Filling the Gaps in Medicare Advantage

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zoodenserorgo of AL 12:00AM October 27, 2009

Well George, you have a couple things wrong. Your hospital stay senerio leaves out one key fact. The Medicare Parts A/B patient still has copayments to meet for any follow up, or other medical care. The Advantage Plan (with most) patient is done spending for the year. Never mind that the vast majority of hospital stays are under 5 days, and the vast majority of Advantage Plans have daily copays under $300.00. You do need to read through the plan, because some are far better then others. Plans also differ on what applies to the "out of pocket max". A good plan will apply all medicare services torwards the max. This feature alone makes someone better off in an Advantage Plan then running with just A and B. You also don't have to worry about where you have your stroke, emergency care is always covered. As stated before, the best bet is to buy a supplement...but if costs makes that tough, Advantage is better then just A and B. Just have to choose carefully.

Dave of IL 2:52PM February 13, 2009

First off, the opinion of anyone who can't write in sentances that make sense and or spell should automatically be discounted. Advantage plans provide a disadvantage, look how clever I am! This would still be true if the doctors and hospital in my county accepted them, which they don't... What they do is tweak how the medicare system works to basically present the notion that they are more comprehensive while still covering the same services. They let the policy holders go only to the doctors and hospitals that will accept their watered down payment, allowing the private insurance company to pocket the difference. For instance you can be in the hospital for one day and pay a $300 coinsurance payment with an advantage plan as opposed to $1068 (the part A deductible), however if you are in the hospital for say 12 days you can pay up to $3600 in coinsurance payments as opposed to the $1068. You can be in the hospital up to 60 days and would still pay just the $1068 under tradtional medicare.
So which is better? It depends what kind of health problems that you happen to have. If you could predict that, there would be no need for insurance. Almost every aspect of every service that is covered by medicare is distorted and covered differently like the example I gave you. The out of pocket expenses on the average are about the same, it's all the same, except... on traditional medicare, you can go to any doctor or hospital which you can't do on an advantage plan. So if you are a senior, make sure you are standing infront of one of the hospitals that accepts your plan in case you just so happen to decide to have a stroke.
Hmm... lets see what is a better idea... Letting the government use the tax dollars that you HAD to pay them for at least 40 quarters of your life to administer your health care benefits or taking all that money (and sometimes more) and giving it to a private insurance company to take care of it, and of course, give you more bang for your buck... If you think the latter, then you may have an insurance company confused with a party who wants liability with no reward, it defeats the purpose.
AND PLEASE... If you think the government is going to provide socialized heathcare, you are right. They have been for over 40 years. Its called medicare. Yeah thats right, and the whole reason for these advantage plans was to shift some of the liability off of the government healthcare system that we have called medicare. What does this mean you wonder??? The government can't even support a healthcare system that only semi-covers a small portion of the population, how are they going to provide more benefits to more people.
This is America, it was founded on capitalism. Nothing is free, deal with it. It is what it is. You are either a winner or a loser in this country and life is about choices. If you don't like the way it is, go to Canada or something.

George of FL 8:16PM February 04, 2009

I'M A DISABLED WOMAN WHO IS GOING TO BE 62 NEXT JAN. I WAS FORCED TO RETIRE AT 55 DUE TO AN ON THE JOB INJURY. THE COMPANY AGREED TO CONTINUE TO PAY FOR MY MEDICAL AND DENTAL AS THEY DID WHILE I WORKED. WITHIN THE YEAR I RECEIVED A LETTER STATING THAT All RETIREES WERE TO BUY THEIR OWN INSURANCE. NOW, SOME INSURANCE COMPANIES DON'T ACCEPT THOSE WHO ARE DISABLED AND UNDER 65 AND THOSE THAT DO, LIMITED MY CHOICES. SO, I WAS FORCED TO GO TO HUMANA HMO. LITTLE DID I KNOW HOW THE GAME WAS PLAYED BETWEEN MEDICARE, HUMANA, AND MY CARE. IT TURNS OUT THAT MEDICARE GIVES THE DOCTOR A CERTAIN AMOUNT OF MONEY FOR EACH PATIENT THAT THE "PCP" DETERMINES HOW AND WHEN THAT MONEY TO THE PATIENT'S CARE. IF THE DOCTOR NEGLECTS THE PATIENT'S NEEDS, THE DOCTOR "POCKETS" THE MONEY. (THERE SHOULD BE AN ESCROW ACCOUNT WHERE THE DOCTOR GETS PAID AND THE PATIENT RECEIVES A STATEMENT ADVISING THE COST FOR TREATMENT FOR EACH VISIT). I DIDN'T BELIEVE MY EARS, BUT IT'S TRUE, CHECK IT OUT FOR YOURSELF. I WAS PUT OFF FOR THREE MONTHS TO SEE MY CARDIOLOGIST, WAS REFUSED AN AUTHORIZATION TO SEE MY ENDOCRONOLOGIST, AND THE REASONS GIVEN WAS THAT. "WE CAN TAKE CARE OF ALL YOUR NEEDS." AS A DIABETIC I WAS FURIOUS SO I PAID $100 TO A GROUP THAT PROVIDES TESTS FOR THE ARTERIES, BONES, & ULTRASOUND. WHEN THE RESULTS CAME IN IT WAS DETERMINED THAT MY CORRADID ARTERY HAD A BLOCKAGE. I IMMEDIATELY NOTIFIED HUMANA AND TOLD THEM THAT THEY WERE MAKING THIEVES OF DOCTORS WHO FOUND OUT HOW TO MAKE EASY MONEY. HUMANA DIDN'T CARE BECAUSE THE DOCTORS WOULD HOLD BACK CARE THAT COULD BE COSTLY TO THE INSURANCE COMPANY. SO, WHO SAYS WE DON'T NEED UNIVERSAL HEALTH CARE??? IF WE HAD UNIVERSAL HEALTH CARE, DOCTORS WOULD HAVE TO PROVIDE THE BEST CARE. I DON'T THINK OUR COUNTRY WOULD SACRIFICE GOOD HEALTH CARE AS SOME SAY, BECAUSE WE WOULD ALL BE IN THE SAME BASKET. WHAT DO YOU CALL WHAT WE HAVE NOW? YOU KNOW, SOME ARE CONCERNED THAT THERE ARE 4,000 ABORTIONS DONE A DAY, WELL, THE CHILDREN THAT DIE FROM LACK OF CARE IS MUCH HIGHER. WE ARE NUMBER 28 IN THE WORLD FOR GOOD HEALTH CARE. SO, WHEN YOU HEAR THOSE SAY THAT UNIVERSAL HEALTH CARE WOULD CREATE LACK OF CARE, WAITING LINES, AND GOOD DOCTORS, DON'T YOU BELIEVE IT! IF YOU HAVE MONEY, IT'S NO PROBLEM, IF YOU HAVE JUST ENOUGH TO MAKE ENDS MEET, YOU'LL HAVE TO CUT CORNERS EITHER BY TAKING LESS MEDICINE OR CUTTING DOWN ON YOUR FOOD BILL. WE NEED TO TELL OUR GOVERNMENT TO STOP SHORTCHANGING ON OUR HEALTH. AREN'T YOU ANGRY ABOUT ASKING FOR AUTHORIZATION WHEN YOUR DOCTOR TELLS YOU TO SEE A SPECIALIST? WHY CAN'T YOU SEE THE DOCTORS YOU WANT WHEN YOU WANT? WHAT'S THE BUSINESS OF "TIERS" FOR FORMULARIES? WHY CAN'T WE BUY BRAND IF WE WANT TO INSTEAD OF GENERIC? WHY SHOULD DRUGS COST SO MUCH MONEY WHEN THEY COST PENNIES TO MAKE??? WE NEED TO STAND UP AND SAY, "ENOUGH IS ENOUGH!" LET'S PUSH BACK THOSE ROCKS AND GET OUT OF THE HARD PLACE THEY'VE PUT US IN!

MADDY LEPORE of FL 1:02AM October 22, 2008

One Size Fits All states that Medicare Special Needs Plans are the answer for those with chronic conditions. Look a few up and see what is defined as a chronic condition. The definitions are narrow. Many diseases today that are terminal for example, are really chronic in nature for many years. A cancer patient can live for 10 years, or more, with out of control medical expenses and inadequate insurance (i.e., advantage plans or original medicare). Special needs plans do not cover the needs of cancer patients, as well as many other patients whose diseases persist and are incredibly financially debilitating. You are right that the "chronically" ill can not afford supp plans, but Special Needs Plans are the answer for a limited few.

Lisa of 7:31PM October 02, 2008

Seniors are not the only consumers who suffer at the hands of Medicare Advantage Plans. As a disabled person with Stage IV cancer, I am running into more coverage gaps than I was led to believe existed. Having already been bankrupted by my illness, I am hardly in a position to afford a Medicare Advantage Gap plan. In fact, I didn't even know they existed before reading this article. I'm pretty knowledgable about health insurance, and it came as quite a surprise.
Cancer patients in particular are forced into Medicare Advantage Plans as Original Medicare requires a 20% co-payment on Part B drugs (i.e., chemotherapy)! This is a fact that is neatly obscured by Medicare explanations (what senior thinks that they are going to get cancer and know that chemo is a part B drug)? Medicare advantage plan marketing materials make no effort to point this out either. I'm sure it comes as a surprise to many seniors as well as disabled medicare enrollees. In fact, most advantage plans cover chemo at only 80%. I found only one advantage plan that covered my chemotherapy and requires only a small co-pay. I was lucky enough to be young, educated and aware enough of the complexities of health insurance to choose a plan that helped me the most with my cancer treatments. However,I am still struggling to meet my medical expenses. The dance I have to do to pay my bills is unbelievable, never mind fighting the cancer. To add insult to injury, I recently discovered that there is no mental health parity for Original Medicare or Medicare Advantage Plans. Those $35.00 co-pays add up! While H.R. 6331 was recently passed and guarantees mental health parity (for Original Medicare Enrolless only), this guarantee will not be fully implemented until 2013. I doubt I will live long enough to be able to take advantage of H.R. 6331, even if I was in a position to be able to afford Original Medicare. Imagine being terminally ill and not being able to get the mental health care you need to help you cope with your situation!
The fact is, most American's are incredibly ignorant about health insurance, until they get very sick, and then it is too late. Most seniors can't understand their choices and can't find the support they need to help them make informed decisions. The misinformation out there is simply shameful. While I am better off with an advantage plan, it hardly meets my needs. Don't get me started on the Part D donut-hole for prescriptions! People are afraid that with socialized medicine their health care will suffer. Only rich people can think like that, the rest of us are already suffering. Don't get me wrong, I would love to be able to pick and chose my doctors, or go to a big university medical center for help. Now that I know what I know, I would do so with a heavy heart knowing that there were others out there that died earlier because they couldn't afford to live.

Lisa of NY 7:19PM October 02, 2008

I was just looking at the Medicare Advantage plan with the help of a medcare person. I'm a heart transplant particpant of 9 years and we had Medcaid at one time. My wife and are no longer on Medicaid medical due to and increase of income when Plan D came in effect. However, they still pay part B. We're under extra help with Medicare. The problem we are having is paying the 20 percent that Mediare don't pay. So I start looking for a advantage plan. I have know ideal what is best for us. Maybe I should be looking for a supplement type. I be 64 this month and my wife is 71 young. I have a long list of Advantage plan that is in this state of Pa. though Medicare. But the only ones that I like that "say any Doctor". Some of these plans start with Monthy premium up to $300.00 I'm looking at $50.00 to 65.00 dollors for premium if I have to. As long that we have full covage.
We have part A&B And we get perscrtion plan D I was wondering if you could help us in what would be best for Us. Thanks or your time, Gary

Gary White of PA 3:24AM September 11, 2008

i think that if a medicare advantage does not deliver as they say they will do they should loose there lienses to sell insurane no insurance is safe to buy there all out to make money on the poor seniors and not give them anything in return but so long as we got a republican in office they will continue to rip off the poor seniors.

charles harbin of AL 7:26PM September 02, 2008

Denise of AZ, your delusional if you think that its that black & white when it comes to Med supps vs Advantage plans. Everyone is different. Thats why there are choices. Thats why there are various Advantage plans & various Supplement plans because not everyone is a clone!
If a beneficiary can qualify for it, the Special Needs Advantage plans are a good bet for those with Chronic conditions. $0 premiums, coverage in the donut hole, lower or $0 co-pays & low Out of pocket max are better than Medi-gap plus a useless D plan or than a standard Advantage plan. Many beneficiaires also benefit fro the additional care management & vision care from these plans. Medi-gap plus D isn;t always the best for the chronically ill. Do a little more research...And by god, how much money do you think these people make in their tiny social security checks? Most can;t afford a MED supp & those under 65 don't qualify in most states.....How did u get an insurance license?

JWUHC of WI 11:21PM June 06, 2008

To the gentleman who wrote that he'll keep his BCBS plan I say, "Smart move!" As an insurance agent who deals with Medicare Advantage plans and Medicare Supplements, I tell people who can afford their supplement plan to keep it. Unfortunately insurance companies spend millions of dollars to convince seniors that they can do much better with a Medicare Advantage plan, and this is rarely the case. I don't understand how Medicare allows Medicare Advantage companies to get away with some of the plans they offer. The AARP Medicare Complete plan with a $295 per day hospital co-payment (up to $3600) comes to mind as a very bad plan.
Medicare's position seems to be that seniors are given lots of choices and they are responsible for understanding those choices and making good decisions for themselves. While many seniors are able to work through the details and sales pitches, I believe a majority of seniors have no idea what they're really signing up for. And these seniors are left to the mercy of insurance salesmen/women, many of whom are more interested in their commission than the welfare of their client.
President Bush and his administration keep fighting any changes to these Medicare plans and the windfall they represent for insurance companies. They seem to know that as each year passes and more and more seniors are signed up with these plans, it will be difficult for a Democratic president and/or Congress to make changes that will affect so many people.
The ultimate goal of the Republicans is to privatize Medicare - but at what cost to seniors? In this scenario the insurance companies win and seniors lose.

Denise of AZ 5:34PM April 11, 2008