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
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
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