Medicare advantage trap-

[bedrock]

I wish more seniors were aware of this trap and that they can’t go back to regular Medicare.

Older Americans say they feel trapped in Medicare Advantage plans — NPR

As enrollment in Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.

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[Agast]

I wish more doctors were aware of it, too! I don’t remember if it was here or somewhere else but someone was arguing with me that you could still switch.

 

[painER]

It's the classic insurance tactic of being able to say they (technically) don't restrict you while at the same time making it financially impossible to go back. All they care about is getting the initial sale and then you're trapped.

 

[Kissmyabjj]

I was fortunate enough for the first time to be able to talk to a patient before he went onto Medicare. he was strongly considering signing up for Medicare advantage. I talked his ear off about it. Hopefully he reconsiders.

 

[Agast]

Oh get this BS - latest from an Aetna Medicare plan in my area


1. Thing gets denied (MRI, epidural, whatever)
2. plan does not allow for a peer to peer, so you submit an appeal that goes into the void
3. If you lose the appeal, you cannot order the same thing for 60 fricking days

 

[Ferrismonk]

Oh get this BS - latest from an Aetna Medicare plan in my area


1. Thing gets denied (MRI, epidural, whatever)
2. plan does not allow for a peer to peer, so you submit an appeal that goes into the void
3. If you lose the appeal, you cannot order the same thing for 60 fricking days

And it's often a stupid clerical error (many times on their end by not actually reading my note) that caused the denial.

 

[hyperalgesia]

I wish more doctors were aware of it, too! I don’t remember if it was here or somewhere else but someone was arguing with me that you could still switch.

From the article, it sounds like you can still switch back to trad Medicare. But if you want a medigap plan, that plan can be more selective/expensive.

Am I wrong?

 

[Ducttape]

I was fortunate enough for the first time to be able to talk to a patient before he went onto Medicare. he was strongly considering signing up for Medicare advantage. I talked his ear off about it. Hopefully he reconsiders.

i warn them also.

From the article, it sounds like you can still switch back to trad Medicare. But if you want a medigap plan, that plan can be more selective/expensive.

Am I wrong?

medigap plans are more expensive. and it does not include medications, so those who choose medigap have to pay for meds or have to get separate insurance coverage for Part D.

many people who do choose the Medicare Advantage plans are financially strapped and living on social security.


===
apparently one has a 12 month window to switch back to traditional Medicare.

and they can switch between the various Medicare Advantage programs, tho it probably doesnt make that much of a difference....

 

[wysdoc]

Every October Medicare sends you a reminder that it is time to re-evaluate your plan and switch to a different one if you want to.

The plan you pick in the October to December window is the one you are chained to until the following October. If you hate the Medicare Advantage plan, you can switch back the following October.

Regular Medicare allows you to choose your own doctors AND get care in other states for an illness or injury while traveling. Medicare Advantage ties you to a narrow panel in your area. Most people who listen to the TV ads for Medicare advantage do not realize this at all.

 

[NMOI]

When it comes up I tell my patients that those are “Medicare disadvantage plans”. I tell them the advantage belongs to the insurance company who saves money by denying and creating barriers to care. There a reason someone pays for all those fancy advertisements.

 

[hyperalgesia]

Since no one else has commented on the main point of the article, I'll highlight.

"While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or can base their prices on medical underwriting."

 

[pastafan]

Patients also fail to understand that part D plans vary widely in what medications cost them out of pocket and that the formulary may change yearly. Often they pay a premium but get better savings paying cash with Goodrx card.

 

[Ducttape]

certain meds are not covered by GoodRx, especially specialty meds (think the big high cost ones - chemo drugs for example).


also, GoodRx may not being run the way people envision.... they had previously released private health data to the internet.

FTC Enforcement Action to Bar GoodRx from Sharing Consumers’ Sensitive Health Info for Advertising

The Federal Trade Commission has taken enforcement action for the first time under its Health Breach Notification Rule against the telehealth and prescription drug discount

www.ftc.gov

 

[pastafan]

certain meds are not covered by GoodRx, especially specialty meds (think the big high cost ones - chemo drugs for example).


also, GoodRx may not being run the way people envision.... they had previously released private health data to the internet.

FTC Enforcement Action to Bar GoodRx from Sharing Consumers’ Sensitive Health Info for Advertising

The Federal Trade Commission has taken enforcement action for the first time under its Health Breach Notification Rule against the telehealth and prescription drug discount

www.ftc.gov

I’m believe it is good to have part D coverage especially for the drugs you mentioned. Interesting about GoodRx but hopefully that has been corrected.

I also push costplusdrugs.com, Mark Cuban’s company altothe formulary is limited.

 

[BobBarker]

Part D is so confusing for the patients and us. I have a s/p stroke pain patient on nucynta er for 6 years.

“Hey doc, our part D plan ‘ended’ and the new one we got doesn’t cover nucynta.”

🤦