]

Shoot,

...I went for blood tests last week and the doctor said I am doing very well, everything is right in the middle where it should be , blood pressure 120 over 80. He was very impressed that I lost so much weight and he himself will be eating strawberries and yogurt now too to deal with his weight issue. So...

Are you threatening us that you are not going anywheres and sticking with us? eh?

Bon santé!

 

[Doodski]

Shoot,

Are you threatening us that you are not going anywheres and sticking with us? eh?

Bon santé!

Yes, you will never be rid of me or my kind! Hehe.

 

[amirm]

I don't have first hand knowledge about "rationing" care in countries where healthcare is a right.

I know of UK for when my brother and family lived there. I was shocked how much begging/complaining they had to do to get an appointment for minor illnesses. Appointments were weeks and months in the future for what would be a few days for us.

My brother had an episode of severe coughing that would not go away. They took them to the hospital and I went there to visit him. The doctor came in and was lamenting with the nurse on "this is the only medications we can get???" What is readily available but expensive in US was not an option there it seemed.

Mind you, if something bad happens to you like a heart attack, you will get instant treatment, no questions asked.

 

[JStewart]

It was well understood at the time ACA was passed that premiums would go up just as fast as before, but anything to avoid universal healthcare that every wealthy country has

Perhaps you could provide a link to a lawmaker who voted for it saying that?
For the record, I didn’t get to keep my health plan either. Did get to stay with my Doctor though. Thankfully.

 

[Pareto Pragmatic]

Perhaps you could provide a link to a lawmaker who voted for it saying that?

Lawmakers say a lot, so such a quote might exist.

The ACA mechanism for keeping premiums down was the rule (MLR or medical loss ratio) that 80% of premiums (85% for large group plans) had to go to patient care, so that leaves 15-20% for everything else. If an insurer spends less than 80/85% on care, they have to reimburse the customers the difference. That meant that jacking up premiums, or restricting care, would not lead to more profit.

They could get a year of float out of it though. Make money on it before sending out checks. In 2024 that totaled about 20% of all health insurance spending. Lots of profit investing 300+ million for a year.

As a note, MLR uses a 3 year average for calculations.

The float. Never forget the float when thinking about insurance companies.

 

[kidprofessor]

Perhaps you could provide a link to a lawmaker who voted for it saying that?
For the record, I didn’t get to keep my health plan either. Did get to stay with my Doctor though. Thankfully.

Well understood by economists, of course politicians said nothing about that.

 

[xanalog]

I stole this from our humor thread:

I dare you to call it OT!

 

[Beave]

I have a chronic gastro problem that requires me to see a gastroenterologist on a regular basis with intermittent testing done.

I had an upper endoscopy earlier this year, Charges to insurance were something like $18,000 for an outpatient procedure that took 15-20 minutes. I had to pay $1800 out of pocket in copays. I have an "Affordable" Care Act plan that costs $1300/month before subsidies and maybe $900/month after subsidies. That's with no spouse or children on the plan, just me.

I just called today to schedule my next office visit with the gastroenterologist, with whom I have been a patient for nearly ten years. Her next available appointment is five months away.

So I pay $900/month net for insurance that still charges a fortune if I actually need anything done, and for a doctor who is barely available.

The system is completely broken.

 

[Beave]

A few years ago I had to have an MRI for the same condition. There are several places nearby that could do the MRI. My insurance required me to do it at a specific nearby hospital, which turned out to be the MOST EXPENSIVE option around. They wouldn't cover it at any other place. Afterwards, I complained to the insurance about the cost of the procedure, and a different insurance company representative told me I should have done it at a different place that was less expensive. I told them I wanted to, but that they wouldn't let me. Incredibly stupid.

 

[Beave]

My friends say I could write a book about all the nonsense I've dealt with in medical care, but I won't bore you all with the long list of crazy stories, so I'll stop here.

 

[Soandso]

…I do have first hand knowledge of some US Health insurer's delaying treatment authorization or outright denying coverage as a normal practice.…

It seems my Med.Advantage plan hadn't played games with me in all the years been enrolled. Maybe it's because I'm domiciled in the right place.

Once after hospital surgery my hospital sent me notification that I owed them several thousands of dollars for a specific test done at that time. After I reported this to my Med.Advantage approved surgeon he was adamant it was necessary and promised to look into it. All I know is when I checked back with the hospital billing department they told me everything had been resolved and I owed U$0.00.

Another time a specialist wanted a specific diagnostic test and at first the Med.Advantage plan notified me that Medicare did not approve of that test so Med.Advantage couldn't cover it's cost. Again this doctor who is in my Med.Advantage HMO plan's network of providers (as they're called) challenged the postion. He did what is termed a "Doctor to Doctor" appeal which means personally contacted the Med.Advantage plan's supervisory medical Doctor engaging in professional explanation of why he, as my specialist, needed that diagnostic test. And yes, my Med. Advantage plan paid for it even though Medicare wouldn't pay them back U$0.01.

As for time delays; nope:

My Med.Advantage primary care Doctor has sometimes seen me and decided he wanted me to start consulting a new specialist. In more than one instance he explained that he would be submitting referrals to Med.Advantage on an "urgent" classification basis. And in a matter of days the Med.Advantage plan's local coordination administration ("P.C.P.") has telephoned me who/what/where I am authorized to contact for an appointment since they knew their mailed out authorization might be slow.

Likewise when specialists decided they wanted particular diagnostic tests to get a handle on my issues they put in "urgent" categorized requests which my Med.Advantage always approved all of in a prompt manner. Fortunately I reside in a city/town with many types of medical testing facilities which usually can schedule me in about 1 week or less. In one situation my specialist reviewed my testing and arranged for Med.Advantage to authorize a surgical intervention so fast I was in the hospital 3 days later - the hospital billed over U$100,000 of which Med.Advantage negotiated the settlement with no out-of-pocket cost to me.

Both times when one of my specialists moved or left my Med.Advantage HMO approved provider network they initiated contact notifying me. My plan then provided me with alternative Doctors in my network and after I contacted those finding one with openings for me Med.Advantage gave me an authorization to see the Doctor. The Med.Advantage plan had/has nothing to do with any delay(s) in getting any medical office appointment slot.

One specialist proposed an invasive procedure and when I inquired over the phone my Med.Advantage representative promptly provided me authorization for a 2nd opinion specialist. In that situation and others of a similar vein I've been able to discuss with the Med.Advantage representative exactly which specialists were in my network for planning my logistic convenience (I don't have a private vehicle).

Then to, my Med.Advantage primary care Doctor ("PCP") the family's long term physician who over the years got too ill to come into the office arranged for his associate to handle his patients. Eventually the Medical Group notified me that my original Doctor had formally retired so I contacted my Med.Advantage plan to officially update the name of my primary care physician. Well the representative couldn't find that Doctor in the P.C.P. network and it turned out he was not eligible because was strictly in the specialist classification of HMO participants. In turn the on-duty Med.Advantage supervisor waived that categorical restriction assuring me that the Doctor who'd been handling my care would continue being my legitimate primary care Doctor - duly sending me a new plan member card with the updated Doctor's name.

Lastly if it seems I've been overly active on this relatively fresh Original Post it's partly because have down time while have been and continue being in the midst of several specialist interventions all of which my Med.Advantage HMO plan has promptly approved for me. Yesterday I came home after yet another out-patient surgery attended by a team of nurses, anesthesiologist and neuro-surgeon whose group medical practice will bill Med.Advantage well over U$1,000 and get paid whatever amount Medicare approves. But as for me, well I've no co-pay due. And before the next 30 days have passed I've 2 more relatively costly medical interventions scheduled my U$0.00 monthly premium Med.Advantage plan is covering.