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When you sign up for Medicare Advantage, and you shouldn't, you will still have to apply for and qualify for Medicare (65, 40 quarters of work, ...). You will g

When you sign up for Medicare Advantage, and you shouldn't, you will still have to apply for and qualify for Medicare (65, 40 quarters of work, ...). You will generally pay the Medicare Part B premium ($164.90/mo this year) and any Medicare Advantage premium. But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. With Medicare Advantage, you get to spend the rest of your life fighting health insurance companies. And for the most part, you're stuck on Medicare Advantage. Guaranteed enrollment is only in your first year. BTW, brokers are incentivized to sign you up for Medicare Advantage. Their commission is much higher for Medicare Advantage than for a Medigap plan. Medicare Advantage is vulture capitalism. Traditional Medicare generally pays 80% and you get a Medigap plan for the other 20%. My UHC Plan G costs $139.28/mo with a $226/yr deductible, no copays, no coinsurance, no restricted network. And you'll need a Part D drug plan. My SilverScript SmartRX PDP costs $4.50/mo. Bernie is right. Medicare for all would be awesome.

toast0 4y ago
> But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. I'm much too young to figure this stuff out now, because it will be drastically different by the time I would need to use it, but ... If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? Or does medicare not deny or delay coverage? Not all doctors take Medicare either, but I do understand it's pretty widely accepted. I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? And doesn't the patient have to pay some portion of some procedures etc? You could get Medigap insurance for the patient pays portion, but does that have limits or judgement, or are they compelled to follow Medicare's decisions?
- CalChris 4y ago
  > If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? There are no death panels. If Medicare covers the procedure (you can look the procedure up in the What's Covered app) and the doctor deems it medically necessary, Medicare pays and then your Medigap plan pays. So cosmetic surgery isn't covered but removing skin cancers is. In the Medicare Advantage case, you are an account and when your account gets expensive, Allison Janey's company gets very passive aggressive. Traditional Medicare sets a policy. Medicare Advantage sets a policy AND manages a cost (you're the cost). > Not all doctors take Medicare either The vast majority of doctors take Medicare and accept Medicare Assignment, the standard amount that Medicare pays for a procedure. Cedars Sinai takes Medicare. > I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? Yeah, that's nonsense. > And doesn't the patient have to pay some portion of some procedures etc? Medicare pays 80% (except for preventatives where it pays 100%). You get a Medigap plan for the 20%. Mine is UHC Plan G which costs $134/mo and includes some extra benefits. There is no logical way that Blue Cross or Kaiser can sit between you and Medicare (they get paid by Medicare to take your risk) make billions and still provide the standard of coverage that Traditional Medicare offers. That's a shell game.
  - mindslight 4y ago
    > There are no death panels. The overall function of private "insurance" is appropriately labeled a "death panel". In general I find it very odd how so much scare propaganda against changing things is based on describing the actual current dynamic.
  - chimeracoder 4y ago
    > Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.
ThePowerOfFuet 4y ago
>Bernie is right. Yes, but you don't even need to listen to him: the rest of the civilized world figured this out years ago.
- tstrimple 4y ago
  This country’s obsession with NIH can be maddening.
  - jewayne 4y ago
    Not Invented Here? That's too kind. More like "the universe ends at our borders, and anything done outside it can be dismissed offhand".
    - deleted 4y ago
      [deleted]
PopAlongKid 4y ago
For a contrasting viewpoint, I have MA plan with Kaiser Permanente (HMO). As far as I can tell, it is essentially the same as what I previously had under employer group coverage, which was satisfactory to me for many years. Fortunately I have no major medical issues requiring expensive treatment, but if I do, I'm pretty confident that my coverage won't be so scant that it leads to bankruptcy or anything. The monthly total premium for both Part C (MA) and Part D (drugs) is $70, and the only co-pay I've seen is $10 for each office visit after the first one of the year.
- jewayne 4y ago
  For a contrasting viewpoint to your contrasting viewpoint, I took over my parents' finances as my father was dying from emphysema. He had a number of comorbidities that led him to see a number of specialists, so he was definitely using a large number of health services. After he died, I steeled myself for the dreaded slow drip of medical bills in the ensuing weeks and months. They never came. Because my father had Medicare and a Medigap plan.
- saltcured 4y ago
  I've been assisting elderly relatives with myriad physical and mental problems, and they also have Kaiser Medicare Advantage plans. For this elderly couple, out of pocket long-term care costs are about twice the US median income and that's sticking to a somewhat modest board and care environment. It's nice that the Kaiser copays and other billings are not significantly adding to that pile. I can't say every moment has been golden, but I think I will choose the same for myself if the landscape hasn't completely changed by then. I've had to reality-check myself at times, realizing that many of my complaints are about the sad decline of my relatives, rather than any actual problem with Kaiser's care. It can be overwhelming, and you'd wish there was someone to magically fix it. With end-of-life declines, the care outcomes often don't feel very satisfying. I've seen them through hospitalizations, ER trips, nursing home rehab, and home health visits. The only part that is frustrating is Medicare-induced rules, where they suddenly reach a threshold for transfer or discharge and you have to scramble in a reactive mode. I'm not sure how unique this is to Kaiser, but they can fail to consolidate communications through a care coordinator. So, you get chaotic days where multiple different staff and third party vendors are trying to reach you about the same topic all at once.
xienze 4y ago
This comment is much like the article, lots of detail about how Medicare Advantage is a terrible deal and yet there must be _something_ enticing about it or at some point it would be common knowledge that MA is just Medicare with an insurance company sitting in front of it. So what’s the appeal of MA then?
- JoBrad 4y ago
  Probably the advertised inclusion of dental and vision, and for some, the comfort of staying with the same insurance company you had before retirement. There’s also the confusion/difficulty in signing up for Medicare. Apparently it’s not very straightforward to do that?
- CalChris 4y ago
  They advertise and they sell the hell out of MA. I called UHC about their Plan G Medigap. They sell both MA and Medigap. I was getting the hard sell for MA on the phone right now today. UHC makes more money off MA and the brokers make more commission off MA. UHC doesn’t make this money off better service. They aren’t magically more efficient. But they do make it, a lot of it. Why is that? I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or restricted networks. Overall, I think it's a much much better deal than Medicare Advantage.
  - giardini 4y ago
    CalChris says >"I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or..."< What "ballooning copays/insurance" are you speaking of? FWIW we have Medicare Advantage from Kelsey-Seybold. I don't see any balloons in my future that aren't from China. You are convinced regular Medicare + Medigap is better than Medicare Advantage. Why don't you show us an exhaustive list comparing the two instead of floating balloons past us one at a time to shoot down. My MA plan with a single provider has been excellent. One of the best "advantages" is that my medical records are centralized and I have a true medical history going back 40 years in silicon (and on paper when I need it). When go into an ER they have it all there in front of them. I'm open to change, but provide hard arguments and numbers, please.
ars 4y ago
> When you sign up for Medicare Advantage, and you shouldn't Yes you should. The regular Medicare is utter garbage. Medicare Advantage is WAY WAY better. > Bernie is right. Medicare for all would be awesome. Bernie is wrong about basically everything. Unpopular opinion, I know. But the thing is Bernie never thinks about the consequences of his ideas. He'll put out some amazing (in his mind) idea, not realizing people will adjust their actions in response, completely ruining his plan. He does this over and over. His colleagues know this - check his record, he has never even once gotten a bill of his passed, even his own party votes against him, because they are smarter than him and actually think about consequences of things. I listened to him at first, I don't anymore. > Traditional Medicare generally pays 80% And Medicare Advantage pays 100%. And there are Medicare Advantage plans that don't cost anything extra at all - and still pay 100%. It's better than Medigap.
deleted 4y ago
[deleted]

toast0 4y ago

> But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage. I'm much too young to figure this stuff out now, because it will be drastically different by the time I would need to use it, but ... If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? Or does medicare not deny or delay coverage? Not all doctors take Medicare either, but I do understand it's pretty widely accepted. I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? And doesn't the patient have to pay some portion of some procedures etc? You could get Medigap insurance for the patient pays portion, but does that have limits or judgement, or are they compelled to follow Medicare's decisions?

CalChris 4y ago
> If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? There are no death panels. If Medicare covers the procedure (you can look the procedure up in the What's Covered app) and the doctor deems it medically necessary, Medicare pays and then your Medigap plan pays. So cosmetic surgery isn't covered but removing skin cancers is. In the Medicare Advantage case, you are an account and when your account gets expensive, Allison Janey's company gets very passive aggressive. Traditional Medicare sets a policy. Medicare Advantage sets a policy AND manages a cost (you're the cost). > Not all doctors take Medicare either The vast majority of doctors take Medicare and accept Medicare Assignment, the standard amount that Medicare pays for a procedure. Cedars Sinai takes Medicare. > I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? Yeah, that's nonsense. > And doesn't the patient have to pay some portion of some procedures etc? Medicare pays 80% (except for preventatives where it pays 100%). You get a Medigap plan for the 20%. Mine is UHC Plan G which costs $134/mo and includes some extra benefits. There is no logical way that Blue Cross or Kaiser can sit between you and Medicare (they get paid by Medicare to take your risk) make billions and still provide the standard of coverage that Traditional Medicare offers. That's a shell game.
- mindslight 4y ago
  > There are no death panels. The overall function of private "insurance" is appropriately labeled a "death panel". In general I find it very odd how so much scare propaganda against changing things is based on describing the actual current dynamic.
- chimeracoder 4y ago
  > Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.

ThePowerOfFuet 4y ago

>Bernie is right. Yes, but you don't even need to listen to him: the rest of the civilized world figured this out years ago.

tstrimple 4y ago
This country’s obsession with NIH can be maddening.
- jewayne 4y ago
  Not Invented Here? That's too kind. More like "the universe ends at our borders, and anything done outside it can be dismissed offhand".
  - deleted 4y ago
    [deleted]

PopAlongKid 4y ago

For a contrasting viewpoint, I have MA plan with Kaiser Permanente (HMO). As far as I can tell, it is essentially the same as what I previously had under employer group coverage, which was satisfactory to me for many years. Fortunately I have no major medical issues requiring expensive treatment, but if I do, I'm pretty confident that my coverage won't be so scant that it leads to bankruptcy or anything. The monthly total premium for both Part C (MA) and Part D (drugs) is $70, and the only co-pay I've seen is $10 for each office visit after the first one of the year.

jewayne 4y ago
For a contrasting viewpoint to your contrasting viewpoint, I took over my parents' finances as my father was dying from emphysema. He had a number of comorbidities that led him to see a number of specialists, so he was definitely using a large number of health services. After he died, I steeled myself for the dreaded slow drip of medical bills in the ensuing weeks and months. They never came. Because my father had Medicare and a Medigap plan.
saltcured 4y ago
I've been assisting elderly relatives with myriad physical and mental problems, and they also have Kaiser Medicare Advantage plans. For this elderly couple, out of pocket long-term care costs are about twice the US median income and that's sticking to a somewhat modest board and care environment. It's nice that the Kaiser copays and other billings are not significantly adding to that pile. I can't say every moment has been golden, but I think I will choose the same for myself if the landscape hasn't completely changed by then. I've had to reality-check myself at times, realizing that many of my complaints are about the sad decline of my relatives, rather than any actual problem with Kaiser's care. It can be overwhelming, and you'd wish there was someone to magically fix it. With end-of-life declines, the care outcomes often don't feel very satisfying. I've seen them through hospitalizations, ER trips, nursing home rehab, and home health visits. The only part that is frustrating is Medicare-induced rules, where they suddenly reach a threshold for transfer or discharge and you have to scramble in a reactive mode. I'm not sure how unique this is to Kaiser, but they can fail to consolidate communications through a care coordinator. So, you get chaotic days where multiple different staff and third party vendors are trying to reach you about the same topic all at once.

xienze 4y ago

This comment is much like the article, lots of detail about how Medicare Advantage is a terrible deal and yet there must be _something_ enticing about it or at some point it would be common knowledge that MA is just Medicare with an insurance company sitting in front of it. So what’s the appeal of MA then?

JoBrad 4y ago
Probably the advertised inclusion of dental and vision, and for some, the comfort of staying with the same insurance company you had before retirement. There’s also the confusion/difficulty in signing up for Medicare. Apparently it’s not very straightforward to do that?
CalChris 4y ago
They advertise and they sell the hell out of MA. I called UHC about their Plan G Medigap. They sell both MA and Medigap. I was getting the hard sell for MA on the phone right now today. UHC makes more money off MA and the brokers make more commission off MA. UHC doesn’t make this money off better service. They aren’t magically more efficient. But they do make it, a lot of it. Why is that? I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or restricted networks. Overall, I think it's a much much better deal than Medicare Advantage.
- giardini 4y ago
  CalChris says >"I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or..."< What "ballooning copays/insurance" are you speaking of? FWIW we have Medicare Advantage from Kelsey-Seybold. I don't see any balloons in my future that aren't from China. You are convinced regular Medicare + Medigap is better than Medicare Advantage. Why don't you show us an exhaustive list comparing the two instead of floating balloons past us one at a time to shoot down. My MA plan with a single provider has been excellent. One of the best "advantages" is that my medical records are centralized and I have a true medical history going back 40 years in silicon (and on paper when I need it). When go into an ER they have it all there in front of them. I'm open to change, but provide hard arguments and numbers, please.

ars 4y ago

> When you sign up for Medicare Advantage, and you shouldn't Yes you should. The regular Medicare is utter garbage. Medicare Advantage is WAY WAY better. > Bernie is right. Medicare for all would be awesome. Bernie is wrong about basically everything. Unpopular opinion, I know. But the thing is Bernie never thinks about the consequences of his ideas. He'll put out some amazing (in his mind) idea, not realizing people will adjust their actions in response, completely ruining his plan. He does this over and over. His colleagues know this - check his record, he has never even once gotten a bill of his passed, even his own party votes against him, because they are smarter than him and actually think about consequences of things. I listened to him at first, I don't anymore. > Traditional Medicare generally pays 80% And Medicare Advantage pays 100%. And there are Medicare Advantage plans that don't cost anything extra at all - and still pay 100%. It's better than Medigap.

deleted 4y ago

[deleted]