When aging, if you live long enough, healthy can be great until it’s not.
I wish all of us could live a wonderful healthy active life and one day drop dead. Unfortunately this rarely happens.
I know that when my mom fell last Christmas and was admitted to a rehab facility, having traditional Medicare was incredibly helpful. If she had a MA plan, her admission would have to have been approved. With a traditional plan, we could move her immediately
With regular Medicare you pay 20% for each chemo treatment so…
If you have a supplement you don’t pay once you met your deductible, right? There are no supplements for MA plans AFAIK.
And how much per month do you pay for the supplement?
It’s my understanding that most MA plans have drug coverage. It’s helpful to work with a qualified agent to review your H’s options, including making sure any drugs your H needs are covered.
I have traditional Medicare and a Plan D for drug coverage. Right now I have a Wellcare ValueScript plan that has a $0 premium, which works for me because my drugs are all low cost generics. But I will need to reevaluate every year to see if I need to change my Plan D.
I am currently paying $131/month for my Plan G supplement with AARP/UHC. Of course that’s in addition to the Part B premium which is $175 for 2024. And as mentioned in another post, I have a Plan D with WellCare with a zero monthly premium, which works for me for now but will need to be re-evaluated every year.
This depends on what supplement plan you choose. With Plan G you pay the $240 deductible but otherwise it’s pretty full coverage. But there are other supplement plans with lower premiums where you have less comprehensive coverage. Compare Medigap Plan Benefits | Medicare
The supplement covers all copays for all services. So typically it’s cost effective. I don’t have Medicare yet so can’t answer your question.
Not sure who you are referring to, but it is unlikely any MA plan has an allowable for any service that would be higher than the traditional Medicare allowable for that service. Can you provide any example(s)?
Isn’t Sutter the company that bought up many Nor Cal hospitals and then jacked up the cost of maternity care b/c all companies had to provide it to their insured (employees)? Am I remembering that right?
Yup. That’s them. The also fought tooth and nail for gag clauses in all their contracts to prevent price disclosure. They are horrid.
FWIW…a standard blood panel would cost me about 1K OOP if run thru the ‘conveniently co-located’ to my Sutter Dr. lab. While the exact same panel at Quest costs about $350 OOP. And Sutter makes it very hard to get those lab orders over to Quest…somehow they seem to get ‘lost’ on a suspiciously often basis.
I have a Medicare supplement plan with Anthem Blue Cross. I have had surgery, colonoscopies, treatments, lots of doctor visits and I haven’t paid a dime apart from the premiums. I have had no issues with in or out of network. I don’t need insurance company approvals. I choose whatever doctors I want. The Medicare Advantage plan my husband has is cheaper but much more difficult regarding all of the above.
I think UCSD has cut ties with Medicare Advantage plans.
Yes, Sutter acquired many smaller practices, so many areas are mostly a duopoly between them and (less expensive) Kaiser. The cost of non-Kaiser plans (employer, ACA) is likely based on Sutter costs, and appears to be substantially higher than Kaiser plans with similar coverage.
If you do not like either Sutter or Kaiser, there are still other options, but some are even more expensive / less in-network (e.g. Stanford), and some others have gone concierge-like.
Not sure if this falls under a different category, but I went to a Kaiser Urgent Care center (closest available at the time), and they accepted my Traditional Medicare + (non-Kaiser) Supplement plan.
Insurance arrangements typically allow urgent or emergency care through providers otherwise out of network or not covered, and urgent or emergency care providers know that out of network patients often show up because the provider is the nearest available one.
Of course, sometimes sorting out the insurance issues associated with out of network urgent or emergency care can still be aggravating.
Many years ago there was a young child whose family had Kaiser, who developed some sort of bad infection and parents had to take him/her to the ER. They lived on the South side of town, and were told by Kaiser they couldn’t go to the nearest ER but had to drive up to the north side of town to an approved facility. That delay cost the child some extremities. The attorney who handled the lawsuit lives in a huge house that is known as “the house that Kaiser built”. I can’t find the article about it on line, but there is a similar case of a Kaiser treatment delay cost a woman a leg and cost Kaiser $28M Woman Who Sued Kaiser Over Lost Leg Awarded $28.2M - CBS Los Angeles
Ah-- found the child case. 1993! Cost Kaiser, back 30 years ago, $45M! https://publications.aap.org/pediatrics/article-abstract/95/6/900/59394/45-MILLION-MALPRACTICE-VERDICT?redirectedFrom=fulltext
How’d one of you end up with traditional medicare and one with MA?
And as an aside, I just texted the friend (who was the provider that couldn’t see the WellMed pt. I mentioned earlier) who uses Kaiser and she sent this -
“ I just called Mayo to schedule my annual physical and I asked her. She said they do not accept any MA plans.”
I appreciate the article. I’m not 65 yet but I’ll not be signing up for an Advantage plan. I want choice as to where I get treatment. I know people in my area with Advantage plans. I think they are required to stay in an HMO type of network. We have just one hospital so I don’t think it’s limiting what type of plan you pick for hospital care. What is limiting is that the major group that the Advantage plan contracts with has a reputation as being hard to get Dr appointments. That group ironically started its life as a high end clinic that people traveled to see physicians. Over the years it merged with another large clinic and a few months ago became part of Sutter.