ut of pocket e Advantage plans vs Medicare... - Kidney Dialysis

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ut of pocket e Advantage plans vs Medicare supplement Out of Out of O MOhHow does the oop costs for a MO MAPD compare to Med SUPP Costs?

Tissybell profile image
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Out of pocket costs for MO MAPD for dialysis and nephologist?

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Tissybell profile image
Tissybell
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checkman profile image
checkman

I'm sorry.. what?

Darlenia profile image
Darlenia

Hi Tissybell. The biggest difference between Medicare Advantage (MA) Plans and Medicare Supplements (MS) is access to doctors. In the MA plans you will likely be subject to doctors in network and this is often regional, not just national. To illustrate, a typical hospital stay will have in network providers and out of network providers contracted with hospitals. With a MA you may save a lot of premium upfront but if you get seriously sick you may have exposure to large out of network bills from out of network doctors. MA plans are similar to regular insurance plans whereas MS is a plan where you can go to any doctor or provider that accepts Medicare. All of this info is from my hubby, a dialysis and transplant patient, and a professional in the insurance field.

Tissybell profile image
Tissybell in reply to Darlenia

Thank you for your reply. I am a Medicare Broker, so that is familiar to me. What I am looking for is the personal experience with the MA dialys costs one would experience on d

Aloha49 profile image
Aloha49 in reply to Darlenia

Darlenia, thanks for the insurance info on MA and MS plans. I am very concerned in switching to a MS plan (medicare supplemental) of what they will pay for in my kidney care and what I will have to pay. I am on Kaiser now but not receiving the best care and not able to list with any transplant center I want. So, considering UHC supplemental switch but want the best cost coverage for dialysis or transplant total costs and meds. Also I am stage 4 and MS may not accept me if I wait and turn stage 5 ESRD. Thank you, BB

Tissybell profile image
Tissybell in reply to Aloha49

You are right to look into Med Supps before you get to Stage 5 or ESRD. What state do you live in? I can only advise for Missouri, but I do know you can get service from any Medicare provider. Some states do not sell plans to those disabled with ESRD. If you do qualify, see a Broker for plan options. I have had UHC Med Supp pplan G for 3 years, and lovefor that after I pay my premium , there are no copays for my dialysis, several specialists, and my transplant would covered. Of course there is a $203 deductible for the year.

Tissybell profile image
Tissybell

dialysis. and nephrologist costs . With my Med Supp the plan pays about 600 a month for the doctor and same for dialysis. So would the MA amounts be similar or less? I have my premiums paid by the NKF,. If income is low, but not eligible for Medicaid, one could apply for copay help

Darlenia profile image
Darlenia in reply to Tissybell

The coverages and amounts paid by MA plans are state and/or region specific. You'll need to contact the vendors in your area regarding those plans that interest you for details. And, of course, one can only select one or the other - a MS plan or an MA plan, not both.