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I work in case management at a hospital serving a good chunk of hill people.
They’ve all benefitted “well” from having the choice to (not) choose Medicare.
Most common thing that becomes my problem is the people who don’t get Part D because they haven’t needed prescription meds before. Suddenly they end up needing a $500/month blood thinner or insulin and are convinced they’re being screwed by The Man.
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Can you clearly say what they got that was better than Medicare once 65?Quote:
Originally Posted by jm2e
I love those people. They end up paying penalties too. You can get a part d for $7!- month too. They are Usually the first to complain why everything isn’t free by their age. Veterans are pretty bad too. They don’t take out there prt B, when I tell them they have too, they hang up on me. Later on, they end paying a penalty every month the rest of their lives. I actually took their cause to Washington DC, spoke with both republicans and democrats from my state, and none of them gave a shit that they were dicking disabled Vietnam veterans. Surprised I made it past the gate keepers though. I tried.Quote:
Originally Posted by jm2e
Sarcasm.Quote:
Originally Posted by liv2ski
Our culture promotes the idea that choice is good. That the free market will win the day. The poor and uneducated are the ones who suffer. Actually, the kinda poor suffer. The real poor end up with Medicaid.
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Not to make this political. But healthcare really explains how fucked up everything is. Basic medicare and a supplement is the only choice people should have in my opinion, it works great. It’s an example of how well a govt system can work. But at the end of the day, everyone likes a deal so medicare advantage is growing, and so are profits. It’s good we have both choices, but medicare advantage actually costs tax payers more money. I remember hearing paul ryan say his mother got “free trips” to a doctors office on MA. Shouldn’t that guy be giving his own mother a fucking ride? As in, the take care of your own attitude schmucks like him haveQuote:
Originally Posted by jm2e
Again, not bagging on MA, just so long as you know what it is and why you are doing it. but when I hear people refer to it as a supplement it’s my job to correct them. Sold one today. 600 bucks, plus lifetime renewals of 300 a yr. United healthcare does not want me selling supplements when they. Can squeeze 1000 a month out of medicare. That’s why UNH is booming.
So are you saying I should be in a supplement plan as opposed to an advantage plan because it saves the Govt money? As I said above I pay zero premium, get $2000 for dental, $300 for eye ware, gym membership etc. While you said it is more expensive for the Govt the advantage plans do accept a risk of agreeing to pay the costs regardless of what the cost for a particular patient is during that calendar year.Quote:
Originally Posted by Cono Este
It’s really easy not to do. Just shut the fuck up. It’s that easy.Quote:
Originally Posted by Cono Este
I never thought I'd see a bunch of geezers talking about Medicare on TGR. sad so so sad
Wait till you see a similar thread on newschoolers.
It’ll happen.
One day you may place more priority on hospitalization and less on 300 in frames or contacts. Nothing wrong with an advantage plan. Just realize it’s not actual medicare and you don’t have a supplement, but most importantly most doctors and hospital prefer original medicare and things like skilled nursing, or physical therapy, a lot of people won’t take it or your choices are limited. . Your original benefits are suspended while you’re in the plan. You can return to Original medicare the 1st of any yr. You most likely will have to answer health questions for a supplement though.Quote:
Originally Posted by bigdude2468
Look, I’m not trying to scare anyone out of medicare advantage. I get paid a lot more to sell them, it’s the reason I can workout for two yrs through Covid. Lifetime earnings! Vs 6 yrs for a supp. I don’t fight it anymore. I just want people to understand it’s different.
I have to be direct because one of you grouchy fucks may have cancer and how the fuck will I know that? If you are very I’ll original medicare all day long. I’m a diabetic, so I’ve lived with the pre existing bullshit.
United healthcare offers free shit on the supplements. Gym, and if you are really cheap, or live in a rural place with limited services, , you can buy a high deductible supplement G for like $50. It’s a great choice. No agent will ever tell you about though when he can make like 3000 grand off you instead.
Quote:
Originally Posted by Elkhound Odin
And I never thought I'd be at an age where I should pay attention to this subject, but I am.
Maybe I am missing something, what are the shortcomings of an Advantage plan?Quote:
Originally Posted by Cono Este
The two advantage plans I have had I (or my wife) never had to answer a health care question. There is no annual maximum amount the plan will pay. In four years with the current plan we have never had a denied claim nor has Aetna ever not paid the provider promptly. The statements I receive are quite simple, It shows the amount they paid, they amount they disallowed for being more than the Medicare reimbursement amount and what if anything I owe. Then in big letters it says "do not pay any amount beyond what is shown as your portion".
+1.. I am very happy with my advantage planQuote:
Originally Posted by bigdude2468
Quote:
Originally Posted by bigdude2468
It’s simple. On an advantage plan the bills go to an insurance company. If you like insurance companies then you have nothing to worry about. You’ve “replaced”medicare with the benefits in your plan. Your medicare card wont work anymore. Your benefits are suspended. On original medicare the bill goes to medicare. From my experience, that is a very, very big deal to some, and not so much to others, then about 50% don’t even get the explanation. They call Broadway Joe on TV. Such a nice man.
To most, they don’t care, but too some, they’ll get so mad they’ll talk lawsuits for not getting told.
I’ve been on 2000 appointments. A lot of people joined advantage plans 10 yrs ago that were advertised as “free supplements”. They are not. I get called to the house to explain shit and they get steaming mad. They paid for a supplement for 10 yrs for nothing, can’t get it back, and now they are at an age where the free plan is no longer free, they’re generating copays, and not using the gym.
No wrong answer here, both good insurance, but for 1-25, a very big difference.
Remember, I go into homes where people are on oxygen, dialysis etc, and there is no advantage to advantage for those people. I walked out on a guy whose wife had liver cancer and demanded an Mapd.
Very simply put and understandable.Quote:
It’s simple. On an advantage plan the bills go to an insurance company. If you like insurance companies then you have nothing to worry about.
Thx.
UNH has part G that includes the extra fringes like renew active (gym) etc. so those perks are not exclusive to advantage. I called UNH to make sure.
Except your supplement plan is also an insurance company. For the five years I have been in Aetna's MAP including the year when I had $200,000 of claims the dental benefit which I have used every year has exceeded my total out of pocket for that year. Maybe other advantage plans have issues but i have not. I have received statements indicating a provider has not submitted the necessary documentation or perhaps a coding error but in those cases the providers have never sent me a bill requesting payment. In fact I never get a bill from a provider until they have been reimbursed by Aetna. If there is a copay due they bill me after Aetna has paid their portion.Quote:
Originally Posted by Bunion 2020
I sell those plans, nothing wrong with them.Quote:
Originally Posted by bigdude2468
It’s a personal choice, but people deserve to know the differences because if you have pre existing conditions, you often only get one chance to buy a supplement with no health questions.
Random question. Went in today to get Covid & Flu shots. When I registered online I was asked if I wanted any "free" Covid tests. WTF says I, yeah, I will take 4. Get to the pharm and they give me 8. Now I know they sell these same tests at the counter for like 12 bucks, so did someone (yeah them) pay for those or is this paid for by the first second or third Covid relief bills. Or in other words, we all did.
I have a derm that I really like. With advantage HMO I will have to get a referral every time I go for a routine visit. With PPO I can go whenever I want. It’s a minor inconvenience but I’m not sure it’s worth the risk. -$1k a year more for top of the line PPO. Less for a higher deductible.
Yes, it makes it a slam dunk in my area. You can probably go cheaper than a plan G if anyone is being a tight wad.Quote:
Originally Posted by 4matic
Plans vary by territory, but the PPO are what’s getting better. They used to all have a monthly premium and higher out of pocket, now they are 0 premium, with slightly higher out of pockets. Some still have a $500 deductible on hospital and some other things.Quote:
Originally Posted by 4matic
I tell the people who want maximum value to still go with the hmo. The ppo often has that deductible plus you don’t get some things like the quarterly credit to buy shit with.
Minor minor differences though 90% of picking a plan is original medicare vs advantage decision.
I ended up w a Medigap plan , Plan G. Still don't completely understand the differences btwn MAdv and MGap but I "think" I did the right thing.
A client once told be that sounded like the “conservative” choice. And it is, because in most cases, you won’t get another chance to do that without answering health questions, and Medicare Advantage takes everyone. So what’s the hurry?Quote:
Originally Posted by Hopeless Sinner
However, if you feel you understand what the differences are , and know you really don’t want to pay for a supplement, or may cancel it if it goes up, (and it will), then advantage plans have a lot of free shit. And who doesn’t like free shit.
After working my head around this from 7 different direction I am of the opinion its all about guessing how healthy you are when Medicare kicks in or if you need a bunch of care in the near term.Quote:
Originally Posted by Hopeless Sinner
Basic Medicare and United Health via AARP has been my approach. Prepay the deductible of around $225/yr and haven't had any bills. Be sure to get the most out of your free annual visit to your PCP with all the screenings and vaccinations. If your doc is a hottie like mine you might enjoy the prostrate screening : )
A few things which might be of interest...
Which to Choose: Medicare or Medicare Advantage?
11/20/22 NYT article - Try browser reader view if you get paywalled
Medicare Agents and Brokers
Agent Commissions in Medicare and the Impact on Beneficiary Choice
Attachment 434890
New versions published every year - check your public library
That’s very accurate, but I missed where they point out that medicare advantage pays more, and pays for life. Vs a supplement that pays less and for only 6 yrs. The difference is 2-3x the commission and that’s why everyone and their mother wants you to join an advantage plan.Quote:
Originally Posted by fomofo
Cono, your posts in this thread are very high value, and worth re-reading for anyone who's trying to sort this shit out. Particularly #38 and #50. Huge bonus to have someone on the inside weighing in!
For someone who wanted to find a broker to work with, what would be the best way to do that? I've had some friends recommend an agent that signed them up for this or that MA plan, but I'd like to focus on traditional medicare coverage options with a supplement first.
A good independent agent will spend 90% of his time with you explaining both options. Original medicare vs medicare advantage. They will look up your drugs in ALL plans in case something stands out.Quote:
Originally Posted by fomofo
I don’t trust other agents etc. If you want to do that yourself pm me your zip code and I’ll tell you who the best deal is on supplements where you live. If you pm me your drugs I’ll tell you which drug plan to join. Takes me 5 minutes.
On a side note. Be careful calling medicare. They are trying to funnel business to themselves but often give bad advice. They are un licensed and don’t know what they are talking about.
I have a woman right now who was told by medicare she had a united healthcare supplement, but after I looked into it she does not. Now she’s paying 20% for chemo thanks to that govt twit.
The one thing about advantage plans. And I have nothing against them, is that you give up your right to a guarenteed supplement. That’s very important to understand. In most circumstances, if you have health issues, you will be stuck in the advantage plan for life.
So it pays to know the rules. Etc. start with a supp you can always switch to advance. But not the other way around.
Again, thanks for answering these very confusing questions in a way most of us can understand.Quote:
The one thing about advantage plans. And I have nothing against them, is that you give up your right to a guaranteed supplement. That’s very important to understand. In most circumstances, if you have health issues, you will be stuck in the advantage plan for life.
Thanks for mentioning the part about supplement vs advantage. The advantage plans seemed to cover pretty well from what i saw helping my buddies podiatry practice, but getting locked in is significant. There should be some legislation to remove thatQuote:
Originally Posted by Cono Este
Don’t get locked into an advantage plan unless you are totally sure it works for you long term!
There seems to be an explosion of the number of supplement options in the last few years that has added s ton of confusion as well
The problem is that medicare doesn’t spend billions on tv marketing. Advantage plans also look familiar to people coming off group coverage. Dental etc. original medicare is truly unique in that it cuts out the middleman.
I talked to a guy today, had a supplement through me for about 5 yrs,l. He called telling me his girl friend gets a free gym membership on her advantage plan and wtf. I was more than happy to put an advantage plan In the mail to shut the guy up. He can blame his GF. . I get tired of that shit. Worth probably $2500 to me vs like 50 bucks a yr now on the supp.
Then he mentioned his cancer. Cancer treatments, and I told
Him the usual shit and he went from being interested to telling me “no” like i was trying to sell him. He doesn’t want to lose his supplement and never get back again.
I’m a very bad sales guy.
Who can know how long the "long term" will last, or what it will bring, or when? You don't buy fire insurance for your house because there's a fire coming up the valley. All the little up front bells and whistles, (and some dental would be a nice B&W), provided by MA are great, but isn't catastrophic coverage what most people are concerned about? (Or should be?)Quote:
Originally Posted by mcski
Maybe you're just an "honest" broker. ;-)Quote:
Originally Posted by Cono Este
As a friend of mine used to say...
You'll get your reward. In heaven.
Total consciousnessQuote:
Originally Posted by fomofo
Wasn't religious, but he did have a wicked dry sense of humor. Also liked a dry martini, as he was a hard-core alcoholic, and a drug addict. Like so many others with whom I crossed paths, wonder whatever became of him?
Back on topic, this can be a biggie...
You can get the lowest cost if your doctor or other health care provider accepts the Medicare-approved amount as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it’s for all Medicare-covered Part A and Part B services.
https://www.medicare.gov/basics/cost...ccept-Medicare
I guess it's straightforward enough to clarify up front if your PCP accepts Medicare, and assignment, but what about Docs and perhaps other healthcare providers you might be treated by if you unexpectedly end in a hospital? Kinda hard to try and find out on the fly if someone in particular "accepts assignment", much less break off and go a different way if they don't.
I'll take an answer off air, and save my diatribe about how ridiculous/inefficient/corrupt the healthcare system has become for later.
Just about every hospital etc accepts medicare. It’s the most widely accepted insurance in the country x 10.
Yes, if your into Indian medicine or something, or need hair on your head, chew on viagra, you won’t get any.
Medicare is always a bit behind, the govt is slow. The new shingles shot is still not covered. That’s actually where advantage can be better. Part b medical supplies too, seems confusing, but every provider you show the red white and blue to should know what it’s worth. Like PT, you get so much every yr and the PT people know. Then you need a doctor to order more.
So does the granularity end at the hospital level, i.e., if you're admitted to General Hospital, and General Hospital accepts Medicare, and assignment, then everything that happens while you're there will be covered at assignment levels?Quote:
Originally Posted by Cono Este
Or do you need to pay more attention to who exactly sees you, and what services/procedures they order, lest receive unpleasant surprises when the billing comes through?
If you're in California, (and some other states - see link below), this could be of interest to you...
Medicare beneficiaries in California are allowed to enroll in a Medigap plan during the days leading up to their birthday and the days directly after their birthday. ... During this window, you cannot be denied for health conditions. There is one catch. You must already be enrolled in a California Medicare supplement in order to take advantage of the birthday rule. You can keep the same plan type or choose one of the California Medigap plans with lesser benefits. For example, you can go from Plan G to Plan G, or from Plan G to Plan N, but you can’t go from Plan G to Plan F.
https://boomerbenefits.com/medigap-underwriting
https://youtu.be/Bo59zW3ZUyo
Good general info regarding Medigap (Medicare Supplements)
https://youtu.be/QjWl-nuvuc0