Since many are of Medicare age. This needed sharing

[southernlady]

Hospitals take aim at Medicare Advantage

“Hospitals have been dropping Medicare Advantage plans over high claim or prior authorization denial rates since at least 2018, but it was an uncommon move until recently. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over high denial rates.”.

Charles ran across a YouTube on this which is why I went looking for the article.

Charles and I have Medicare Supplement plans. Yes, it’s pricy, especially since we are both on the grandfathered Plan F. Charles looked last year at all the Medicare Advantage plans in our area, his issue was not all our current physicians were on a plan, oh they all accepted Medicare but there wasn’t a single plan common to all.

So before making your choices this fall, do your due diligence and make sure you won’t run into issues with hospitals in your area not accepting the plan you choose.

 

[JackieOnLine]

I not to Medicare age yet (65?) but it's complicated enough I need to start learning more now.

so thanks, Liz.

 

[southernlady]

Found another article. How accurate it is, I don’t know. It’s more of an opinion piece. But it’s concerning anyway.
https://www.msn.com/en-us/news/poli...e&cvid=167e97aac7c740ce8c309e0ef195a3de&ei=43
'This should be a national scandal': Medicare Advantage plans using AI for denials’
“As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare's top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.”
continued in article.

 

[southernlady]

Another tidbit I learned this year poking around on Medicare.gov, many Medicare Supplement plans offer Household Discounts if both spouses are using the same company. Example, my husband and I are with USAA, and I called them yesterday to ask, yes, they do offer it. Sending us the paperwork to apply. But if you don’t ask, you don’t get it.

 

[Spiky Bugger]

And…just an aside. The REASON I was irritated (on another thread) that his retirement system stopped offering our supplement plan was because I thought all Medicare Advantage plans were HMOs and I’m too persnickety for HMOs. But we have a Medicare Advantage PPO plan. We can go to “in-network” doctors AND to doctors who accept Medicare. It’s a super-dooper plan that costs his retirement system a pretty penny…like $864/mo, for the two of us, plus the $200+/mo they reimburse us for Medicare. Office visits and specialist visits are covered 100%. Meds cost $5 or $10, or for the Tier 4 stuff a max of $95/mo or $190 if a three month. AND, they return to us the money that is deducted from SS checks for Medicare. So we are covered AND retirement sends us $2600+ annually, because…I dunno, because he was upon a good union? Probably.

This is all part of a trade off. He did a kind of work that paid VERY WELL with independent contractors, less with govt/quasi-governmental agencies, but few or no benefits/retirement plans. If he had gone that way, we would have had to save a lot for retirement…and we’d be broke now Because we aren’t that reliable. He opted for a lesser working income but decent benefits and retirement.

And the retirement thing! His system calculates something like:
“average of three highest years base pay x years of service x whatever percentage they are using.”
His “overtime whore” buddies who are still working have a base pay of around $165k. But with the insane overtime hours they work, they are EARNING +/-$450k now. They go into COMPLETE shock when they retire and start receiving A PERCENTAGE OF that $165k base pay.

It’s a weird country we live in…so many have their later years’ comfort dependent on decisions they made in their 20s.

Oh…and we are barely middle class. Certainly not WEALTHY. But we do get regular checks with a tiny bit of inflation protection.

 

[Georgepds]

FWIIW... I found a low cost partD supplement plan in my area, $0.50/ month (wellrx)

Suits me fine since I use goodrx for my needs

The only reason I keep part d is someday I might need it, and then I'll rely on the out of pocket limit. My understanding is if you let part d slide, it's more expensive to get back in

This whole business is one long aggravation. The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

 

[southernlady]

FWIIW... I found a low cost partD supplement plan in my area, $0.50/ month (wellrx)

Suits me fine since I use goodrx for my needs

The only reason I keep part d is someday I might need it, and then I'll rely on the out of pocket limit. My understanding is if you let part d slide, it's more expensive to get back in

This whole business is one long aggravation. The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

I’m using the same one this time. Actually I've found that SingleCare sometimes beats GoodRX, and Kroger (who is in my area) has their own program that can beat both of them. So I keep all three “in my back pocket”.

 

[JackieOnLine]

The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

yes, and just in general the harder life is (for whatever reason) the less you can deal with all the details and confusion.