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Anyone considering a Medicare Advantage plan should take a look the Executive Summary of this U.S. Senate report. It starts with this: “Every day, doctors evaluate thousands of seniors recovering from falls, strokes, and other ailments, and enter a recommended course of treatment into an online portal, or in some cases feed it into a fax machine. But whether the requested service is determined to be medically necessary is a decision that belongs to people at the other end of the line. This is prior authorization. And for beneficiaries of Medicare Advantage, the alternative to Traditional Medicare in which private companies contract with the government to administer health plans, it has become not just a bureaucratic maze, but a potential threat to their health.”
No form of paying for health care can be affordable unless there is some oversight for medical necessity- pre-certification, concurrent review or retrospective review.
In fact, Medicare has been criticized several times for not doing much of it at all mainly because it is blocked by law. That is one of the reasons it takes so long to uncover the considerable fraud.
MA is popular and still growing because premium wise it’s often free with minimal added benefits despite internal OOP costs and limited networks.
They are essentially a form of HMO which has the same tradeoffs. It has worked well in California for decades. Some people now in Washington want MA to be the default option for Medicare.
Personally, we stuck with Medicare and Plan G and glad we did considering the specialists Connie has needed, especially for her eye injury. Going to the top eye facility in the country was our choice.
My wife and I both have a MA PPO plans. My wife and I have never had to get a referral to see a specialist. We can see doctors outside our network (higher copay). I’ve had 5 surgical procedures in the last 5 years without incident. Another HD member reports he and his wife pay $2000/month for Medicare plus Medigap, plus additional costs for dental and vision, that’s over $24,000 a year. My wife and I both pay $185/month ($4400 yearly total) for Medicare part B and that’s about it. Our MA PPO has prescription, dental ($1500) and vision coverage at no additional cost. Our total yearly costs are about $5,000, or $19,000 less than the referenced couple. Over 10 years we would be ahead by about $190,000, or over $250,000 if invested and earned 10%/year. I’ve heard the argument MA works until it doesn’t, so far it’s worked for us.
Do you mind me asking which company and plan you are on?
You are still subject to IRMAA premiums should they apply to you. Any deductible out of net work? What is dental coverage beyond checkups and basic care?
Keep a close eye on your plan because Congress is aware of the overpayment subsidies being made to MA and if action is taken to save money, you may see big changes in your plan and/or costs.
No deductible out of network. $1,500 per person to spend for any dental care, I had a $1,000 crown last year…. fully covered.
Good post. Or as often said, “Medicare Advantage is great….until you get sick.”
Which is one reason I have “original” Medicare plus Medigap. Others include networks and referrals. I value the ability to choose my own doctors.