I don’t want to find myself in the position where the bean-counters decided my medical care, procedure, or medication will impact their bottom line in the 3rd fiscal quarter. I’ve traded all that ‘wellness care’ for potentially life-saving care down the road. Nursing home care too. I haven’t seen a Medicare’Advantage’ plan that covers nursing home, hospice, or palliative care.

My doctor does a review of systems, talks about any issues I may have and orders the labs she thinks I need.

Other coverage issues, based on my experiences with an aunt who needed nursing home care, my own experiences with Part B and my 7 years spent as a Claims Analyst for Part B include:

Nursing home is covered by Medicaid after the first 90 days or if you are sent to the hospital from a nursing home and then go back to the nursing home. In that situation your Medicare coverage of Nursing Home renews for a short period(not sure if it is 90 or 60 days) A good example is a fall in a nursing home, resulting in a fractured hip. Patient goes to hospital, stays 3 days and returns to Nursing Home. That would reset the 90 Medicare coverage then Medicaid would step back in.

In order to qualify for Medicaid coverage, you have to exhaust your available funds. When I was going through this for my aunt, we sold her house, had an estate sale and finished off her residual cash. When she qualified for Medicaid, in additon to the Nursing Home it picked up the deductible and co-pay from her original Part B; she was able to cancel her supplemental plan so she had very little out of pocket. Her Social Security check went towards the Nursing Home payment except for a small amount each month which she could use for personal expenses.

Some rules can vary from state to state, mostly related to property. You can sign off your house, and your investments joint with your children and avoid sacrificing their value but it has to be done at least 5 years prior to admission to a Nursing Home.

Part B has a hospice care feature but that could have changed since I was a Claims Analyst. I am not sure about palliative care but that could be included with hospice. ( my father in law had an Advantage Plan and he did receive in home Hospice which was for him essentially palliative care)
Part B is not as obsessed with bean counting, it is non-profit.
Part B has no networks. If I am in Arizona with my daughter and need medical care, I am covered exactly as I am here in Texas. Do not go out of network in an Advantage Plan, they will eat your lunch!
Part B has the fastest turnaround time, the lowest error ratios and lowest cost per claim in the industry.

I would never get an Advantage Plan because of the profit aspect and the darn networks. It would be nice to have a basic dental and vision plan as an option with Part B but the Advantage ones may have network limitations

Have for decades. Remember HMOs? Now they use "AI" to decide if we need a test, or a certain medication, or if we'll be left behind because we cost too much. And it's only going to get worse.

But, what I have been told is that the biggest places it saves money is on skilled nursing days. That can't be all. I had a 95 year old neighbor who paid a supplement her whole retired life and rarely was sick. But with age comes falling. With falling comes hospitalizations. With hospitalization comes discharges. I kept telling her she could save money by switching to managed care. She did change plans that year. They sent her home too soon and everything that followed paved her way to an early death, she could have lived to 100. Insurance companies don't want us to live to 100. I've been kicking myself ever since.
But, I still have it. They have only denied a couple of meds for me. But they must be royally messing with enough people for a young man to throw his life away by taking revenge on the CEO. If we had national healthcare this and Medicaid/Medicare cuts would be a non-issue.

MA is great for regular checkups.

I am on regular Medicare and I bet you can't do what I did.

I am in the process of switching doctors and hospitals from my rural setting to Pittsburgh. I dumped my cardiologist and now see a fantastic doctor at UPMC, a totally different hospital. I dumped my orthopedic doctor and got my new knee from a great surgeon working out of MaGee hospital in Pittsburgh. I then went to a neurologist out of UPMC Spine Center in Wexford to do tests on my foot neuropathy

Did I mention my cardiologist almost killed me at Penn Highlands treating my A-fib. I went to a great doctor at UPMC Passavant who did an ablation on my heart 6 years ago and I have been in rhythm ever since, knock on wood. The doctor at Penn Highlands treats A-fib with a defib and pacemaker as a first option, my new doctor uses that as a last option.

I never wasted one minute of my time arguing over my insurance. I did have to wait a couple of months longer to see my new doctors because my daughter researched their records and picked me the best.

Yeah, over the years I have paid thousands of dollars in dental care out of my pocket but my insurance doesn't overcharge Medicare because it is Medicare and not a private insurance company.

For home care. She very strongly advised her dad and me to go with traditional Medicare with a supplement. Said that the Advantage plans always second-guess and try to reduce the number of days of home care the sick and elderly patients need. The almighty dollar ALWAYS comes first. Those plans are probably fine for the “young” and healthy but not for the old and sick.

It was a nightmare. No Medicare Advantage for me.

Costs her over $300 per month or $3700 per year.

It was a little less than traditional Medicare, which is why she chose it. But then her entire health system didn't accept her Medicare Advantage for over a year. And then, her plan wouldn't allow her to go into rehab after a hospital stay. I was going to pay $10k out of pocket because she HAD to go. After days of fighting with them her doctors finally got Aetna to agree.

The fact is that we don't have good health insurance system in the U.S. None of the options are good and it's way too expensive.

Including that, she is paying approx. $500 per month out of her SS check

We pay under $500 combined. As we pay the same agency, our autopay is the sum of 2 policies.
Major provider, too.
Not doubting your number, just surprised.

Others think they should not be allowed to make the choice that is best for them.

To be fair, managed care has always worked reasonably well in states like Minnesota and California. MN was at the forefront as far back as the 1980s.

I chose a plan based on the medical group I have been using for years. It's a full-service medical group in Minnesota that has a bunch of its own hospitals, physicians in every conceivable specialty and essentially covers just about anything that can happen to you. Which is not to say that it is perfect. I know of nothing that is. Am I gambling with my health? Sure, but we're all doing that some degree or another. As long as I stay in network, I'm going to be able to get care for whatever health issues I end up having. I'll be 80 next month. I have a health directive that reflects my attitude about health crises.

I watched my father go through some mind-bending health emergencies. He kept surviving them, but between the time he was 80 and when he died at 96, I watched him deteriorate to a degree I won't allow for myself. As long as I can experience some happiness in my life, I'm good. When that becomes impossible, then my directive will let me pass out of this life without heroic measures that keep me alive but with no quality of life.

You sort of have to know what it is you want and make choices based on that, i think.

There are less options with MA. MA works just fine for routine care.

MA plans are private insurance plans that overcharge Medicare and shorten its viability.

My choice was no brainer because I have Medicare and a Union secondary insurance.

I doubt that anyone on MA could have done what I did with my healthcare choices.

apply to the 53% who evaluated their situation and decided differently.

Congress needs to get off their rears and enact a rational healthcare system. Until then, I'm for letting people decide what is best for them with respect to healthcare, not forcing what is best for you on them.

... yet.

Health care here is pretty damned good. I've lived her for 20 years. I picked one of the major health care networks early on, and got insurance that had that network as one of its principal ones. I have had the same internist as my primary care doctor for 17 years. I chose him because of how he handled a health concern that I had at the time, but no longer have.

I've moved across the metro, but still drive to my original clinic where he is a staff member when I need attention. He understands my priorities and acts accordingly. I have a good understanding of medicine, myself, so our conversations are collaborative. I am totally compliant with medications and absolutely honest with him when it comes to questions he needs answered. He remembers me, even though I see him only once a year, and we get along very well in the office and know about each others' lives outside of that environment.

But, I am a patient of one of the largest medical systems in the area. It's not going anywhere. So, I'll stick with it and the Advantage plan that makes that system it's primary provider. I live where I live, in part, because of the ready availability of high quality medical services, even though I don't have need of them all that much. I know I will at some point.

I just don’t see it the same way. I am sorry my mom somehow got on MA. Even more so since she’s low income. I strongly dislike a system based so much in profit. My energy would be directed towards improving regular Medicare. That’s the best for our health care.

just ask the people in hospitals or in doctor's offices who deal with insurance. Ask those people what insurance they would rather deal with, Medicare or private insurance, I guarantee they will all give the same answer. I know what I am getting, or not getting, with Medicare.

who quickly became "the guy who deals with the insurance companies".

He has told me and DH multiple times NEVER to get Medicare Advantage based on his experience trying to help his customers. But, we're in Iowa, where health care isn't a priority, so....

These companies don't pay their bills to doctors and hospitals. So, every year it's a game of chicken to see if our local healthcare systems will refuse to accept Aetna, United, Humana, etc.

Right now it's my wife in the crosshairs, as her health care provider considers dropping her Medicare Advantage carrier. Almost happened to her last year. Happened to my mom.

I'm on traditional Medicare. I get the same free annual wellness checkup. I never have to worry that I won't be able to see my doctor.

It didn't when I signed up. So, that's the arrangement I have. I find it interesting.

I will argue that health systems drop carriers because the companies don't pay their bills. I could see the truth of that when I reviewed my mom's paperwork.

I'm sure there's a counter argument and the companies make it.

The result is that we the consumer get caught in the middle.

because the dollars are more important than caring for poor people.

by at least $23 billion every year. The program is more costly than traditional Medicare, not more efficient.

It is destroying Medicare.

suspected of improper billing and services.

They can go up to 6 years. After that, the providers can celebrate their fortune, unless they are still billing fraudulently. The insurance companies that adjudicate original Medicare claims only audit a fraction of providers, in essence allowing a certain amount of fraud for expediency. So original Medicare waits years to audit.

Medicare Advantage plans typically have 12 months to recoup improper payments. Consequently, they deny claims upfront and ask for supporting documentation.

It's one of the things Medicare Advantage can't mess with. Because they are a Medicare plan, they have to offer the annual wellness check without charge. Don't give Medicare Advantage credit for things which they are required, by law, to provide.

I'm not giving my Advantage plan any credit for that. I just happen to be in a Medicare Advantage plan. Before I was, I still got the annual wellness check and from the same doctor I went to yesterday.

Advantage plans cover all of the things Medicare covers. For doing that, they get the amount that is subtracted from your SS for Medicare Part B. I picked an advantage plan that I pay $67 each month, on top of that. That lowers my copay on most doctor visits to zero. My Part D prescription coverage is also part of the plan, as it is with most Medicare Advantage plans. I take three regular prescriptions, and my MD has prescribed Tier 1 meds, so I pay no copay at all for those prescriptions. "No charge," the pharmacy at my supermarket says, every three months when I pick up my automatically refilled supply. .

So far, I have not needed any expensive medications, nor have I needed any surgery or hospitalization I may, in the future, and my plan includes several of the largest, best equipped hospitals in the Twin Cities metro area as hospitals in the system. The medical system I am in offers specialists in every conceivable specialty. there's a $25 copay for visits to them. I have a $2500 out of pocket maximum per year for hospitalization, etc.

All of that for $67/month out of my pocket.

I'm fortunate to be relatively healthy for an 80 year old man. I realize that will not always be the case, but if you read my advance health care directive, you would see that there isn't going to me any sort of exotic health care expense in my future. I won't have it. Period. I don't want it, frankly. I've already lived my "three score and ten," plus another ten. I'm very fortunate, indeed.

I did not choose the particular Medicare Advantage plan I have by picking one out of a hat. I researched plans that were available carefully, including traditional Medicare, plus Part D and plus a supplement. My choice was the plan I currently have.

I also like not having to worry about whether my provider will suddenly be cut off.

And you will have the resources to take care of yourself during the transition but you supporting ma instead of real Medicare drains the system for the rest of us that don’t have that luxury cushion

They only have Medicare Advantage so I stayed with them & I'm very happy with my care & service & cost. I live in a Kaiser rich area, though. Lots of clinics to choose from. I have vision & IDK about dental. I should look into that.

is different than other advantage plans because Kaiser is both the hospital system and the health insurance provider.

No 'Advantage' here, just plain old Medicare.

Paid by Medicare.

The huge over costs of Medicare Advantage are so enormous that it encourages the Republican attacks on Medicare as too costly for America.
The irony is that Republicans sold it to us as a program that would save money. It does not. Instead we are supporting the insurance companies who are acting as middlemen and profiting while direct service providers and patients are being squeezed.

Medicare and a blue cross supplement through my husband’s former employer. I get same Medicare wellness check at no cost. My doctor I see doesn’t prescribe any medication that I take. My specialist’s do. Nephrologist and rheumatologist. One of the arthritis medications I take is quite expensive ( over fourteen thousand dollars). At the beginning of the year I paid 60 dollars for that prescription and haven’t paid anything for my prescriptions since then. Could this possibly be because of the prescription program that President Biden got passed last year? If so, thank you President Biden!

I have a Medicare Advantage plan I’ve been quite happy with, even after a major injury and cancer treatment. But a friend in a different state is having a nightmarish time getting basic care.

You have to do some research and comparison to find the right combination for your own needs.

The normal wellness checkup is free under regular Medicare.

I have COPD, type II Diabetes, and Kidney issues (though Ozempic seems to have corrected this). I am happy with my coverage compared to what I had to pay as a partner in my law firm before I went on Medicare