Great health insurance agent

[Irish mist]

A caution on "advantage plans". If you leave your original medicare Medigap plan for an advantage plan, and then try and go back to your original medicare Medigap you may be subjected to underwriting...which means if you are deemed to have health issues you can be rejected.

Advantage plans have gatekeepers that look to save them money hence the often narrow networks you can use for treatment. Also, advantage plans have deductibles as high as 7k.

Unless the advantage plan has a PPO attached I would not use one. Just my 2 cents.

[TheProfessor]

Each to their own, of course.

“Federal Investigators Find Medicare Advantage Plans Too Often Deny, Delay Needed Care.

Medicare Advantage plans that provide health insurance coverage to millions of US seniors deny some medically necessary care that should be covered, possibly unfairly rejecting tens of thousands of such requests annually, says a new report from the Department of Health and Human Services Office of Inspector General (OIG).”


LINK

[camp guy]

To quote TheProfessor, "Each to their own", is so true. Everybody's got a story about health insurance, but what it all boils down to is the level of comfort you experience with your agent, discussing your health needs, and your ability to pay. Any stories about other people and their insurance are simply just that - other stories. Once you establish a relationship with an agent, the details of the actual Plan are the agent's responsibility. This is why you, the consumer, should concentrate on making sure the agent knows exactly what you want based on your health situation. To this end, I do not believe in 1-800... for my insurance. I have a local Agency, and I have a local Agent, and for more than 15 years everything has been very satisfactory. However, as I said in the beginning, TheProfessor is right with what he had to say.

[Merrymeeting]

Originally Posted by Irish mist

Unless the advantage plan has a PPO attached I would not use one.

Can you briefly elaborate? Why would a PPO make an Advantage plan more acceptable?

[Irish mist]

Originally Posted by Merrymeeting

Can you briefly elaborate? Why would a PPO make an Advantage plan more acceptable?

A PPO plan allows you to use out-of-network doctors. You do not need referrals from your primary physician. They do sell PPO plans attached with some advantage plans.

[SailinAway]

Originally Posted by Irish mist

A caution on "advantage plans". If you leave your original medicare Medigap plan for an advantage plan, and then try and go back to your original medicare Medigap you may be subjected to underwriting...which means if you are deemed to have health issues you can be rejected. Advantage plans have gatekeepers that look to save them money hence the often narrow networks you can use for treatment. Also, advantage plans have deductibles as high as 7k. Unless the advantage plan has a PPO attached I would not use one. Just my 2 cents.

Here in New Hampshire we have the advantage of being situated in the middle of a very strong network of practitioners. My Harvard Pilgrim Advantage plan covers Concord Hospital, Dartmouth Hitchcock, and Boston specialists, among others. I've had two joint replacements with this plan. One was $1200 and the other was $600 everything included, even physical therapy. Full cost of one joint was about $75,000. Harvard Pilgrim was in agreement with all of my doctors' recommendations. There were no "gatekeepers" opposing my treatment. HP and the clinic handled everything from start to finish. There was one simple bill at the end. HP partners with Concord Hospital and Dartmouth Hitchcock, so they're unlikely to disagree with doctors at those facilities.

The cost of the Advantage plan at the time was $360 a year. Plus the cost of Medicare Plan B. Last year Harvard Pilgrim did away with the requirement for authorization before seeing a specialist. Any problems I've had have been bureaucratic, possibly related to an individual, not problems with the plan itself. Customer service has been 90% positive. The other 10% was a pain, to be honest, but I've encountered such problems with every insurance company I've even been with.

[Irish mist]

Originally Posted by SailinAway

Here in New Hampshire we have the advantage of being situated in the middle of a very strong network of practitioners. My Harvard Pilgrim Advantage plan covers Concord Hospital, Dartmouth Hitchcock, and Boston specialists, among others. I've had two joint replacements with this plan. One was $1200 and the other was $600 everything included, even physical therapy. Full cost of one joint was about $75,000. Harvard Pilgrim was in agreement with all of my doctors' recommendations. There were no "gatekeepers" opposing my treatment. HP and the clinic handled everything from start to finish. There was one simple bill at the end. HP partners with Concord Hospital and Dartmouth Hitchcock, so they're unlikely to disagree with doctors at those facilities.

The cost of the Advantage plan at the time was $360 a year. Plus the cost of Medicare Plan B. Last year Harvard Pilgrim did away with the requirement for authorization before seeing a specialist. Any problems I've had have been bureaucratic, possibly related to an individual, not problems with the plan itself. Customer service has been 90% positive. The other 10% was a pain, to be honest, but I've encountered such problems with every insurance company I've even been with.

There are gatekeepers with your advantage plan. Yours approved all of your care in this instance.

A link the professor left in this thread explains the issues with advantage plans.

[SailinAway]

Originally Posted by Irish mist

There are gatekeepers with your advantage plan. Yours approved all of your care in this instance.

A link the professor left in this thread explains the issues with advantage plans.

I misspoke. I meant to say that there was no opposition from Harvard Pilgrim to any treatment ordered by my doctors.

[Irish mist]

Originally Posted by SailinAway

I misspoke. I meant to say that there was no opposition from Harvard Pilgrim to any treatment ordered by my doctors.

Advantage Plans are cost-saving, there is no doubt about that and work well, especially when you are young and healthy. My concern is that many people don't know that once you enroll in an Advantage Plan in most states, not all, if some health issues arise, you will be subjected to medical underwriting and not be allowed back into original Medicare.

If you enroll in original Medicare at 65 you are guaranteed to be let in regardless of pre-existing conditions.

[SailinAway]

Originally Posted by Irish mist

Advantage Plans are cost-saving, there is no doubt about that and work well, especially when you are young and healthy. My concern is that many people don't know that once you enroll in an Advantage Plan in most states, not all, if some health issues arise, you will be subjected to medical underwriting and not be allowed back into original Medicare.

If you enroll in original Medicare at 65 you are guaranteed to be let in regardless of pre-existing conditions.

All this has always been a head-scratcher for me despite hours of research. I enrolled in Plan B plus an Advantage plan at 65. Isn't Plan B "original Medicare"?

[Irish mist]

Originally Posted by SailinAway

All this has always been a head-scratcher for me despite hours of research. I enrolled in Plan B plus an Advantage plan at 65. Isn't Plan B "original Medicare"?

A & B are original Medicare which pays 80% of your bill. The supplement you enroll in, which pays the other 20% can either be a traditional Medigap policy, or the Part C Advantage Plans...which are private plans paid with Medicare money.