comparing Medicare advantage

to Medicare supplement plans:

Concerns for people on Medicare:Medicare supplementMedicare Advantage
Freedom to pick your doctors and hospitalsYESNO
No Co-pays or Cost SharingYESNO
Prior Authorization for Tests and ProceduresNOYES
Must use a Network of doctors & HospitalsNOYES
Can I lose my plan?NOYes, many people have to change year to year because the plan they had before no longer exists
Large Cost sharing (usually 20% of the bill) for Durable Medical Equipment and Part B administered drugs (Part B administered drugs are, injections, Chemotherapy)NOYES

What about Medicare Advantage?

Medicare Advantage

Medicare Advantage is an option for people on Medicare A&B. People always ask me how an insurance agent can offer them a Medicare Advantage plan with Zero premium? Well, how a Medicare advantage plan works is, when you sign up for a Medicare Advantage plan, the program takes over as your primary insurer, and Medicare pays that company a monthly premium to take all your risk from Medicare and put it on that private insurance company. They send these companies a lot of money, several thousand dollars a year. So there are significant commissions in it for insurance agents. All that being said, you get what you pay for is an excellent quote for Medicare Advantage.

There are a lot of out of pocket expenses involved with Medicare advantage, cost sharing and co-pays for everything that you do. However, where most people struggle with advantage, is not having control over their health care.

Most advantage plans nowadays are HMO (Health Maintenance Organizations) which means they manage your healthcare. There is nothing worse than being sick or having significant health conditions and being at the mercy of your insurance company for treatment. It is not uncommon to have to jump through several hoops and get many referrals before receiving any expensive treatment. Let’s use an example, Mrs. Jones has Medicare A&B plus a Medicare supplement. Mrs. Jones goes to her doctor and the doctor says, Mrs. Jones, you’re going to need a $40,000 surgery, well Mrs. Jones meets with her surgeon and in the next month gets her surgery, hopefully that solves her problem and she can move on with life. Now, Mrs. Jones has an HMO Medicare advantage plan, Mrs. Jones goes the doctor and again the doctor says, Mrs. Jones you need a $40,000 surgery, her advantage plan doesn’t want to pay for it, so they send her to one of their “in-network” specialists, she meets with the specialist and the specialist says, before surgery, we should try physical therapy first ( so her advantage plan doesn’t have to spend $40,000). Mrs. Jones tries Physical therapy for 2 months, it doesn’t work, and 6 months down the road she ends up getting the same surgery she would have received had she had original Medicare plus a supplement.  This is a scenario with just a simple surgery. When you develop serious Medicare conditions, Heart issues, Cancer, Respiratory issues, Kidney disease, anything where you’re going to be seeing a lot of doctors and specialists, the HMO scrutiny becomes much more intense. The entire premise of an HMO advantage plan is to manage your health care to save the company money. The company considers it as keeping, you-the policy holder, from wasteful spending of the advantage plans money. As if receiving quality healthcare is wasteful spending.

The Real cost of Medicare advantage, is not being able to get good health insurance when you need it. Once you develop Medicare conditions and start having problems with a Medicare Advantage plan, you won’t be able to return to original Medicare and purchase a Supplement. A Medicare Supplement must be purchased when you first start Medicare, or by passing underwriting with your good health. So, by the time most people realize how weak their health insurance is with Medicare Advantage, it is already too late, and they’re stuck on the plan.

All that being said, with original Medicare and a Medicare supplement, you can go to any doctor or go to any hospital in the entire country, as long as they accept Medicare, you can go there. There is no managed care with Medicare either; you have control over your healthcare.

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