Medicare Advantage plans are a great example of privatization of healthcare. They are paid by the number of people enrolled in their plan. The insurance companies use the Medicare dollars to advertise their plan to sell it. The more enrollees the more money they are paid. If you are a high user they will offer you a free work up then you can be part of the high risk pool and the for profit insurance company will be paid more money by Medicare for those patients. They make their money my limiting tests and interventions. They sell their plans by the perks like meals after a hospital stay. I would rather have my healthcare dollars go to providing healthcare than advertising plans so they can make profits.
I’m very happy with my MC plan. “Perks” like vision and dental coverage, which are not covered by standard Medicare, add to my overall health status. I’ve got holistic coverage rather than piecemeal coverage.
My Medicare Advantage plan has been more than reasonable in covering my care. Aside from the year-long delays in getting from a vertebrae displacement, requiring numerous hoops to go through before authorizing the necessary surgery, my copays were $30/doctor visits, $0/MRIs, $10/PT visits , $100/spinal injection, and $250/surgery & 2 day hospital stay. I added up all the charges on the various statements I received for the surgery and they totaled $105,000. They are losing money on me.
As a provider the authorization process and having to justify why the patient needs the procedure to the insurance company is all about the insurance making money by denying services. If you decide you are not happy with your advantage plan after 3 years then supplemental plans have the right to deny you coverage based on pre existing conditions . Many specialists are not willing to be on their panels because of this. They also reimburse the providers at a lower rate and if the paper trail is not complete the provider is denied payment for their services. Where I live it was impossible to find mental health providers who would accept the advantage plans.
You are so right Susan! I have standard Medicare and a great supplemental plan that pay 100% of my copays. It’s not that expensive when you factor in what copays can expand to. Sure, I had to get separate vision but I am receiving the best mental health care of my life! There have been no caps on the number of visits as with our previous corporate employee (very expensive) insurance and of course no copays. It has certainly been an important shift in my life.
I was recently gobsmacked to learn that a routine blood test for cancer was not routinely covered by a patient's Medicare coverage (no idea which plan she has) even though she has a history of cancer!
From the wide variance in responses, it seems that the disparities among communities, providers, and companies point to the real problems with MA plans - there is no equity. I believe the impetus for Medicare-for-all is that there would be equity of benefit and that doesn't seem possible with private insurance staying in the mix and with differences between states. We older white folx with decent coverage in areas with plenty of providers in our plans' networks feel no need to change because we may be getting better coverage than we've ever had before in our long lives. However, it's clear even from this small sampling that there is a big equity issue when the entirety of those "covered" is considered.
For me, it was a no-brainer to sign up for the County provided PPO medicare supplement. My monthly payment is $385 but I've had no co-pays other than for my meds, no charges for labs etc. The only significant bills since 2014 have been $200 for my knee replacement surgery and $90 for meds (I brought all my own meds with me) during my 2 week nursing home stay (which WAS covered!) after the replacement and $650 for a ceramic crown on my dental coverage (that was my co-pay; the total was $1300) (My 35 years as a nurse @ the County Nursing Home has served me well.)
This profit motive rules "healthcare"
You are so sadly, tragically right. "Medical necessity" correlates to medical practitioners' profit, not to mention insurance companies.
Medicare Advantage plans are a great example of privatization of healthcare. They are paid by the number of people enrolled in their plan. The insurance companies use the Medicare dollars to advertise their plan to sell it. The more enrollees the more money they are paid. If you are a high user they will offer you a free work up then you can be part of the high risk pool and the for profit insurance company will be paid more money by Medicare for those patients. They make their money my limiting tests and interventions. They sell their plans by the perks like meals after a hospital stay. I would rather have my healthcare dollars go to providing healthcare than advertising plans so they can make profits.
I’m very happy with my MC plan. “Perks” like vision and dental coverage, which are not covered by standard Medicare, add to my overall health status. I’ve got holistic coverage rather than piecemeal coverage.
They're great plans until you get sick. That's when you find out that copays are much higher than standard Medicare.
Exactly. And their networks can be entirely inadequate, especially in less populated areas.
Same experience for me, and copays or my share has always seemed fair, in the years where health events happened
My Medicare Advantage plan has been more than reasonable in covering my care. Aside from the year-long delays in getting from a vertebrae displacement, requiring numerous hoops to go through before authorizing the necessary surgery, my copays were $30/doctor visits, $0/MRIs, $10/PT visits , $100/spinal injection, and $250/surgery & 2 day hospital stay. I added up all the charges on the various statements I received for the surgery and they totaled $105,000. They are losing money on me.
As a provider the authorization process and having to justify why the patient needs the procedure to the insurance company is all about the insurance making money by denying services. If you decide you are not happy with your advantage plan after 3 years then supplemental plans have the right to deny you coverage based on pre existing conditions . Many specialists are not willing to be on their panels because of this. They also reimburse the providers at a lower rate and if the paper trail is not complete the provider is denied payment for their services. Where I live it was impossible to find mental health providers who would accept the advantage plans.
You are so right Susan! I have standard Medicare and a great supplemental plan that pay 100% of my copays. It’s not that expensive when you factor in what copays can expand to. Sure, I had to get separate vision but I am receiving the best mental health care of my life! There have been no caps on the number of visits as with our previous corporate employee (very expensive) insurance and of course no copays. It has certainly been an important shift in my life.
But of course Medicare for All is the way to go. It has and will be quite an uphill battle that I may not see to resolution
I was recently gobsmacked to learn that a routine blood test for cancer was not routinely covered by a patient's Medicare coverage (no idea which plan she has) even though she has a history of cancer!
From the wide variance in responses, it seems that the disparities among communities, providers, and companies point to the real problems with MA plans - there is no equity. I believe the impetus for Medicare-for-all is that there would be equity of benefit and that doesn't seem possible with private insurance staying in the mix and with differences between states. We older white folx with decent coverage in areas with plenty of providers in our plans' networks feel no need to change because we may be getting better coverage than we've ever had before in our long lives. However, it's clear even from this small sampling that there is a big equity issue when the entirety of those "covered" is considered.
For me, it was a no-brainer to sign up for the County provided PPO medicare supplement. My monthly payment is $385 but I've had no co-pays other than for my meds, no charges for labs etc. The only significant bills since 2014 have been $200 for my knee replacement surgery and $90 for meds (I brought all my own meds with me) during my 2 week nursing home stay (which WAS covered!) after the replacement and $650 for a ceramic crown on my dental coverage (that was my co-pay; the total was $1300) (My 35 years as a nurse @ the County Nursing Home has served me well.)