Medicare coverage insurers

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

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. 

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

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.

I had a tooth ache and went to the Dentist last month.. Said it was a root touching a nerve and due to SINUS / cold... Would go away in 3 weeks... Took x-rays... $200. paid by Medicare......... ALso told me i need DEEP CLEANING and would be $3000.  ..... My Advantage plan pays $1000. per year .... Told them to "put that on hold"....   

Seems a good hygienist now using the latest water jet (ultrasonic) equipment can do a lot more than the old scrape and scratch tools , but with each new device the trying to UPSELL comes in .