General Discussion

Silent Type

(7,297 posts)

113. Your drug and MediGap policy are private too. And private insurance companies do all the admin

Mon Sep 16, 2024, 10:40 PM

Sep 2024

work for original Medicare including paying claims, answering your questions, credentialing of providers, audits, sending EOBs, interpreting Medicare rules, etc.

Edit history

Please sign in to view edit histories.

Recommendations

1 members have recommended this reply (displayed in chronological order):

Think. Again.

238 replies

= new reply since forum marked as read

Highlight:

Holy shit. Be prepared for the consumer to get screwed on your healthcare advantage programs. [View all] LilElf70 Sep 2024 OP

I would never purchase Medicare Advantage radical noodle Sep 2024 #1

I've had an Advantage plan for five years. Costs me $0 additional. I love it. Sibelius Fan Sep 2024 #3

I have the same thing. 0 out of pocket LilElf70 Sep 2024 #6

it's costs the governemnt and the taxpayers PLENTY Skittles Sep 2024 #7

It is part of Medicare. former9thward Sep 2024 #23

Calling Advantage "Part C" is part of the bait & switch dflprincess Sep 2024 #39

Clinics love to overbill and upbill routine procedures. former9thward Sep 2024 #42

Clinic systems have contracts with insurers and the reimbursement rates are already negotiated dflprincess Sep 2024 #52

How is your friend Blue_Roses Sep 2024 #151

Hanging in there dflprincess Sep 2024 #163

Oh, that's great! Blue_Roses Sep 2024 #231

We agree. Silent Type Sep 2024 #108

Quick Tip. OldBaldy1701E Sep 2024 #156

Agree. former9thward Sep 2024 #168

Medicare Advantage is privatized Medicare vapor2 Sep 2024 #48

They get commissions on advantage and drug plans too, which are private insurers. Silent Type Sep 2024 #109

Thanks for this article. Nt spooky3 Sep 2024 #35

Traditional Medicare is paid for by the government too. Demsrule86 Sep 2024 #187

EDUCATE YOURSELF Skittles Sep 2024 #222

doctor's visitss VGuerra276 Sep 2024 #27

My GP visits are $5. All my prescriptions except one are $0. enough Sep 2024 #34

I have no copay for doctor visits. Generic drugs are $0. A three-month supply of Sibelius Fan Sep 2024 #181

In 5 years. "0" out of pocket. Medicare a UH advantage plan. OAITW r.2.0 Sep 2024 #127

What supplement do you have? jmbar2 Sep 2024 #12

I have Florida Blue radical noodle Sep 2024 #25

Thanks for the info jmbar2 Sep 2024 #118

In the last few years radical noodle Sep 2024 #159

So true jmbar2 Sep 2024 #167

I have $2000 worth of dental work that needs to be done next month which I now will get done elocs Sep 2024 #173

Is that Medigap, or an Advantage plan? jmbar2 Sep 2024 #175

Advantage. But Wisconsin's Medicaid (BadgerCare) has dental coverage. n/t elocs Sep 2024 #183

Humana has a plan which covers dental extensively in Ohio...I have never been on it but good reviews. Demsrule86 Sep 2024 #188

Thanks for the info - will put it on my research list for Oregon jmbar2 Sep 2024 #235

Fortunately, I have had excellent coverage from the UHC Advantage Plan. elocs Sep 2024 #177

"I know some people are limited financially and must go with what they can afford" elocs Sep 2024 #176

Call your local Council on Aging and/or your senior center SheltieLover Sep 2024 #106

Great advice - thank you so much jmbar2 Sep 2024 #119

You are most welcome! SheltieLover Sep 2024 #125

Here is the Medicare.gov website detailing the gap plans SheltieLover Sep 2024 #129

Thanks again! jmbar2 Sep 2024 #137

YW! SheltieLover Sep 2024 #140

You can't get F anymore. G is now the one to get. kerry-is-my-prez Sep 2024 #184

Bummer! SheltieLover Sep 2024 #185

I could not afford any of these plans...and it is still private insurance. Demsrule86 Sep 2024 #190

Yes - you have to be able to afford it. On the other hand, having to pay the 20% of B could be bankrupting. kerry-is-my-prez Sep 2024 #215

"Supplement" is the wrong term if you are talking about privatized Medicare Jmb 4 Harris-Walz Sep 2024 #192

If something seems too good to be true, it definitely is. We won't get Medicare Advantage either. lostnfound Sep 2024 #16

Yup, Medicare Advantage is privatized Medicare. My concierge dr won't take you if you have a disadvantage program vapor2 Sep 2024 #50

Your concierge doc probably does not take traditional Medicare either, especially new patients. Silent Type Sep 2024 #110

Who is your supplement with? MiKenMi33 Sep 2024 #54

AARP United Health Care Medicare supplement we can do it Sep 2024 #95

Thank you! MiKenMi33 Sep 2024 #115

Thanks! jmbar2 Sep 2024 #120

Not everyone has guaranteed issue for a Medigap policy dlk Sep 2024 #82

You are initially, don't fall for advantage if you're going to be new to Medicare. we can do it Sep 2024 #97

It must be nice to have the choice because many of us do not. n/t elocs Sep 2024 #174

I think it all depends on the Advantage Plan that was chosen. There are several to choose from; suggest you Jmb 4 Harris-Walz Sep 2024 #194

Max out-of-pocket for prescriptions drops to $2000 next year. That's $3,000 in savings. Sibelius Fan Sep 2024 #2

I think that's a big deal; however I'm not sure what that will do to premiums. Silent Type Sep 2024 #111

From what i have read BigMin28 Sep 2024 #4

Not difficult, but it requires planning: NameAlreadyTaken Sep 2024 #43

You can switch back to Original Medicare. Demobrat Sep 2024 #77

Pricing of those Medigap plans, slightlv Sep 2024 #99

Get a new plan...you can switch Advantage plans. Demsrule86 Sep 2024 #191

The switch is possible in some states but not all. nt pnwmom Sep 2024 #131

I'm almost reluctant to comment soandso Sep 2024 #217

I spent 46 days in hospital, had open heart surgery, two subsequent heart surgeries and take Eliquis- Demsrule86 Sep 2024 #46

What health care plan do you have? n/t halobeam Sep 2024 #67

Humana Gold Advantage PPR give back ( GB means I get just over 100 back monthly from part B) Demsrule86 Sep 2024 #193

What "plan" are you referring to which you have if I may inquire? Tarzanrock Sep 2024 #73

Part C is medicare advantage Kali999 Sep 2024 #86

I have Humana Gold. You have regular Medicare. I couldn't afford it. I pay no premiums and get 100 + a month back in Demsrule86 Sep 2024 #186

Part C is Advantage...you have traditional now. And Medigap covers the 20% Part B doesn't cover and insurance companies Demsrule86 Sep 2024 #198

I have gym membership free with my supplement and can go to any doc who takes Medicare w/o asking insurance permission. we can do it Sep 2024 #100

It was signed in 1997. jimfields33 Sep 2024 #107

I'm sorry. leftieNanner Sep 2024 #5

Same here Rebl2 Sep 2024 #38

Do you realize that Advantage plans are private plans and not Medicare plans? Think. Again. Sep 2024 #8

The U.S. government and Medicare says you are wrong. former9thward Sep 2024 #20

Nope, Advantage plans are offered and run by private companies... Think. Again. Sep 2024 #24

It is part C of Medicare. former9thward Sep 2024 #32

You should read the link you provided. Think. Again. Sep 2024 #37

Your statement is not true. Big Blue Marble Sep 2024 #47

Part C is part of Medicare. former9thward Sep 2024 #53

Part C is only nominally a Medicare Option. Big Blue Marble Sep 2024 #76

THIS!!! MotownPgh Sep 2024 #152

And insurance companies sell Medi-gap policies...so I don't see the difference. Demsrule86 Sep 2024 #199

Then you need to study the system. Big Blue Marble Sep 2024 #207

That is your opinion. I have advantage and I get 100 per month back on part B, no premium and everything is Demsrule86 Sep 2024 #209

It is more than my opinion. Big Blue Marble Sep 2024 #216

Amen LilElf70 Sep 2024 #233

Medicare works with it, but doesn't administer it. Medicare gives Medicare Advantage pnwmom Sep 2024 #142

That's just a label -- it means it's approved by Medicare as an option, but it's not managed pnwmom Sep 2024 #135

That's a practical fallacy!! Tadpole Raisin Sep 2024 #154

Your drug and MediGap policy are private too. And private insurance companies do all the admin Silent Type Sep 2024 #113

So is Medi-gap coverage. I don't see the difference. Other than I pay more for traditional. Demsrule86 Sep 2024 #195

The difference is Medicare is a government program while Advantage (and medi-gap) are corporate programs. Think. Again. Sep 2024 #200

No, they are private plans that Medicare regulates and pays on your behalf. The plans aren't run by Medicare. pnwmom Sep 2024 #83

That is BS. Unless you want to pay 20 % out of pocket, you have to get an additional plan with a commercial insurer Demsrule86 Sep 2024 #49

The supplement plans are not subject to networks or preapprovals dflprincess Sep 2024 #55

That is not true. My sister in law had regular Medicare and she was denied care. They can and will deny you. Demsrule86 Sep 2024 #204

She should have fought that denial dflprincess Sep 2024 #214

Are you asking me how a federal plan is different from a commercial plan? Think. Again. Sep 2024 #56

I am sorry Aetna which has a medi-gap plan is not a government insurer. Demsrule86 Sep 2024 #205

Exactly! You're SO close! Think. Again. Sep 2024 #208

You misinterpret...you pay Medi-gap plans for coverage..and these plans are insurance based...not different that Demsrule86 Sep 2024 #210

I never meant to be arguing, but you're right, let's just drop it. Think. Again. Sep 2024 #212

The difference is whether your own doctors and hospital decide on the care you need, pnwmom Sep 2024 #87

You are kidding yourself if you think traditional Medicare doesn't deny certain procedures. Demsrule86 Sep 2024 #206

The Advantage plans have limited provider networks, which can eliminate pnwmom Sep 2024 #224

The supplement plans are basically check-writing plans. Ms. Toad Sep 2024 #96

Supplements are private insurance plans, though with little discretion. As are drug plans, Silent Type Sep 2024 #114

But the lack of discretion is the key piece. pnwmom Sep 2024 #130

You need to take a look at original Medicare policies that limit all kinds of coverage for "excessive" Silent Type Sep 2024 #132

Original Medicare doesn't restrict you to certain doctors or hospitals. pnwmom Sep 2024 #136

+1. An extremely important distinction dalton99a Sep 2024 #121

Medicare Advantage DC77 Sep 2024 #9

I have never been LilElf70 Sep 2024 #22

I'm really glad it's worked so well for you up to now. It appears less stellar in other regions. I'm sorry the LauraInLA Sep 2024 #98

Have you or your wife ever needed X-ray treatments that cost more than $10K each? pnwmom Sep 2024 #128

Bad news. Private insurers get paid billions to administer original Medicare too. So you Silent Type Sep 2024 #116

No, they don't. Medicare itself administers Parts A & b with the money people pay into it. pnwmom Sep 2024 #150

Absolutely wrong. Private insurers have subsidiaries that administer original Medicare. Give me your state and Silent Type Sep 2024 #165

Medicare "Advantage" is a rip off.... gainesvillenole Sep 2024 #10

what is a supplement and who makes them nt msongs Sep 2024 #15

Insurance companies make them, I guess. My mother, who died in 2009, had the United American supplemental plan, LauraInLA Sep 2024 #103

AARP is one place that sells a good supplement. nt pnwmom Sep 2024 #178

I went through a broker who does both Supplemental or Advantage. kerry-is-my-prez Sep 2024 #189

+1 dalton99a Sep 2024 #19

I live in Cleveland on my Advantage plan...I can us Cleveland Clinic, UH or Metro...all fine insurers. Demsrule86 Sep 2024 #51

It's Only An HMO RobinA Sep 2024 #169

yeah I had read that would be happening Skittles Sep 2024 #11

Medicare "advantage" Cirsium Sep 2024 #13

I agree LilElf70 Sep 2024 #18

all the money being wasted on the "Advantage" scam Skittles Sep 2024 #78

Bill Clinton was the one that signed it into law in 1997 MichMan Sep 2024 #28

This message was self-deleted by its author Chin music Sep 2024 #45

"No Democrat should be supporting or praising this right wing privatization scam, this assault on Medicare. " MichMan Sep 2024 #57

This message was self-deleted by its author Chin music Sep 2024 #58

Show me where I have a history of jumping on Bill Clinton MichMan Sep 2024 #62

This message was self-deleted by its author Chin music Sep 2024 #71

He was wrong Cirsium Sep 2024 #170

This message was self-deleted by its author Chin music Sep 2024 #182

I have family in Ireland and universal is not working real well lately. Demsrule86 Sep 2024 #211

Fox in the henhouse Cirsium Sep 2024 #236

thank you Skittles Sep 2024 #44

I stuck with regular Medicare. Ocelot II Sep 2024 #14

That's the way to go BOSSHOG Sep 2024 #31

LOL Auggie Sep 2024 #60

My 2024 benefits LilElf70 Sep 2024 #17

the 2025 changes that save the beneficiaries money shift the financial burden to the plans Coexist Sep 2024 #21

Once you get locked in, it may be difficult to go back to original Medicare. They now own you. keithbvadu2 Sep 2024 #26

THIS Auggie Sep 2024 #61

You can go back to original Medicare (parts a & b) at any time during open enrollment hot2na Sep 2024 #149

You can go back to traditional. Big Blue Marble Sep 2024 #218

Just getting caught up to the inflationary effects the last few years MichMan Sep 2024 #29

Rightly or wrongly, MA rates were cut. Personally, until our government-- regardless of party -- Silent Type Sep 2024 #30

For comparison with Traditional Medicare plus supplement Otto_Harper Sep 2024 #33

Thom Hartmann has talked about Medicare Advantage pitfalls repeatedly live love laugh Sep 2024 #36

Most people that dislike dabbing LilElf70 Sep 2024 #59

The issue is the trade-off. We turned down Advantage and its freebies (free dental, gym, etc) pnwmom Sep 2024 #80

Might be worth checking the AARP United HC Medicare Supplement. It provides gym memberships. we can do it Sep 2024 #104

We could afford a gym membership if we wanted one. What we can't afford pnwmom Sep 2024 #126

I get it. Your situation like half of Medicare eligible people is unfortunate and you're right Cheezoholic Sep 2024 #85

Bingo!!! Rhiannon12866 Sep 2024 #102

So sorry you're facing that LearnedHand Sep 2024 #40

I plan to stick with traditional Medicare when I retire next spring dflprincess Sep 2024 #41

Wow. I've had an Advantage plan for 10 years. Joinfortmill Sep 2024 #63

There's An Element On DU RobinA Sep 2024 #172

Medicare advantage is NO ADVANTAGE AT ALL. READ THE FINE PRINT. ashredux Sep 2024 #64

If you already have Medicare Part "A;" Part "B;" and, Part "D" ... Tarzanrock Sep 2024 #65

Part C is an "advantage" plan SheltieLover Sep 2024 #133

Thanks. I appreciate the reply and the answer. Tarzanrock Sep 2024 #146

Medigap coverage pays copays & possibly other charges. SheltieLover Sep 2024 #147

I get Medicare and pay UH @ $300/m0. 70 YO. OAITW r.2.0 Sep 2024 #66

300 a month? LilElf70 Sep 2024 #89

Stay with real Medicare. Advantage will eventually rip you off. Liberal In Texas Sep 2024 #68

Less hospital overnights paid IGoToDU Sep 2024 #69

Did you recently have a milestone birthday? SocialDemocrat61 Sep 2024 #70

We are looking for a plan now samplegirl Sep 2024 #72

Call you senior center and / or council on aging. SheltieLover Sep 2024 #138

Why now? Because they wait till it's too late for you to switch back to Medicare, pnwmom Sep 2024 #74

Well, CMS is cutting rates for next year. Whether that is justification for cutting "extra" benefits Silent Type Sep 2024 #123

Medicare Advantage has always been a scam! WVreaper Sep 2024 #75

As a pharmacy tech... buzzycrumbhunger Sep 2024 #84

When I was checking policies bobandrileysmom Sep 2024 #79

Medicare Advantage is a ripoff, and I would never choose such a plan. Buyer beware! Martin68 Sep 2024 #81

Consumer expert Clark Howard: Why I Think Medicare Advantage Plans Stink Pinback Sep 2024 #88

❣️ . . . . . . . Seek advice from your local HICAP advisor . . . . . . . ❣️ CoopersDad Sep 2024 #90

It's an election year. And the current administration is democratic. Vdizzle Sep 2024 #91

First thread of ten thousand! dpibel Sep 2024 #92

The private insurers running MA plans have been subsidized, to the disadvantage of regular Medicare. Ms. Toad Sep 2024 #93

It's happening now to affect the election. ecstatic Sep 2024 #94

No, I think people are just bringing it up, to shed medicare in a bad light during an election, and stoke discontent. Think. Again. Sep 2024 #122

If we're going anecdotal... markodochartaigh Sep 2024 #101

It's amazing how it's always the friend of a sister dpibel Sep 2024 #117

I saw tens of thousands of my husband's co-retirees threatened with the loss of their doctors pnwmom Sep 2024 #134

Almost... dpibel Sep 2024 #141

That kind of BS doesn't go on between regular Medicare and providers. pnwmom Sep 2024 #143

That's a bit of a diversion, isn't it? dpibel Sep 2024 #145

The people screwed by advantage are dead...they aren't going to answer questionseverything Sep 2024 #155

One of the biggest providers in the city will not take Advantage anymore. kerry-is-my-prez Sep 2024 #202

My friend needed a cochlear implant mcar Sep 2024 #164

Need advice! I have original Medicare and I want to add Medigap (in Minnesota) now KatK Sep 2024 #105

There are no pre-existing conditions for a Medigap plan. Ms. Toad Sep 2024 #197

Thanks! KatK Sep 24 #238

I've had an Advantage plan for about 20 years. Dem2theMax Sep 2024 #112

Lots of people are happy with MA. That's why 52% of Medicare beneficiaries choose it. Silent Type Sep 2024 #124

When they join they can only hope they'll be happy long term. And in most states, if you wait too long to switch back, pnwmom Sep 2024 #139

I know, some folks think that 52% are too stupid to make the right decision for them. Silent Type Sep 2024 #166

In the insurance industry they have a phrase moniss Sep 2024 #144

Medicare Disadvantage - 11 years ago when I was considering 'Advantage' plans, that's what an agent called it GoneOffShore Sep 2024 #148

I posted about this awhile back. Supposedly it is the unintended Tadpole Raisin Sep 2024 #153

ISN'T MEDICARE ADVANTAGE A REPUBLICAN INVENTION HagathaCrispy Sep 2024 #157

If it involves profiting off the average American and Tadpole Raisin Sep 2024 #158

Actually Bill Clinton signed it into law. Silent Type Sep 2024 #179

There is nothing free, especially from a health insurance Co.. nt Hotler Sep 2024 #160

Hospitals are dropping Medicare Advantage plans left and right dalton99a Sep 2024 #161

hospitals and clinics are not getting adequate reimbursement from them travelingthrulife Sep 2024 #162

I gave up on them. I just use regular Medicare Part A & B. n/t Jacson6 Sep 2024 #171

Medicare DISadvantage has always been trash. Jirel Sep 2024 #180

How did I know that the doom and gloom post would be from a relatively new member? ZonkerHarris Sep 2024 #196

You're a real LilElf70 Sep 2024 #232

ironic from you ZonkerHarris Sep 2024 #234

Not really. LilElf70 Sep 2024 #237

I get a ton of calls trying to sell me an advantage plan LetMyPeopleVote Sep 2024 #201

Medicare Advantage is designed to destroy Medicare. Eliot Rosewater Sep 2024 #203

This sums it up perfectly. Big Blue Marble Sep 2024 #219

In case you haven't noticed, the only significant upgrades to our healthcare system-- ACA, drug plans, Medicaid Silent Type Sep 2024 #220

Amen LilElf70 Sep 2024 #226

THANK YOU Skittles Sep 2024 #223

There is nothing more confusing than Medicare. I still haven't wrapped my head around it but someone stopped me from kerry-is-my-prez Sep 2024 #213

I have Medicare and Tricare for Life so I don't need or want Medicare Advantage LogDog75 Sep 2024 #221

UPDATE: LilElf70 Sep 2024 #225

You also need to understand that moniss Sep 2024 #227

I get what you're saying LilElf70 Sep 2024 #228

Amen and I have written before about moniss Sep 2024 #230

All the back-and-forthing is moot to me. Straw Man Sep 2024 #229