Given a fair number of "Senior Citizens" hereabouts, I thought this might well be of interest.

In the beginning, a loooooooooooong time ago, I went on Medicare. It's good stuff, never mind it's the only game in town for most of us. It pays for your healthcare needs---some of it anyhow. Given the desire for something to pay for what Medicare doesn't, two options are offered by what I'll call the private (non government) insurance industry. One such is known as Medicare Supplement coverage---the other as Medicare Advantage. Medicare Supplement is good stuff----pays for damn near any and everything Medicare doesn't. (My only personal experience involved three days in Cardiac Intensive Care, three more days in (regular, everyday cardiac care), and the tab was $60,000. I paid exactly NOTHING out of pocket!)

After a spell on Supplement coverage (with ever increasing premiums as the clock ticked over another year), I switched to Medicare Advantage---costs less, pays less---think of it as "Supplement Light".

In both cases, my impression was Medicare called the shots. (They paid what your doctor(s)/other providers charged---in accord with the terms of the particular contracts----with NO INVOLVEMENT in determining what was or was not appropriate treatment. In other words, your providers did their thing as they deemed appropriate, billed Medicare and whatever other coverage you had, and that was that.

Enter the "new and improved" Advantage: It now seems the Advantage carriers are calling the shots---as to what is and is not appropriate treatment for whatever ails you----rather than your doctor(s). (!!)

My experience: I'd been waiting a good spell for treatment prescribed by my doctors. When I asked my lead doctor about the delay, I was told my Advantage carrier was requiring "Pre-certification" of the treatment---and that THEY had declined to approve his first two submissions----and that he was working on the THIRD submissions----and that Medicare had nothing to do with any of this---besides what they'd pay when they were billed by the doctor. Given possessed of a fairly short fuse, I fired my Advantage carrier straightaway, and told the doctor to get on with it, and that I'd pick up the tab as need be. He did, and I did.

Then I went shopping for Supplement coverage---the good stuff! The good stuff is expensive ($200 and something per month in my case)---which is understandable--and while it's understandable, it made me think.

Here's what I thought: I thought I might very well forget about any protection over and above Medicare, and tend to such charges out of pocket. So I did just that!

Here's how that's working out: Instead of paying $200 and something each month for insurance over the past coming up four years, I've paid what Medicare didn't out of pocket. I kept close track of it for awhile. After about two years, and out of pocket about $800, I decided keeping close track of it was a waste of time. Now, after about four years, it's somewhere just a bit over $1,000. If that strikes you as chump change, you're right on target!!

Here's another thing I've learned----very recently! The TV is AWASH with commercials for Medicare Advantage insurance. That means the Advantage insurance companies are paying the TV folks STAGGERING sums of money for this "air time"!! AND that means the Advantage premiums they're collecting minus the claims they're paying make it all worthwhile----BIG TIME!!

Now I'm not advocating doing what I did for any and everybody. It depends on your ongoing healthcare needs---and the cost thereof. If your situation is such that you need additional protection, buy the Supplement coverage---the good stuff! "It only costs a little more to go first class!"

My conclusion after all this is Medicare Advantage is NOW a scam! It didn't used to be, but it for damn sure is now!! God forbid the same thing happens with the Supplement programs!

Ralph Tremaine

I don't think Medicare Advantage plans are a scam, but I do think not all plans are the same, with some being terrible and some being very good. You also need to find a plan tailored to your needs — good coverage for your drugs, your doctors, your lifestyle — and available to residents of your county of residence.

As has been discussed in several threads, there are licensed medicare brokers who can help you find the right plans for you, as well as free advice offered by state governments.

Medicare itself also annually rates mdicare advantage plans: What Are the Medicare Star Ratings?

Here's what I know about Medicare Advanage (which isn't much, this is just from my parents and their friends).

My folks are patients at the Mayo Clinic. They have just straight Medicare (no Advantage or other supplement plans). They have friends who have Medicare + an Advantage plan (don't know which). Mayo will NOT take them as a patient.

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Common sense isn't so common.

I am a survivor of some nasty cancer. Before I signed up with my particular medicare advantage plan provider, i called up MD Anderson, Sloan Kettering and Mayo to ask if they would take the plan I was considering if I needed their care. They said they would.

You need to do your research to be sure your needs are covered with whatever plan you choose.

I'm happy with my UHC-Medicare coverage and I wish Medicare would stop calling us.

I’ve had the same insurance for 40+ years, as only, and now secondary. Don’t need any + or supplement.

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I’m your Boogie Man, uh huh.

I've heard a few stories about doctors not getting their treatment plan approved with the private insurance companies. One was a freeze treatment for prostate cancer. They didn't approve the freeze treatment because they consider it experimental.

As I mentioned in another post, my wife and I travel a lot. I didn't want to worry about finding a clinic or hospital that accepted a specific Advantage plan. I keep Medicare and bought a supplemental [medigap] plan.

I have also read a few govt officials want Advantage plans to stop using "Medicare Advantage". It's not medicare, it's simply private health insurance.

I’m also a patient at Mayo.
No way I’m going to jeopardize that level of care with an “Advantage Plan”.
Copayments on basic Medicare at trivial once your deductible is met.
I expect healthcare to cover catastrophic injuries and major medical expenses. Not every nickel and dime expense.

Like my local presbyterian Senior Plan.
Pres is a large local Medical Provider.
I should mention that I have good fortune of excellent health.
So am I a Fortunate Son?
Hell Yes!

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NRA LIFE MEMBER

I just turned 65. This Medicare stuff makes my eyes glaze over.

I kept BC/BS Federal into retirement. My wife (60) is covered under that. They sent me a Medicare card, so I guess I have that too.

I’m sure I’m paying more than I would need to, but its worth it to not have to think about it.

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Rule of law, not a man.

Since 2004 my medical expense receipts would fill a barge. My OOP has been microscopic by comparison. I am under the network blankets of The Christ Hospital, Bethesda Hospital and Kettering Hospital. My levels of care have been stellar.

I have no complaints about the insurance system as it pertains to me.

What a country!

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Music/Sports/Beer fan

I kept Medicare A&B with UHC "AARP supplement." Paid for tests, doctor visits, dentist, glasses, drugs on top of a $250/mo premium. Switched to Humana "PPO Gold Plus" and no premium, no drug costs (I only take 3 Rx that are generic) routine dental cleanings $0, $30 co-pay for specialist visits, $400/ yr glasses allowance, $200 OTC yearly. Yes, the co-pay (deductible is almost $5K) for hospital stays but in 2 years I have saved $6K in premiums.
Health Insurance is a scam but hey, who's looking out for "us?"

PS, they won't quit calling until Pearl Harbor day (Dec 7) just because they can. Joe

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Behavior Creates Destiny

My supplement (Aetna) has gone up from $250 to $280/month recently. But it covers 100% of most everything, including prescriptions and most dental. I can afford it at my age. Fortunately my wife retired from the State, and her retirement plan includes good supplemental health coverage as part of it. And she has needed it for both cancer and heart surgery. So I need to pay only for mine.

Same here, hardly ever have any out of pocket expenses and have yet to find any provider that doesn’t accept it. BC/BS can be a bit expensive but the knowledge that it’s going to cover everything we need is priceless

After two trips to the ER, I was recently hospitalized with near-fatal blood clots in both lungs. Several doctors said I was lucky to have standard Medicare instead of all the "alternatives" and to keep the standard. A week in ICU and I paid nada.

Same story, I developed sepsis of the knee last year. Doc told me the stuff is serious. In the hospital 4 days, surgery, a month in rehab for an intravenous dose of antibiotics everyday. The lady that ran the insurance at the rehab said I had the good Medicare
Group A, B and G handled by Blue Cross. Never paid a cent.

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LIVE FROM THE DAWGHOUSE

There we have it, free healthcare, no one pays anything

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I’m your Boogie Man, uh huh.

PE? You are fortunate to be alive. Had that back in 4/2020.

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I’m your Boogie Man, uh huh.

That's what they all said. Came from my leg, they determined. Unprovoked. No clue or signs or history I had a leg clot. Just got really short of breath. First ER trip they saw "something" on a CT scan (no contrast--allergic) and thought start of pneumonia. Three days later about collapsed going to mailbox, so back to ER. Whatever they saw when checking vitals sent me directly to exam room and a swarm of doctors and nurses working on me. Another scan, with contrast this time, showed the lung clots and they found one in my left leg. Six days later they let me leave.

Medicare premiums and plans are offered to you by what county you live in. My local medical center is not affiliated with Advantage plans who want you to go to the next big town. The locals will apologize to you if they can't fit you in the next day. I keep a supplement.

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Front sight and squeeze

I have been on Medicare plus the Federal BC/BS since I retired at 75 from NCI 10 years ago. (Sig had to retire earlier as an FBI agent). Is the extra a trifle expensive?, yes is the answer, but on the plus side, my wife's heart valve replacement and pacemaker fitted at the University of Pennsylvania (one of the top three or four hospitals in the US) was "listed at >$176,000". My payment of $50 was the parking charges in their garage. Magnificent care!

Sig, keep the Federal BC/BS as unlike most of these the Federal one works overseas as well, medicare does not. Dave_n

This is the key. Access to good healthcare and how much you pay varies hugely according to where you live. One of Nevada's dirty little secrets is the lack of healthcare providers. Sure, we have emergency rooms and trauma centers, but for cancer and such, most 'proper' care requires travel and lodging with all the expense that generates. Try doing that when you have a job in a 'right to work (fire)' state given the limited PTO most get in the US.

US employers need to have their 'you being sick is your fault' beaten out them, on YouTube, with Game of Thrones enhancements for tough cases.

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Release the Kraken

So if you have Medicare A&B only it would have covered 80% of that $60,000. In other words not having a supplement plan it would have cost you only $12,000. If you have a serious illness that 20% can put you on Mediaid (after you've lost everything, house IRA, savings,etc. and your wife's money

I've been on Medicare for over 8 years. I have a high deductible Plan G ($2800 deductible). Once I met the deductible I'm covered 100%. Originally I started on Plan G no deductible, 1s year was cheap, 2nd year it doubled, 3rd year it doubled again so I switched to the high deductible for $38 a month. Also try switching plans once you're on one plan. Insurers once a complete physical. I keep getting turned down because I have a touch of arthritis,

My wife has an advantage plan and I have traditional Medicare with a supplement. The supplement is $222 during my 77th trip around the sun. I’m sure it will go up in February when it renews. It pays all deductible and copayments. The sum of these routinely exceeds the $222. I have COPD and some of the drugs to treat are incredibly expensive. Drugs are not covered at all, but breathing treatments delivered via a nebulizer are covered under part B as durable medical equipment.
Bottom line is that if you are pretty healthy the advantage plans may work well for you. If not, stay far, far away from them.

Was a Hospital Admin for 15 years, with the Pa Hospital Association then private practice representing Hospitals negotiating contracts w/ Insurers for 20 years.

We're lucky as my wife was a Commonwealth Employee and the retirement benefits include supplemental coverage.

Ins Companies make a ton of money off "Advantage" Plans ..... all I can say is .........................go Supplemental

Many years ago, when I signed up for Medicare, I talked with an insurance agent and he said to stay away from Advantage, and just get a secondary insurance plan, which I did. He said he had several people who signed up for Advantage and after a couple bad experiences wish they hadn't. I have had Medicare and Physicians Mutual as a secondary since 2014 and am very satisfied . If it ain't broke, don't fix it !!!

It's confusing and hard to decipher but this is my understanding.

I'm relatively healthy, the Advantage plans work for me. The HMO I like to use at first only took their own Advantage plans so it wasn't a tough choice. Now their plans have been gutted of extra benefits and they are accepting some of the Advantage Plans from UHC, Aetna, and Wellcare. But still, they only take Advantage.

The one I'm thinking about is $0 per month, $3,000 dental, $300 Vision, and $120/month OTC that rolls over month to month, and Gym Membership. The thing I use the most is the Dental.

Regular Medicare would work for me if my provider organization took it. The problem with it is if you get really sick and run up huge bills. The Advantage plans have an annual maximum out-of-pocket that ranges from $3,000-$10,000. There is no maximum out-of-pocket with regular Medicare, hence the supplemental insurance. If you get something expensive you could end up with quite a bill if you have Medicare alone.

You're not kidding. About 4 years ago I spent 3 days in the hospital because of a possibility that I was having a stroke. When I got the Explanation of Benefits I about choked when I did some mental arithmetic to calculate what the 20% Medicare didn't cover would have been. Luckily I had prepared by having a supplemental plan.

Hospital "charges" [the statement you get] are generally nowhere near what Hospitals actually get from an Ins Co. , Medicare or Medicaid.

Back in the day the only ones that paid charges were Auto Ins and Workers Comp claims........ about 7% of the business. Today, by law, they pay the Medicare/Medicaid rate + 5-10%

Not unusual for Hospitals and Physicians [in Pa,] get less than $ .50 on the dollar vs "charges"

Most Hospitals here, by Board/Hospital policy, will accept as little as $ .50-.60 on the dollar from self pay or on deductibles. You need to ask.

Hospital margins are are better than Grocery stores but still only about 3-6% which is why many Community Hospitals are closing or downsizing.

Ya, the system has been screwed up since about 1983.

Recent article in the Wall Street Journal shows that Medicare Advantage plans are not for the sick. Once you get expensive, they start throwing up obstacles to prevent you from getting care. Such as the OP is experiencing with multiple rejections.

The business plan of Medicare Advantage Insurance companies is to collect premiums, and deny benefits.

Greedy attorneys are the primary reason Nevada (especially Las Vegas) is short of healthcare professionals.
☹️☹️

I kept my Blue Cross Blue shied when I retired from the federal government. I also have Medicare and Medicare Part D. Some of my diabetes meds are outrageously expensive. Those alone would be about twice what I am out of pocket for BC/BS for a month.

When my wife went through palliative care for her battle with brain cancer, the bills. were over $600,000. I look at my BC/BS bill which combined with Medicare covered everything and think I will keep it because I will always be ahead. Also I owe a special thank you to Lutheran Hospice Care who were wonderful in her final weeks

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Kind regards, Heinz

Given the average age range of the forum and how often this comes up maybe we should ask the management for a "Medicare" subforum.

Medicare Advantage is good as long as you are healthy. Other than that, it's very limited in what it will do.

BAM-BAM made some great points, so I'll try to limit my comments as much as possible.

I learned more than I ever wanted to about medical billing when I was the project manager for my services electronic Patient Care Report system.

At the time, auto insurance paid every penny billed on a first come - first served basis until the money was gone. So, it was a race to get the bills in first. We lost that race because of our archaic paper based billing system. We also lost three billable reports a day for one reason or another.

Medicare pays a pretty small portion of what is billed, which is why a supplement is necessary. They'll pay 80% of what they allow, not what the hospital bills. The supplement makes up the rest. Some hospitals will do a sliding scale based on your income, but many won't. No supplement, you pay "retail."

Medicaid is even worse for the hospitals and other medical providers. The people on Medicaid pay nothing.

You can be on both Medicare and Medicaid, but as someone else mentioned you have to spend down your money. You do NOT have to sell your house if one spouse is still living and living there. My friend had Dementia and had to go to a nursing home and his wife did have to "spend down" much of their savings before applying for that. They exam the finances thoroughly and take their sweet time. She had to hire an attorney ($10,000) to get through the process. She also had to pay for the first month in the nursing home ($16,000) and that is not reimbursed. Sadly, he died during that first month.

Medical facilities do not have to accept Medicare and FL and TX lead the nation in having facilities that don't. However, if they do accept Medicare, they have to accept your supplement.

There was a time where municipal retirees in MA didn't have to go on Medicare, but the law changed about 10 years ago. I don't know if that is federal or just MA law.

A general rule I follow about insurance ads on TV is the better the advertisement, the worse the coverage and willingness to pay out.

As BAM-BAM says the system has been screwed up since the 1980s and every attempt to make it better just makes it worse.

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Can open, worms everywhere.

As I recently learned medical facilities in NC do not have to accept Medicare either. This comes up if you're in a car accident. The hospital doesn't want to accept 33 cents on the dollar so they go after the auto insurance. If the auto insurance doesn't pay they threaten to put a lien on your house. At my age I'm not moving so they can fight it out with the mortgage company after I die.