What about Medicare advantage plans?

14 years ago

The Medicare advantage plans are the ones that cost nothing over your regular Medicare premium (I believe), and include drug coverage. Co-pays are required, and possibly other contributions.

I've avoided them because a) the health insurance companies push them, and I figured if they're good for the insurance company, they're bad for me, and b) my understanding is that the government is planning to shut them down. Is this true?

At the dentist today, I was talking with a woman I've known for years. She's in her 50s, and her parents have Geisinger Gold, a PA Medicare advantage plan. She told me they both have had serious health issues for several years, and they LOVE their health insurance plan. They pay a $100 for an MRI, for instance. I'm going to look into this because it seems like a reasonable way to take a certain amount of risk and--if the risk pays off--reap a considerable reward.

It might be good for me at this point in my life, but I don't know how much I'd want to commit to it. Can someone leave an advantage plan and go back to a regular Medicare supplement?

Any other thoughts on these advantage plans?

Thanks! You've all been so helpful.

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Comments (11)

monica_pa Grieves
14 years ago
Advantage plans, especially Blue Cross, have co-pays for everything, referrals for specialists, and you have to go to their doctors.

Co-pays for everyone and everything, and you better check with your doctor(s) to see if they even accept the advantage plan - many around here don't.
alisande
Original Author
14 years ago
I've gotten quite used to no co-pays, but if I could save myself $200-300 per month, that would cover a lot of co-pays. Much to think about......and I have six days before the deadline.

Also, BC is still looking at some of my claims from March 2010 and beyond. If I drop that plan, are they likely to give me a hard time about these claims? I wonder.
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MornieFl
14 years ago
The Advantage plans are different state to state. I just recently found that out when we moved from NM to Fl. We have had the Advantage in NM for the past 3 years and we elected the PPO (no referrals necessary). We were very happy with the coverage and that included my husband having a DaVinci prostate procedure that cost us only $500 everything else (in excess of $30K) was covered in total. The plan cost us $107 a month plus whatever Medicare part A and B was paid. Here in Fl. no charge for BC/BS PPO and slightly better coverage. FWIW, don't want to start an argument by commenting.
kacram
14 years ago
FWIW what does that mean?

I am petrified of the day (years away yet) that we have to decide, with my cancer and all... it sounds all so confusing
alisande
Original Author
14 years ago
FWIW means "for what it's worth."

I don't understand why you think an argument might ensue, Mornie. Thanks for sharing your experience.
kacram
14 years ago
ty alisande!
lol
Granlan_TX
14 years ago
This summer, I received the Medicare book for 2012 and started reading it right away until I had a headache. I've also spent time on the computer. I'm still so unsure and confused as to how I should proceed. Even though I know the deadline is not far away, I'm no closer than I was months ago in making the right decision for me. Sigh. :(
alisande
Original Author
14 years ago
I feel your pain, Granlan. :-)
MornieFl
14 years ago
The good thing about this whole decision making process is the various plans cannot refuse you for past medical history. However the supplement plans can raise the cost monthly you have to pay based on our experience the Advantage did not. As I said here in Fl there is no monthly charge which surprised me no end. Granlan, whatever you decide you will only have to keep it for a year - you can change it next year if you are not happy.
juellie1962
14 years ago
I am not on Medicare, but do medical billing. I THOUGHT that the whole idea of Medicare Replacement programs was that Medicare itself was overwhelmed with so many people being on Medicare that they allowed private insurance companies to sell a product to seniors.
There is a big difference between a supplemental plan and a replacement plan.

I don't envy anyone trying to make these decisions. I cannot imagine an elderly person with no one to converse with about it, making this decision. I have many patients who thought they were buying one thing and ended up with another. Myself, I THINK I would stick with traditional Medicare and buy a good supplement.

One other thing is that more and more doctors are starting to not take Medicare. The reimbursements to the doctors are getting smaller and smaller. The doctor I work for is currently going through revalidation, something you have to do every so many years. We talked seriously about not accepting it anymore. We're doing it more out of a courtesy to our current patients. NOT a money maker!
chisue
14 years ago
juellie -- Your contribution is so valuable here. Thank you! As for a doctor NOT accepting Medicare assignment...how many patients would he have?

Even ten years ago we had an awful time trying to find a new internal medicine MD. The big money is in specialties, and few new doctors think they will recoup expensive training by being a plain old internist. Some MD's were already going into what I call 'Retainer Medicine'. (You retain an MD for a set annual fee.)

We've been so pleased with the medical group we did find. Calls are returned the same day. They will make an appointment today or tomorrow if necessary. Nobody garbles a prescription request. Why, there's even good medical care! LOL However, they have just been bought by one of the huge hospital groups here. It's been cut-throat competition between three major hospital groups who are absorbing smaller hospitals and grabbing medical practices. (Ours is a profitable demographic.)

DH and are repeating for 2012 what we did this year: Medicare Part B ($2400); Aetna Medical Supplement ($744 from DH's former employer); Two different Medicare Part D plans (two premiums totaling $866). That's $4010. We will pay for our 'discounted' prescriptions: $3738. The total is now $7748. We'll also have dental bills.

This is more than my food budget. We are able to pay...for now. This game of insurance and pharmacutical industries owning Congress has got to stop!

What about Medicare advantage plans?

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monica_pa Grieves

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What about Medicare advantage plans?

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