We’re cancer doctors. Here’s why Medicare Advantage fails America’s elderly.

[Northeast Agent]

https://thehill.com/opinion/healthcare/5342603-medicare-advantage-failing-elderly-patients/?fbclid=IwY2xjawK3mcdleHRuA2FlbQIxMQBicmlkETFicktsVExrYjRFQklpWXZXAR5y4ZcEI7B_1cDqJ2NCbcJBRUS9Xn6YAf0SzFNkiTtf06_TR02Y4oCwSy-yGQ_aem_2WgxJgmi0odO2jB88U4ACg

One of us met Tom nearly three months after his CT scan, and his doctor discovered the abdominal mass. The job as the first oncologist he had been able to see after months of jumping through hoops was to get initial scans, identify an in-network provider, wait for further referral and approval processes and finally schedule and complete a biopsy.

 

[somarco]

From the linked article . . .


Tom's first question was, "It's going to be fine, right?"

Despite the urge to reassure him, Tom's life and treatment options were not up to a doctor. They were up to his insurance. The same insurance that delayed urgent testing and care.

Sounds like practicing medicine without a license . . .
Often, people do not enroll in supplemental insurance because they do not understand its importance, believe they will never get sick, miss the deadline for approval without a medical exam (you must do this within three months before or after your 65th birthday), or think it is too expensive.

Obviously, the one who penned this article does not understand Medicare rules.

Although supplemental insurance costs nearly $500 a month (exact amounts vary based on age and income), choosing this add-on — and paying roughly $6,000 a year — is much more affordable than Medicare Advantage's yearly out-of-pocket (potentially adding up to $8,500) and fighting for approvals for basic treatment.


$500/month seems to me to be an exception, not the rule. AFAIK I don't have any clients paying that much. Most pay less than $200/mo and many less than $300.

 

[annon123]

Although supplemental insurance costs nearly $500 a month (exact amounts vary based on age and income), choosing this add-on — and paying roughly $6,000 a year — is much more affordable than Medicare Advantage's yearly out-of-pocket (potentially adding up to $8,500) and fighting for approvals for basic treatment.


$500/month seems to me to be an exception, not the rule. AFAIK I don't have any clients paying that much. Most pay less than $200/mo and many less than $300.

I agree they have the supp prices way off and way too high. I don't have anyone paying anywhere near that either. That is unfortunate they screwed that up in the article.

 

[somarco]

That is unfortunate they screwed that up in the article.

Unfortunate is not the word I would use.

Given that they claimed you have 3 months after your 65th birthday to enroll in a supplement plan without underwriting is completely uninformed.

 

[annon123]

Unfortunate is not the word I would use.

Given that they claimed you have 3 months after your 65th birthday to enroll in a supplement plan without underwriting is completely uninformed.

Dangerous to the seniors is more like it when posting misinformation that affect choices that may or may not be able to be undone. I should have added that to my post too.

 

[InsuranceGuy29]

I trust literally nothing from that commie rag media website. It's no secret that these commies just hate private insurers and want to see them completely go away. Who is "Tom?" What's his last name?

I could sit here and invent characters at anytime. Here's "Dave." Dave says Medicare Advantage is awesome when he had cancer!

I mean, I have an army of people that are on Medicare Advantage. Many who are very sick. No issues like this, however. So, I mean, we can all trade anecdotes all day and night.

 

[renee15]

I trust literally nothing from that commie rag media website. It's no secret that these commies just hate private insurers and want to see them completely go away. Who is "Tom?" What's his last name?

I could sit here and invent characters at anytime. Here's "Dave." Dave says Medicare Advantage is awesome when he had cancer!

I mean, I have an army of people that are on Medicare Advantage. Many who are very sick. No issues like this, however. So, I mean, we can all trade anecdotes all day and night.

anyone with cancer treatments will likely meet their OOP each year on a MAPD plan, were they informed by you this would happen?

 

[InsuranceGuy29]

anyone with cancer treatments will likely meet their OOP each year on a MAPD plan, were they informed by you this would happen?

Yes, the same maximum-out-of-pocket that is $2,150 on most plans I write. Which happens to be lower than many stand-alone supplement premiums that are guaranteed to insurance companies every year.

On other plans, it hover around $3,600 in my area. On the off-chance someone does get cancer, hitting a $2,150-$3,600 MOOP is literally a non-issue when you factor all costs associated with supplements into account, as well as all the other bonus money in extra benefits they receive.

Supplement-only agents that love to pretend like this is the end of the world do crack me up though.

There are people that aren't 65, like me, that would damn-near kill to have a $0 insurance plan with a low MOOP. Oh no, the "horror." My deductible alone on my plan is $8,000, and I pay tons of money for it every single month.

It's as if people forget you are literally paying nothing for the plan every single month. Zero, zip, zilch, nada. Do you have any idea how insanely great that is?

Plus there's no deductible.

 

[annon123]

Yes, the same maximum-out-of-pocket that is $2,150 on most plans I write. Which happens to be lower than many stand-alone supplement premiums that are guaranteed to insurance companies every year.

On other plans, it hover around $3,600 in my area. On the off-chance someone does get cancer, hitting a $2,150-$3,600 MOOP is literally a non-issue when you factor all costs associated with supplements into account, as well as all the other bonus money in extra benefits they receive.

Supplement-only agents that love to pretend like this is the end of the world do crack me up though.

There are people that aren't 65, like me, that would damn-near kill to have a $0 insurance plan with a low MOOP. Oh no, the "horror." My deductible alone on my plan is $8,000, and I pay tons of money for it every single month.

It's as if people forget you are literally paying nothing for the plan every single month. Zero, zip, zilch, nada. Do you have any idea how insanely great that is?

Plus there's no deductible.

There is no MOOP even remotely close to that around here. Here is what the situation is here: (Ignoring dual eligible, which are MAP and MAAP, and which are HMO, HMO-POS, PPO, and regional only):



Ignoring the network issues, this kind of major difference really affects the costs for people.

Here is G for a t65 female not tobacco user



Of course adding in vision, dental and hearing would raise that a bit but many of the people I talk with aren't interested in those except periodically, especially since you can get, for $50 added on the vision exam (so you pay) for glasses added to the annual B wellness check for vision. Glasses/contacts out of pocket are often less than vision. Plenty of places here you can get glasses frames and progressive lenses which are the most expensive (or contacts) for $200-300 total. Dental is another issue but the dental school is $78/cleaning and $208 for a filling.

As a result this dramatically changes what is the cheapest when you add it all up. Please remember that when some of us talk about supplements vs MA's. Your area has completely different comparison financials than mine (and I'd suspect at least some of the rest of us).

 

[somarco]

@annon123 read the responses from IG29 and decide if he/she is credible.


maximum-out-of-pocket that is $2,150 on most plans

On the off-chance someone does get cancer, hitting a $2,150-$3,600 MOOP is literally a non-issue



Most of the argument focuses on premium and ignores everything else.

It might be a good idea to put him/her on ignore and move on. I see nothing of value in those posts.