Medicare Advantage Plan Advertising

glenbo

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Thank you for your kind reply.
 

rotor

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Part of the plan to think about. You call the number listed and speak to an insurance agent who will get a commission steering you to a Medicare C (advantage plan). You find out your family doc and pharmacy are in the plan. So is your hospital. Sounds good.
What happens if you have a heart attack the first night on the plan and you are not at your local hospital? Will anything be covered? If you are at your local hospital is the ER doc on the plan? You are admitted, will the invasive cardiologist be on the plan? How about the surgeon, radiologist, pathologist, anesthesiologist, pulmonologist and any other doctor that renders care? You may be responsible for a huge bill if these docs are out of network. Did you family doc get prior authorization for treatment?
In reality it is almost impossible to find out if the doctors that will care for you are on your plan. Regular medicare, almost all of the hospitals doctors will be on regular medicare and some of them may accept some medicare advantage plans. If not you are out of network. This is one of the ways you get stuck with the bill.
With regular medicare if a hospital takes medicare then most likely the staff does too. You can have that heart attack anywhere in the country and be covered. You are in California (god no), does the hospital take your plan?Does the staff take your advantage plan? And there are a bunch of them so some may be accepted and some not. Do you think you will be able to pick your doctor to make sure he/she is in network?
The insurance agents can convince you that your doctor and hospital are covered but usually that is your family doctor who is also your gatekeeper and as you all know, they don't even go to the hospitals nowadays and they have to refer you for everything or you get the bill.
I post this info to try to inform people of the tricks insurance companies play to not spend money on you. Those of you that think they are getting a good deal may find that fighting an insurance company to pay the bill is not an easy thing to do.
I speak from experience. Have been there and done that.
What do I suggest, regular medicare, medicare supplement, part d Rx plan. More expensive yes. Covers you virtually anywhere, yes. If you are never going to be sick or hospitalized go with an advantage plan.
This post is not to criticize you but to help you avoid some of the traps that the advantage plans use to not pay. We all know the horrors of an HMO, my wife is in one now as it is the only one available in our area (she is not on medicare yet). She sees doctors out of network because they don't take the HMO and we pay cash full price. When you need a specialist and he is not in network you will pay the bill.

Medicare C is the biggest moneymaker for health insurance companies. The government pays them a premium to cover you. Insurance companies are in it to make money. You do that by denying care and not paying bills.

This simple article helps explain things
 

Wiliamr

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Apr 15, 2011
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What Rotor speaks of is the truth. My credential in this area is having been a health benefit representative for a group of employees covered by the Federal Employee Health Benefit Programs. There are a lot of plans available to chose from for active duty employees, and the Medicare age employees are always asking why they need the FEHBP insurance if they can get free Advantage plans. I always caution them about if it sounds to good.....

The companies that push these "Advantage Plans" spend huge sums of money and notice they harp on the "FREE" and "Money back in your Social Security account". First, ask yourself, since when is the single most expensive part of life (Medical in elder care) FREE? Who pays for all that advertising and the "Free" calls?

Advantage plans can sound good and if you do not travel (Most Advantage plans have a very limited area of coverage and you have to go to their plan doctors, hospital, labs, etc) they can be ok. Where they begin to fall apart is if one travels a lot, or if you are in San Antonio with a Austin Advantage plan coverage and have a heart attack and are in the hospital a week or more. You find out very quickly how little the "Advantage" plan pays. One our members last year dropped our associations FEHB plan cause he didnt like the premium in addition to his Meidcare premium. He was in another state, had a heart attack and discovered that the Advantage plan would only pay for a few things and he was saddled with a nearly 600,00 dollar bill from hospital, doctors, emergency room, ambulance etc.
Choosing medical insurance is not a simple nor easy endeavor. It is not something to just slip into. One has to look at not just the costs of premiums, but the costs if something goes very wrong with your health. It can and does and often without warning. Choose wisely.
 

glenbo

Active Member
Lifetime Member
Rating - 100%
2   0   0
Sep 3, 2014
493
93
San Leon
Part of the plan to think about. You call the number listed and speak to an insurance agent who will get a commission steering you to a Medicare C (advantage plan). You find out your family doc and pharmacy are in the plan. So is your hospital. Sounds good.
What happens if you have a heart attack the first night on the plan and you are not at your local hospital? Will anything be covered? If you are at your local hospital is the ER doc on the plan? You are admitted, will the invasive cardiologist be on the plan? How about the surgeon, radiologist, pathologist, anesthesiologist, pulmonologist and any other doctor that renders care? You may be responsible for a huge bill if these docs are out of network. Did you family doc get prior authorization for treatment?
In reality it is almost impossible to find out if the doctors that will care for you are on your plan. Regular medicare, almost all of the hospitals doctors will be on regular medicare and some of them may accept some medicare advantage plans. If not you are out of network. This is one of the ways you get stuck with the bill.
With regular medicare if a hospital takes medicare then most likely the staff does too. You can have that heart attack anywhere in the country and be covered. You are in California (god no), does the hospital take your plan?Does the staff take your advantage plan? And there are a bunch of them so some may be accepted and some not. Do you think you will be able to pick your doctor to make sure he/she is in network?
The insurance agents can convince you that your doctor and hospital are covered but usually that is your family doctor who is also your gatekeeper and as you all know, they don't even go to the hospitals nowadays and they have to refer you for everything or you get the bill.
I post this info to try to inform people of the tricks insurance companies play to not spend money on you. Those of you that think they are getting a good deal may find that fighting an insurance company to pay the bill is not an easy thing to do.
I speak from experience. Have been there and done that.
What do I suggest, regular medicare, medicare supplement, part d Rx plan. More expensive yes. Covers you virtually anywhere, yes. If you are never going to be sick or hospitalized go with an advantage plan.
This post is not to criticize you but to help you avoid some of the traps that the advantage plans use to not pay. We all know the horrors of an HMO, my wife is in one now as it is the only one available in our area (she is not on medicare yet). She sees doctors out of network because they don't take the HMO and we pay cash full price. When you need a specialist and he is not in network you will pay the bill.

Medicare C is the biggest moneymaker for health insurance companies. The government pays them a premium to cover you. Insurance companies are in it to make money. You do that by denying care and not paying bills.

This simple article helps explain things
Now do dental for seniors.
 

Davetex

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Mar 27, 2010
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Pflugerville
At what age are you supposed to get on medicare? When is the best time to sign up?
I'm approaching that time, but I'm unsure of details.
 

baboon

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Out here by the lake!
With all due respect can you get care outside the area you live in? If you develop cancer can you go to Mayo Clinic, MD Anderson, any facility you pick? Actually I know quite a lot about Medicare C. Best of luck with your choice.
When I choose my Advantage program I was living in Houston. It started right when we moved. With the move I had to pick an all new plan based on the new region in Texas. And all that did was drag out my coverage and ability to find providers.

We have been here 2 months shy of a year. I just seen a new eye doctor last month.
 

rotor

TGT Addict
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0   0   0
Nov 1, 2015
3,099
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Texas
At what age are you supposed to get on medicare? When is the best time to sign up?
I'm approaching that time, but I'm unsure of details.
Three months before turning 65.
 

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