Medicare 2026 Update Vid

[demarpaint]

This thread has been informative and eye opening all wrapped into one. Here's the rub, simply put the Advantage plans are clearly regional, and vary greatly. What bothers me is Medicare and Social Security are benefits from the Federal Government. "In my opinion" I feel the coverage should be identical from one state to the next, even the Advantage Plans. I busted my back, as did many others here working most of their lives, and seeing the differences in benefits and out of pocket costs and how they vary from state to state is a real sickening eye opener. Yes doctors get paid more in NY than many of the other states, but the program is Federal, and should be the Federal Government's problem not mine. Supplemental plans are optional and costs can vary based on regions, I'm OK with that. Mini rant off................Flame suit on...........

 

[Jim Rogers]

This thread has been informative and eye opening all wrapped into one. Here's the rub, simply put the Advantage plans are clearly regional, and vary greatly. What bothers me is Medicare and Social Security are benefits from the Federal Government. "In my opinion" I feel the coverage should be identical from one state to the next, even the Advantage Plans. I busted my back, as did many others here working most of their lives, and seeing the differences in benefits and out of pocket costs and how they vary from state to state is a real sickening eye opener. Yes doctors get paid more in NY than many of the other states, but the program is Federal, and should be the Federal Government's problem not mine. Supplemental plans are optional and costs can vary based on regions, I'm OK with that. Mini rant off................Flame suit on...........

Your position definitely has some points in favor of it, and the same could be said of all programs (and, actually, all laws).

E.g., why is a given window tint legal in one state, and illegal in the next state over?

But it's the old tradeoff problem-- by federalizing programs (and laws) you get much better uniformity and rid the system of (sometimes ridiculous) contradictions that come from a scattered hodgepodge of laws.

However, the downside with that is everything becomes "one size fits all," and all the benefits of flexibility and creativity that comes from multiple "laboratories of democracy" are lost.

So, upsides and downsides to both approaches.

It's the old truism "there are no answers, only tradeoffs!"

 

[nomas]

Was this on a Medicare plan? If so, which one did you have?
Glad the review board worked for you!

I'll ask her tomorrow for some details . This wasn't a Medicare issue . She was still on her employers plan . My comments were more about the Pre Authorization issue .

 

[demarpaint]

Your position definitely has some points in favor of it, and the same could be said of all programs (and, actually, all laws).

E.g., why is a given window tint legal in one state, and illegal in the next state over?

But it's the old tradeoff problem-- by federalizing programs (and laws) you get much better uniformity and rid the system of (sometimes ridiculous) contradictions that come from a scattered hodgepodge of laws.

However, the downside with that is everything becomes "one size fits all," and all the benefits of flexibility and creativity that comes from multiple "laboratories of democracy" are lost.

So, upsides and downsides to both approaches.

It's the old truism "there are no answers, only tradeoffs!"

I hear ya! Having said that, everyone got the same COAL increase in their Social Security. So why not give identical medical coverage, and supplemental plan costs can vary by region, that seems fair to me. Especially since we are talking about the Federal Gov't. Now if someone decides they want to pay extra for supplemental coverage we no longer have one size fits all since it is optional coverage, and costs can vary by region.

 

[Jim Rogers]

I hear ya! Having said that, everyone got the same COAL increase in their Social Security. So why not give identical medical coverage, and supplemental plan costs can vary by region, that seems fair to me. Especially since we are talking about the Federal Gov't. Now if someone decides they want to pay extra for supplemental coverage we no longer have one size fits all since it is optional coverage, and costs can vary by region.

Good question! Unfortunately, I don't have any answers.

 

[JeffKeryk]

Thanks.

Not doubting the decision at all (sounds like a reasonable move to me), but still wondering why moving to G now is a good idea if it wasn't originally.

Is it just that you're older now, and making an actuarial decision that the risks of not having the gold-plated plan early on were worth the savings, but at a more advanced age, it makes more sense to pay more than it did at the beginning?

Or are you worrying about denials in your later years?

I'm always curious about those who switch from Advantage to G when the opportunity presents itself to them. Seems like there has to be some sort of clue as to the real value of the competing plans hidden somewhere in those decisions.

alarmguy did the same thing, despite the fact that he sees no deficit in Advantage coverage.

Just trying to learn as much as possible about the larger picture by examining the more local decisions people make.

When I retired, I wanted to keep my Stanford coverage. The Advantage plan did that. I do not exactly remember, but when my Advantage Plan was cancelled perhaps there was not another Advantage plan offering Stanford Doctors. With Plan G there is no network restriction, which can be big. The money difference was not an issue.

It's really that simple. I feel pretty well covered and pretty lucky overall.
I had an agent who I heard about by an invitation to a seminar. He was paid by Medicare, or maybe the Plans, dunno for sure. Steve helped me navigate the waters. Full disclosure, I could have done a better job of paying attention.
Good luck to you.

 

[CKN]

My wife had back surgery . The Hospital sent us a bill for 65k . The Doctor failed to get authorization . Their response was basically " oops " . It took a couple of months to resolve but a review board finally told the Insurance company to pay it . Thank you Jesus ...

Glad it was figured out. However it's up to the individual getting the procedure to double check it was approved.

 

[Jim Rogers]

When I retired, I wanted to keep my Stanford coverage. The Advantage plan did that. I do not exactly remember, but when my Advantage Plan was cancelled perhaps there was not another Advantage plan offering Stanford Doctors. With Plan G there is no network restriction, which can be big. The money difference was not an issue.

It's really that simple. I feel pretty well covered and pretty lucky overall.
I had an agent who I heard about by an invitation to a seminar. He was paid by Medicare, or maybe the Plans, dunno for sure. Steve helped me navigate the waters. Full disclosure, I could have done a better job of paying attention.
Good luck to you.

Thanks for the info-- appreciate it!

 

[alarmguy]

...

It is not as simple as "if Medicare covers it, MA covers it."

It's more like "if Medicare covers it, MA must consider covering it but has broad authority to deny coverage if they deem a claim to not be medically necessary."

That decision authority is a huge hammer to hand to the insurance companies, and they have a well-earned reputation for using it often and effectively.

Let's not forget to remind everyone that if denied a procedure the APPEALS process is robust in Medicare. I think your statement is misleading.
I would ask anyone in here who is not on Medicare, is your company appeals process as robust as Medicare? Answer - not even close Medicare appeals is so robust, if notify Medicare of an issue, they will look at the issue, if they agree with the denial they will automatically send it for another review by an independent "entity"
So I dont get the hysteria HOWEVER I do agree, choice is good if you are. one who fears an issue, go with Medigap. The whole subject is so overblown by some. However... choice is good!

https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans

 

[Jim Rogers]

Let's not forget to remind everyone that if denied a procedure the APPEALS process is robust in Medicare. I think your statement is misleading.
I would ask anyone in here who is not on Medicare, is your company appeals process as robust as Medicare? Answer - not even close
So I dont get the hysteria HOWEVER I do agree, choice is good if you are. one who fears an issue, go with Medigap. The whole subject is so overblown by some. However... choice is good!

View attachment 311273
https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans

You make a valid point on private plans-- the low-tier ones can be very bad about denying claims, and their appeal processes can be pretty rigged.

You are correct in stating that because CMS is structurally involved in MA appeal processes, they will likely be better than the worst private plan processes.

So, I do agree with you that with the MA appeal process, you have a fighting chance of winning, while with the crappier private plans the whole system will be rigged against you.

So, MA does win at that level and if you select an Advantage plan you can be fairly confident that you're not going to be ripped off by some fly-by-night, scam insurance company.

CMS does ensure that only legitimate companies with legitimate appeals processes are able to offer MA plans and has clear auditing mechanisms to quickly weed out scammer companies.

 

[alarmguy]

Thanks.

Not doubting the decision at all (sounds like a reasonable move to me), but still wondering why moving to G now is a good idea if it wasn't originally.

Is it just that you're older now, and making an actuarial decision that the risks of not having the gold-plated plan early on were worth the savings, but at a more advanced age, it makes more sense to pay more than it did at the beginning?

Or are you worrying about denials in your later years?

I'm always curious about those who switch from Advantage to G when the opportunity presents itself to them. Seems like there has to be some sort of clue as to the real value of the competing plans hidden somewhere in those decisions.

alarmguy did the same thing, despite the fact that he sees no deficit in Advantage coverage.

Just trying to learn as much as possible about the larger picture by examining the more local decisions people make.

Your questions sort of show your bias against the system. (my personal feelings)

When my Advantage plan wasnt being offered the following year, you ask why did I elect to go to Plan N?
Answer - The same reason I have Advantage plans. (in the order of importance)

1.To get the best price and services for insurance and get the same exact care and services in the locations that matter to me. This includes Dental and Vision.

2.The end cost of both the HMO and Plan N for 2025 (keeping in mind decision had to be made Dec 7th 2024)was projected by me to be the same and possibly lower in Plan N than the Advantage HMO But it was close

3. Fresh with a brand new Cancer diagnosis at the end (last quarter) of 2024 besides my already upset mental state I already had a networks of Doctors for my cancer as far as over 100 miles away up at Duke Cancer Clinic in Raleigh all the way down to the coast in Wilmington NC So piece of mind that all the doctors I currently was aligned with in the Aetna HMO Plan would still be with a new plan.

Also at the time, the Duke doctors were scrambling to get me in a fast as possible for a PSMA Pet scan again, all the way from Raleigh/Durham to Wilmington NC They couldnt get me in until the first week of 2025 in Raleigh however they worked with a group on the coast and managed a scan a few days before Christmas 2024 in Wilmington. This scan so new the radiology scheduler in Wilmington had to put me on hold because she never heard of it.
So again, peace of mind at the time, switching plans but we must remember, everything was going perfect under the Aetna HMO but they weren't offering it the following year and (this is important) I was not willing to accept a plan with a much higher MOOP.

Anyway back around Thanksgiving with all going on. I always wait unit the first week of Dec to switch plans. (which is what I am doing right now! )
Best plans and price wins with Advantage (or plan n). Since Aetna was not offering my plan for 2025 I went into Plan N. I had enough going on in my life at that point and to start looking at other plans... well .... HOWEVER back to reason #1 above/ The cost would have been the same and mostly likely maybe even saved a few dollars in this case with Plan N but either way it was close. Hey, I look to save money but that does not mean I consider a few hundred to a thousand a lot of money. The cost difference was really a "draw" part of this was because for few dollars my wife added me to her company Dental and Vision plan so that took care of that.

Bottom line - Knowing I was about to undergo Guessing 100k or more of treatment and drugs (drug alone was 14K) I might hit the out of pocket limit of I think the lowest Advantage plan at the time was 3,100 and another plan just around $4,000 (pulling numbers out of my head right now, I know one was 3,100 MOOP)so an Advantage plan it might be reasonable to assume I might hit or come close to that out of pocket, though I might question if I would have, it was a feasible thought. Plus the fact my wife was able to add me to her dental and vision company insurance made a switch easier.

So with the above said my Aetna HMO plan was paying for and paid for every doctor and medical procedure in the last quarter of 2024, Not one hang up, not one delay. Actually I was impressed *LOL* PSMA PET scans are only a couple years old, I didnt even know an approval was done in the background after they set the appointment. I was not involved but I got a letter saying it was approved. That would mean Aetna HMO approval took ... I'll go on a limb and say maybe ten calendar days, no, I bet less than that.

SO the math heading into 2025 knowing I am going to start radiation and drug therapy in Jan 2025
Plan N $145.00 a month x 12 = $1,740 Plan D per month $0.00 x 12 = $0.00

Total cost of insurance with a cancer diagnosis was $1,740 plus the medicare B deducible of $270 ish. and $20 co-pays for specialists but for some reason I dont think that even hit $100 or about that. Something about paying a co-pay once for the same treatment or something like that. Also for some reason, I think being this was a new drug, which I took a pill a day at $75 a pill for 6 months. Typically with plan D you must pay up to $2,100 deductible/co-pays but the hospital pharmacy either they or the drug company somehow gave me some kind of credit that was applied to my deductible ... all I know is I only paid about half that.

Advantage plan with MOOP might have cost me between 3 and 4k so the numbers were close enough to not think any further.

(DARN IT) my posts are to long and part of that is I am on a desk top computer typing on a regular key board. Yeah I suck at typing though. Bottom line, between the Advantage plan MOOP and the Plan N, all things equal in very rough in my head numbers, the cost for the year would have been close enough either way and the reassurance my wife got me on her company plan for dental and vision. So at the same cost, sure Plan N won. At a time of that decision by Dec 7th I still didnt know if the cancer has spread as the Pet scan wasnt till the end of Dec. A team of Doctors, to give an idea of caliper my Aetna HMO paid for, one was the director of research at Duke Cancer Clinic, three doctors labelled me high risk, they couldnt understand why my PSA was so high for so little cancer in the biopsy.

Ok, so bottom line. I am going back to an Advantage plan for 2026 after having Plan N for 2025
I hate when they use the word Advantage Plan Cancelled. It is an overly dramatic statement.
You cant cancel a plan that does not exist. You can only stop offering it. But that is the majority of public that does not think critically. Advantage plans are ONE year contracts for health insurance. It should not be expected to be offered the following year until it is. That is what I mean by the statement.
Granted because government funding the programs stopping giving the plans increases for 3 full years there has been major fallout and I am going to post on that next.

 

[Jim Rogers]

Your questions sort of show your bias against the system. (my personal feelings)

!. When my Advantage plan wasnt being offered the following year, you ask why did I elect to go to Plan N?
Answer - The same reason I have Advantage plans. (in the order of importance)

1.To not over pay for insurance and get the same exact care and services in the locations that matter to me.
2.The end cost of both the HMO and Plan N for 2025 (keeping in mind decision had to me be in Dec 2024)was projected by me to be the same and possibly lower in Plan N But it was that close

3. Fresh with a brand new Cancer diagnosis at the end (last quarter) of 2024 besides my already upset mental state I already had a networks of Doctors for my cancer as far as over 100 miles away up at Duke Cancer Clinic in Raleigh all the way down to the coast in Wilmington NC So piece of mind that all the doctors I currently was aligned with in the Aetna HMO Plan would still be with a new plan.
Also at the time, the Duke doctors were scrambling to get me in a fast as possible for a PSMA Pet scan again, all the way from Raleigh/Durham to Wilmington NC They couldnt get me in until the first week of 2025 however they worked with a group on the coast and managed a scan a few days before Christmas 2024.
So again, peace of mind at the time, switching plans but we must remember, everything was going perfect under the Aetna HMO but they weren't offering it the following year.

Anyway back around Thanksgiving with all going on. I always wait unit the first week of Dec to switch plans. Best plans and price wins with Advantage (or plan n). Since Aetna was not offering my plan for 2025 I went into Plan N. I had enough going on in my life at that point to start looking at other plans. HOWEVER back to reason #1 above/ The cost would have been the same and mostly likely maybe even saved a few dollars in this case with Plan N but either way it was close. Hey, I look to save money but that does not mean I consider a few hundred to a thousand a lot of money. The cost difference was really a "draw" part of this was because for few dollars my wife added me to her company Dental and Vision plan so that took care of that.

Bottom line - Knowing I was about to undergo Guessing 100k or more of treatment and drugs (drug alone was 14K) I might hit the out of pocket limit of I think the lowest Advantage plan at the time was 3,100 and another plan just around $4,000 (pulling numbers out of my head right now, I know one was 3,100 MOOP)so an Advantage plan it might be reasonable to assume I might hit or come close to that out of pocket, though I might question if I would have, it was a feasible thought. Plus thefact my wife was able to add me to her dental and vision company insurance made a switch easier.

So with the above said my Aetna HMO plan was paying for and paid for every doctor and medical procedure in the last quarter of 2024, Not one hang up, not one delay. Actually I was impressed *LOL* PSMA PET scans are only a couple years old, I didnt even know an approval was done in the background after they set the appointment. I was not involved but I got a letter saying it was approved. That would mean Aetna HMO approval took less than two weeks. I'll go on a limb and say maybe ten calendar days.

SO the math heading into 2025 knowing I am going to start radiation and drug therapy in Jan 2025
Plan N $145.00 a month x 12 = $1,740 Plan D $0.00 x 12 =$0·d $0.00
Total cost of insurance with a canner diagnosis was $1,740 plus the medicare B deducible of $270 ish. and $20 co-pays for specialists but for some reason I dont think that even hit $100 or about that. Something about paying a co-pay once for the same treatment or something like that. Also for some reason, I think being this was a new drug, which I took a pill a day at $75 a pill for 6 months. Typically with plan D you must pay up to $2,100 deductible/co-pays but the hospital pharmacy either they or the drug company somehow gave me some kind of credit that was applied to my deductible ... all I know is I only paid about half that.

(DARN IT) my posts are to long and part of that is I am on a desk top computer typing on a regular key board. Yeah I suck at typing though. Bottom line, between the Advantage plan MOOP and the Plan N, all things equal in very rough in my head numbers, the cost for the year would have been close enough either way and the reassurance my wife got me on her company plan for dental and vision. So at the same cost, sure Plan N won. At a time of that decision by Dec 7th I still didnt know if the cancer has spread as the Pet scan wasnt till the end of Dec. A team of Doctors, to give an idea of caliper my Aetna HMO paid for, one was the director of research at Duke Cancer Clinic, three doctors labelled me high risk, they couldnt understand why my PSA was so high for so little cancer in the biopsy.

Ok, so bottom line. I am going back to an Advantage plan for 2026 after having Plan N for 2025
I hate when they use the word Advantage Plan Cancelled. It is an overly dramatic statement.
You cant cancel a plan that does not exist. You can only stop offering it. But that is the majority of public that does not think critically. Advantage plans are ONE year contracts for health insurance. It should not be expected to be offered the following year until it is. That is what I mean by the statement.
Granted because government funding the programs stopping giving the plans increases for 3 full years there has been major fallout.

If I'm understanding what you're saying, you were in a unique situation (with the cancer diagnosis) in which you didn't need to guess as to whether you were going to have high expenses in the coming year-- high expenses were guaranteed.

Thus, for anyone in a situation where high-cost treatments are guaranteed (not guessed at) for the coming year, it's only rational to choose the plan with the lowest MOOP.

And you found that, not only did plan N have the lowest MOOP, but the premium cost was also low enough that there wasn't even a premium cost penalty in making the choice to go with N.

So, with a looming $100K in medical expense in the next year, N having the lower MOOP and roughly the same premium cost as the Advantage plans offered to you, plus the N plans guarantee of keeping the medical team you preferred intact, it was a no-brainer for you to choose N in that unique situation.

If that summary is correct, then I agree that you made a rational (and obvious) choice to go with N, and it is not irrational for you (at least on the basis of the reasoning you are using) to choose to go back to MA after the cancer storm passes.

 

[alarmguy]

This thread has been informative and eye opening all wrapped into one. Here's the rub, simply put the Advantage plans are clearly regional, and vary greatly. What bothers me is Medicare and Social Security are benefits from the Federal Government. "In my opinion" I feel the coverage should be identical from one state to the next, even the Advantage Plans. I busted my back, as did many others here working most of their lives, and seeing the differences in benefits and out of pocket costs and how they vary from state to state is a real sickening eye opener. Yes doctors get paid more in NY than many of the other states, but the program is Federal, and should be the Federal Government's problem not mine. Supplemental plans are optional and costs can vary based on regions, I'm OK with that. Mini rant off................Flame suit on...........

I understand but really, the Medicare plan is exactly the same across the USA.
Part A and Part B are federal programs. Cost is the same across all states too.

You then have many options to buy the exact same supplement plans offered by private insurance covering the same exact things nationwide and those as an example are Plans G, N etc. Plus plan D.

I dont agree that private business should be restricted to just the above if they can come up with something else like Advantage plans. Medicare A and B are Federal plans I like the options that private plans offer. I dont believe in forced into anything more or sharing the high costs of others states anymore than I already do. (no politics) Post #22 highlights states like NY over and over. The costs up there insane but so is everything else. Including networth, home values, incomes! All goes with the area we choose to live.

 

[demarpaint]

I understand but really, the Medicare plan is exactly the same across the USA.
Part A and Part B are federal programs. Cost is the same too.

You then have many options to buy the exact same supplement plans offered by private insurance covering the same exact things nationwide and those as an example are Plans G, N etc. Plus plan D.

I dont agree that private business should be restricted to just the above if they can come up with something else like Advantage plans. Medicare A and B are Federal plans I like the options that private plans offer. I dont believe in forced into anything more or sharing the high costs of others states anymore than I already do. (no politics) Post #22 highlights states like NY over and over. The costs up there insane but so is everything else. Me in my house down here in NC I should not expect to pay NY rates when their homes are 300% high than the value of my home.

I guess we'll have to agree to disagree on this one. No point in me elaborating for my reasons why. FTR medical insurance is probably going to result in another Gov't shut down in January. Stay tuned.

 

[alarmguy]

Here is a note of caution with Advantage plans and I THINK some people with lessor means might a mistake.
I think the MOOP (maximum out of pocket limits) are insane for some of the Advantage plans. It really depends on where you live, if you are in a high cost area like the video in post #22 shows.

I like Advantage plans HOWEVER I am not as 100% on them for everyone anymore in the last year or two.
I would caution people to look at your maximum out of pocket limits (exposure) of some of these plans. The Medicare system has cut the annual raises they give to these plans back around 2021 and only 4 years later did they give the plans a raise.

I would never settle on one of these plans with MOOP exposure of what can be $10,000 or more a year. That is crazy. You can get SEVERELY sick in Sept end up costing you $10,000 and then the following year still sick and another $10,000 out of pocket exposure. Now these cases are far and few between but my limit is around a $5,000 out of pocket limit. So far I have never had anything over $4,900 and I am on the verge of entering an Advantage plan for 2026 with an out of pocket limit of $3,100.

Ok, so follow me on this:
It would be REALLY hard to hit an out of pocket limit of those high numbers is my feeling. EXCEPT for in the case of Part B (NOT D) drug expenses AND radiation treatments. Most Advantage plans require you to pay 20% of the cost of part B drugs which consist of things like Chemo administered in a medical facility, radiation and even some allergy injections. SO its important to read your "Evidence Of Coverage" which I suspect few people do. Except me, I read them many, many, many times over.
SO for extensive radiation or chemo you may or may not hit those high limits. I certainly would have hit my $4,100 limit in 2025 if I had an Advantage plan vs Plan N. (I forgot to mention that in my OTHER long winded posts!)

SO key is, know what you are buying and if you dont, and you can afford it, simply get a Plan G, Plan N or high deductible Plan G plus Plan D instead of an Advantage however the thing is, I looked at my old state Long Island NY and the cost for everything is crazy up there and even these plans are costly. Way more costly than the south where I live.

One other thing, when you are paying 20% of the cost, you are paying 20% of Medicares Contract Price, not the retail price so 20% of the contract price will be lower.
This is an example, this is one months bill this year in 2025 while I was getting radiation.
It shows the retail price and the actual contracted price. you add Total Medicare paid and Total that my Plan N paid together, then take 20% of that. If you didnt have a supplement plan you would have owed $1,576 on this particular bill for this particular simple treatment.

 

[alarmguy]

It's a fair question and I am happy to respond.
As the video pointed out, a Plan G is considered the gold standard. See any doctor, no approvals, etc.
In my area, you have to go through a qualification to switch to a Plan G unless your current plan is discontinued.
My agent advised me this was a good opportunity and the time might be right. I agreed. The additional monthly cost was in the budget.

I am certainly not as well versed in this topic as @alarmguy; not even close. Perhaps he might chime in.

I hope this helps.

Yes, for others, this is important. Once in an Advantage plan ALWAYS in an Advantage plan unless you go through underwriting or switch during your one time opportunity when first going into Medicare. (btw a handful of states have laws overriding this policy and resulting high costs) You can pretty much bet if you had/have cancer, heart disease, diabetes etc you wont even get to page 3 of an application to get into medigap supplement plan if your trying to switch from an Advantage plan = REJECTED or at the min a greatly HIGHER rate. Heck you wont even be able to switch from one companies Plan G to another! ( think, I cant with my plan N)

I did it for fun. I current have PLAN N which I switched into after my Advantage plan wasnt being offered for 2025. SO for fun while I have plan N I tried to switch companies still staying with Plan N. I cant even get past page 2 on some applications. *LOL* They dont want me.

So as Jeff mentioned if your Advantage Plan is not offered the following year, you will get automatic acceptance to a Plan G if you want and dont want to switch to another Advantage plan. This is why it drives me NUTS when the media EMBELLISHES on an Advantage plan not being offered the following year. Simple stuff, log into your account and you are 100% FREE to chose anything you want, Medigap Supplement or another Advantage plan.
An Advantage plan is never cancelled, it is only a ONE year contract to provide health insurance. The following year that plan may not be offered. But the public does not read what they buy so they think it's cancelled. Nope, it's just not offered anymore.

 

[alarmguy]

I'll ask her tomorrow for some details . This wasn't a Medicare issue . She was still on her employers plan . My comments were more about the Pre Authorization issue .

Don't go crazy finding out. Thank for your followup answer!
This is what I have been saying throughout this thread about my wife and my own experiences.
IN four years now, battling heart disease and cancer I have NEVER, (I swear) ever had an issue with my Medicare Adavantage plan denying or holding up anything. Gosh, I got every state of the art tests on my heart multiple times and also a heart angiogram. (my heart thankfully in GREAT shape) Nothing ever held up. There is too much crying in the Medicare media field when company health insurance is terrible compared to Medicare.

This is what I have been almost "preaching" in here. Medicare gives endless options to have them handle any rejections even if you get one.

Myself with at the time, my employee health insurance denied me an MRI that my doctor wanted as we looked for prostate cancer. I even got a (forgot the name) oh patient advocate involved who agreed with me 100% but was still denied and had to wait 6 more months of another bad PSA test.

My wife never had an issue with her beast cancer company coverage (thank god) but her company health insurance had her and her doctor jump through hoops for I think up to a YEAR to get a procedure done on her legs. Finally approved.

So both approval problems were always with company health insurance plans and I never had a negative experience with a medicare plan of any type. I also mentioned in these threads about a sibling, who has undergone more procedures than anyone most likely still living in this forum and never a bad experience with the plan. He has a device in his chest that reports his heart activity to a central station that his doctor can view. Also a built in ICD should anything every drastically go wrong with his heart. All paid for with no headaches by his advantage plans.
I mean look at how people rate their plans it is right on the government website.

 

[alarmguy]

I guess we'll have to agree to disagree on this one. No point in me elaborating for my reasons why. FTR medical insurance is probably going to result in another Gov't shut down in January. Stay tuned.

It's ok, you're sounding like a NY'er! I used to be one too! Loved growing up there but I got out while the going was good.
The people of your state had their elected officials further drive up the cost of these plans by overriding the Federal medicare program and instituting more benefits at a higher cost than the vast majority of other states dont have in their already higher taxed high cost state. Im not sure if you thought about that. Why do you think business all leave or want to leave your state> Endless regulations.

New York State is one of VERY few that overrides the standard Federal Medicare program allowing you, a NEW York State Resident to switch in and out of Advantage plans and Medigap plans at will. When only less than a handful of other states allow that. Well that cost money on top of the other high costs there. People get sick on an Advantage plan and at will can switch into a Meidgap plan and teh other way around.

This is strictly not about politics, it is the people of your state. So by you saying, you think everyone should pay the same, you are forgetting about your high costs of living and high incomes. But forget all that, you are (unknowingly) saying the rest of the country should pay for the extra MAJOR benefits that NYS medicare residents have that the rest of the nation does not by being able to switch between Advantage plans and Medigap plans at will, at anytime! I like the Federal program I do not want my state of NC to increase costs by what they do in another state.

 

[demarpaint]

It's ok, you're sounding like a NY'er! I used to be one too! Loved growing up there but I got out while the going was good.
The people of your state had their elected officials further drive up the cost of these plans by overriding the Federal medicare program and instituting more benefits at a higher cost than the vast majority of other states dont have in their already higher taxed high cost state. Im not sure if you thought about that. Why do you think business all leave or want to leave your state> Endless regulations.

New York State is one of VERY few that overrides the standard Federal Medicare program allowing you, a NEW York State Resident to switch in and out of Advantage plans and Medigap plans at will. When only less than a handful of other states allow that. Well that cost money on top of the other high costs there. People get sick on an Advantage plan and at will can switch into a Meidgap plan and teh other way around.

This is strictly not about politics, it is the people of your state. So by you saying, you think everyone should pay the same, you are forgetting about your high costs of living and high incomes. But forget all that, you are (unknowingly) saying the rest of the country should pay for the extra MAJOR benefits that NYS medicare residents have that the rest of the nation does not by being able to switch between Advantage plans and Medigap plans at will, at anytime! I like the Federal program I do not want my state of NC to increase costs by what they do in another state.

Like I said earlier: "No point in me elaborating for my reasons why." We'll end up getting the thread locked. The good news is I learned what to do if something does go wrong, and have it work for me. There's more than one way to skin a cat.

 

[alarmguy]

Like I said earlier: "No point in me elaborating for my reasons why." We'll end up getting the thread locked. The good news is I learned what to do if something does go wrong, and have it work for me. There's more than one way to skin a cat.

yes there is!