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Where's the Advantage? Aetna Medicare Advantage Plans Out of Network in 2025

DrQ

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Aetna Medicare Advantage Plans Out of Network in 2025​


I'm glad we chose traditional Medicare with a supplement (Medigap). These plans are hawked so aggressively, but even if you select a PPO, you are going to pay through the nose.

I was getting some imaging done yesterday and the woman behind the desk was making call after call that they were no longer "in network" and would have to self pay or cancel.
 
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As a former Medicare sales rep, the only "advantage" is saving healthcare money when you stay in network. On the other hand, anyone on an MAPD can switch one last time between now and March to another one (insurers can not market it) or drop to Medicare PFFS (Paid Fees For Service, aka traditional Medicare).

TS
 

DrQ

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... On the other hand, anyone on an MAPD can switch one last time between now and March to another one (insurers can not market it) or drop to Medicare PFFS (Paid Fees For Service, aka traditional Medicare).
Yes, but unless you live in VERY few states, you cannot get a Medicare supplement without meeting underwriting requirements. If you can't meet those requirements, you have to pay the 20% out of pocket.

Aetna is still operating in the market, it is just that a BIG chunk if the providers are now "out of network". If they had pulled out of the market, then the victims could have qualified for acceptance under an SEP (Special Enrollment Period) without underwriting.
 

emeryjre

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The Scripps Network in San Diego cancelled health services for 30K health care customers at the beginning of 2024
Certain Medicare advantage plans did not pay Scripps sufficient reimbursement to provide health care to these people
There will be fewer providers for advantage plans going forward (IMHO)
I pay a hefty monthly sum to Medicare and Blue Shield
I am in a situation where I can do this fortunately
I am seeing several friends beginning to struggle financially as costs continue to rise for medical care, property taxes, car and home owners insurance
Maybe the new administration will come through for us with the promises of lower costs
 

DrQ

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Maybe the new administration will come through for us with the promises of lower costs
I don't hold any hope. Mehmet Oz has been tapped to head the Center for Medicare and Medicaid Services (CMS) who is a big proponent of Medicare Advantage.

Private equity reduces patient care while enriching investors, Senate report finds​

The bipartisan investigation of hospital systems purchased by Apollo Global Management and Leonard Green & Partners reinforced the findings of past academic research.

“As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures,” Whitehouse said in a statement. “Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.”​

Dr. Oz wants to expand private Medicare plans. Here's how he could do it.

The budget stakes​

There are growing concerns in Washington about Medicare Advantage’s cost, thanks to studies that have found the government now spends more per enrollee than it does for similar customers in traditional Medicare, partly due to how insurers game the payment system. The Committee for a Responsible Federal Budget estimated in 2023 that the government could end up overpaying insurers in the program by $810 billion to $1.6 trillion over the next 10 years, which will put more drain on Medicare’s trust fund and likely lead to higher premiums on the traditional side of the program.​
 
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Sugarcubesea

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The Scripps Network in San Diego cancelled health services for 30K health care customers at the beginning of 2024
Certain Medicare advantage plans did not pay Scripps sufficient reimbursement to provide health care to these people
There will be fewer providers for advantage plans going forward (IMHO)
I pay a hefty monthly sum to Medicare and Blue Shield
I am in a situation where I can do this fortunately
I am seeing several friends beginning to struggle financially as costs continue to rise for medical care, property taxes, car and home owners insurance
Maybe the new administration will come through for us with the promises of lower costs
In Michigan --- These two advantage plans can no longer used at these Healthcare Organizations.

MyMichigan Health dropped Aetna Medicare Advantage
Trinity Health dropped Humana Medicare Advantage
 

emeryjre

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I don't hold any hope. Mehmet Oz has been tapped to head the Center for Medicare and Medicaid Services (CMS) who is a big proponent of Medicare Advantage.

Private equity reduces patient care while enriching investors, Senate report finds​

The bipartisan investigation of hospital systems purchased by Apollo Global Management and Leonard Green & Partners reinforced the findings of past academic research.

“As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures,” Whitehouse said in a statement. “Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.”​

Dr. Oz wants to expand private Medicare plans. Here's how he could do it.

The budget stakes​

There are growing concerns in Washington about Medicare Advantage’s cost, thanks to studies that have found the government now spends more per enrollee than it does for similar customers in traditional Medicare, partly due to how insurers game the payment system. The Committee for a Responsible Federal Budget estimated in 2023 that the government could end up overpaying insurers in the program by $810 billion to $1.6 trillion over the next 10 years, which will put more drain on Medicare’s trust fund and likely lead to higher premiums on the traditional side of the program.​
My sarcasm is very subtle at times
 

Brett

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In Michigan --- These two advantage plans can no longer used at these Healthcare Organizations.

MyMichigan Health dropped Aetna Medicare Advantage
Trinity Health dropped Humana Medicare Advantage

In Virginia many of the doctors and hospitals have dropped Humana
I hope United Healthcare keeps paying and doesn't deny (or delay)
 
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