Hospitals, doctors drop private Medicare plans over payment disputes

[Ralph Sir Edward]

Did you actually read the paper? As an old microbiologist/molecular biologist, this is a gold standard paper. Merely an initial breakthrough, much, MUCH, more research to go, but it gives a direction to research in. What are the biota generating that is absorbed by the gut, and can we reproduce it in the lab?

 

[Greg G]

Maybe a bit off topic but other have posted they are looking for Medicare plans.

I recently turned 65 and researched Medicare Supplement (Medigap) plans, and Medicare Advantage plans quite a bit on the internet (what a headache) as my retiree health insurance would expire at age 65. Also contacted a few insurance brokers and even an independent insurance agent to get quotes, suggestions, and information.

During that research, one site that really impressed me with explaining Medicare, how to decide whether a Supplement or Advantage plan was right for you, and the detail on how these plans work as well as what to look for when choosing a plan and how to compare plans was https://medigapseminars.org/ .
That site has many, many videos and articles. What was also impressive is they show the sources for facts they use to draw conclusions and compare plans. I also watched many of the videos and read many of the articles before even contacting them. They also research the insurance companies to find those they believe will most likely have the lowest total cumulative premiums/costs over the life of the health insurance policy (granted this is more uncertain but at least they try and apparently have the skills to do it). There is no fee to use them as they do get paid a fee indirectly thru the insurance companies/policies they recommend if you go ahead and get one thru them.

Now this site does take the approach of first determine if a Medigap plan would work for you and then if it doesn't fit for financial or other reasons, then look at an Advantage plan.
I ended up choosing a Medigap plan as I did not want to be constrained to networks or getting pre-authorizations, even though I am healthy now, and financially it was feasible.

 

[dago]

Maybe a bit off topic but other have posted they are looking for Medicare plans.

I recently turned 65 and researched Medicare Supplement (Medigap) plans, and Medicare Advantage plans quite a bit on the internet (what a headache) as my retiree health insurance would expire at age 65. Also contacted a few insurance brokers and even an independent insurance agent to get quotes, suggestions, and information.

During that research, one site that really impressed me with explaining Medicare, how to decide whether a Supplement or Advantage plan was right for you, and the detail on how these plans work as well as what to look for when choosing a plan and how to compare plans was https://medigapseminars.org/ .
That site has many, many videos and articles. What was also impressive is they show the sources for facts they use to draw conclusions and compare plans. I also watched many of the videos and read many of the articles before even contacting them. They also research the insurance companies to find those they believe will most likely have the lowest total cumulative premiums/costs over the life of the health insurance policy (granted this is more uncertain but at least they try and apparently have the skills to do it). There is no fee to use them as they do get paid a fee indirectly thru the insurance companies/policies they recommend if you go ahead and get one thru them.

Now this site does take the approach of first determine if a Medigap plan would work for you and then if it doesn't fit for financial or other reasons, then look at an Advantage plan.
I ended up choosing a Medigap plan as I did not want to be constrained to networks or getting pre-authorizations, even though I am healthy now, and financially it was feasible.

Yep, there are tons of You Tube videos out there. I have looked at https://medigapseminars.org/ . Very good. Another good one is https://MedicareSchool.com

 

[WinniWoman]

Thanks. So Medigap is only for part B?

Part A is free so he should just sign up for that and decline B for now.

 

[DrQ]

Part A is free so he should just sign up for that and decline B for now.

UNLESS you are on a High Deductible Plan at work and contribute to an HSA. That will keep you from contributing AND the effective date for Part A goes back 6 months and will invalidate prior contributions.

 

[jp10558]

So, the problem with all this is that the plans are basically retiree / location specific in many cases. My Dad was retired from a big university (as cleaning staff, so not special professor stuff) around 2000. He was on their ancient 80%/20% plan that apparently had been around since at least the 1970s. I think he went normal Medicare because it was "the same plan". Sure, everyone took it, but every time he had to take an ambulance or go for surgery or anything, it was a thousand to over 10 thousand dollars in co-pays. The university offered him an Advantage plan for less premiums than the old 80/20 plan, I think it was $19 a month. When that started in the early 2010s, it massively changed his medical life for the better. No doctor, hospital or anything changes, just the doctor was a fixed $25, rather than a random 20% of whatever they billed. The ambulance was a fixed $50 rather than $250 in co-payment or more. I think an ER visit was a fixed $150. An in hospital admission was a fixed $250, which included the ER visit. I think there was a fixed rate when he had his colon cancer surgery in 2018. I recall it being well under $1,000. Any surgery under the old plan ran him closer to $10k. This stayed the same through his passing in 2021. I would strongly recommend the plan for any small monthly premium, but other than it being administered via Aetna, I have no idea how anyone who didn't retire from the university could get it.

Now, all the advertised Medicare Advantage plans were crap that came in the mail. The few that looked *slightly* better didn't seem worth taking the risk of changing or misleading ads on to save $19 a month.

Personally, I think it's such a scam that somehow it makes enough money for the various companies at $19 a month if a university negotiates it - with probably 75,000 group members considering employees and retirees, but somehow the government can't get something like that put together with millions in a group. And this is all just because the government can't just handle healthcare like every other developed country.

 

[rapmarks]

So, the problem with all this is that the plans are basically retiree / location specific in many cases. My Dad was retired from a big university (as cleaning staff, so not special professor stuff) around 2000. He was on their ancient 80%/20% plan that apparently had been around since at least the 1970s. I think he went normal Medicare because it was "the same plan". Sure, everyone took it, but every time he had to take an ambulance or go for surgery or anything, it was a thousand to over 10 thousand dollars in co-pays. The university offered him an Advantage plan for less premiums than the old 80/20 plan, I think it was $19 a month. When that started in the early 2010s, it massively changed his medical life for the better. No doctor, hospital or anything changes, just the doctor was a fixed $25, rather than a random 20% of whatever they billed. The ambulance was a fixed $50 rather than $250 in co-payment or more. I think an ER visit was a fixed $150. An in hospital admission was a fixed $250, which included the ER visit. I think there was a fixed rate when he had his colon cancer surgery in 2018. I recall it being well under $1,000. Any surgery under the old plan ran him closer to $10k. This stayed the same through his passing in 2021. I would strongly recommend the plan for any small monthly premium, but other than it being administered via Aetna, I have no idea how anyone who didn't retire from the university could get it.

Now, all the advertised Medicare Advantage plans were crap that came in the mail. The few that looked *slightly* better didn't seem worth taking the risk of changing or misleading ads on to save $19 a month.

Personally, I think it's such a scam that somehow it makes enough money for the various companies at $19 a month if a university negotiates it - with probably 75,000 group members considering employees and retirees, but somehow the government can't get something like that put together with millions in a group. And this is all just because the government can't just handle healthcare like every other developed country.

Those are lousy copays. Your dad never had a supplement insurance or a maximum out of pocket? And it isn’t $19 a month difference mire like 100 or 200 per month per person

 

[jp10558]

Those are lousy copays. Your dad never had a supplement insurance or a maximum out of pocket? And it isn’t $19 a month difference mire like 100 or 200 per month per person

I never knew you could get supplement insurance to your normal insurance. He couldn't get anything better than the 80/20 till this Advantage plan came out. It was a total $19 a month premium. I think it was $30 or so on the old plan with 20% co-insurance to something like $12,000 a year. So the Advantage plan saved tens of thousands over the old basic Medicare he had, and the old plan he had when working. So each month he saved about $11 dollars, and when he had surgery it was I think $500 for everything compared to my parents needing to take out a loan under the older system. One difference was he was on SSDI / some sort of different Medicare from 60 to 65, and I don't know if that prevented him from getting anything but the required bog standard Medicare when he turned 65. This all happened when I was in College, so I wasn't deeply in his finances at that point, and probably didn't know squat about medical coverage to try and help anyway.

But while I while working have a $20 vs $25 copay for a doctors visit, I'm also on the hook for like $4,500 a year in co-insurance and don't get the sweet fixed co-pay for hospital trips etc. I'll see how painful my recent ER trip and specialist visit for a kidney stone turns out to be.

 

[Luanne]

I never knew you could get supplement insurance to your normal insurance. He couldn't get anything better than the 80/20 till this Advantage plan came out. It was a total $19 a month premium. I think it was $30 or so on the old plan with 20% co-insurance to something like $12,000 a year. So the Advantage plan saved tens of thousands over the old basic Medicare he had, and the old plan he had when working. So each month he saved about $11 dollars, and when he had surgery it was I think $500 for everything compared to my parents needing to take out a loan under the older system. One difference was he was on SSDI / some sort of different Medicare from 60 to 65, and I don't know if that prevented him from getting anything but the required bog standard Medicare when he turned 65. This all happened when I was in College, so I wasn't deeply in his finances at that point, and probably didn't know squat about medical coverage to try and help anyway.

But while I while working have a $20 vs $25 copay for a doctors visit, I'm also on the hook for like $4,500 a year in co-insurance and don't get the sweet fixed co-pay for hospital trips etc. I'll see how painful my recent ER trip and specialist visit for a kidney stone turns out to be.

I'm not sure what older plan you are referring to. When both my husband and I had surgery we had $0 out of pocket with our Medicare B and our Plan F supplemental plans. We also have no copay when we visit the doctor. No advantage plans for us.

 

[jp10558]

I'm not sure what older plan you are referring to. When both my husband and I had surgery we had $0 out of pocket with our Medicare B and our Plan F supplemental plans. We also have no copay when we visit the doctor. No advantage plans for us.

No one I know ever heard of Medicare part F, so he had Medicare part A,B and I think D? So "traditional medicare" you get if you don't know about the magical Part F, G, N that I've only ever heard of in this thread. "No one" knows how to get on those, and most people - when they mention traditional medicare mean Part A and B. Some add the drug coverage, but it's not implied that I know of.

The other "Older Plan" I referenced was to the 80/20 plan he had when working via Aetna. Not a government plan at all. But the coverage between that and what he had under Medicare A,B was for all intents and purposes "the same", i.e. very expensive if you got sick, because you had to pay 20% of everything. The only "benefit" was no Network at all, everywhere was covered the same. No prior auth or anything needed. Probably because of how much it cost really.

 

[DrQ]

No one I know ever heard of Medicare part F, so he had Medicare part A,B and I think D? So "traditional medicare" you get if you don't know about the magical Part F, G, N that I've only ever heard of in this thread. "No one" knows how to get on those, and most people - when they mention traditional medicare mean Part A and B. Some add the drug coverage, but it's not implied that I know of.

The other "Older Plan" I referenced was to the 80/20 plan he had when working via Aetna. Not a government plan at all. But the coverage between that and what he had under Medicare A,B was for all intents and purposes "the same", i.e. very expensive if you got sick, because you had to pay 20% of everything. The only "benefit" was no Network at all, everywhere was covered the same. No prior auth or anything needed. Probably because of how much it cost really.

Medigap policies started becoming available in 1966. In the 1990's, they were standardized under the current LETTER designations.

 

[rapmarks]

Older plans or plans pre Medicare usually had a cap on them. So you didn’t have enormous bills. My Medicare advantage plan has an 1100 cap per year. It’s really too bad your dad was unaware of medigap policies
my father born in 1916 had a medigap policy so that would have been 1981 or so, they have been around a long time

 

[Luanne]

No one I know ever heard of Medicare part F, so he had Medicare part A,B and I think D? So "traditional medicare" you get if you don't know about the magical Part F, G, N that I've only ever heard of in this thread. "No one" knows how to get on those, and most people - when they mention traditional medicare mean Part A and B. Some add the drug coverage, but it's not implied that I know of.

The other "Older Plan" I referenced was to the 80/20 plan he had when working via Aetna. Not a government plan at all. But the coverage between that and what he had under Medicare A,B was for all intents and purposes "the same", i.e. very expensive if you got sick, because you had to pay 20% of everything. The only "benefit" was no Network at all, everywhere was covered the same. No prior auth or anything needed. Probably because of how much it cost really.

There is no "Part F". For Medicare Part B my husband and I chose a Plan F. And we also have a Part D for drug coverage.

 

[dago]

The way Medicare Advantage is promoted and marketed and advertised, one would think there is no such thing as a Medigap or Supplement policy. You never (OK, maybe very rarely) hear about Supplement policies. It's almost implied that Medicare Advantage is the only thing available. That is troublesome to me.

 

[rapmarks]

The way Medicare Advantage is promoted and marketed and advertised, one would think there is no such thing as a Medigap or Supplement policy. You never (OK, maybe very rarely) hear about Supplement policies. It's almost implied that Medicare Advantage is the only thing available. That is troublesome to me.

Correct
my advantage plan has rejected my petscan, they previously approved it
my cancer has metastasized
I am going to need those pet scans regularly unless I just give up.

 

[jp10558]

The way Medicare Advantage is promoted and marketed and advertised, one would think there is no such thing as a Medigap or Supplement policy. You never (OK, maybe very rarely) hear about Supplement policies. It's almost implied that Medicare Advantage is the only thing available. That is troublesome to me.

Thank you. I guess I basically failed to make my point that back in the aughts, we knew about Medicare, we got mailings every year. We got a bunch of mail about when part D was created. Then we heard of the new Advantage plans. I never saw a mailing, a TV ad, or even a government publication where someone might stumble apon it, NOR even retirement advice from different companies mention a Medigap or Supplement policy. I heard about Medigap on Youtube at some point, but it made it sound like it was too late at that point - i.e. unless you somehow knew about something NO ONE mentioned outside the far reaches of the Internet (and this was circa 1999 to be relevant as I understood it) BEFORE you retired, you were screwed because you had to make the right choice AT 65, no changing later on down the road.

This is the same sort of "hidden knowledge" as resale timeshares IMHO. You would have to even think to search for info about Medigap, something you don't know about. Not to mention the whole set of plans reminds me of the intentionally complex and confusing different systems too. But this is for people's health care, not their vacations.

But then, even in my Dad's case these premiums of $200 a month are pretty prohibitive vs $19 a month. I don't think he ever would have chosen something that expensive. He was lucky in that the premiums for his health plans were always very low with good coverage via the university. And that continued with the Advantage plan once it was available.

 

[clifffaith]

Only reason we knew anything about supplement plans was from sitting with an agent switching Cliff from one Advantage plan to another. This was the year before I’d start Medicare, and as the agent was going through the “spreadsheet” with all that Aetna would provide Cliff I said “sounds good, I’ll sign up for this next year”. Agent immediately said, “No, with your back problems you’ll want a supplement plan”. That’s also when we learned Cliff wasn’t eligible for such a plan because it needed to be selected in first couple years of Medicare eligibility and/or go through underwriting, and his skin cancer diagnoses shut any hope of that down. We are forever grateful that eighteen months ago when his Aetna PPO (we switched from the HMO once they found bladder cancer) wouldn’t work with UCI on a clinical trial, that the broker UCI sent us to knew that there was a supplement entrance moratorium available with one company and that Cliff is now on a supplement plan.

 

[WinniWoman]

UNLESS you are on a High Deductible Plan at work and contribute to an HSA. That will keep you from contributing AND the effective date for Part A goes back 6 months and will invalidate prior contributions.

Yes. Right. The year before my husband was turning 65 I had him stop contributing to his HSA for that reason.

 

[dago]

The way Medicare Advantage is promoted and marketed and advertised, one would think there is no such thing as a Medigap or Supplement policy. You never (OK, maybe very rarely) hear about Supplement policies. It's almost implied that Medicare Advantage is the only thing available. That is troublesome to me.

LOL
I just got an e-mail advertising(soliciting?) Medicare Supplement "Why you should consider a Medicare Supplement Plan" .
There actually is such a thing as Medicare Supplement.

 

[SusanRN]

Thank you to the posters on this topic! And special thanks to those who recommended the independent brokers at MedicareSchool.com
Although I have been happy with my Johns Hopkins Medicare Advantage plan for 6 years, I had always focused on the "Johns Hopkins" part and my use of JH providers exclusively and not the annual potential maximum out-of-pocket costs of $7,500 and $11,500 for in- and out-of-network costs. My policy cost $100/month beyond the Part B cost. As I see family members start to have major medical issues, I've begun to worry....
I decided to *try* to go to original Medicare, which I've never had, plus a Medicare Supplement policy, which I knew would require medical underwriting...better to try now while I'm relatively healthy at 72. I walk with a cane and had three minor brain bleeds in my 40's (I could still jog), but the most recent was in 2000. However, my "innards" are good -- no diabetes or pulmonary, liver, or kidney issues, thankfully, except mild intermittent asthma once a year or so.
I had an appointment with an indpendent insurance rep from MedicareSchool.com (thanks for the recommendation) on Monday -- extremely knowledgeable, organized, and friendly. The bottom line is he found me good Supplement and Drug coverage for $140/month. My medical underwriting was approved in 5 minutes at a "preferred" level! My state (Maryland) permits me to switch to a different Supplement company around my birthday each year without more medical underwriting, if I want to change.
While we were discussing Supplement coverage, I mentioned my individual BC/BS Dental plan. He found me a dental plan from Ameritas with no waiting period that is a few dollars less per month and has double the annual coverage.
Again, thank you to everyone who invests their time in offering advice in the TUG Lounge. It truly makes a difference!
Susan

 

[DrQ]

...
I decided to *try* to go to original Medicare, which I've never had, plus a Medicare Supplement policy, which I knew would require medical underwriting...better to try now while I'm relatively healthy at 72. I walk with a cane and had three minor brain bleeds in my 40's (I could still jog), but the most recent was in 2000. However, my "innards" are good -- no diabetes or pulmonary, liver, or kidney issues, thankfully, except mild intermittent asthma once a year or so.
...

I'm glad you got a chance to make an informed decision. While your JH Advantage Plan was probably a very good plan, it is on written for a year at a time. Your Supplement Plan is now yours as long as you pay the premium. Now you do have to enroll in a Part D plan for prescriptions, but I would rather set my Doctor/Hospitalization costs as a fixed cost.

I liked MedicareSchool.com because he seemed very transparent as to how they make their money and were up front that they would make more commission on selling Advantage plans.

I get so sick of the huckster shilling for Advantage Plans:

I love the comments:

If this couple showed up on the news as a murder-suicide, I’d think, “that doesn’t surprise me.”​

​

 

[Ralph Sir Edward]

Thank you to the posters on this topic! And special thanks to those who recommended the independent brokers at MedicareSchool.com
Although I have been happy with my Johns Hopkins Medicare Advantage plan for 6 years, I had always focused on the "Johns Hopkins" part and my use of JH providers exclusively and not the annual potential maximum out-of-pocket costs of $7,500 and $11,500 for in- and out-of-network costs. My policy cost $100/month beyond the Part B cost. As I see family members start to have major medical issues, I've begun to worry....
I decided to *try* to go to original Medicare, which I've never had, plus a Medicare Supplement policy, which I knew would require medical underwriting...better to try now while I'm relatively healthy at 72. I walk with a cane and had three minor brain bleeds in my 40's (I could still jog), but the most recent was in 2000. However, my "innards" are good -- no diabetes or pulmonary, liver, or kidney issues, thankfully, except mild intermittent asthma once a year or so.
I had an appointment with an indpendent insurance rep from MedicareSchool.com (thanks for the recommendation) on Monday -- extremely knowledgeable, organized, and friendly. The bottom line is he found me good Supplement and Drug coverage for $140/month. My medical underwriting was approved in 5 minutes at a "preferred" level! My state (Maryland) permits me to switch to a different Supplement company around my birthday each year without more medical underwriting, if I want to change.
While we were discussing Supplement coverage, I mentioned my individual BC/BS Dental plan. He found me a dental plan from Ameritas with no waiting period that is a few dollars less per month and has double the annual coverage.
Again, thank you to everyone who invests their time in offering advice in the TUG Lounge. It truly makes a difference!
Susan

One more thing for you to consider. Some supplemental plans have gotten capped (no more people could enter them after a certain date - Plan F is one that was cut off in 2020). There was multiple years warning in advance. Avoid such policy types. While you won't lose the coverage, the prices will go up, relative to other plan types.You see each plan type is a pool, with new 65 year olds (being more healthy, relatively speaking) keeping the pool cost lower. Once you stop more 65 year olds, the remaining people in the group get older and sicker, raising the average price for members of the pool.

 

[SusanRN]

Now you do have to enroll in a Part D plan for prescriptions

Thank you, but I did that as part of the MedicareSchool.com consult. It's included in the $140/month, although I'll need to pony up extra bucks for the two meds I take (of 5) that are not in Tier 1. The overall cost will still be pretty low.

 

[SusanRN]

One more thing for you to consider. Some supplemental plans have gotten capped (no more people could enter them after a certain date - Plan F is one that was cut off in 2020). There was multiple years warning in advance. Avoid such policy types. While you won't lose the coverage, the prices will go up, relative to other plan types.You see each plan type is a pool, with new 65 year olds (being more healthy, relatively speaking) keeping the pool cost lower. Once you stop more 65 year olds, the remaining people in the group get older and sicker, raising the average price for members of the pool.

Yes, I've followed the situation with Plan F, even though it didn't apply to me. I have Plan G. I would be surprised if it goes down that path, but I will keep my eyes open.
Because I was aware of the danger of a small pool, I initially told the insurance agent that my inclination was to go with the AARP United Health Medicare Supplement policy, so I wouldn't potentially be "priced out" later. He pointed out that my state (Maryland) allows me to change my Medicare Supplement plan each year within 30 days of my birthday. The law was effective in July 2023. With this new Maryland Birthday Rule Law someone who already is enrolled in a Medigap policy can now switch to a new Medigap plan with any carrier offering equal or lesser coverage without requiring medical underwriting, as long as you do it within 30 days of your birthday. Mine is in November, so that's a convenient time. Now that I'm "in" a Medigap policy, it seems I can always stay in.

 

[SusanRN]

Here is more information about the several states allowing residents to change Medigap policies *without medical underwriting*:
https://www.senior65.com/medicare/article/switching-medigap-plans-here-are-your-options

States with a Medigap Birthday Rule are California, Idaho, Illinois, Louisiana, Maryland, Nevada, Oklahoma, and Oregon.
Connecticut and New York have guaranteed issuance for all at any time.
Maine allows Medigap enrollees to switch at any time of the year.
Missouri has a Medigap Anniversary Rule.
Washington State allows a switch to anything except Plan A at any time of the year.