How is this plan working for those of you that have it?
Humana Medicare Advantage : How is this... - Advanced Prostate...
Humana Medicare Advantage
Written by
Wahoo_
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36 Replies
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Medicare Advantage plans are horrible, IMO.
What would you suggest? It is a group plan. Our previous plan was really good. Does a group plan change things?
I chose Medicare Parts A, B &D and a Supplemental Plan. Next year, the maximum out-of-pocket for drugs on Part D is $2,000.
Who do you use for part D and the Supplemental plan?
Unless BSBC CA waives underwriting this year, we are stuck in advantage plans
Plan G for we who are stricken with cancer, if accepted is over $500 month.
Unless BSBC CA waives underwriting this year, we are stuck in advantage plans
California permits you to change plans once a year. I think its your birthday.
But not certain if that includes advantage plans.
you can change supplemental on bday.
You can go from advantage to supplemental in October. But if you have cancer the cost is prohibitive.
"But if you have cancer the cost is prohibitive."
Is that so is you are just going from supplemental to supplemental?
And I assume you are talking about California? Most states don't give you that option.
Especially those in the South East and South West. They tend to be Red states whose politicians on average are more susceptible to Insurance lobbyist money. But there are plenty of Blue states too.
Advantage plans have no limitations on preexisting conditions, and you can change once per year.....you can try to change from Advantage to a supplememnt, or from one supplement to another, but pre-existing condition can disqualify you. There are at least 12 states that do require /allow no underwriting change of supplement plans once per year...often at your birthday.
A PPO Advantage plan allows more flexibility re networks......out of network is covered , but with quite large copays, eg 30%. However, there is always a max annual out-of-pocket even for out-of-network...typically $8000-$10000, whereas in-network might be $3000-$5000 max OOP. Kaiseer is a fantastic Advantage integrated plan.......as long as you are fine with using Kaiser Docs only......some are great/top notch, and some so so...but thaT GOES FOR NON-Kaiser Docs too.
In Portland, one group of primary Docs at a well-known clinic n o longer accepts Medicare assignment, but those same Docs do accept patients with certain Advantage plans. SO, it can go both ways!! the LARGE Legacy Health system is threatening to drop out of AARP United Healtcare advantage plan networks!!!!
My guess is that drug costs are the biggest part of most patient annual sppending...in addition to the premiums for Part B, D, supplement and annual dental bills. Sucking up 18%of our country's GDP.
Medicare Advantage are private commercial plans. I have the same plans as Tall Allen. Never once had a need to appeal a pre auth or denial.
What plans do you have?
Right now I pay $53 a month for Xtandi and $0 a month for Firmagon. But, my ex employer is changing from UHC to Humana. This may be the wrong forum to discuss this.
Advantage plans are not good for anyone with any kind of cancer. And not good for anyone old enough to qualify for them.
Is that based on experience, or from a few that have had problems??
Im stuck with MA. Until the poster says above, if Blue Shield drops underwriting this year. Kaiser has treated me like a king. No denials of anything. 2 PSMA/PET scans per year. Same meds and cancer treatment as anyone else. Radiation for lymph node done at Kaiser Sunset
Today I have no evidence of disease.
Ironically Tall Allen hates MAs, but Im seeing an MO and RO that he recommended!!!
healthy.kaiserpermanente.or...
What is an MA? Ohhhh Medicare advantage.
The problem is structural. They have the wrong set of incentives. Way too much moral hazard.
And you are sort of stuck with them once you sign up to one. They get a new CEO who wants to pump his numbers at your expense. What are you going to do? Change to a new vendor, or just eat what you are fed?
Private Equity hasn't found them yet. But once they do and they start buying them up. They will pump and dump.
remember Medicare advantage plans are for profit plans regular Medicare with a secondary are not. Many clinics do not accept Medicare advantage and if you do want to go somewhere who are not in that plans “ net work”. You pay more. Two of Mayos do not accept and Rochester only some plans. If you start out with a medical advantage and want to switch to regular Medicare there is an increased monthly fine. We started out with regular Medicare, and he was able to keep his regular BCBS at retirement which became secondary. He has been stage 4b for 10 years and see Dr. Kwon at Mayo and have since surgery when PSA didn’t go below 3 as had gone into lymph in chest. Look real close.
Medicare advantage can work out well if you never switch providers…..eg Medicare advantage plans( most) accept the medical group in which I participate….if I went with a map I could pay a LOT less monthly than I do now for standard Medicare,part d and a supplement……BUT I recently needed a consult and testing at memorial Sloan Kettering and they are NOT fond of advantage plans…..if you don’t want the extra worry of wondering if your insurance will pay for a complicated medical regiment stay away from Medicare advantage plans…..you’ll save a lot of time and hassle.
"If you start out with a medical advantage and want to switch to regular Medicare there is an increased monthly fine"
Actually they get to underwrite you afresh. Never good for anyone who has cancer.
Advantage plans are not the way to go for cancer patients. Medicare A, B, D and a supplemental and it’s been great.
Ed
And Im here to deny your statement!!😕
If you have the right to exercise choice, you don't need to.
Medicare |Advantage is like living in a company town.
when I was going to turn 65. I sat down with an insurance agent that sold different Medicare plans, etc. as soon as I said cancer, she said F plan best thing I ever did. I can go anywhere and get treated without having to get permission I've been to UCLA Dana-Farber and the mayo clinic I just paid the transportation and hotel bill. My part D is picking up my Nubeqa and dupixant for the rash I got from the Nubequa
Wahoo_
My opinions mirror Tall-Allens.
A supplemental Plan G is the best approach. AARP United Healthcare, Humana, and a host of other companies offer them at slightly different prices, but the benefits are governed by Plan G rules.
There is a company in Kansas City that can help you wade thru the Medicare mess. They are unitedmedicareadvisors.com/ Look them up and call them.
I will warn you there are a lot of scammers that fake they are the actual United Medicare Advisors company. You call then first and get an advisors name and number, then you call them. Do not answer a call from a different number and do not respond to a text other than calling the advisor you know.
Lastly do not get sucked into a bad Advantage plan based on all of the commercials on TV. Go with a supplement and just forget about Copays other than the Medicare part B of $260 for 2024.
It takes a LOT of copays to equal the total premiums for Plan G, Part D, separate dental insurance etc. Out of pocket drug costs are pretty much the same with Advantage and separate Part D coverage.....both will have the $2000 annual max.
Note: If possible please do not be brief with your bio...... The more info you share is best for you and best for us. All info is voluntary. Thank you!!! (Good to be way up the Wahoo).
Good Luck, Good Health and Good Humor.
j-o-h-n
Humana is dropping 200,000 from their Medicare Advantage plans - Humana CFO Susan Diamond told investors on Wednesday that the insurer is likely to lose a "few hundred thousand members" as it adjusts to ongoing pressures in the Medicare Advantage space. fiercehealthcare.com/payers... Also, more healthcare systems are dropping Medicare Advantage plans altogether.
That's fascinating reading. They're dumping people in plans that aren't making them money, and the basically don't give a sh!t about how this effects their customers.
They hope to hold on to some of them by switching them to other MA plans they offer that do show a profit, but if they can't - too bad. Wow.
They mention making those plans even more profitable by reducing benefits... and I don't think they're talking "Silver Sneakers" memberships (when friends who haven't gotten sick tell me how great their MA plan is - they alway mention "Silver Sneakers" - but look at me with a blank look when I ask when they've used that. Turns out it's very limited in scope and only accepted by a very small number of gyms.)
Medicare Advantage plans suck off billions of dollars in "suppliments" from the Medicare budget, provide inferior service and outright denial in some cases. The reason they're pushed like mad during enrollment periods - the agen selling you the plan gets a several hundred dollar fee for signing you up - and then gets that every year you remain with the same plan.
I echo the thoughts of the earlier comments. I can tell you as both a Stage 4 PCa survivor and as a licensed insurance agent, You should go with a Medicare Supplement (Medigap) plan and Part D prescription plan, unless your financial circumstances make it unaffordable. This is my humble opinion of course!
Supplements are not inexpensive. Think about it......Part B covers 80% aand costs $174/mo........a Plan G can cost $250 and covers 20% !!!!!
And they are allowed to deny you basedd on pre-existing conditions, whereas Advantage plans are not so allowed!!!
It is quite simplistic, IMHO, to claim that A is good, and B is bad. There are a LOT of folks who simply can't afford to be locked into supplement premiums, and at some oint down the road face an army of collectors!!!
With some luck, they might avoid that with the advantage plan......with payments due only for actual services, not monthly premiums. At Kaiser, it takes a LOT of services to reach the $3000 annual out-of-pocket...whereas that $3000 is guaranteed for many Plan G supplements.
Yes. As I noted, affordability is definitely a factor. With the treatments we, with adv PCa deal with, we are more likely to hit that out of pocket max. Many Med Adv plans in many (not all) states have annual OOP max of $5000-$7000. 20% co-insurance for chemo treatment for example can blow through that. Then there is the challenge of providers that may not be in network. I'm not against Med Adv plans. They can make very good financial sense as you noted. I'm focusing more on folks like us that could have significant medical expenses and may need to seek out medical providers in another state to get a particular treatment.
Good point about pre-existing conditions. If you are not new to Medicare or have one of the "guaranteed issue rights", the cost of a Supplement is quite high and may not be a good choice if you have significant medical conditions.
I have had Humana Gold Plus HMO for two years.Copay for specialist $15. Just had triple bypass,
I Paid $352.00. I live in Surprise, Arizona.
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