Some medicare advantage plans work anywhere for emergency purposes; you just need to be in your home state to get the regular checkups or see your doctor or get dental and vision etc. That is what I have. I resisted the advantage concept at first but it has turned out to be excellent. I do not pay a dime more than I would pay anyway for medicare but get much better coverage. There is also a phone number I can call to talk 24/7 to speak with a registered nurse who can help me to determine if I need to see a doctor for something or not, and if not what I can do about it myself, which is an advantage when I am travelling.
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The one I have doesn't cost any more that I would have to pay for ordinary medicare, and I think the coverage is much better. for me, anyway. I think it would work well for someone who lived on the road as well, as long as you were in relatively good health and did not need to see a doctor often. I figure if I were on the road full time I would just come back to my home state a couple times a year or so, whatever worked, and see my main doctor and dentist then, and get my glasses and so on. the rest of the time the advantage plan would still cover me if I had an emergency somewhere else. Of course I haven't done this so can't say it works but it seems as though it would be OK. Not necessarily for everyone.
Morgana
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user 22017
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It was Medicare Advantage that I kept seeing articles about in my FB news feed... warnings about it. I just did a search for Medicare Advantage + problems and a slew of articles popped up. This is the first one I found (it has links to others):
https://pnhp.org/news/oh-so-many-problems-with-medicare-advantage/
^^^I felt the same way until I realized Advantage plans only pay 80%! With being told by my nurse of hospitals charging $11,000 a day on average that is $2,200 a day! I would much rather go with plan G. I highly recommend everyone speak with a SHIP representative for unbiased information 3 months before turning 65 and let them know the details of your lifestyle. Being cared for by the VA (which is basically socialized medical care) has not been near perfect care but it hasn’t bankrupted me like insurance companies have when dealing with privatized medical care. Yet another example of big corporations leveraging political power to steal our tax dollars from our government as well.
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Morgana
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By coincidence, the New York Times has a long article today on the health insurance industry exploiting Medicare Advantage. "Most large insurers in the program have been accused in court of fraud." (This particular article focuses on how these co's bill the government, not how they treat patients.)
Very timely this discussion; thanks to whoever first raised it!
Very timely this discussion; thanks to whoever first raised it!
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That's probably what stopped me. All it takes is one unpleasant surprise ... OK, I won't get my hopes up that there's some gem in there that I overlooked. But I suppose it's worth a read-through all the same during open enrollment.
I like the Medicare website. I mean, nothing makes this easy. But IIRC it's pretty coherent as these things go. And there's all these services like SHIP and SHINE. On the information front, it could be worse!
I think all insurance companies are fraudulent and a rip off.....that is the basis of insurance. Personally I dislike the whole concept of insurance and don't like to support it. But when you get a bit older you may need more health care, and at a later age getting heavy debt could wipe out unreplaceable funds, so I got it .
One reason i went with the Advantage insurance I have is that there is a cap on how much can come out of your pocket, no matter where you are or what medical attention you need, and that amount is something I could manage to pay off if I had to. If the medical care is "in network" the cap is even lower, and there are "in network" doctors all over the country, in every state so it doesn't mean I have to be in my home state. I like the peace of mind of knowing that no matter what I won't ever be wiped out under a terrible load of medical bills that I couldn't ever in my lifetime pay off.
I don't understand why someone would think that advantage plans only pay 80%. I think it makes a difference which one you have, and what medical care you are talking about. They don't all only pay 80% of any or everything.
Mine pays 100% of dental, eye exams and glasses, as many visits to my doctor as I need per year, most medications (all of the ones so far that I have needed have been free), and pays a large percentage of things like a chiropractor that I think many insurance companies (and regular medicare) won't pay for at all. A number of diagnostic tests and screenings are also free. The co-pay for seeing a specialist or having a procedure done is significantly lower than it was for me when I had only regular medicare. There is no annual deductible, or deductible for any kind of service. It beats paying for everything out of pocket as I did all my life previously.
I think it all depends on a person's health needs and where you are and so on. So far I have really liked the advantage plan I have, but I am all too aware that you cannot trust an insurance company, and I just cross my fingers and hope that it continues to be a good choice for me.
I'd never suggest to anyone they get what I have, or not get it either, because it's such an individual thing. I had good advice from someone who knew the ropes before I chose, and who could answer all of my questions fully without having a stake in which insurance I chose, and think that's a good idea.
One reason i went with the Advantage insurance I have is that there is a cap on how much can come out of your pocket, no matter where you are or what medical attention you need, and that amount is something I could manage to pay off if I had to. If the medical care is "in network" the cap is even lower, and there are "in network" doctors all over the country, in every state so it doesn't mean I have to be in my home state. I like the peace of mind of knowing that no matter what I won't ever be wiped out under a terrible load of medical bills that I couldn't ever in my lifetime pay off.
I don't understand why someone would think that advantage plans only pay 80%. I think it makes a difference which one you have, and what medical care you are talking about. They don't all only pay 80% of any or everything.
Mine pays 100% of dental, eye exams and glasses, as many visits to my doctor as I need per year, most medications (all of the ones so far that I have needed have been free), and pays a large percentage of things like a chiropractor that I think many insurance companies (and regular medicare) won't pay for at all. A number of diagnostic tests and screenings are also free. The co-pay for seeing a specialist or having a procedure done is significantly lower than it was for me when I had only regular medicare. There is no annual deductible, or deductible for any kind of service. It beats paying for everything out of pocket as I did all my life previously.
I think it all depends on a person's health needs and where you are and so on. So far I have really liked the advantage plan I have, but I am all too aware that you cannot trust an insurance company, and I just cross my fingers and hope that it continues to be a good choice for me.
I'd never suggest to anyone they get what I have, or not get it either, because it's such an individual thing. I had good advice from someone who knew the ropes before I chose, and who could answer all of my questions fully without having a stake in which insurance I chose, and think that's a good idea.
Yep, seriously. Costs exactly the same. I pay my regular payment to medicare, and that's it. I don't pay any premiums directly to the insurance company that has the advantage plan I use; medicare pays them from the premuims I pay to medicare. Definitely take another look.
I don't think that's accurate across the board. see my post above.
I agree with your opinion of the insurance industry.
Which state are you in, and which carrier provides your specific Medicare Advantage plan?
I'm in Nevada with United Healthcare (aka OptumCare Network of Nevada) and it pays nothing when outside of Southern Nevada, specifically Clark and Nye counties. They expect their herd of retirees to stay on the ranch. They call the livestock in to the barn for tests and exams to pump up the bottom line.
Check with SHIP or the nonprofit organization in your state and find out the facts about the policy you have and let me know if I am wrong. I really hope I have been misinformed. The insurance company is getting paid by the government to manage your healthcare. The less they pay out the more they profit. The more claims they file without having to pay out the more they profit. These insurance companies are getting unbelievably rich and politically powerful. In my opinion universal government controlled health care such as veterans have with the VA can’t be made available to everyone soon enough. Not saying it is perfect but the VA hospitals I have dealt with have been much better than the public hospitals the last couple of years mainly due to insurance accountants trying to manage my health care instead of my doctors. Their excess profits should be going towards better treatment of the people they serve not in politicians pockets.I don't think that's accurate across the board. see my post above.
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I have medicare advantage. I have co-pays but nothing else; however, almost no dental coverage. The "only pays 80%" is wrong in my case. I had to get an implant for a broken tooth; I got to pay 100%. However I had a stress test, an echocardiogram, an endoscopy, etc. and was only charged the usual specialist co-pays. I pay $170.10 each month to medicare but nothing extra for medicare advantage.
Big problem I have is how do you know what insurance companies will approve and pay? After hours and several calls to the insurance company trying to find a doctor, hospital, medical equipment supplier and rehab facility (absolutely none of the lists we were given by the insurance contact were completely correct or even close!) finally asking what would be covered and would not the standard reply was “we won’t be able to tell you until after the procedure and we submit the doctor’s recommendations.” Maximum out of pocket only applies to procedures the insurance agrees to pay for but they can’t determine that until you have already agreed to pay for services received whether the insurance pays for it or not. At least with Medicare A, B and G it seems to me you have a much better idea of what you are paying for and pretty much can get medical treatment most places, sort of important if you are a traveling nomad. Can’t say this enough, talk to a SHIP or a state recognized nonprofit organization that can give you honest answers about Medicare at least 3 months before your 65th birthday!
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user 22017
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I turn 65 in May. I've been on Medicaid for many years and the only complaint I have is with the lack of dental coverage. At one point it was removed completely (except for extractions). Anyway, I'm hoping Medicare is as good a program as Medicaid. Curious what I will have to pay, since I'm on Social Security with no pension.
I know I want to support Medicare and not use Medicare Advantage. Especially after reading what these doctors had to say about Medicare Advantage:
https://jamanetwork.com/journals/jama/article-abstract/2792809
I know I want to support Medicare and not use Medicare Advantage. Especially after reading what these doctors had to say about Medicare Advantage:
https://jamanetwork.com/journals/jama/article-abstract/2792809
My plan is United Health Care, AARP Medicare Advantage Walgreens. (the Walgreens part is just that if I get my prescriptions filled there a lot of them are free) Not paying for prescriptions has saved me a lot of money even though I only take two and they are not super expensive. I figure that the money I save not paying for medication and not paying anything for dental or visual or glasses would help to cover the extra if I had to go out of network for something.
I have a print out from the company that they send me every year and it's right there in black and white. The only thing that changes if you are away from home is the cost of emergency care, which costs less if you are away from home and for some reason have to go out of network. Other than that, no matter where I am in the US if I go to an in-network doctor the cost is the same as if I were at home. The company is big and they have in-network doctors in every state.
With my plan all I have to do is look at the chart. If I had questions I could call them and ask specifically about something. If I want to go to a particular doctor, wherever I am, I just call the doctor's office to ask if they take my insurance plan and if they do I am good to go.
One thing I never do is call the company to ask for a list of doctors or for a doctor in the area who does a specific thing. I have learned that they will give you names but they do not keep their info up to date or even remotely accurate, so I am better off calling the individual doctors myself and asking them. So far I have found this very simple to do.
The maximum out of pocket in my plan is a total annual dollar amount, and it doesn't matter what kinds of things you have had done and what you paid for, what your co-pay was or how much of those things the insurance company covers. It just adds up the dollar amount you had to pay out of pocket and when that reaches a certain amount you stop having to make co-pays or pay for any other doctor visits or procedures for the rest of the year. There are 2 different maximums, one for in network and one for not in network, though, and the "not-in" is twice as high, so you have to keep track carefully. It seems to me that with a company that has in network doctors in every state and city of any size it wouldn't be very difficult for me to find in network doctors no matter where I am. I wouldn't get primary doctor free visits out of state because there's only one person you can name for your primary, but everything else would be the same. But even if I go out of network and the co-pay is therefore higher, it will still count toward the annual amount (of out of network total). I think with the right kind of management I will be able to stay in network the vast majority of the time.
As for what they will pay for, if the procedure was not on the chart they send me I would ask the doctor what they recommend or plan to order and then call the company and ask them what my co-pay would be for X, Y, or Z procedure and then I would know before I had it done. They have a number they answer 24/7. The only thing I have to agree to ahead of time is the doctor's fee and I would know already whether or not they were in network and therefore what it could cost.
I don't agree ahead of time to pay for any procedures. I check to see what I will have to co-pay first. Or if I will have to pay for it I make the doctor's office tell me what they cost first. sometimes that has been a pain in the butt but I always did that back when I didn't have any insurance at all. I would simply sit and refuse to go forward until they told me, saying I wouldn't do it until I knew if I could afford to pay for it or not!
(Now, I know that is somewhat confrontational and not everyone is really able to do that. This is just how I have done it.)
Of course, this is how it has worked for me so far. I am not saying my insurance plan is foolproof, but no insurance company or plan is and we always have to keep in mind that no insurance company wants to pay for anything if they can get out of paying for it. So it's important to be very up to date and understand what you are getting into with whatever you choose, and then make sure you know what changes they have made with each new year. So far the changes that have been made with the plan I have are all for the better, but that can change. It is also very important to keep track of what and when and what doctor and what you paid with receipts and so on so you have proof of everything if you need it. There are free or low cost places where you can get help disputing something with an insurance company if you end up having to do that.
In my opinion we shouldn't have to do all this at all. I grew up in a country with national health care for everyone and it is shameful that we do not have it here in the US.
^^^D’L you have have a much better experience working with the insurance companies than we have. Communication is not always quick or easy which adds to the problem. Getting incorrect information from the insurance companies and being required to have primary doctor referrals to those doctors who can’t always tell you what will be approved is a costly problem, especially if your normal living conditions won’t accommodate a mobility injury/surgery and it takes over 6 weeks to get the initial visit. We travel and live several hundred miles between Arizona, Utah, Colorado and Kentucky. We generally live remotely which means a trip to the doctor is expensive as it involves usually a 500 mile round trip and staying over night in an urban area. Even quickly getting a “free” prescription can cost $100 in fuel. If the medical issue is serious then it usually is an air evacuation. If the issue is mobility or less than life threatening it usually is a painful 4 hour trip in a vehicle. Mobility also means getting into and around in our home isn’t possible. It means you have to be somewhere a wheel chair fits or at least daily hygiene can be accomplished without causing infection and more complications. Having access to doctors and physical therapy hundreds of miles away doesn’t work or it seems isn’t part of insurance approval considerations. It doesn’t help that their charts are in black and white if the information isn’t complete and correct. When it says they will pay up to many times in our case it means they won’t approve or pay anything even with the doctor’s recommendation. “Out of pocket” expenses have to be submitted to and approved by the insurance company and even after paying those any additional expenses have to be submitted and approved. Just because a doctor is in network does not mean the insurance company will automatically pay all expenses or costs. Everything gets submitted and has to be approved. Time is money in our case and some approvals took taken several days, surprisingly holiday weekends cause delays that can cost several thousands of dollars in hospital bills. Yes we were told before hand everything was covered and “most likely” would be approved with a doctor recommendation which we got. Didn’t find out it wasn’t until weeks later. Medical procedures costs are seldom the same and doctors and hospitals don’t willingly give estimates even though they are required to in many cases, just saying. It appears “results may vary” is applicable here. In the long run in our case Medicare A, B and G payments will cost much less than the expenses of having an Advantage plan, I just hope it continues to be an option as insurance companies and politicians continue to try to take it away. Just a friendly suggestion talk to a SHIP person and don’t believe anything an insurance company gives or tells you they aren’t concerned about your care only how much profit they will make after lawyer’s fees.
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user 22017
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I just started reading at Medicare.gov and it appears that you pay almost nothing for medical care and prescriptions if you are below certain income limits (and resource limits). So anyone living on $700 a month (even $1500 a month) is covered. Unless you have a vehicle, home, stocks, etc. worth more than a certain amount. IIRC, $8k for individual). The charts are at Medicare's website.
^^^It should be in everyone’s best interest to make sure everyone is healthy enough to work and enjoy living in this country instead of paying for dealing with people living in poverty that don’t have the resources to get well and working. In fact many end up being poor and homeless because of lack of treatment or medical costs. Why do we wait to just help the ones that live to be 65 years old!
user 22017
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Medicaid in Illinois helps most folks. I've never heard of anyone not getting help in Illinois. And Illinois isn't even in the top 10 states providing excellent government healthcare for low income people (we are 23rd). Then there are the states that don't help their residents. The bottom ten states:
| 41 | Kansas | 31 | 48 | 35 | ||||
| 42 | Missouri | 36 | 40 | 41 | ||||
| 43 | Georgia | 46 | 41 | 37 | ||||
| 44 | Kentucky | 16 | 46 | 46 | ||||
| 45 | Alabama | 42 | 35 | 45 | ||||
| 46 | Louisiana | 26 | 47 | 47 | ||||
| 47 | West Virginia | 22 | 43 | 50 | ||||
| 48 | Oklahoma | 48 | 45 | 44 | ||||
| 49 | Arkansas | 40 | 50 | 48 | ||||
| 50 | Mississippi |
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