3 ms·

Medicare Advantage is not more of a free market than Traditional Medicare. Both restrict their markets but in different ways. MA restricts your access to docto

Medicare Advantage is not more of a free market than Traditional Medicare. Both restrict their markets but in different ways. MA restricts your access to doctors and sets fees. Someone on a Kaiser Permanente Medicare Advantage plan won't be able to go to the Mayo Clinic but the Mayo Clinic and Cedars Sinai do accept Traditional Medicare. In addition, you'll need preauthorization ("Delay, deny, die") from the insurance company for many procedures. On the other hand, TM sets the fees to what is called Medicare Assignment (and also allows something else called Excess Charges). But any doctor can accept Medicare Assignment. At UCSF, I need a referral for a colonoscopy for which Medicare pays Assignment but then I don't need a preauthorization from Medicare for that. My elevator argument for Traditional Medicare (A+B+G+D) and against Medicare Advantage (Part C) is: why would you want to spend the rest of your life arguing with an insurance company?

jasode 3y ago
>My elevator argument [...] against Medicare Advantage (Part C) is: why would you want to spend the rest of your life arguing with an insurance company? It's an affordability issue so it's not as simple as you laid it out. Some corporate-sponsored health benefit plans for retired ex-employees pay 100% for Medicare Advantage and not Traditional Medicare + Medigap. The UHC Medicare Advantage has some aspects of "Medigap" included in that plan and 100% of that total premium is reimbursed by the company. So choices are: - $0.00/month for Medicare Advantage - $2100/year out-of-pocket for Traditional Medicare + $$$ extra for Medigap That's the tradeoff math that some seniors contend with. Some choose to hypothetically "argue with an insurance company" because they don't have $2100 to spare.
- CalChris 3y ago
  No, it's not an affordability issue and you're not getting something for nothing. First, you assign your Medicare benefit over to a corporation who then covers your health care costs at their discretion. Then you'll pay your Part B premium ($174.70/mo) out of your Social Security benefit. So you will have the magical illusion of a $0.00/mo premium and the insurance company then makes a substantial profit to boot. I spend about $300/mo for A+B+G+D. My OOP max is the $240 Part B deductible (except for drugs but I only take a statin). That will go up over time, Community Pricing. I have no preauthorizations, no copays, no coinsurance. And generally no paperwork. When I went to my UCSF PCP for a sprained MCL, I made an appointment a few days later. I showed up and said who I was. A few minutes later I saw the doc. After that I walked out. The wallet stayed in the pants and I didn't fill out a single form. A colonoscopy had a little paperwork, disclosures and actual ID. I watch the billing on MyChart, but it's a spectator rather than participatory sport. It's UCSF vs Medicare and it settles in a month or so. A+B+G+D is by far the best health insurance I've had in my life.
  - jasode 3y ago
    >So you will have the magical illusion of a $0.00/mo premium and the insurance company then makes a substantial profit to boot. I spend about $300/mo for A+B+G+D. I guess I don't understand what you're trying to explain. There is no "$0.00 illusion". For the situation I've laid out, there's literally no $174/month or $300/month spent. >"Then you'll pay your Part B premium ($174.70/mo) out of your Social Security benefit." < ... that $174.70 is 100% reimbursed by the company -- but only if the ex-employee enrolls in the company's approved Medicare Advantage plan from UHC. If instead they go your route by rejecting Medicare Advantage, the company reimburses 0% of that $174.70 Part B premium. The math for out-of-pocket premiums payments is literally: $0/year < $3600/year > I have no preauthorizations, no copays, no coinsurance. Yes I understand, and that "no red tape bureaucracy" ability you enjoy costs you ~$3600/year more than some seniors have the ability to pay if they're restricted by what their ex-employer will reimburse. It's still a tradeoff.
    - CalChris 3y ago
      What you're talking about is something like a company retiree with an additional union retirement benefit. That's different from me. In that case, they are signing over their Medicare benefit and their union/company negotiated over their retirement health benefit. That is a different case. In my case, I had a choice between Traditional Medicare (A+B+G+D) or Medicare Advantage (C). Kaiser, for example, wouldn't have been $0/mo. I chose Traditional Medicare which for me is currently about $300/mo but I can go to UCSF or Mayo or anywhere that takes Medicare. I'm very happy with Traditional Medicare but I understand that there are retirees who've had their Medicare+company retirement benefits negotiated away. Their situation is ok but I prefer mine.
tpmoney 3y ago
One reason you might want MA instead of TM would be that as near as I can tell you can’t get Medicare to pay for anything from a provider that doesn’t accept assignment. If there’s a specific provider you want (or need) to see and they don’t accept assignment, Medicare won’t pay anything. No concept of “out of network”, no reimbursing your own costs.

jasode 3y ago

>My elevator argument [...] against Medicare Advantage (Part C) is: why would you want to spend the rest of your life arguing with an insurance company? It's an affordability issue so it's not as simple as you laid it out. Some corporate-sponsored health benefit plans for retired ex-employees pay 100% for Medicare Advantage and not Traditional Medicare + Medigap. The UHC Medicare Advantage has some aspects of "Medigap" included in that plan and 100% of that total premium is reimbursed by the company. So choices are: - $0.00/month for Medicare Advantage - $2100/year out-of-pocket for Traditional Medicare + $$$ extra for Medigap That's the tradeoff math that some seniors contend with. Some choose to hypothetically "argue with an insurance company" because they don't have $2100 to spare.

CalChris 3y ago
No, it's not an affordability issue and you're not getting something for nothing. First, you assign your Medicare benefit over to a corporation who then covers your health care costs at their discretion. Then you'll pay your Part B premium ($174.70/mo) out of your Social Security benefit. So you will have the magical illusion of a $0.00/mo premium and the insurance company then makes a substantial profit to boot. I spend about $300/mo for A+B+G+D. My OOP max is the $240 Part B deductible (except for drugs but I only take a statin). That will go up over time, Community Pricing. I have no preauthorizations, no copays, no coinsurance. And generally no paperwork. When I went to my UCSF PCP for a sprained MCL, I made an appointment a few days later. I showed up and said who I was. A few minutes later I saw the doc. After that I walked out. The wallet stayed in the pants and I didn't fill out a single form. A colonoscopy had a little paperwork, disclosures and actual ID. I watch the billing on MyChart, but it's a spectator rather than participatory sport. It's UCSF vs Medicare and it settles in a month or so. A+B+G+D is by far the best health insurance I've had in my life.
- jasode 3y ago
  >So you will have the magical illusion of a $0.00/mo premium and the insurance company then makes a substantial profit to boot. I spend about $300/mo for A+B+G+D. I guess I don't understand what you're trying to explain. There is no "$0.00 illusion". For the situation I've laid out, there's literally no $174/month or $300/month spent. >"Then you'll pay your Part B premium ($174.70/mo) out of your Social Security benefit." < ... that $174.70 is 100% reimbursed by the company -- but only if the ex-employee enrolls in the company's approved Medicare Advantage plan from UHC. If instead they go your route by rejecting Medicare Advantage, the company reimburses 0% of that $174.70 Part B premium. The math for out-of-pocket premiums payments is literally: $0/year < $3600/year > I have no preauthorizations, no copays, no coinsurance. Yes I understand, and that "no red tape bureaucracy" ability you enjoy costs you ~$3600/year more than some seniors have the ability to pay if they're restricted by what their ex-employer will reimburse. It's still a tradeoff.
  - CalChris 3y ago
    What you're talking about is something like a company retiree with an additional union retirement benefit. That's different from me. In that case, they are signing over their Medicare benefit and their union/company negotiated over their retirement health benefit. That is a different case. In my case, I had a choice between Traditional Medicare (A+B+G+D) or Medicare Advantage (C). Kaiser, for example, wouldn't have been $0/mo. I chose Traditional Medicare which for me is currently about $300/mo but I can go to UCSF or Mayo or anywhere that takes Medicare. I'm very happy with Traditional Medicare but I understand that there are retirees who've had their Medicare+company retirement benefits negotiated away. Their situation is ok but I prefer mine.

tpmoney 3y ago

One reason you might want MA instead of TM would be that as near as I can tell you can’t get Medicare to pay for anything from a provider that doesn’t accept assignment. If there’s a specific provider you want (or need) to see and they don’t accept assignment, Medicare won’t pay anything. No concept of “out of network”, no reimbursing your own costs.