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I can speak about an apparently non-scam Medicare Advantage plan that my wife and I are on. It is effectively a PPO (similar to the Kaiser plan someone else me
by Blammar 4y ago
I can speak about an apparently non-scam Medicare Advantage plan that my wife and I are on.
It is effectively a PPO (similar to the Kaiser plan someone else mentioned), so we have access to exactly the same physicians that we had already where we were paying for private insurance. Our annual premiums went from about $85k a year (on the private insurance) to around $10k out of pocket.
We are fairly healthy, though my wife is going to have some major joint surgery. What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. (That stalling finally motivated my wife to make the switch out of the private insurance.)
The downside of our MA plan is that we are not going to be able to move out of the area easily. But you always have that issue regardless -- finding a whole new set of doctors and dentists when you move...
I do get these phone calls asking to schedule a "wellness" check that the article writer mentions. Oddly enough, my wife didn't get any (so far.)
- everybodyknows 4y ago> (That stalling finally motivated my wife to make the switch out of the private insurance.) They would have known that you had the option of going elsewhere. The stalling looks strategic and, unfortunately, successful.
- Blammar 4y agoIndeed. Got to play the hand dealt.
- asah 4y agoShe's probably already high risk, so the visit would be an additional cost to the insurance company.
- deleted 4y ago[deleted]
- Trisell 4y agoThat call is because Health Plans are rated by CMS on if you get certain types of services, or skip them. By skipping those checkups you are reducing your health insurance plans STARS rating, which means they lose significant monies from the government. Each .1 of a start equals around 1 million US in government funding to a health plan doing MA.
- bknight1983 4y agoWellness calls are also a starting point for shared savings and other value-based contracts
- 88913527 4y agoIs $85k annual premiums a typo? That's about an order of magnitude higher than my expectations would have been for near retirement age health care.
- deleted 4y ago[deleted]
- lotsofpulp 4y agoNo, the Affordable Care Act restricts premiums for the most costly insureds (age 64) to 3x the least costly insureds (age ~21). So the health insurance premiums you see for ACA compliant health plans are very subsidized by younger plan members, but this subsidy ends starting age 65. In other words, expected healthcare costs for old people are massive. Edit: also, annual premiums for age 64 are around $20k to $25k, and that is with the subsidy from younger plan members.
- cmurf 4y agoIt is not a health care system, it's a sick and dying payment plan system. They definitely don't want you to die because then you stop paying into the system. But they don't care about quality of life, they want to pay out as little as possible.
- JoshTriplett 4y ago> this subsidy ends starting age 65 As I understand it, the subsidy ends at 65 because at that point the "affordable care" option is Medicare. Thus, there's less motivation to subsidize private insurance.
- watwut 4y agoThe whole point of insurance is that sick get paid from money of healthy.
- lotsofpulp 4y agoThe problem with health insurance is the healthy know who they are and the unhealthy know who they are, so you have massive adverse selection. Hence, the ACA rule (now defunct per 2017 TCJA) to require everyone to buy health insurance.
- DiggyJohnson 4y agoDo you have some sort of special private insurance? 85k /yr is unbelievable to me.
- lotsofpulp 4y agoI wonder if 65+ health insurance plans are allowed to price insurance based on the insured’s health, since the Affordable Care Act pricing rules only applies up to age 64. If so, I can see someone with chronic ailments with high probability of things like heart attack, stroke, and other high cost events cause a premium that high.
- wrycoder 4y agoYou don't stay on private insurance after 65 in the US. You go on Medicare. 85K per year is unbelievable and the OP isn't responding.
- WeylandYutani 4y agoBeing old is one of those preexisting conditions insurance probably doesn't like.
- Blammar 4y agoSorry for the lack of an immediate response. Yes, both of us are over 65. The insurance was a high end PPO with no lifetime max and $20 copay. My wife is a cancer survivor, and I take drugs to minimize my cancer risk. Additionally, the premium growth rate accelerated considerably after 65. We did not actually pay $85k for a year but that was going to be the price. We were told what the new premiums would be, and instead of paying the $85k (paid monthly in installments), I switched immediately to the MA plan and told my wife, let's see how this works out. She held on for six months, then ran into the stalling, and then it took her another six months before she could get on the same MA plan. The reason our MA plan works is that it's offered by the same medical center we happened to use 100% of the time on our previous insurance. So we didn't need to switch any physicians. Regarding predatory MA's, my wife's surgeon, who was trying to get the approval for her surgery, told her, "This isn't going anywhere, you're past the time to switch to medicare, get an MA. However, be sure you avoid these companies." Yes, we switched to medicare late, and we are reminded of that every month when we pay the penalty. (I should mention our current MA plan is a HMO, not a PPO -- my typo.)
- cool_dude85 4y ago>What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. At least one part of the scam seems to have worked here: you use "private" to describe your old plan, to contrast with MA. In reality, both your old and new plans are private.
- mortenjorck 4y agoWell, yes and no. The MA plan is privately operated, but funded in part by public dollars. To the article's point, the problem arises when private insurers arbitrage the services those public dollars are supposed to be going toward.
- Blammar 4y agoI'm fully aware that both plans are private.
- jrs235 4y agoAre they immediately approving the surgery so you stay on for a year and then are hooked? How long from approval until the procedure takes place? Will they deny future, follow up or other, procedures down the road?
- Blammar 4y agoAs I mentioned elsewhere, the MA covers the same health center we've used for 40+ years as a HMO. I've had no issues with getting stuff approved. Her surgery was approved in less than a month and it's scheduled in a month. She'll need another later this year, but approval of that must wait until we see how this one turns out. There's always the possibility the MA will stall. If it's egregious, we'll need to look into legal alternatives.
- noobermin 4y agoSo American insurance is bad but there is no way you are paying well above the median income of America per year on just premiums.
- Blammar 4y agoWant to see my bills? I don't shred paperwork until 3 years go by, so they're around somewhere. We were able to afford it, though it did take a good chunk of our retirement income away. And it was less in previous years. The goal was to protect against really bad things happening that would result in hospital bills of a million or more -- and screw up our retirement completely. (We had private insurance because both of us retired early, and the early premiums were reasonable. Also, my wife had heard that Medicare was a bad insurance to have, and didn't want to take the risk she couldn't get the care she might need.)
- trogdor 4y ago>Want to see my bills? I wouldn’t have asked, but since you are offering, yes. (With your personal information redacted, of course.)
- Blammar 4y agohttps://imgbox.com/OwGh0xwd https://imgbox.com/OwGh0xwd . That's my wife's. Mine is buried in a box in the garage and it's staying there. I am ~four years older than her so my premiums were noticeably higher. Please let me know if I failed to anonymize the image.
- tamyinfo 4y ago49 years old, married (same age), six kids, and my ACA plan in my area is $3k/mo for bronze, and $4 to $5k/mo for gold, with $10k deductibles. We have paid cash for five of our six kids. Thankfully, my spouse and I and kids are healthy, but that's so much money that if I'd carried insurance when building my startup, we wouldn't have a startup today. The ACA kills the American Dream. One possible fix is that I should be able to buy any insurance I want from anywhere in the country I want; this would mean real competition; currently, I can only buy from a few providers that operate in my local part of my (large) state. Anyway, I find $85k shocking, but not that shocking given that I'm looking at $60k/year (not including deductibles) at a much younger age. (When I first started in my career, that was more than I made in a year!)
- PaulDavisThe1st 4y agoThe current version of the ACA (i.e. as subsequently amended) limits your premiums to 8.2% of your household AGI were you to sign up for the 2nd most costly Silver plan in your state. So no, you're not paying $60k a year unless you have a shockingly high AGI. You need to look into federal subsidies. You can get them either through the relevant (federal|state) marketplace or as refunds on your federal tax bill. The subsidies reduced my wife & I (late 50's, New Mexico) premiums by more than 50%.
- ryanobjc 4y agoThis type of experience heavily depends on which state one is in!
- PaulDavisThe1st 4y agoNot really. The subsidies are provided by the federal, not the state government. If your state isn't making it easy to access them, then just claim them on your federal tax return.
- wrycoder 4y agoThe subsidies are provided by the other taxpayers.