Hospitals, doctors drop private Medicare plans over payment disputes

[DrQ]

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 (myself until I reach 65 and a disabled dependent who has Medicare.)

How will his Kaiser family plan work with his Medicare eligibility if we want to get good rates with Medigap at 65? What does he need to do?

TIA

If you DH is working for a company larger than a certain size (Insurance covers more than X employees) you can delay enrolling in Medicare A & B. If you are covered by a high deductible plan and are socking $ in an HSA, you can continue to do so after you turn 65. That is what I did.

You can then use the HSA to pay the Plan G premium with tax free money.

 

[amycurl]

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.

No way to solve this, says only industrialized democratic nation for whom this is a problem.
*sigh*

The US doesn't have to reinvent the wheel here, but the US is stymied by the idea of rotation...

 

[Luanne]

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

All I'm really sure about is that at age 65 he has to sign up for Medicare Part A. If he is still covered by insurance through work he shouldn't have to sign up for Part B. When my dh turned 65 we were both still working and he was covered under my insurance. He didn't have to sign up for Part B and get a supplemental (MediGap) plan until I stopped working and he was no longer covered.

 

[CalGalTraveler]

Thanks. So Medigap is only for part B?

 

[DrQ]

Thanks. So Medigap is only for part B?

No Medigap (Medicare F, G or N) is for the gaps in Medicare A and B

 

[dago]

This has been a very informative thread as my DH is approaching 65. We have been flooded with Advantage marketing.

You will continue to be flooded with Advantage Marketing. It will never end. I have been on Medicare for 13 years and I continually get blitzed with Medicare Advantage literature.
Especially this time of year. Between e-mails, postal mail and even text messages. It's relentless. Not to mention the TV ads.

 

[SusanRN]

I'm going to be a contrarian about Medicare Advantage plans, although I admit my situation is geographic-specific. I live in the greater Baltimore area and have had a Johns Hopkins Medicare Advantage PPO Plan for 6 years. Love it!
I chose it knowing that all of the practitioners and facilities have been vetted by Johns Hopkins. A high percentage are employees of JH. In 6 years going to to a PCP and at least 3 specialists each year, I have always felt I've received excellent treatment managed very professionally. It is clearly part of the JH policy that all employees be friendly and polite. All patients are required to be seen within 15 minutes of their appointment time, and it's usually sooner.
Plus, everything is handled expeditiously and with the most up-to-date methods.
For instance, records of visits, test results, prescriptions, and messages to/from my providers are in an electronic health record to which I have access. I can check-in to my appointments online by updating and verifying my information in advance and then scanning a bar code at a kiosk at the doctor's office, although in-person check-in is permitted.. Information related to claim status is readily available on the Advantage website.
I admit I have not tested the claims system by having surgery or any other significant medical issue, although I do have chronic conditions that are stable.
I don't know if other highly regarded medical systems sponsor their own Medicare Advantage plans (Mayo, Cleveland Clinic, and Massachusetts General come to mind), but if so, I would certainly check into them.

 

[Sugarcubesea]

Yes

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

@DrQ , thanks, I have never joined AARP but might have to in order to take advantage of insurance

 

[Sugarcubesea]

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


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@m61376 , I just attended a meeting yesterday with my Medicare advisor supplied free thru my company. She told me that because I had to turn 65 prior to Jan 1, 2020, Plan F and Plan C are not available to me and I even confirmed that thru Medicare .gov. I live in MI, so in a few years when I am 65, I will have to revisit this

 

[4TimeAway]

No way to solve this, says only industrialized democratic nation for whom this is a problem.
*sigh*

The US doesn't have to reinvent the wheel here, but the US is stymied by the idea of rotation...

Never enough money for all the things we want to do.

I think medical tourism is the path I would take for most preventative procedures.

Dental insurance is another racket in the US. I mostly feel dental insurance is not insurance, it's a prepaid membership plan as it either has low annual caps on benefits or is just a discount services plan.

The reality of US medicine is that they push a ton of new drugs and some of that spending is not efficient. We do have the ability to prolong the number of days but seem to be failing on the quality of those days. For example, Dementia seems like the largest issue we can't seem to address and if feels like it has become worse over the last couple decades.

 

[winger]

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
...

is it $450 a month for one person or a couple?

 

[CalGalTraveler]

Do all doctors and hospitals take Medicare? Is there more flexibility than an HMO?

 

[Ralph Sir Edward]

Never enough money for all the things we want to do.

I think medical tourism is the path I would take for most preventative procedures.

Dental insurance is another racket in the US. I mostly feel dental insurance is not insurance, it's a prepaid membership plan as it either has low annual caps on benefits or is just a discount services plan.

The reality of US medicine is that they push a ton of new drugs and some of that spending is not efficient. We do have the ability to prolong the number of days but seem to be failing on the quality of those days. For example, Dementia seems like the largest issue we can't seem to address and if feels like it has become worse over the last couple decades.

Here is a scientific paper of some forms of dementia being correlated with certain gut bacteria.

Microbiota from Alzheimer’s patients induce deficits in cognition and hippocampal neurogenesis

Grabrucker et al. show that young adult rats that received transplants of gut microbiota from patients with Alzheimer’s disease performed poorly in memory

academic.oup.com

The research is very well done.

 

[Luanne]

Do all doctors and hospitals take Medicare? Is there more flexibility than an HMO?

No. I know all doctors don't. Not sure about hospitals. But I think there is definitely more flexibility than with an HMO.

 

[dago]

is it $450 a month for one person or a couple?

I am guessing a couple. We pay currently $500 a month total for both us. We are in our late 70's.

Luanne is correct, not all doctors accept Medicare, but most do. I have never run into that.

 

[PcflEZFlng]

I'm going to be a contrarian about Medicare Advantage plans, although I admit my situation is geographic-specific. I live in the greater Baltimore area and have had a Johns Hopkins Medicare Advantage PPO Plan for 6 years. Love it!
I chose it knowing that all of the practitioners and facilities have been vetted by Johns Hopkins. A high percentage are employees of JH. In 6 years going to to a PCP and at least 3 specialists each year, I have always felt I've received excellent treatment managed very professionally. It is clearly part of the JH policy that all employees be friendly and polite. All patients are required to be seen within 15 minutes of their appointment time, and it's usually sooner.
I don't know if other highly regarded medical systems sponsor their own Medicare Advantage plans (Mayo, Cleveland Clinic, and Massachusetts General come to mind), but if so, I would certainly check into them.

I'll add to this. I've mentioned this another time in a different thread, but my situation, also geographic-specific, is similar to yours. Here in San Diego, I use Sharp Medicare Advantage, sponsored by Sharp Healthcare, which is a large, highly-regarded, self-managed non-profit hospital and clinic group. It also happens to be my former employer, and I've always had great care, both as an employee, using Sharp's own Sharp Health Plan, and as a retiree. If it weren't for Sharp's self-managed non-profit status, their Medicare Advantage patients would likely instead be at the mercy of outside commercial insurance carriers, in which case when I retired I would have chosen a Medigap plan instead.

DW just started Medicare. However, she's been a Scripps patient for many years (Scripps being a competitor to Sharp and also highly-regarded), and she was dismayed to learn that Scripps was no longer accepting Medicare Advantage plans, none of which were ever sponsored by Scripps. Knowing of my experience with both Sharp and Scripps (I was also a long-time Scripps patient under previous employers), she decided to switch to Sharp Medicare Advantage. We'll see how it goes from here.

 

[clifffaith]

Do all doctors and hospitals take Medicare? Is there more flexibility than an HMO?

We have just encountered a strange situation, and wondered if it was a Medicare issue. Cliff’s oncologist recommended he see a “gastro guy” for lingering after effects from radiation. UCI has bumped his appointment backwards four times since March, finally ending with a spot just before Thanksgiving. In September I made him an appointment with a more local (UCI is 45 minutes away by freeway) gastro group of five doctors, anticipating that UCI could bump him again. That appt was supposed to have been this past Monday. But the Friday before I get a call flat out canceling the appt. Wait, you have FIVE gastro doctors. She just repeats that appt is canceled. So tell me is there a shortage of gastro guys? We have been waiting since March to get in at UCI. Repeats again appt is canceled. I asked another question which elicited the response “and when you make a new appointment be sure not to choose anyone in Saddleback Medical Group”. That’s when I decided that I bet they don’t accept Medicare patients, and the person who booked the appt should have turned us away. Up until then I figured our Medicare supplement plans got us in anywhere. (My pain doctor doesn’t accept Medicare, but we suspect that when his long gone partner got in trouble with his insurance billing a decade ago, that Dr Wu got banished too; we pay him directly).

 

[emeryjre]

is it $450 a month for one person or a couple?

In my case $450 is for one person
I am including the amount taken out of my Social Security Benefit for Part A and Part B Medicare coverage
The cost of my medigap policy
The cost of my Part D drug plan

 

[dago]

In my case $450 is for one person
I am including the amount taken out of my Social Security Benefit for Part A and Part B Medicare coverage
The cost of my medigap policy
The cost of my Part D drug plan

OK, I am in that range, if I include all that. The medigap policy (Plan F), just for me is a little more than $250 a month. Of course, it will increase in 2024.

 

[emeryjre]

OK, I am in that range, if I include all that. The medigap policy (Plan F), just for me is a little more than $250 a month. Of course, it will increase in 2024.

I was looking at inexpensive advantage plans several years ago
Several were going to use my social security benefit that is deducted from my monthly payout
It struck me then that this is real money going to my monthly medical costs

 

[kq2mtx]

I have been waffling between regular medicare which I've had for 12 years and medicare advantage because of the advertisements that it might be cheaper. Then I read an article in AARP that said so many people are taking the advantage plan that traditional medicare might end up going away. I read another article about a congressman saying that medicare advantage should be eliminated because it's just private insurance companies sucking up the medicare money and not giving good value. So I'm staying with traditional medicare and luckily I'm federal retired so I pay for supplemental for $250 a month

 

[kq2mtx]

I believe Kaiser is a medicare advantage plan

 

[Luanne]

I am guessing a couple. We pay currently $500 a month total for both us. We are in our late 70's.

Luanne is correct, not all doctors accept Medicare, but most do. I have never run into that.

When we moved to New Mexico dh became Medicare eligible. So he needed to find a doctor that accepted Medicare. The doctor his sister and her husband were using was not accepting any new Medicare patients (good thing as he retired fairly soon after we moved there). We found a doctor that was accepting Medicare patients. When I needed an OB/GYN I asked if she was taking Medicare patients. Nope. But if you were an existing patient and then became Medicare eligible she would keep you as a patient. So I made sure to get in for an appointment before I turned 65 so I could keep her. Unfortunately she has now also retired.

 

[4TimeAway]

Here is a scientific paper of some forms of dementia being correlated with certain gut bacteria.

Microbiota from Alzheimer’s patients induce deficits in cognition and hippocampal neurogenesis

Grabrucker et al. show that young adult rats that received transplants of gut microbiota from patients with Alzheimer’s disease performed poorly in memory

academic.oup.com

The research is very well done.

Thank you.

I was looking at this and it is interesting. I think the holy grail is reversal of the disease or prevention.

Perhaps, shun antibiotics, eat more vegetables and fiber.

 

[DrQ]

Here is a scientific paper of some forms of dementia being correlated with certain gut bacteria.

Microbiota from Alzheimer’s patients induce deficits in cognition and hippocampal neurogenesis

Grabrucker et al. show that young adult rats that received transplants of gut microbiota from patients with Alzheimer’s disease performed poorly in memory

academic.oup.com

The research is very well done.

Doctor is stripped of his medical license after selling bogus $15,000 fecal transplants he claimed could treat AUTISM in toddlers​

• Fecal transplants to treat autism symptoms has not been proven in large studies
• Former doctor performed transplants in at least 60 children in four countries

Doc's medical license revoked for fecal transplants to 'cure' autism

Now-former Canadian doctor Jason Klop has been stripped of his medical license after conning families out of thousands of dollars for a bogus autism cure - fecal transplants.

www.dailymail.co.uk