Medicare 2025 Discussion

[TerryMiller]

Don’t think so, The SS check amount doesn’t change after you enroll in an Advantage plan, if that plan doesn’t have a premium.
Addendum:
Oops, maybe if the Advantage plan has a premium, it comes out of the SS check. But an Advantage plan without premium won’t have anything deducted from the SS check.
BTW, some Advantage plans do have a small premium & some don’t from what I’ve seen. There are tons of plans out there with all different coverages. It’s best to get advice from an expert in this stuff

Thanks, but I'm not interested at all in the Advantage plans. Since the wife and I tend to travel quite a bit, both for work and pleasure, I refuse to do an Advantage plan. We learned that the hard way after I signed up for one when in Colorado and it was useless when we moved to Oregon for 17 months. With our regular Medicare and our supplements (hers is Plan F and mine is Plan N), we are extremely happy with what they do for us and allows us to go to any doctor we want that takes Medicare.

When I went in for my partial knee replacements, we hadn't even gotten a referral to the surgeon, but they did ask for one before the surgery. I may soon be looking for a good urologist in the future, so I'll probably see about a consultation before actually getting a referral, provided the urologist goes along with that idea.

 

[Free Trapper]

All you guys need to stop worrying.

When Kamalita gets elected, we will all be riding Unicorns and farting Rainbows !!........

 

[okcBob]

Thanks, but I'm not interested at all in the Advantage plans. Since the wife and I tend to travel quite a bit, both for work and pleasure, I refuse to do an Advantage plan. We learned that the hard way after I signed up for one when in Colorado and it was useless when we moved to Oregon for 17 months. With our regular Medicare and our supplements (hers is Plan F and mine is Plan N), we are extremely happy with what they do for us and allows us to go to any doctor we want that takes Medicare.

When I went in for my partial knee replacements, we hadn't even gotten a referral to the surgeon, but they did ask for one before the surgery. I may soon be looking for a good urologist in the future, so I'll probably see about a consultation before actually getting a referral, provided the urologist goes along with that idea.

Well, I’m not selling any, lol. Just commenting on my experiences with patients who are on them. If you travel, it’s prob best to go traditional. You’ll pay more in premiums, but will have better protection while traveling.
As I’ve said, everyone is different. So, different policies are available for those to research.

 

[Snattlerake]

Don’t think so, The SS check amount doesn’t change after you enroll in an Advantage plan, if that plan doesn’t have a premium.
Addendum:
Oops, maybe if the Advantage plan has a premium, it comes out of the SS check. But an Advantage plan without premium won’t have anything deducted from the SS check.
BTW, some Advantage plans do have a small premium & some don’t from what I’ve seen. There are tons of plans out there with all different coverages. It’s best to get advice from an expert in this stuff

Yeah, the insurance company that has the advantage plan gets paid directly from the government $1K to $2K per month. I do not know where the government is getting this money from. I'm damn sure it isn't out of their coffers. You are paying for it somehow, be it SS or the medicare fund you contributed to for your entire working career.

 

[Snattlerake]

It is usually at this point when I remember to tell y'all we have our own Medicare insurance broker on here.

@trickormate is the broker I use.

PM me for his phone number and email.

Or PM him. He sometimes is watching for these threads.

 

[dennishoddy]

So did you op-out of Medicare Part B? Do you have to go all the way to OKC for healthcare?

I still carry the full Medicare including part B along with the VA care.
You can opt out of Medicare as long as you have a qualified medical insurance. I retired early before my wife, so when hitting 65, I stayed on her company insurance for two years before she retired.
The government doesn't recognize the VA as a qualified insurance evidently as I can't opt out of Medicare, nor would I want to.
We travel so much that there could be areas without VA medical care, so I would have to fall back on Medicare in that case with some exceptions I'll explain below.
An example would be a car accident with injury at some small town in wherever. The VA does offer reimbursement for emergency care in that situation which thankfully I've never needed so I can't say how payment would be made and how much they would cover. After initial lifesaving or emergency care though, the VA does have to option to transport to a VA facility or work with the facility for payment.
As to your question of do I have to travel to OKC for healthcare, the answer is yes and no.
Some Doctors are contracted to the VA for primary care. Mine is in Blackwell, 15 miles away.
For more major issues like testing for this or that or specialty care like Podiatry or something like that, I can choose to travel to OKC from Ponca or ask for Community Care which Trump pushed through congress that says if a vet is so far away from the VA facility and community care is available closer to the vets home, they can defer to the local facility or specialist.
When requiring something like an Xray, I can request that the Ponca City Hospital do it, and they easily put in a referral to do so.
If needing to travel to the OKC VA Hospital, I do qualify for travel pay, so that travel expense is covered as well. Not all Vets do qualify though, so the Community Care program is very important for them.

 

[JD8]

Well, you already know the coverage & network going in. So, that’s not a surprise. If your hospital & docs are all in network, it’s not an issue. Plus, if you have an Advantage PPO instead of an HMO, your network isn’t restricted.

Yeah because you can possibly know what docs you will use if you get cancer lol. You are incorrect about the restriction of networks. An advantage PPO can absolutely restrict your network due to the fact that they are limited by the docs that will contract with whatever carrier the advantage plan is on. Let's pick United Healthcare for argument's sake, as they are the largest MA plan provider out there. They don't even come close to comparing to Original Medicare assignment which is like 80% of the doctor's and hospitals in the United States. To put it simply, fewer doctors will contract/take Medicare Advantage plans and it's not even close.

Also seen them get denied for SNF transfer because of Medicare episode of care rules. Traditional MCR can limit your coverage too.

Not sure what SNF transfer is, but I've literally seen Advantage plans deny all sorts of treatment and medications. From easily treatable cancers, to diabetes meds, to manageable heart conditions. I saw enough to say it's a scam. Damn near criminal IMO.

So, it really depends on your health & what benefits you want to have. Compare both & ask what coverage am I getting for my money, & what coverage do I need? Do i have expensive meds, travel a lot, have frequent hospitalizations or procedures? It all plays into that decision.

The notion that hey I'm 65ish and I'm forever gonna be healthy is quite a bit naive...... and bless the hearts of those that believe Father Time will not catch up with them. If you are 18-40 sure......

Add: just remembered, we also see traditional MCR patients get denied transfer to LTACH’s because they don’t meet the MCR requirement for ICU days.

So the LTACH benefits are clearly defined by Medicare for all to see. If you could, please define what Medicare Advantage plans offer instead and how they are more broad. Please be specific with reference. Also.... could you offer how many Long Term Facilities will take MA plans vs traditional Medicare. FWIW, you should probably stop while you are ahead on this one.

 

[JD8]

Yeah, the insurance company that has the advantage plan gets paid directly from the government $1K to $2K per month. I do not know where the government is getting this money from. I'm damn sure it isn't out of their coffers. You are paying for it somehow, be it SS or the medicare fund you contributed to for your entire working career.

They get just under 12K per person a year.

 

[okcBob]

Yeah because you can possibly know what docs you will use if you get cancer lol. You are incorrect about the restriction of networks. An advantage PPO can absolutely restrict your network due to the fact that they are limited by the docs that will contract with whatever carrier the advantage plan is on. Let's pick United Healthcare for argument's sake, as they are the largest MA plan provider out there. They don't even come close to comparing to Original Medicare assignment which is like 80% of the doctor's and hospitals in the United States. To put it simply, fewer doctors will contract/take Medicare Advantage plans and it's not even close.



Not sure what SNF transfer is, but I've literally seen Advantage plans deny all sorts of treatment and medications. From easily treatable cancers, to diabetes meds, to manageable heart conditions. I saw enough to say it's a scam. Damn near criminal IMO.




The notion that hey I'm 65ish and I'm forever gonna be healthy is quite a bit naive...... and bless the hearts of those that believe Father Time will not catch up with them. If you are 18-40 sure......




So the LTACH benefits are clearly defined by Medicare for all to see. If you could, please define what Medicare Advantage plans offer instead and how they are more broad. Please be specific with reference. Also.... could you offer how many Long Term Facilities will take MA plans vs traditional Medicare. FWIW, you should probably stop while you are ahead on this one.

I think if you read my post #30, you will find that I already stipulated that Advantage plans have more restrictions than traditional MCR.
“Advantage plans have no monthly premiums and offer extra benefits like vision & dental but they restrict your choice of providers and require preauthorization for some stuff. You won't have those problems with traditional Medicare with a supplemental plan, but you'll pay a lot more every month.”

Everyone knows this. So, I’m not sure what your point is here. My point is that they are cheaper & may be an option for some people. That’s it. Even the insurance expert said it in the video in post #35. However, they may not be an option for other people. This is why I also recommended people speak with a MCR insurance specialist in post #40.

Also, I did give a few examples (that I saw at work) of traditional MCR restrictions-only to illustrate they don’t cover everything either. Anecdotally, I have been involved in Ltach auth peer to peer to get patients approved with Advantage, where the patient wouldn’t have met traditional MCR requirements. But generally, ltachs prefer traditional MCR as there are no hoops to jump thru. Again, it’s just one example to show there are some limitations to traditional MCR. But overall, Advantage plans have way more restrictions, as everyone knows.

 

[dennishoddy]

So the LTACH benefits are clearly defined by Medicare for all to see. If you could, please define what Medicare Advantage plans offer instead and how they are more broad. Please be specific with reference. Also.... could you offer how many Long Term Facilities will take MA plans vs traditional Medicare. FWIW, you should probably stop while you are ahead on this one.

I'm not sure what LTACH stand for, but here is a story I've had to deal with someone on advantage care.
My sister is on the OKC recommended advantage plan she got on after retirement from them.
She went into AFIB, needed an ablation and went to the OKC Heart Hospital to get it done.
Her health is very poor, legally blind, and so on. We talked to the social worker trying to get her into a rehab center for some care.
With the Advantage plan she has, she got 7 days. Then got kicked out no matter what her condition was. If she was on Medicare, she would have got I think it was 20 some days and if she wasn't' better another 20 days or something like that.
She can't be talked out of it, says it's great because she is stationary, has all of her doctors in the plan and gets a few bucks for this or that, none of which helps her in the long run.
We gave up. Make your own decisions.