Below me is the link to a stunning article from NBC News about Medicare Advantage plans acting in their own best interest and evoking the two worst words in insurance, Delay and Deny.
Medicare Advantage plans can delay performing surgeries until they approve it. What if they tell you they will only approve therapy after your doctor picked a hip replacement? It happens! What if they tell you they'll approve a pin in your hip instead of the surgery your doctor wants you to have?
Doctors will tell you this can be a major problem. Ever had a client with cancer wait three weeks once he was determined to have cancer before he was sent to a specialist? I remember that guy well. He didn't make it and his wife said "I'll always wonder it he might have survived had he gotten treatment earlier!"
Deny payments or only approve parts of the patients treatment. This article is full of stories documenting that. How the hospital sometimes pays the bill to help the client get treatment. And how this can close smaller hospitals over time.
Also the article points out that the further you are away from cities, the worse and the thinner the networks get for Advantage plans and the more likely someone will not get treated or paid or both.
Original Medicare (A&B and a supplement) to my knowledge has no such issues. Original Medicare (A&B) plus a supplement pays 100% for most surgeries, if you have met the $226 deductible for the year. Surgery is scheduled, completed and the client is not normally involved in any way in the billing. Medicare pays all the claims, not the profit seeking insurance companies. If you have a supplement, unlike the under 65 world or group insurance, Medicare pays the bills and surprisingly, they mostly do it very well !
I'm as capitalistic as anyone, but the way Advantage plans are advertised, all benefits and no issues or costs shown, to end up having life threatening surgery denied or delayed is reprehensible. Think your better off on an Advantage plan with networks (original Medicare has none) than without? What if your network drops your doctor on 1/1/24 this year. I worked with a couple the other day who had multiple doctors pushed off of one plan that they had happily used for sometime. Remember, Advantage plans and drug cards are written to last one year under it's rules. 1/1 of the next year, you may do nothing and let it roll over, but the plan changes on 1/1 each year, unless it's a supplement or Original Medicare.
Treat health insurance like home owners insurance, where many could lose almost everything they have, not like dental insurance, evaluated by whether it paid me back this year! Is your house worth goof proof insurance? Or as close to that as can be? Well how about you? Ask your doctor before picking your plan if he'd rather see on you Original Medicare (with a supplement) or on an Advantage plan?
And know that if you have an Advantage plan, you passed up in your first six months, a "guaranteed issued" supplement plan approval. Now, after the first year on an Advantage plan (it's call the "Advantage Plan trial", if you don't get to month 13, you can turn around and go back to original Medicare and be "guaranteed issued", no health questions of any kind. But that's normally only in the first 6 months of signup or in the first year of your first Advantage plan. Want to move to a supplement later? You must do it between 10/1 and 12/15 each year. I'd say 12/31 but you need at least 15 days to see if you pass underwriting. So do it closer to 10/1 than 12/1 !! Like now !! Reach out to learn more about it.
I am not taking any drug plan only clients this late in the season. Just not enough time to do only part of your plan, especially as little as they pay. I'm happy to them for my health clients but just don't have time to write drug plans only. I am rewriting supplement clients to lower cost plans starting after 12/10, when the season ends. Supplement rewrites can be conducted 12 months a year. I have a 2 page form that will give you a good idea if you can pass underwriting to move to a supplement for the first time or to move to lower your costs. The fall season is about drug plans and Advantage plans only. Supplement rewriting, I'll say it again, works all twelve months. I have rewritten over 150 of them! Including my own twice !!
Gary / 713-376-5608 / email me at ges01@comcast.net and PLEASE give me a phone no. to call you back. / I've been on this site since 2006, a paid sponsor 9 or 10 years of that time/ approximately 450 active Medicare clients today / 20 year licensed independent agent covering all 254 counties of Texas / and am super busy till 12/7 at midnight !!
https://www.nbcnews.com/news/amp/rcna121012
Medicare Advantage plans can delay performing surgeries until they approve it. What if they tell you they will only approve therapy after your doctor picked a hip replacement? It happens! What if they tell you they'll approve a pin in your hip instead of the surgery your doctor wants you to have?
Doctors will tell you this can be a major problem. Ever had a client with cancer wait three weeks once he was determined to have cancer before he was sent to a specialist? I remember that guy well. He didn't make it and his wife said "I'll always wonder it he might have survived had he gotten treatment earlier!"
Deny payments or only approve parts of the patients treatment. This article is full of stories documenting that. How the hospital sometimes pays the bill to help the client get treatment. And how this can close smaller hospitals over time.
Also the article points out that the further you are away from cities, the worse and the thinner the networks get for Advantage plans and the more likely someone will not get treated or paid or both.
Original Medicare (A&B and a supplement) to my knowledge has no such issues. Original Medicare (A&B) plus a supplement pays 100% for most surgeries, if you have met the $226 deductible for the year. Surgery is scheduled, completed and the client is not normally involved in any way in the billing. Medicare pays all the claims, not the profit seeking insurance companies. If you have a supplement, unlike the under 65 world or group insurance, Medicare pays the bills and surprisingly, they mostly do it very well !
I'm as capitalistic as anyone, but the way Advantage plans are advertised, all benefits and no issues or costs shown, to end up having life threatening surgery denied or delayed is reprehensible. Think your better off on an Advantage plan with networks (original Medicare has none) than without? What if your network drops your doctor on 1/1/24 this year. I worked with a couple the other day who had multiple doctors pushed off of one plan that they had happily used for sometime. Remember, Advantage plans and drug cards are written to last one year under it's rules. 1/1 of the next year, you may do nothing and let it roll over, but the plan changes on 1/1 each year, unless it's a supplement or Original Medicare.
Treat health insurance like home owners insurance, where many could lose almost everything they have, not like dental insurance, evaluated by whether it paid me back this year! Is your house worth goof proof insurance? Or as close to that as can be? Well how about you? Ask your doctor before picking your plan if he'd rather see on you Original Medicare (with a supplement) or on an Advantage plan?
And know that if you have an Advantage plan, you passed up in your first six months, a "guaranteed issued" supplement plan approval. Now, after the first year on an Advantage plan (it's call the "Advantage Plan trial", if you don't get to month 13, you can turn around and go back to original Medicare and be "guaranteed issued", no health questions of any kind. But that's normally only in the first 6 months of signup or in the first year of your first Advantage plan. Want to move to a supplement later? You must do it between 10/1 and 12/15 each year. I'd say 12/31 but you need at least 15 days to see if you pass underwriting. So do it closer to 10/1 than 12/1 !! Like now !! Reach out to learn more about it.
I am not taking any drug plan only clients this late in the season. Just not enough time to do only part of your plan, especially as little as they pay. I'm happy to them for my health clients but just don't have time to write drug plans only. I am rewriting supplement clients to lower cost plans starting after 12/10, when the season ends. Supplement rewrites can be conducted 12 months a year. I have a 2 page form that will give you a good idea if you can pass underwriting to move to a supplement for the first time or to move to lower your costs. The fall season is about drug plans and Advantage plans only. Supplement rewriting, I'll say it again, works all twelve months. I have rewritten over 150 of them! Including my own twice !!
Gary / 713-376-5608 / email me at ges01@comcast.net and PLEASE give me a phone no. to call you back. / I've been on this site since 2006, a paid sponsor 9 or 10 years of that time/ approximately 450 active Medicare clients today / 20 year licensed independent agent covering all 254 counties of Texas / and am super busy till 12/7 at midnight !!
https://www.nbcnews.com/news/amp/rcna121012
