Medicare 2025 Discussion

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1Mudman

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I have used Humana for several years and was happy with their service. Now all of a sudden Human is parting ways with Integris Health Care whom Ive had two surgeries including a hip replacement in July. I received a "stack" of letters informing me that I could no longer used Integris or my Dr's, Surgeon's, My primary care Dr and assigned me to others I dont know and never heard. Well Humana has tried to socialize everything since covid days and I have fought and argued long enough. They tried the robot system and it was horrible. Then the person that spoke broken english. Anyways Ive had it and looking for a New Insurance Company. I will not be control in a socialized medicine platform. It had gotten to the point appointsment were taking 4 to 5 months to get in. They tried to force me to used other Drs ect.. Sick of Insurance screwing us for the almighty dollar!
 

chuter

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Friend of mine has an advantage plan. He got prostate cancer and they didn't want to pay for the proton treatment. At one point he said the anxiety about the bill was about as bad as the cancer.
The hospital told him not to worry and after a while they got the advantage plan to pay for it, but not without a lot of stress.

I've got a supplement plan and have been very happy with it.
 
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I've had a completely different experience, I have an Advantage PPO plan through Humana, it's so good I can't believe it, I'm embarrassed because it's like being on welfare. In late 2020 I had an accident, in 2021 I racked up a little over 250 thousand in med bills, they paid it all, I was out of pocket about 7 thousand. I go to any doc I want, they have never said no to anything. The bad part is they call me constantly wanting to know if I want this or that, all kinds of free stuff. I quit answering the phone, and I don't call back. This isn't a Medicaid thing, I was on Medicare and talked to an agent and she said this is a no brainer, I wasn't on any prescription, I was healthy, no problems, then boom. I'm sure I could have milked the system, I could have gotten disability, but I didn't ask for it, even though I haven't worked in 4 years, I could have sued the surgeon, I'm in constant pain and I don't walk right, on and on. but after they paid that 250k I just decided to take my winnings and go home.
 
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My mom has a United Healthcare Advantage plan and it has been really good so far. Sure, there are approvals and assessments out the wazoo, but she hasn't got a single bill past her small copays, and she's had a whole bunch of care lately going back to covid breaking out. She developed cancer during Covid and with her cancer policy she's had for years she came out ahead on that.

I don't know the details but it's provided from the Arizona public safety retirement system. She wants to go regular medicare this period with a supplemental but I'm pushing her to just let it ride, at least for now. We'll see when she gets the new packet pretty quick.
 

KOPBET

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Friend of mine has an advantage plan. He got prostate cancer and they didn't want to pay for the proton treatment.

Insurance companies (MA) routinely deny coverage for expensive treatments just to make you appeal the decision (which you can). Sometimes the appeal is successful, but it takes a lot of time that cancer patients don't have a lot of.
 

JD8

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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.

The "expert" also has other videos....



Great video actually.






Watch the first part of the last one lol..... can't tell you how many similar stories I heard while I was a broker.
 
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JD8

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I've had a completely different experience, I have an Advantage PPO plan through Humana, it's so good I can't believe it, I'm embarrassed because it's like being on welfare. In late 2020 I had an accident, in 2021 I racked up a little over 250 thousand in med bills, they paid it all, I was out of pocket about 7 thousand. I go to any doc I want, they have never said no to anything. The bad part is they call me constantly wanting to know if I want this or that, all kinds of free stuff. I quit answering the phone, and I don't call back. This isn't a Medicaid thing, I was on Medicare and talked to an agent and she said this is a no brainer, I wasn't on any prescription, I was healthy, no problems, then boom. I'm sure I could have milked the system, I could have gotten disability, but I didn't ask for it, even though I haven't worked in 4 years, I could have sued the surgeon, I'm in constant pain and I don't walk right, on and on. but after they paid that 250k I just decided to take my winnings and go home.

So basically, you'd be in the same boat as someone with Traditional medicare + supplement. Except you wouldn't be paying the 7 grand.
 

JD8

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Friend of mine has an advantage plan. He got prostate cancer and they didn't want to pay for the proton treatment. At one point he said the anxiety about the bill was about as bad as the cancer.
The hospital told him not to worry and after a while they got the advantage plan to pay for it, but not without a lot of stress.

I've got a supplement plan and have been very happy with it.

They typically won't pay for the Proton treatments for Prostate cancer.
 

chuter

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My part D plan with Blue Cross is going from $24.80 to $59.80, so I'm looking at the medicare website: there is a Wellcare Value Script plan for $0 monthly premium. Yep: $0
I'm searching to find out why it's zero dollars, haven't found anything bad yet, just that Wellcare is basically a good company.
I've tried the online plan comparison and I don't see any big differences.
Any thoughts? Hard to pass up $0 premium. I don't take any prescriptions at this time.

Edit: just found this on https://www.bogleheads.org/forum/viewtopic.php?t=438783;
"What allowed WellCare to do this was the total elimination by WellCare of commissions for brokers in 2025 (for both new policies and existing policies) and the implementation of the newly-created $5-$8 billion Premium Stabilization Demonstration Program by CMS (Google it and then click on “News”).
 

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