Why, if you have prostate cancer, you don't want a medicare advantage plan
statnews.com/2023/03/13/med...
On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone. Meanwhile, medical notes in June 2019 showed Walter’s pain was maxing out the scales and that she could not dress herself, go to the bathroom, or even push a walker without help.
It would take more than a year for a federal judge to conclude the insurer’s decision was “at best, speculative” and that Walter was owed thousands of dollars for more than three weeks of treatment. While she fought the denial, she had to spend down her life savings and enroll in Medicaid just to progress to the point of putting on her shoes, her arm still in a sling.
Changng Insurance (Reluctantly)
I may have prostate cancer
Why keep prostate after cancer has spread?
USA Supplemental plans
Which treatment plan should we start for Metastatic Prostate Cancer?
I have a number of family members who love to brag on how much they're saving on a MA plan vs regular Medicare. The bragging generally lasts until they actually have to make use of the Medicare Advantage plan - then they go silent about it until they're challenged - they then switch to "yeah, but..." to try to save face.
Why they can't begin to fathom that anything advertised as heavily as MA plans are right around enrollment time must be a major profit center for their owners, and they can only do that by denying/delaying care is a mystery to me.
Insurance companies are in it for the money, they aren't altruistic charitable organizations - it's the money and nothing BUT the money that counts. People get subpar care - it's not a problem as long as the next quarters profit numbers are good.
They suck. But hey! "I've got Silver-Sneakers" said the fat man who never went to a gym since high-school..
That's strange, I have been on aarp united healthcare advantage plan fir 6 years, they just got done paying over 72 thousand for my cancer treatment fir December.
Very valid concerns. Remember not all insurance companies and even for the same company not all offered plans are the same, and may be radically different. AARP Advantage is provided by United Healthcare. We just went to Medicare Part B (the medical part and what most of the care we all need except inpatient stays and surgery and some other items) and switched from my spouse's corporate plan. We didn't get a Med Supplement and go on Medicare Part B (the other major option besides Advantage plans) until she retired.
Her whole career was in insurance and in Medicare provider insurance software so we are not newbies. This insurance stuff can be too confusing for most. But even without that many of you are very smart about insurance.
On Med Supplement we went with the "Cadillac" and most expensive plan G (used to be F). $176 a month each. You can get cheaper Supplement plans. The difference usually boils down to how big your deductibles are plus some other less important items. Deductibles can eat your lunch (your money). Knowing that I have PCa we knew that a lower deductible would pay for the extra monthly cost.
Advantage plans vary all over the place. They have extra sweeteners which may sound great and sometimes they are but often are just good marketing. Drug coverage can be a good thing added but what they cover for what deductibles are all over the place. They can be part of many Advantage plans. They are not included in Med Sup and you have to get Part D separately on your own. Every state has different regulations on how these plans work.
Even though we are much savvy than most we got an advisor (free and no kickbacks from plans he recommends) to run the numbers for drug coverage and which Med Sup plan made the most sense for us.
Not trying to be too pedantic here (which I am sorry that I can be). But many get Advantage plans for the lower monthly costs and then get eaten up by what is or is not covered. And they restrict you to what hospitals and doctors you can use, or pay a big extra. One of the reasons we got Med Sup was that we could go to any state and most any hospital or clinic or doctor if they take Medicare at all. And, Medicare tells the Supplement provider what they have to cover. If Medicare B would cover it then the insurance has to cover it. Not so Advantage plans.
And, it is very difficult to change from a less advantageous plan to a better (more things covered and smaller deductibles). We went with the best Med Sup plan to avoid that. We can always go down to cheaper, worse plans but not up (except with very large premiums).
But back to the issues of Advantage plan providers and even Med Sup providers (we have Regence Blue Cross in Washington state). They often refuse to cover a given therapy so they can make as much profit as possible (what you pay less claims they pay). They can be real jerks. Borderline and many times completely over the line illegal denials of coverage. I've had to appeal a few things - depression therapy and DNA analysis were two biggies for me. We got a Foundation to cover 100% of the DNA and appalled and won on the depression therapy.
We think going with the cheapest plan, especially Advantage plan, does not make sense for anyone with potential high cost therapy, like many elderly people and certainly cancer diagnoses. The high cost of the plans can just be too high for many though and they really don't have much of a choice. They just can't pay the monthly plan costs out of Social Security or pension income they get, or out of savings. We are lucky that we can pay the higher plan monthly payments.
Do your homework and try to find the most honest and reputable insurers. Very hard to do usually. You can change to another insurer once a year though. If one is screwing you then try to find a better insurer. Our advisor was helpful in giving us hints. He could not out and out say one insurer was better than another. Your doctors and clinics might be able to help. They want to work with the insurers who will pay. They hate doing appeals or seeing patients get knocked around. Ask friends who have coverage.
I hope this makes sense and I hope I have been accurate in what I have said. Best of luck and homework to find the best insurance plan and insurer for your individual case. I can't help but believe for those with advanced cancer that going with a better, lower deductible, plan would make sense. Pay me now or pay me later.
Very very good. I gave it a heart.