Are all Medicare Advantage Plans bad? THE TRUTH!

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Please call my office for free, unbiased assistance. We would love the opportunity to help you if we can! #medicare #medicaresupplement #medicareadvantage #medigap #turning65

[AbtInsuranceAgency]

I'd love to hear your personal experience with your Medicare Advantage Plan -- please share below!

[wtc]

I was on an Advantage plan when my cardiologist's pre-authorization request to perform a heart catheterization was denied. This occurred during the enrollment period and I had already decided to switch back to a supplement plan due to the higher out-of-pocket expense in the event of a catastrophic health event. So I told my cardiologist to schedule the heart cath after Jan1 (about 3 weeks away) when the supplement plan takes effect. The heart cath showed I had two coronary arteries 100% obstructed, and a third that was 85% obstructed! I was immediately scheduled for heart bypass surgery and I am doing great today 3 months later. I tell everyone about my experience and to NOT enroll in an Advantage plan. Advantage plans makes more sense for young healthy people, not aging seniors.

[fredost]

When Advantage plans become the doctor and then ration/deny care for profit, they become my enemy. I would only do Advantage if I had NO other options.

[stevemoon]

The same happens on a typical HMO / PPO. I've work in the filed of Cardiology as a Cardiac Sonographer for some 20 years. Unfortunately, it's not uncommon to watch a frustrated cardiologist trying to explain to an insurance "doctor" why a procedure is warranted vs not.
A good example happened a few months ago. A young man, 45, arrives at ED with active chest pain, shortness of breath, and non-specific EKG changes and a significant family history of heart disease in a first degree relative. Based on these criteria, our cardiologist recommemded admitting him, performing a cardiac cath to determine if in fact he had significant arterial blockages or not. The insurance company refused. They argued he was too young and wanted him to try medications instead. Our cardiologist had to inform him that he was at a major risk for a future event, and return to the ED if symptoms worsened. Insurance in America...

[MSDOGS]

I would go with G-hd over Advantage. At least you can get your procedure done without fear of being denied. Yes you could be stuck with some of the cost of the procedure but there is a stop loss on the amount. And some hospitals will work with you and discount it down.

[dancurran]

We have been with Kaiser North (California) HMO for over 30 years. Our son was born at Kaiser and we have been treated for life threatening illnesses there. After I retired we stayed with them through Covered California (ACA) and will stick with them for Medicare (Kaiser Advantage). The out of pocket max for each of us will be $6K per calendar year. That's a lot of copays and coinsurance!

[bbouc]

I have United Health care and I have nothing but problems, unless you are willing to pay out of pocket for your PCP and Dentistry, you will need to use who they send you to, it was great in the beginning but they change things without warning leaving you liable for anything they decide is out of network

[freecycling]

Thanks for another informative video. One point I'd add is that an advantage of the supplement plans is that, if you start out with one of them, you always have the right to "try out" an Advantage plan in the future, and more importantly, to switch *back* to your supplement plan if you don't care for it - all without medical underwriting.
And btw - it would be great if you did a video on what medical providers are required to tell you as far as exactly which of their recommended procedures, etc. Medicare covers! I've done some research on this and it's very difficult to determine what their obligation is to the patient in this regard. And I've read some about the "ABN" notices, but even that's just not very clear.

[garypola]

I luv my Med Adv plan. Works for me. I signed up with you on April 1st. Thanks Stephanie

[paulstein]

I went with original Medicare plus a supplement plan because after the first trial rights period on an advantage plan, I’m be stuck in one for life because I likely wouldn’t get approved by underwriting. Thank you for listing that as a con, because that’s very important for people to know.

Aren’t certain advantage plans hard to use in rural areas because of very limited provider networks?

[maaloufgeorge]

Excellent video Stephanie. I am learning a lot from your. No one who can afford the original medicare should get the advantage plan. They should change the name of this plan to "Disadvantage plan". Seniors need peace of mind and not need the harassment and the headache when they are sick or they need medical attention.

[bp]

Excellent video. You convinced me to stay away from Advantage Plans and stay with my current Plan G (at least in my case). :)

[frankpasini]

It is my understanding 5 states where no prior approval is needed for Medicare Gap are very expensive. Medicare Gap plan in New York State rates is absurd. We more or less don't have a choice but to go with Medicare Advantage in NY.

[freecycling]

Yet another informative video! Just one point - if you start on Medicare with a supplement plan, you can always try out an Advantage plan without underwriting - *and* if you change your mind, you can go back to that supplement plan without underwriting. (And this is in all states, afaik).
And btw, I have a request - do you think you could do a video on what a medical provider has to disclose about which services they're recommending for you are covered by Medicare? I've tried to do some research on this and it's just about possible to determine what their obligations are in this respect. I've read about the "ABN" notification, but it's just not clear! And many providers ask you to sign that "financial agreement" document, which I've always felt was like signing a blank check.

[LiberatoInsurance]

Great video and very educational. Medicare Advantage plans cover what is considered medically necessary. Things like plastic surgery and "upgraded" cataract lenses are not medically necessary and not covered.

[Bsquared]

Good overview, however - you left out that when one has a Medicare Advantage plan, one has access to a Case Manager - usually a nurse or social worker to help you with things like navigating the health system, learning how to manage your condition, finding specialists. When an individual is really sick or has a really complicated medical situation - having access to a case manager is like gold. No one talks about this and thus it is not well known. On traditional Medicare, you are completely on your own.

[dennisschnobrich]

I have Medicare disadvantage only because I can't afford the supplement plan plus I am diabetic which would result in denial of coverage. I just wish this stupid country would follow the lead of Canada and the UK.

[DLTJR]

I will have an Advantage Plan offered to me by the state of NC. It is a PPO plan that will save my wife and I $7K per year in premiums. In addition the PPO plan has a max out of pocket of $4K per person with a max of $2500 per person on drugs. The Medicare has a max out of pocket of $5900 per year. You would have to purchase an additional drug plan. The plan states that you can see any provider in or out of network, anyone that accepts Medicare and accepts your insurance, and preferably a provider that accepts Medicare assignment.

I know a lot of folk on this plan and they all love it. Have a friend that needed knee replacement with no issues at all with the prior authorizations. My sister has had no issues with her prior authorizations also. It looks like to me it's sorta hit and miss on the authorizations but Humana and the state plan seems to have a good reputation around here. Thank you for your videos. Very informative and helpful. I appreciate it.

[MultiCax]

How does Medicare work for FERS? Retired federal employees who still have Healthcare through the pension. Should they drop it? Or continue paying the premium plus medicare bill once they reach 65?

[tedjohnson]

Some Medicare Advantage cover Emergency Room care overseas. The Medical City Chain in the Philippines can bill SOME Medicare Supplement & Tricare since they have a Hospital in Guam. Source: Philippine Expat Forums. I will carry both US & Philippine Coverage if I stay in the Philippines after age 65.