Medicare coverage insurers

I just went to my local insurance agent. She could explain the options and give advice. Throw all that junk stuff they send in the mail away without opening it. I think mine is Blue Cross and Blue Shield. I can still go to my own DR and not one of those "in network" places in the city. They have paid well for me.

Sadly these ‘Advantage ‘Plans that are supposed to reflect what Medicare will convert to are as bad with some worse. If have no deep maladies or issues they can perform well yet so too can Medicare at same money and with doctors more readily accepting. For any serious issues as with the Cubital Tunnel in both my elbows the typical is only around 50% payment where the Clinics Doctors or Hospitals billing the patients for the remainder. And No, even if on the plan program they yes must accept the payment level of the provider, however, that does not impress they cannot bill for the remainder. Medicare is straight forward and absolute, you have A Single level percentage to pay after medicare pays their amount.

Quickly finding from others they must swap plan providers every few years as they either reduce payouts to physicians where they stop being On Program or the plans start ramping back support values. Ring around the Rosey.

Dental is a altogether different animal, my ex employer provides a bulk draw system of $3100/yr, max is a two year bank, submit billing and the money is reimbursed. So far the employer is still supporting that.

Advantage is for the Insurer not the patient in general Regard, they get paid your Medicare premium and you get what they drip out.


Edited by DMiller - 03 May 2024 at 3:55am

We have an Advantage plan because the doctor we have been using was in the system for that plan. My wife had kept a Delta Dental plan from her old job as until the one doctor dentist left suddenly and the new dentist that took over informed us, she would not except Delta or our Advantage plan dental coverage. My wife found one group dental office that excepts our Advantage dental plan. After a years wait went in for a teeth cleaning yesterday. They only do Special Deep Cleaning with a copay of $45 per quadrant or $180. So in a standard 1 hour appointment the hygienist did 1/2 my teeth for $90. 

I had not been to the Dr for several years... Turned 70 and thought i should start getting a "yearly test" ..... Called the Local office that has 3-4 Dr. all in the same building.. Got an appointment 2 weeks later. All setup with Medicare payments.. I didnt do anything but show them "THE CARD"..

Edited by steve(ill) - 30 Apr 2024 at 9:59pm

I still use the Aetna ADVANTAGE PLAN.. been on this for 3 years.. WAs on Humana for 2 years before that.. Monthly Premium is ZERO  ... $0.0 .... works for me  Yearly checkup at Doctor and i paid  ZERO... Put me on  Temsoline (??) for prostrate ( makes you pee better).. and i pay ZERO ....  Glucose was a littel high so he wanted me to do the daily finger poke testing for 90 days... Pharmacy supplied the "kit" and i paid ZERO.... Went to the Dentist for a tooth ache 3 weeks ago.. took x-rays and checks-- said due to sinus infection, will go away soon.. and i paid ZERO.

I stayed with traditional Medicare because I travel some and Medicare covers me wherever I am.   No such thing as ‘out of network’ with part B. Also lots of horror stories from denials with part C, resulting in huge profits at government expense for those part C providers.

Unless I missed something. Will the company pay what they would pay an in network person and you pay the balance. We do that with our dental. Still not all of it but it helps. 

Michael, when you turn 65 years old the GOVT puts you on MEDICARE for Insurance ( unless you are Employed and the COMPANY will continue to cover your meds-- most will NOT)... The GOVT then takes $170. per month out of your Social Security check as a Premium for the coverage.. You get PART A - Doctor and some Hospital.. You can buy EXTRA to cover Hospital ( part B) and prescription drugs ( part D) ...... You buy the B +D from an Insurance Company as a SUPPLIMENT... Starting several years ago they came up with an "ADVANTAGE PLAN" where you get EVERYTHING from the Insurance Company (A+B+D) and they call it a "C" plan...... The insurance company gets paid by the GOVT from your $170. per month and what you have been paying in TAXES for the last 50 years. ........Many find this more convenient to be with ONE COMPANY and leave the GOVT out of it........ The ADVANTAGE PLANS are becoming more and more popular every year... as the GOVT backs out of administering Medicare..

24 will be the tell tale, will be on Aetna as of Jan 1.  Main provider financial departments were positive on use, also stated would be Far Less if ANY copays under Aetna.  Will See.

Ucare MN paid for everything when wife had cataract surgery for both eyes , then they paid also for surgery for her dropping upper eyelids , then new glasses which it seems she only needed for some fine detail sight , there would have been a additional charge if she had chosen a different type of lens they use in the eye as were 3 choices for that. 
  Way back a member on here 427 from Rochester MN and I compared BCBS and Ucare and I was paying $54 and he had a premium of $125 and coverage was the same as far as we could tell . 
  Part of the Biden - Budget Reduction Act - cut 2% from Medicare reimbursement to doctors and hospitals so many doctors dropped treating Medicare Patients . 
  Hospice care reverts any and all treatment and drug costs back to Medicare but coverage seemed to be 100% , Wife had 6 weeks Hospice, here at home with Nurse coming in every other day , personal care attendant for bath and other duties on days Nurse didn't come .  

They Have to "Cover" does not mean HAVE to Pay same.  Coverage is there, just not at the payment level Doctors and hospitals will any longer accept.   Columbia Ortho where I go accept Medicare, outright, and a 20% copay by a supplement or will adjust that figure if have NOT got one.  Humana, fails to pay Timely(90-180 days) adjusted rates Ongoing never same twice and always challenged.  As to the Cataract Surgery, becomes Semantics and no Humana does NOT have to pay for anything except part of the surgical procedure, ruling internally the rest is a Optical Insurance yet Medicare will pay it all as all Surgically Related.  Already had this discussion with a Medicare Rep who stated Humana is already in trouble with how they do business.

Just remember that NONE of the Medicare ‘advantage’ plans are actual Medicare. They are private insurers that are not working for you, but rather their stockholders.

Spoke with My GP, the Audiology Doc, the Spine treatment group and a few odd others as to what Insurer they would prefer, ALL Stated Medicare with a Supplement.  Insurers are flavor of the day for them, where some drop coverage or apply tactics to not pay, Medicare has a Fee System, pays like clockwork so long as paperwork is correct.  They also stated BCBS is about the easiest as far as Supplemental plans for handling any Medicare Covered expense and paying the 20%.

Been hard at it, spoke to a business rep at Humana as to either they cease the claims as ‘better than Medicare’ or I go through Insurance commission here. They stumbled and fumbled around trying to justify yet I had already spoken to MO Ins Board commissioner as to this where suggested I speak directly to them on the argument first.

Seems have been dozens of complaints in last few months on this very subject and his office is already investigating.

Spoke to our benefits support group for retirees, they stated I can go back to basic Medicare with a supplement come 11/1 this year, will just have to pay the additional premium, almost $100/mo. Nothing can do for now but wait. With that and thinking on where at age wise, will be less opportunistic on getting major fixes, get evaluated and see what is urgent to repair and leave the rest alone.

Wife is more on board with that as less chance of threatening vacation rides and trips for foreseeable future. Truck is still here just sitting for now.

Opened the Care Provider lists for a couple of these Medicare Providers, nearly all had been removed from those service providers I have and will continue to use.  Doctor Office on Friday at Col Ortho stated they would accept regular Medicare If I choose to return to it and can accept a Secondary Supplemental insurer for the remnant charges, just not HUMANA as Medicare replacement.  They accept their payment, but being Out of Network can continue to recoup lost fees thru charging the Client, she noted the offices generally accept the payments to reduce a clients costs where even In Network the offices are still allowed to charge a client the remnant should the insurer claim to be covering everything after Deductibles are met.  The insurers most generally never explain that to the clients.

Edited by DMiller - 19 Feb 2023 at 7:27am