Exactly. And I would encourage posters to read the article in the original post I linked, that speaks more to the smarmy behavior of the MA companies that suck money from the government and claim many of their customers are sicker than they really are, to get more money. And as you said, once they are sicker, they may not get the care they expect.
From the article:
“ Medicare Advantage plans not only make money by withholding care but, perhaps more significantly, by misrepresenting the severity of illness among their beneficiaries. MA plans are paid a monthly fee by the federal government based upon a patient’s level of illness, known as risk score. It has been well established that, through advertisements (hawking free gym membership, dental care, etc.) directed towards healthier people, these plans enroll patients who are generally healthier, thus spending less in the aggregate.
But, hold on, here’s where they really pick the taxpayer’s pocket. MA providers often upcode patients’ level of illness to make them appear sicker than they really are, or even fabricate nonexistent illnesses. On the positive side, the Dept. of Justice has caught on. Virtually all major MA insurance providers have been fined by the Dept. of Justice for violation of the False Claims Act. This fall, Cigna is on the hook for $172,294,000 in fines, while the quaint and adorable sounding Martin’s Point MA plan out of Maine will need to cough up $27,485,000 for similarly bad behavior.”
No different than the Medigap companies. In many cases, they are the same folks. For example, the Blues offer MA plans and Medigap plans. UHC (ARRP) does the same.
One thing that is good about Medicare/Supplemental combo is that doctors and hospitals usually seem to have decent processes for claim submission…. no “network” constraints. (Can be true of MA too, at least for now). I’m not keen on filing my own paperwork in old age.
I’m only familiar with Medicare + private BCBS PPO. It’s pretty seamless so far for my folks (state employee retirees) and us (fed employee retirees). Medicare covers most things and private insurance covers the balance.
I have had a Medicare Advantage plan for 6 years and have never had to submit my own billing paperwork.
I had regular Medicare plus supplement, plus vision and dental. I had to submit for vision myself all the time…and for anything dental beyond cleanings.
I think if the provider has both your Medicare and supplemental policy information Medicare automatically send the claim on to the secondary after they have paid. Look on one of your eob’s . It should say.
I asked on this thread awhile back if it mattered if the MA plan was through a non-profit company, but no one replied. My MA plan is through HealthPartners, which is an integrated, nonprofit health care provider and health insurance company, so they don’t have to answer to stockholders. So far, I’ve been very happy with it. I’ve never needed a referral, never had to deal with any paperwork, and as a PPO, it has a very wide network. Granted, I’m still relatively healthy with no medications except for a yearly Reclast infusion, which cost me all of $7.43. I know my care will likely get more expensive in the future, but I can afford the out of pocket max with a premium of only $49/month, so I’m taking a chance that it will all even out in the end.
Somehow, the US has to make socialized universal medical insurance for people age 65+ extremely complicated and with potentially high stakes choices when first enrolling.
Given that Blue Cross Blue Shield is “nonprofit,” at least in my state, I honestly don’t think that there’s a whole lot of difference between non profit and for profit in healthcare. They all seem to be profit seeking.
Has anyone moved between states while on Medicare?
We are currently in Mass. MA plans here are good and you can switch to regular Medicare at any time without underwriting so it seems to be an easy decision to start with MA here. But, we are planning to move our official residence to Florida. I’m not sure of the exact time line but probably a couple years from now. I think I want to be on regular Medicare while in FL from what I’ve read here. So I’m thinking that I sign up for MA first here, then when I know we are going to change our residency, switch to regular Medicare here with a supplement from a company that offers it in both states. Then when we move, just give them the new address. Does anyone see a problem with this plan?
A nonprofit business does not have to satisfy investors on Wall Street or wherever, but still has to avoid making negative profit in order to avoid bankruptcy. It can also be subject to principal / agent conflict of interest, such as corrupt acts by employees.
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Has anyone moved between states while on Medicare?
It seems like that would work, but be aware that just because you have a supplement with a company in Mass doesn’t mean it will be the same plan in FL. All insurance is state approved (and priced), so even though it says Blue Cross on the plan doesn’t mean it is the same in MA or FL.
Something will work in each state. You won’t be left without insurance, although you may not get the same plan at the same price.
A slight tangent. We are among those in CA who are having their State Farm homeowners policy cancelled. Right after I found out that lovely bit of info I get a marketing letter from the SF agent…touting the wonderfulness of Humana MA.
Folks I know on MA in this area seem pretty happy. I don’t need to decide for a few more years. It’s the “forever” (without underwriting etc) factor that stresses me. Yes, you can change in year one, but it’s the longterm outlook that worries me.
I think the potential problem is that when you switch to regular Medicare, you will also generally want a supplemental/gap plan. If you choose regular Medicare when you turn 65, you can get a gap plan with no problem regardless of preexisting conditions, etc.
However, that is not the case if you want to switch from an MA plan back to Medicare. Then you are subject to underwriting, etc., for a supplemental gap plan and it may be unavailable or too expensive.
Someone here can correct me if I have that wrong. But we are leaning toward starting with regular Medicare from day one for that reason.