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Anyone else have Medicare Advantage
Prostate Cancer | Last Active: Mar 6 9:03am | Replies (28)Comment receiving replies
Fortunately, I switched from a medicare advantage [MA, aka medicare part C] plan when [five letters, starts with C, but used to start with A] refused to cover the first mpMRI. When I appealed the decision, they never even bothered to respond, even though the MRI clearly found cancer and guided treatment. Since I was within the 6 mos free switch window after turning 65, I could and did get a [high deductible G] supplemental insurance plan along with traditional medicare.
Recently I switched my 91y.o. quasi-dependent from an MA to traditional medicare. Why? 1) It actually saved money on premiums. While she isn't likely to get a good rate on a supplemental plan, she doesn't need one. 2) I find arguing with insurance companies about medical treatment questions an unproductive waste of time. I hope your experience differs if you are in that situation. Unfortunately I still have to argue over drug coverage, since all part D (drug) plans are privately administered by insurance companies.
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Exactly. For the unsuspecting...Medicare Advantage plans (not original Medicare) require you go to their network of doctors/hospitals...and there is no guarantee that their network has right specialists or can offer one all treatment options. And specialists have subspecialties so even if they have a "specialist", there is a good chance that such "specialist" does not have the knowledge you require. That happened to me. But fortunately, I have original Medicare and I ordered specialist to send my records to Mayo. I can self-refer to any doctor in the US that takes Medicare. I pay my monthly premium and I never see a bill and I don't need any approval. Yes, my premium costs more...but that was before I was diagnosed with cancer. Now I am saving many thousands of dollars by NOT having an Advantage plan. And I have never had to worry about getting approval for anything!
Mayo Oncology Dept has brochure about how people should check their insurance, and what to do if insurance refuses cancer treatment!!!! It also states that people with original Medicare do not need to check insurance.
Because how do these Advantage plans work? Medicare sets the price they will pay for a procedure, so the insurance company doesn't have to do more. Then the Advantage insurance company finds doctors willing to take less that what Medicare has established. And they make their customers pay copays etc. and get approval for a procedure. Medicare Advantage plans advertise nonstop on TV with all these extra benefits. How do they make a profit and pay for all that advertising??? By limiting you to their network and requiring copays and approvals for any procedure and refusing many times. There are lots of complaints about this. Tragic when someone has cancer and is waiting for the insurance company to approve a test.
Frankly, we don't need a choice of plans...we need affordable coverage for any eventuality. Why should the insurance company be making big profits? Let Medicare offer the choice and collect. Also Medicare is more cost efficient than these insurance plans. Health insurance is not a "free market" situation because we have to have it!