I’m on original Medicare, with a supplemental private policy (Medigap). The monthly premiums are affordable if you are able to manage a higher deductible-which is still quite modest compared to what we had to cover prior to turning 65.
We don’t have vision or dental coverage—we just pay out of pocket. Our dentist offers a program that for $120 per year we get a preventative exam and a hefty discount on services..the numbers work out to be roughly equivalent to having dental insurance, which is pretty useless in that the annual caps are so low. Vision coverage hasn’t really been an issue—maybe we aren’t average but at this age your prescription doesn’t change that often. I get new glasses every couple of years not because my vision changes, but because my lenses are usually scratched up and it drives me crazy to not have absolutely pristine lenses.
We live in a rural area with limited providers and never even considered MA because of the risk of not being able to find an in-network provider. My mother, who was in the Portland, OR service area for Kaiser, had a Kaiser MA plan that was excellent. They covered her extensive and expensive needs, no questions asked. They covered hearing aids and vision. She had a heart attack followed by a long hospitalization until she could be stable for surgery, and it cost her nothing other than a bill for the ambulance ride to the hospital. I saw the itemized statement from Kaiser and the cost was about $375K.
I don’t know if there are other providers like Kaiser nationally, but I would consider MA but only from a wraparound system like they offer. Traditional Medicare requires more administration from me (buying and managing separate policies), and an ability to cover routine expenses and about $2500-$3000 in out of pocket costs, but if you can manage that the trade off is not being denied care when something serious happens.
You can go to any provider that you want with original medicare. No benefit of MA comes close to that. I am 73 and not sick, on medicare. [1] But I had a fairly serious fractured proximal humerus two years ago and I was able to get the best surgeon. I ended up staying in the hospital for a day and they had a woman in a suit hand me a letter saying that my doctor had decided to hold me for "observation" and that was the best for medicare. [paraphrase - I was on drugs]. The hospital sent an itemized bill, charging the 20%. CMS said no, this is one hospital admission and it is all covered under the PART A deductible. It was less, I can't remember by how much. [massachusetts] [2] I was in a van accident when I was still a tour guide in Florida. They have a weird no fault law that charges your personal insurance as the secondary insurer after the auto insurance. Naples Community Hospital kept sending a bill for $2500. I called and told them to send it to medicare. It was a big deal to get them to bill medicare but they finally did. CMS said NO, you have already been paid enough. CMS reviews the bill and adjusts it regularly. You get statements that say - this is what they billed - this is what we paid - this is the most you can be billed [if you have no other insurance]. There are some rules for MA but not enough. I lobby my fellow seniors to get regular medicare because I think MA is a path to take our medicare away. I think medicare will be improved, especially if we all have it. MA is for profit.
I have original Medicare with a supplemental policy. Five years ago I had a heart attack and a triple bypass surgery. I was in hospital for a week. The bill was well into six figures and I paid zero. With no arguments or troubles either. The home health visits and cardiac rehab sessions were covered 100% too.
Thanks for sharing your experience in some detail. That can help me and others make better decisions. Years ago, when I was managing my parents' health insurance (they were on Medicare and supplementary insurance), in Florida, it was a nightmare to get the bills paid. The Florida insurance department was no help. It seems that things haven't changed much.
MA is a scam. Not only are they being investigated for fraud, but they also use codes to say you’re sicker than you are to increase their revenue. I’ve read about enrollees who have cancer and have been denied treatment as being “medically unnecessary.” I have a Medicare supplement plan. It’s not cheap, but I rarely get a bill for anything. I also like to choose my own doctors.
Thanks for your response. I generally agree. I would only add that insurance companies have been convicted of running the same scam against original Medicare.
Medicare advantage is hmo Medicare. More expensive for the government AND extremely profitable for the vulture capitalist insurance industry. But it’s cheaper for the enrollees, so it depends on your budget. Supplemental insurance is not cheap.
I practiced medicine in Las Vegas for 46 years. The folks I had who had MA PPO provisions often brought me lists of empaneled specialty providers for help choosing referrals. I rarely found practitioners that I would use for my family.
I’m on original Medicare, with a supplemental private policy (Medigap). The monthly premiums are affordable if you are able to manage a higher deductible-which is still quite modest compared to what we had to cover prior to turning 65.
We don’t have vision or dental coverage—we just pay out of pocket. Our dentist offers a program that for $120 per year we get a preventative exam and a hefty discount on services..the numbers work out to be roughly equivalent to having dental insurance, which is pretty useless in that the annual caps are so low. Vision coverage hasn’t really been an issue—maybe we aren’t average but at this age your prescription doesn’t change that often. I get new glasses every couple of years not because my vision changes, but because my lenses are usually scratched up and it drives me crazy to not have absolutely pristine lenses.
We live in a rural area with limited providers and never even considered MA because of the risk of not being able to find an in-network provider. My mother, who was in the Portland, OR service area for Kaiser, had a Kaiser MA plan that was excellent. They covered her extensive and expensive needs, no questions asked. They covered hearing aids and vision. She had a heart attack followed by a long hospitalization until she could be stable for surgery, and it cost her nothing other than a bill for the ambulance ride to the hospital. I saw the itemized statement from Kaiser and the cost was about $375K.
I don’t know if there are other providers like Kaiser nationally, but I would consider MA but only from a wraparound system like they offer. Traditional Medicare requires more administration from me (buying and managing separate policies), and an ability to cover routine expenses and about $2500-$3000 in out of pocket costs, but if you can manage that the trade off is not being denied care when something serious happens.
Thank you so much for sharing your experience! What you report matches my own thinking so far. You’ve helped a lot.
You can go to any provider that you want with original medicare. No benefit of MA comes close to that. I am 73 and not sick, on medicare. [1] But I had a fairly serious fractured proximal humerus two years ago and I was able to get the best surgeon. I ended up staying in the hospital for a day and they had a woman in a suit hand me a letter saying that my doctor had decided to hold me for "observation" and that was the best for medicare. [paraphrase - I was on drugs]. The hospital sent an itemized bill, charging the 20%. CMS said no, this is one hospital admission and it is all covered under the PART A deductible. It was less, I can't remember by how much. [massachusetts] [2] I was in a van accident when I was still a tour guide in Florida. They have a weird no fault law that charges your personal insurance as the secondary insurer after the auto insurance. Naples Community Hospital kept sending a bill for $2500. I called and told them to send it to medicare. It was a big deal to get them to bill medicare but they finally did. CMS said NO, you have already been paid enough. CMS reviews the bill and adjusts it regularly. You get statements that say - this is what they billed - this is what we paid - this is the most you can be billed [if you have no other insurance]. There are some rules for MA but not enough. I lobby my fellow seniors to get regular medicare because I think MA is a path to take our medicare away. I think medicare will be improved, especially if we all have it. MA is for profit.
I have original Medicare with a supplemental policy. Five years ago I had a heart attack and a triple bypass surgery. I was in hospital for a week. The bill was well into six figures and I paid zero. With no arguments or troubles either. The home health visits and cardiac rehab sessions were covered 100% too.
Thanks for your input. This is the kind of story that people need to hear.
Thanks for sharing your experience in some detail. That can help me and others make better decisions. Years ago, when I was managing my parents' health insurance (they were on Medicare and supplementary insurance), in Florida, it was a nightmare to get the bills paid. The Florida insurance department was no help. It seems that things haven't changed much.
MA is a scam. Not only are they being investigated for fraud, but they also use codes to say you’re sicker than you are to increase their revenue. I’ve read about enrollees who have cancer and have been denied treatment as being “medically unnecessary.” I have a Medicare supplement plan. It’s not cheap, but I rarely get a bill for anything. I also like to choose my own doctors.
Thanks for your response. I generally agree. I would only add that insurance companies have been convicted of running the same scam against original Medicare.
Yes. The advantage plans are ALL scams. Just more gatekeeping and money skimming.
Thanks for your comment. I generally agree with you. We need a single-payer, government backed healthcare system.
Medicare advantage is hmo Medicare. More expensive for the government AND extremely profitable for the vulture capitalist insurance industry. But it’s cheaper for the enrollees, so it depends on your budget. Supplemental insurance is not cheap.
Thanks for your comment. Some MA plans are PPO, but you are generally correct. In the end, I think MA should be abolished.
I practiced medicine in Las Vegas for 46 years. The folks I had who had MA PPO provisions often brought me lists of empaneled specialty providers for help choosing referrals. I rarely found practitioners that I would use for my family.
It might be hard to get the medigap ins you will need to cover the 20% that Medicare doesn’t cover.
Thanks for reminding me.
Yes!