Hospitals, doctors drop private Medicare plans over payment disputes

[dago]

All plans seem to have one thing in common
The more the plan costs, the more things get covered
Part A, B and medigap plan F extra (now called G)
It costs about $450 a month for 2024
The neighbors (husband and wife) on a advantage plan were told that their doctors and hospital network would no longer accept their coverage
Their new insurance is going to cost them about $800 a month
Is least expensive plan they could find that would be accepted by by current doctors and hospital network
She has lung cancer and he has a long list of ailments
They are lucky to be able to get coverage with all of their pre existing conditions
But they were not prepared for almost 10K in medical insurance costs for the future

Isn't that the case with most insurance? All things being equal the higher the premium, the more coverage you get.

 

[Luanne]

Isn't that the case with most insurance? All things being equal the higher the premium, the more coverage you get.

Not necessarily with the Medicare Supplement plans. All plans, G, F, etc. have the same coverage. But the premiums will vary depending on which company you get it through. For example, for my Plan F I pay around $110/month. With other companies, for the same coverage, I could pay much more.

 

[dago]

Not necessarily with the Medicare Supplement plans. All plans, G, F, etc. have the same coverage. But the premiums will vary depending on which company you get it through. For example, for my Plan F I pay around $110/month. With other companies, for the same coverage, I could pay much more.

What I was alluding to was... Plan F or G will be more expensive than plan N (with the same company) and you get more coverage with F or G then N.
Also, this is a little off topic but, you can say the same thing for auto ins or home owners insurance again with the same company, the more you pay in premiums the more coverage you will get all other things being equal (same risk factor, same vehicle, etc.)

 

[emeryjre]

Many Americans are led to believe that Medicare is Medicare
They are not aware of the differences in coverage
I have had people tell me I am overpaying
I have had people tell me they have the same access to care
And later they tell me about the 4 thousand dollars the hospital is charging them for their share of a procedure
Some one else: How it takes 6 months to get an appointment for a knee replacement
How the doctor left them with a leg that was 3 inches shorter after a knee replacement
Some one else: How they are in constant pain after a procedure and it will take 4 weeks to be reexamined

 

[BJRSanDiego]

One of the best hospitals in San Diego county is Scripps. We got a notice a couple of months ago that they are dropping their Medicare Advantage patients. Glad that I'm not on Advantage.

 

[DrQ]

All plans seem to have one thing in common
The more the plan costs, the more things get covered
Part A, B and medigap plan F extra (now called G)
It costs about $450 a month for 2024
The neighbors (husband and wife) on a advantage plan were told that their doctors and hospital network would no longer accept their coverage
Their new insurance is going to cost them about $800 a month
Is least expensive plan they could find that would be accepted by by current doctors and hospital network

You need to be aware of the pool of the insured:

• Plan F is a shrinking pool which is raising costs
• AARP(UHC) has the largest demographic of participants which keeps rate increases lower
• I considered Plan N, but I did not see a great reduction in rate to offset the co-payment and exposure to the 15% surcharge which I see as a way that more providers might use to increase profits
• I think Plan G from AARP(UHC) has the largest pool of participants which leads to greater price to stability

With direct (automatic) payment from checking we pay $210/month for both of us for Plan G. This will rise as the initial pricing discounts are removed (age 65 - 68), but UHC utilizes Community Pricing in our area as opposed to Attained Age Pricing which increases premium based on age in addition to cost.

 

[emeryjre]

How do you get price comparisons on plans and companies without having to go through all the lead generators on a search
I can not find a website that just provides information on pricing and comparisons without providing a ton of personal info

 

[DrQ]

How do you get price comparisons on plans and companies without having to go through all the lead generators on a search
I can not find a website that just provides information on pricing and comparisons without providing a ton of personal info

Medicare.gov

 

[simpsontruckdriver]

FYI, with my new career at Walt Disney World as a bus driver, and trying to cut costs, I decided to terminate my Florida 2-40 Health Insurance license. I have no complaints about Medicare on the recipient side, my complaints are on the insurance agent side. I mean, I spend approximately $500 per year to certify and be insured (Errors & Omissions insurance), but I don't have the time to prospect for new customers, meaning I could never recoup the costs. Most senior citizens who join an MAPD don't want to change their plans, and those who just turned 65 say they will stay working until 70-ish. I still have knowledge of how Medicare works, but I can not sell anything. Oh, my total income vs expenditures in the last 11 years? $600 income (from my late dad) vs $4750 required. Yeah, it is not worth it financially.

TS

 

[Sugarcubesea]

You need to be aware of the pool of the insured:

• Plan F is a shrinking pool which is raising costs
• AARP(UHC) has the largest demographic of participants which keeps rate increases lower
• I considered Plan N, but I did not see a great reduction in rate to offset the co-payment and exposure to the 15% surcharge which I see as a way that more providers might use to increase profits
• I think Plan G from AARP(UHC) has the largest pool of participants which leads to greater price to stability

With direct (automatic) payment from checking we pay $210/month for both of us for Plan G. This will rise as the initial pricing discounts are removed (age 65 - 68), but UHC utilizes Community Pricing in our area as opposed to Attained Age Pricing which increases premium based on age in addition to cost.

Do you have to belong to AARP to take the Plan G from AARP(UHC) ?

 

[DrQ]

Do you have to belong to AARP to take the Plan G from AARP(UHC) ?

Yes

I don't agree with AARP, but I will take advantage of the grouping for insurance purposes.

 

[jorcus]

How do you get price comparisons on plans and companies without having to go through all the lead generators on a search
I can not find a website that just provides information on pricing and comparisons without providing a ton of personal info

You can find a Medicare specialist to help you out. They do not cost you anything. My wife used one through AAA if you have a membership. Otherwise check your local senior center. Very helpful if you get someone who knows what is going on in your area.

 

[emeryjre]

You can find a Medicare specialist to help you out. They do not cost you anything. My wife used one through AAA if you have a membership. Otherwise check your local senior center. Very helpful if you get someone who knows what is going on in your area.

I have an independent agent
I was just reading all the information on Medigap policies at Medicare.Gov
The pricing information was very informative
Not something my agent explained to me
In fact, it is different than what was explained to me by my agent
At first glance, I could be saving 500 to 600 a year on my plan
Further research is needed

 

[DrQ]

You can find a Medicare specialist to help you out. They do not cost you anything. My wife used one through AAA if you have a membership. Otherwise check your local senior center. Very helpful if you get someone who knows what is going on in your area.

If you are going that route, use an independent broker that represents all companies.

 

[DrQ]

I have an independent agent
I was just reading all the information on Medigap policies at Medicare.Gov
The pricing information was very informative
Not something my agent explained to me
In fact, it is different than what was explained to me by my agent
At first glance, I could be saving 500 to 600 a year on my plan
Further research is needed

The information on Medicare.gov is generic to allow an apples to apples comparison. There are discounts that are not on the site:

• Partner joint policy discount
• Initial period discount (ages 65 - 68)
• ...

Once you choose the provider, then you can deal with the details (company stability, rate stability ...) with an agent.

I have been using:

Home - Medicare School

">">We create tailored Medicare plans so you can live worry-free Get 1-on-1 Assistance ">">We create tailored Medicare plans so you can live

www.medicareschool.com

This broker has many informative YouTube videos.

 

[Luanne]

How do you get price comparisons on plans and companies without having to go through all the lead generators on a search
I can not find a website that just provides information on pricing and comparisons without providing a ton of personal info

Our State Farm Agent went over the options with us. He was not pushing their plan (I didn't even know State Farm sold Medicare Supplements). Then I used an independent insurance broker to find the best rate for the plan I wanted (Plan F).

 

[dago]

I have been using:

Home - Medicare School

">">We create tailored Medicare plans so you can live worry-free Get 1-on-1 Assistance ">">We create tailored Medicare plans so you can live

www.medicareschool.com

This broker has many informative YouTube videos.

I have been using:

Home - Medicare School

">">We create tailored Medicare plans so you can live worry-free Get 1-on-1 Assistance ">">We create tailored Medicare plans so you can live

www.medicareschool.com

This broker has many informative YouTube videos.

I agree. Very informative and fair.

 

[4TimeAway]

FYI, with my new career at Walt Disney World as a bus driver, and trying to cut costs, I decided to terminate my Florida 2-40 Health Insurance license. I have no complaints about Medicare on the recipient side, my complaints are on the insurance agent side. I mean, I spend approximately $500 per year to certify and be insured (Errors & Omissions insurance), but I don't have the time to prospect for new customers, meaning I could never recoup the costs. Most senior citizens who join an MAPD don't want to change their plans, and those who just turned 65 say they will stay working until 70-ish. I still have knowledge of how Medicare works, but I can not sell anything. Oh, my total income vs expenditures in the last 11 years? $600 income (from my late dad) vs $4750 required. Yeah, it is not worth it financially.

TS

I've been licensed to sell it in the past, but never sold it and don't think I ever will. It's not worth it.

There are pushy agents out there that use fear of you never getting this deal again, not illustrating the full age rate tables and generally maximizing their commissions at the expense of seniors. Reminds me of a timeshare presentation without the discounted room or points!

I estimate the implicit value of Medicare with decent supplements to be in the area of $30,000/year. If your model is good and you can Monte Carlo a 2% savings, awesome you can save $500/year. God bless you. Good luck.

Medicare supplements have differing plan options, doctor options, and coverages. It is very important to consider your unique situation and how it might change.

My advice is:
1. Don't be poorish (either be rich or broke). Note: I recommend being rich.
2. Don't get sick.
3. Buy something you think will work for you and try it.
4. Annual changes are mostly possible (unless you get really sick- see item 2).

Medicare.gov has some useful tools to help you make a decision, but like everything else, it depends on what happens to you in the future and that is impossible to know.

Personally, I've recommended some of the Medicare Advantage products due to the value proposition, but if money is not an issue, then can always self-insure. Most supplements I think have a 50%-ish claim payout relative to premiums (but some might have a higher rate) and has much higher profit margins than group health insurance.

I wish there was a perfect solution out there, that was cheap, easy and simple for seniors. If anyone knows of one, please let us know.

 

[DrQ]

Personally, I've recommended some of the Medicare Advantage products due to the value proposition, but if money is not an issue, then can always self-insure. Most supplements I think have a 50%-ish claim payout relative to premiums (but some might have a higher rate) and has much higher profit margins than group health insurance.

In the current environment with insurance companies using AI to evaluate pre-authorizations and with the rejection rate, I think for the Medicare Part C (Advantage) to become a value proposition, there will have to be reforms to address:

• Excessive denial of pre-authorizations
• Phantom/Ghost providers listed in networks
• Excessive times to pay providers

Right now, some Advantage providers could be accused of dealing in bad faith.

 

[Tia]

Just returned from hospital stay to find a letter from insurance rejecting the pet scan I had last week, which showed something new that was biopsied for the surgery, saying he had one in July so couldn't have another.
I had surgery this past Monday and looks like the surgery approval has now been paused, although it was approved last week. The insurance is really screwing with me. Medicare Advantage at its best.

hopefully you have or can find an advocate to help you with this. Surgery was approved but then they paused it after you had it is just ridiculous.

 

[rapmarks]

hopefully you have or can find an advocate to help you with this. Surgery was approved but then they paused it after you had it is just ridiculous.

Yes and pet scan too. And something new showed on on the scan that had to be checked in surgery.

 

[m61376]

Having spent most of my career doing home care as a physical therapist, I’d never sign up for a Medicare advantage plan.
A Medigap plan not discussed above is the high deductible F+ or G+ (depending on age and eligibility(. For those of us in high premium states like NY, the difference between G and G+ is over $200 a month In premiums, and the only difference in coverage is an additional 2700 deductible. For those paying LI, NY premiums even if I had 13500 in part B expenses and had to pay the 2700 deductible I’d still save a few dollars over monthly premiums. So definitely a plan worth considering for those in high premium locales


Sent from my iPhone using Tapatalk

 

[DrQ]

I have been using:

Home - Medicare School

">">We create tailored Medicare plans so you can live worry-free Get 1-on-1 Assistance ">">We create tailored Medicare plans so you can live

www.medicareschool.com

This broker has many informative YouTube videos.

 

[geist1223]

We count our Blessings that we do not have to deal with "Gap", "Advantage" (what Advertisement Professional came up with the word), etc.

 

[CalGalTraveler]

This has been a very informative thread as my DH is approaching 65. We have been flooded with Advantage marketing. Based on this thread will avoid Advantage plans but will consider Medi-gap.

My DH plans to continue to work past 65 and has medical coverage with Kaiser at work. We need his plan to continue for 2 dependents for two more years (myself until I reach 65 and a disabled dependent adult who already has Medicare but also has the Kaiser plan.)

How will his Kaiser family plan work with his Medicare eligibility if we want to get good rates with Medigap at 65? Should he sign up for a medi-gap plan at 65 even though he has coverage at work to avoid high Medi-gap rates later when he retires and uses Medicare? I will be eligible for Medicare in 2 years so we can all move to full Medicare at that time. What else do we need to do when he turns 65?

TIA