Perils of Medicare Advantage - Advanced Prostate...

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Perils of Medicare Advantage

Papa1 profile image
29 Replies

The Wall Street Journal has an interesting piece on the perils of Advantage. Interestingly, the example they cite is a guy with PC who gets less coverage than he thought.

The Journal has a paywall, so you might not be able to open this, but here’s the link:

wsj.com/health/healthcare/m...

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Papa1 profile image
Papa1
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29 Replies
WillowHawk profile image
WillowHawk

I recall thinking when I first got Advantage that if I ever got cancer I would have to switch. Sadly I didn't make notes at the time.

Alturia profile image
Alturia in reply to WillowHawk

While you can switch back to Original Medicare from a Medicare Advantage plan, you will have great difficulty buying a Medigap (also called Medicare Supplement) plan. That's because you will be subject to underwriting and so the company can deny you if you have a major illness, such as cancer or they will charge you an exorbitant rate.

WillowHawk profile image
WillowHawk in reply to Alturia

That makes sense and is food for thought, although I do have a guaranteed plan option from the company where I retired. Every year I can switch I will definitely try to get the WSJ article and work it through - Not that I'm planning to be sick!

Papa1 profile image
Papa1 in reply to WillowHawk

Be careful. While some employer plans gave monthly or annual switch options, those options and change each year. My wife is a retired teacher and her system just limited the switch option to annual, from 30 days notice.

WillowHawk profile image
WillowHawk in reply to Papa1

Thanks, that's why I want to study this now while I have the annual packet and in hand! My best friend uses the company plan and I always wondered why she was paying over 300/mo instead of going w "free" coverage! Too good to be true rule, eh?

Papa1 profile image
Papa1 in reply to WillowHawk

To some of us, NFL=no free lunch.

TJGuy profile image
TJGuy in reply to WillowHawk

Nobody does, that only happens to the "other guy" right.

in reply to Alturia

Underwriting?

Just for shits and giggles, I just applied to 5 different Plan G policies, and was denied flatly.

Im still good with Kaiser, no delays, no denials. (For now)

Alturia profile image
Alturia in reply to

Yes, that's what underwriting means. They evaluate your application in order to determine whether they are willing to insure you.

in reply to Alturia

I think I know what underwriting means, thanks.

What I meant with the ? was that there was NO underwriting, just flat out denial.

Magnus1964 profile image
Magnus1964

Medicare Advantage is not Medicare and it is not an advantage. It is insurance from a private insurance company.

This is a scam to get everyone off Medicare so they can kill the program.

in reply to Magnus1964

Come on stop the right wing rhetoric

de-luke profile image
de-luke in reply to Magnus1964

Magnus this sounds like "left wing rhetoric", I like it!!

TJGuy profile image
TJGuy in reply to Magnus1964

Your absolutely right, it's an attempt to kill traditional Medicare. Now that more than 50% of Medicare recipients are on it. This is now being discussed if Medicare should resemble Medicare advantage. It has been a ploy of the insurance companies from the beginning to get policy holders off traditional Medicare, so they can further weaken it and promote their more profitable version.

Tall_Allen profile image
Tall_Allen

Lothaire is one of my best friends. Unfortunately, he didn't ask me before he signed up for an Advantage plan. He didn't realize he would get stuck. I got him on a clinical trial that covered his drugs. Fortunately, Blue Shield took pity on him and just yesterday sold him a Medigap plan.

Papa1 profile image
Papa1 in reply to Tall_Allen

Once again Allen, you are amazing in so many ways.

At the risk of being cynical, I wonder if the journal article has anything to do with BS’s generosity.

Tall_Allen profile image
Tall_Allen in reply to Papa1

Maybe, but BS made the offer before the article came out. It is entirely possible that the journalist reached out to them earlier for a reaction. Also, Lothaire spent so much time on the phone with them trying to switch. Less cynically, they may have taken pity on him when Open Enrollment came along. I think insurance companies and Advantage plans are getting so much bad press that they try to be gracious for better PR.

WillowHawk profile image
WillowHawk in reply to Tall_Allen

Do you live here in SoCal, TA?

Tall_Allen profile image
Tall_Allen in reply to WillowHawk

Los Angeles, yes.

Papa1 profile image
Papa1

Good guess that they responded to a call. I misspent 17 years of my youth as a daily newspaper reporter. Shocking how many calls for a comment resulted in a reversal of a decision that looked bad. But maybe is was just coincidence.

jackcop profile image
jackcop in reply to Papa1

🤣💪

Magnus1964 profile image
Magnus1964

I love it. I explain that advantage plans are private insurance and a way to end Medicare. One person says it's left wing rhetoric and another says it's right wing rhetoric.

Do some research dudes. It is insurance from private carriers and Medicare users have been forced or tricked into moving to advantage plans. Once everyone is on a private advantage plan, the government can phase medicare out of existence.

Papa1 profile image
Papa1 in reply to Magnus1964

I get your point, but I tried to create this as a neutral informational thread. I’d appreciate keeping that way.

If you want to discuss the politics and economics of advantage please message me off the thread. I have lots of ideas and feelings, some of which you might share.

Magnus1964 profile image
Magnus1964 in reply to Papa1

Just trying to make the members aware of the dangers of advantage plans.

in reply to Magnus1964

There is no danger, just caveats.

We know you have a hate for advantage plans, let it be.

in reply to Magnus1964

Do you not understand that Medicare is paying for the advantage plans?

Magnus1964 profile image
Magnus1964 in reply to

The private carriers recover their costs from Medicare.

in reply to Magnus1964

Medicare pays them a monthly premium per Medicare patient..

Premiums are higher for individuals with more medical conditions.

You say you are having trouble sleeping, bam!!!, you have insomnia added to your list.

It 's called risk adjustment. Yeah, Medicare sued Kaiser for overdoing it.

As far as being limited with doctors. Im not limited at Kaiser. The Los Angeles (Sunset) facility is a cancer "Center" Of Excellence" with 20 ROs 10 Residents, and as many MOs, They did my radiation with minimal SEs. I understand ROs there collaborate on treatment plans.

I have access to no less than 60 MOs across 4 different Kaiser hospitals in the area.

Nothing has ever been denied, nor waiting for referrals. E.G. Im in my PCPs office, and we discussed my seeing a gastroenterologist. He types in the request, 30 seconds later my phone rings, its the Gastro's office is calling me to schedule.

My MO types in a request for a PSMA/PET scan, my phone rings on my way home to schedule.

Yeah, there are bad advantage plans and there are good ones. Im actually happy at Kaiser. My cancer is regressing very well as a result of quick response with treatment. I get _complete_ labs monthly. MO visits every 3 months. My own oncology pharmacist that calls and tells me she sent in my scripts, and follows up with any lab issues.

So, please dont generalize, and dont make people with Advantage plans regret and feel bad for their decisions. They can always ask here for reviews on other plans, and then seek out another plan. Most of us here are already above 65, and its too late to go to Plan A and B with G. Unless you find one that will accept you with premiums that exceed A and B copays. Or willing to pay the copays.

Papa1 profile image
Papa1

I’ve been trying to post a link to the Wikipedia page for MA but I can seem to pull it off.

If you want a good exposition on MA go to Wikipedia. Com and search Medicare Advantage. A good history and explanation but pay close attention to the controversy tab.

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