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Roadblock to Medical Care? Medicare Advantage Plans
Here at Mayo Clinic Connect we often discuss Medicare Advantage Plans vs. Traditional Medicare. The New York Times published an article recently that takes up the prior authorization required by Medicare Advantage Plans and how some critics say that Medicare Advantage unnecessarily restricts coverage. I have no conflicts of interest. I never worked in the insurance industry in the U.S.
Personally, I have Traditional Medicare (Plans A, B, D and Supplement G)
When ‘Prior Authorization’ Becomes a Medical Roadblock (read the comments too and these are illuminating).
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The whole health insurance situation can be so confusing! My husband and I had great health insurance through his union. It covered everything! However, when he died two months ago the insurance continued for me but only for 3 years and at $400 a month! I had to decline it because I couldn't afford it. I looked into other insurance programs even with AARP but they too were a little more than I wanted to pay! I was at the point where my doctor agreed that I could cut my blood pressure medications down to one a day instead of two so I could afford them. I was very upset about all of this and just kept praying constantly about it! Finally, I called Medicare and this wonderful lady found me a Humana Medicare insurance with no Premium and the medications were at no charge! I only have to pay $25 per office visit! God does come through for you! Sometimes it is at the last minute but that's OK!
PML
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2 ReactionsWow! Medicare Disadvantage is the only thing my retiree healthcare provides. I may have to pay for the supplement instead. Life or death
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2 Reactions@pml Cutting back or discontinuing medications is exactly the problem with the cost of health care in the U.S. and especially for seniors. I'm happy to know that you found an affordable plan. Do you know what the deductible and out-of-pocket maximum is for your Humana Medicare policy?
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1 Reaction@mdk1960 I don't have a way to compare medical care with different types of health care insurance. I do know that both my husband and I have have Original Medicare and we go to the same primary care office. We both receive excellent care and our doctors spend all the time needed to address the reason we are there. My husband had an appointment last week with his doctor and I was there also. The reason for the appointment was to address medication and the doctor spent about 1/2 hour with us.
We go to Mayo Clinic in Rochester, MN for all of our speciality care. I doubt that the medical providers at Mayo are aware of the health care insurance of their patients in that system. We both have received excellent and compassionate care at Mayo Clinic.
My G Supplement policy did go up slightly in cost since I signed up in 2019. But the increase was only $15/mo and I can afford that.
The only difference you will find in Supplement policies will be the cost. Medicare requires that all insurance companies who offer Supplements must offer the same coverage. So as you look through the different insurance company offers that you get the most important information is cost in this case. That was my take-home advice when I started to review policies when I signed up for Medicare.
Your Part D coverage (medications) will vary in cost and coverage. I found it's best to the use the online tool that Medicare provides. The tool allows you to put in your current medications to help you to figure out which policy is most cost effective for you.
Explore your Medicare Options:
-- https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
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5 ReactionsThank you so much.
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1 ReactionCould I ask you other than the price increase you mentioned has there been any more in your premium? I do not want to be intrusive but you and your info are helpful. Thank you
The deductibles vary depending on the treatment. Most are quite reasonable such as $10, $25. However some surgery deductibles go up to $100. It is $0 to see your primary care physician and $25 for a specialist. Also the medications are no charge or at least for me they have been so far. I'm not sure what the out of pocket maximum is. The correct name of the plan is Human Gold Plus H2486-006. I'm convinced this was an answer to a prayer!
I should point out that I wanted to cut my blood pressure medications to save money. However, my blood pressure levels had been in the 120/70 range since January and this was August. I was pretty certain that I could go down to one time a day with no problem but I wanted the doctor to approve that and he did! I currently only take my blood pressure medications once a day. I have had no problem with this. But it shouldn't be the only answer to financial problems!
PML
@mdk1960 Your question is not at all intrusive. I mentioned my Medicare Part D prescription plan with WellCare. When I signed up 5 years ago I believe the plan was about $20/month. For the past two years I have not had any premium - so the cost actually went down. That's odd, isn't it? When do costs ever go down?
I've had two price increases in the time I've been on Traditional Medicare. !) Part B has gone up but that is Medicare-government controlled. It goes up each year by about $10/month. 2) I have had one price increase from Transamerica for my Part G Supplement. It went up $15/month.
Please let me know if I can help you with anything else related to Medicare. It's likely that whatever questions you might have, assuming I can respond with an answer or reference, will be helpful to someone else here at Mayo Clinic Connect.
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1 Reaction@pml. I'm not an expert on health care insurance. I've done a lot of reading and thinking about what health care insurance covers, what it does not cover, and how much it costs. I just wanted to explain the following. Let me say, too, that I'm very happy that you found an affordable plan.
Here is the information on your Humana Plan (I looked it up with the information you wrote).
https://www.medicareadvantage.com/plans/humana-gold-plus-h2486-006-hmo-h2486-006-000
The $25 you pay to see a specialist is referred to as your "co-pay". The deductible is something else and is the amount you pay for covered health care services before your insurance plan starts to pay. Your plan has a deductible of "0". Your out-pocket-cost maximum is $5900.
One of my friends has a Humana Gold plan and when she had a medical emergency she found the Humana Gold plan was very comprehensive. She's pleased with her choice. I can see that your plan is very comprehensive too and I wish we had plan like that available where I live.
Thank you for the information and the link! You are right. I was quoting the co-pay amounts. I am pleased with this plan at least at this point. I've only had it for about a month. I'm surprised that you can't get it also. I merely called Medicare. I would think it would be available nation wide if you are on Medicare.
PML
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