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Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - special - 06-26-2024
Didn't watch it all, still have years to go, but it seems like a good video
https://www.youtube.com/watch?v=77YF-TL0n-8
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Speedy - 06-26-2024
special, good stuff, thanks for the link.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Michael - 06-26-2024
Interesting video. We have Medicare Advantage. The things he mentioned at the very end matter, a lot. His mom basically saved $775 on her $700k cancer battle on the total cost. But, as he mentioned, there are Medicare Advantage programs that include vision, hearing and dental. In ours, we get an annual vision test (value of $100), we get a pair of glasses every 2 years (value of $250) and our dental pays basically half of what our out-of-network dentist charges (value of $500), I can get new hearing aids every year (value of $700 if I use the United Healthcare captive company), we get an unlimited visits to a bunch of health clubs (we use Planet Fitness-value of $120), they give us $120 a year in OTC stuff by debit card, they give us $120 a year by debit card for anything but alcohol or tobacco stuff if we walk 5000 steps 10 days a month, and they give us another $35 if we answer a few health questions and get a flu shot. They cover a lot of drugs; I've been on 5 prescriptions this year (off all now!) and they completely paid for 3 of them and I paid $12 for the other one. The last one I was going to have to pay $115 for but I found one of those drug savings cards that let me pay $11 for it. That was strange, but I'll take it!
One thing he mentioned about Medicare Advantage was the you have to stay in network. That is true with a lot of Medicare Advantage programs in our area. But we chose one that allows us to see anybody who takes Medicare anywhere in the country. None of our doctors are in their network nor is the local hospital and we just go and they take care of the billing. We do get co-pay amounts that are always modest and mostly not able to be easily interpreted! I would not have done Medicare Advantage if we had to stay in network to get any benefit at all--very few of our local doctors are in the United Healthcare Medicare Advantage network.
I had prostate ablation surgery in March with an overnight stay in the hospital. The billing has just been completed. The hospital charged $78k. That was dramatically reduced to $8k by United Healthcare. I'm being billed $507. The several thousand the surgeon, anesthesiologist and lab each charged was reduced and I owe nothing. My Medicare Advantage program has me pay $350 a night for hospital stays. So, the $507 that I owe involved the $350 for the hospital stay and the other $157 is everything else that the hospital billed for the surgery and overnight stay.
I had read, prior to choosing what to do about Medicare, that people who are basically healthy do very well with Medicare Advantage. We usually see maybe 1 doctor a year beyond our annual physicals so we chose Medicare Advantage. Even as we're getting older it seems to be the best option for us. There are reports that the administration is cutting back on Medicare Advantage payments for the upcoming year so I expect our program to change. We'll see how it works out in the future.
In any case, it was a good video that will be helpful for a lot of people choosing. We have good friends who need a lot of medical care. They pretty much all chose Medicare with a supplement plan and are happy with it.
Edit: cleaned it up a bit.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Ombligo - 06-26-2024
Medicare Advantage is great coverage until it isn't.
Great health can become bad health in a heartbeat and then it is too late to get back into Medicare proper. Each person needs to make their own decision, but should base the decision not on their present health, but on a realistic assumption on that their health may be in the future.
I have decided to take the long view and pay the costs associated with Medicare and supplements.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Mike Sellers - 06-26-2024
Ombligo wrote:
Medicare Advantage is great coverage until it isn't.
Great health can become bad health in a heartbeat and then it is too late to get back into Medicare proper. Each person needs to make their own decision, but should base the decision not on their present health, but on a realistic assumption on that their health may be in the future.
I have decided to take the long view and pay the costs associated with Medicare and supplements.
Same here. I'd rather pay on the front end, rather than risk a much larger payment on the back end. And, as you pointed out, once you're on an Advantage plan for over a year, getting back to a Medigap plan is much more difficult.
One word in this video that needs more emphasis is "approved". There's no approval process with a Medigap plan. If your doctor says you need it, you get it. Not so with an Advantage plan and their motivation in to maximize their profits by delaying and denying care.
After dealing most of my life with insurance companies, I couldn't wait to shed myself of them. Jumping right back into bed with them is baffling.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - DeusxMac - 06-26-2024
Michael, what company has an Advantage plan that covers services from “anybody who takes Medicare anywhere in the country”?
Does it also include rehabilitation, nursing homes and other ancillary facilities and services?
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Speedy - 06-26-2024
DeusxMac wrote:
Michael, what company has an Advantage plan that covers services from “anybody who takes Medicare anywhere in the country”?
Our DisAdvantage plan requires us to use in-network or pay through the nose. However, we overwinter in S. Texas so I called the plan to ask what providers there were in their network (none) and they told us we could use any provider and the plan would treat them as in-network for the duration of our travel.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Michael - 06-26-2024
DeusxMac wrote:
Michael, what company has an Advantage plan that covers services from “anybody who takes Medicare anywhere in the country”?
Does it also include rehabilitation, nursing homes and other ancillary facilities and services?
Here's a copy/paste from my account:
United Healthcare Medicare Advantage GA-0002 (PPO)
Medicare National Network Access
Monthly Premium $0
This is a Georgia PPO plan that looks like it's in all of the 159 counties (I didn't count all of them in the list but the list is 15 lines long and the first line has 12 counties).
Here's a copy/paste from their Summary of Benefits: UHC Medicare Advantage GA-0002 (PPO) has a network of doctors, hospitals, pharmacies and other providers. With this plan, you have the freedom to enjoy nationwide access to care at in-network costs when you visit any provider participating in the UnitedHealthcare® Medicare National Network (exclusions may apply). Plus, you have the flexibility to visit any provider nationwide who accepts Medicare. You may pay a higher copay or coinsurance when you see an out-of-network provider.
There's a $6200 max out-of-pocket for in network care and $9500 max out-of-pocket for combined in and out of network care. I just looked it up and my current out of pocket for the year (including my surgery) is $959.87. That's from billing of $121,956 (overwhelmingly that's from my urologist and associated providers but also includes my annual physical and dental cleaning) and a reduced payment from United Healthcare to the providers of $9,660.42. So, I'm a long way from meeting my max out-of-pocket.
They cover rehab services: Physical, Occupational, and Speech and Language at $25 for an in-network provider and $60 for out of network.
They cover skilled nursing care. For in network, it's $0 copay for days 1-20 and then $203 copay per day for days 21-100. For out of network, it's $225 for days 1-43 and then $0 for days 44-100.
It covers all the other stuff I was familiar with from our old work insurance: durable medical equipment, ambulance, substance abuse and so on.
Here's something I didn't know about until I was just looking this up: they'll provide 28 free meals over 14 days, delivered to your door in a cooled container if you've been admitted to the hospital or skilled nursing unit. They don't say who they contract with. I could have done that for a couple of weeks after my one-day hospital stay a couple of months ago!
I know that United Healthcare (and others) have HMO options in Georgia. I see those every year when we review and renew our coverage. I wouldn't do an HMO option because literally none of our doctors are in network for United Healthcare.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - DeusxMac - 06-26-2024
Michael, thanks for the comprehensive response.
But you should be aware that "if you are enrolled in a Medicare Advantage (MA) plan, doctors do not necessarily need to accept your insurance even if they accept Medicare. This is because doctors have separate contracts with private insurers."
And it may require a pre-approval to access medical services outside the Advantage plan's network; meaning emergency services or other immediate needs could NOT be pre-approved, and consequently NOT covered.
Re: Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage - Speedy - 06-26-2024
DeusxMac wrote: And it may require a pre-approval to access medical services outside the Advantage plan's network; meaning emergency services or other immediate needs could NOT be pre-approved, and consequently NOT covered.
Untrue, federal law mandates coverage for emergency services no matter in or out of network and that such services be treated as in-network. No preapproval required.