They put my father on a Medicare Advantage Plan. Now what?

FIND OUT WHO "THEY" ARE AND START ASKING "THEM" THE QUESTIONS!

DR COPPERTINO

What I know about an advantage plan is they can charge you for oxygen where if you are on Medicare and a supplement plan, the Medicare part B covers oxygen.  Medicare does not cover you in an Advantage program...they only work with the plan.

We had an elderly neighbor who had an advantage plan and had oxygen and it cost her $600 a month for her oxygen, so the next year she switched to a supplement and she never paid a dime for her oxygen as it was covered under Medicare part B.

I would check that out because as we age our needs will only get worse most likely and I am looking for big ticket items.  We are taking the BCBS Medicare supplement that pays for everything including the deductibles for Medicare part A and B.  No co pays, no specialty fees and we do not have a network and they cover for any place that accepts Medicare.  It is $219 a month but absolutely no deductibles for hospital stay either. 

I would call your local agency for the aging.  They will help you decide what is best for the price you pay.  It is a pay now or pay later between supplement and advantage policies but at least this way we know exactly what we pay for medical for the year....no surprises.  Medications are covered under a separate policy as is dental...supplement plans are ONLY medical.

I wish you the best as I know it can be very confusing so you need help and not from a sales rep for various policies who will receive a commission or some form of payment for selling you a policy. Prayers to you and your dad.

IMHO, I've heard that not all doctors accept Medicare Advantage.

Which is more advantageous for your dad, an Advantage plan or Medicare with a supplemental really depends on the details of your dads medical needs, including prescription drugs, doctors and to some degree the state he lives in maybe. It's true they messed up they should fix it and it may be that because of some of the rules the only way they could fix it and hold his business was this Advantage plan but it isn't that big a deal right now because we are in that time period where you can select and change plans (to start in January) so it would e wise anyway to talk to someone about your dad's needs, what he qualifies for, how much each would cost and select a plan. Medicare and probably your state have people you can call who review it all with you and help you figure it out. Don't call the Advantage plan or old supplemental (many insurance companies offer both types and it works with his Medicare benefits) if you can help it, call Medicare or the state office set up for just this purpose you can find the number online or in the paperwork that was probably mailed to him.

First, if the insurance company made a mistake they should be willing to correct.  As to whether a Medicare Advantage Plan would be better or worse in you case would depend on various factors - you have to stay in network, which could be a problem, or not.  For sure, I would talk to the insurance company about their mistake.

Medicare Advantage is a Medicare program. My understanding is that Medicare pays the HMO or PPO to administer your health insurance. So, in essence, you no longer will need to use your Medicare card for medical care. You will only be using the insurance card issued to you by your insurance company. However, you are technically Medicare since Medicare is taking payment from you for Part A and Part B, which they pay the insurance company to administer your insurance. I know this sounds a bit complicated. But, it is pretty simple.

You are restricted to health care providers in their registry and you also will need referrals from your primary care doctor for specialists.

I have been on a Medicare Advantage Plan since I turned 65 and my Mom has been on a MA plan for years. I have an Aetna PPO and she has UHC HMO. Strangely, her HMO plan covers more than my PPO! She has to get a referral before seeing a specialist, but it is an easy thing to do. She pays NO premium and no PCP copay! She also gets several of her meds through a mailorder plan with a 3-month supply costing $0! She does have to stay in network with docs and hospital, but since we live in a large Texas city, this has not been an issue.

With my PPO, I have a small monthly premium ($15 next year) with no PCP copay and $40 copay for a specialist. I do not have to have a referral but do have to use network docs, which has not been an issue so far. My biggest complaint is that the plan does not cover the one medication I take!

I do not go to the doctor often, so the low premiums/copay system works for me. Mom fractured her hip earlier this year and had surgery, a hospital stay and post-op rehab at an outpatient facility and I think the whole thing cost her less than $2000!

I was told by a Medicare Insurance broker that if I went back to straight Medicare with a supplement, I would be paying a LOT more in premiums, would have to pay a penalty for the Part D drug portion since I did not opt for it originally and would have to fill out lots of forms that ask for medical information.

My SO is younger and had to get insurance this year and ended up with something called Ambetter (since only two companies offered Obamacare insurance in Dallas!) Very few doctors take this plan. He is looking forward, strangely enough, to turning 65 so he can sign up for Medicare! Yikes!

Have you checked your DHS or Dept of Aging, if your father is eligible for a Medicare Saving Program offered by the State. Please note that State Medicare Saving Programs are NOT Medicaid, but have tiered income and asset restrictions. This may help you and your father immensely.

Also, please check if he may be eligible for Social Security's Extra Help for prescription drugs.

One quick question here as well....
Is your Dad a Veteran? If so can you use the VA for his medical care? That will also reduce cost.

You have a lot of good answers here. I'll just add that after several weeks of going back and forth on the Medicare Advantage (MA) issue, I decided to stick with Plan F. Like your dad, I have my plan with AARP UnitedHealthcare. Although the premiums are more expensive, the plan has always been very good to me. Except for the monthly premiums, I have never paid a cent for anything, and that has included colonoscopies and heart tests. It's a great plan.

Be aware that in 2020, Plan F (with any company) will end for NEW enrollees. What that will mean is that Plan F premiums will probably go up significantly. At that time, I will decide if I can afford it, or if I will switch to Plan G. Plan G is pretty much Plan F, but Plan F covers the Medicare B annual deductible (currently $183) but Plan G does not.

If I cannot afford Plan F or Plan G, then I will probably have to go with UnitedHealthcare's MA. In this case, what I would get is what is called AARP MedicareComplete Choice Plan 1 (PPO). Currently, the premium on this insurance is $18 a month (my monthly premium payments for Plan F for 2019 will be $187.01 per month...older people will pay more...I guess...but it is only a guess...so ask at 1-800-523-5800). NOTE: As others have said, there is an MA HMO. I would NEVER get the HMO. Yes, the monthly premium is, at this time, zero ($0), but it is too restrictive in terms of where it can be used.

So why would I stick with Plan F, if it is more expensive? I can pretty much handle regular doctor bills (I will be 69 in January), as I rarely have to go to the doctor. The big thing for me is if have some major medical event, as with a hospital stay. With Plan F, there is NO maximum out-of-pocket amount. What this means is if I have to go to the hospital in February then go back in in, let's say May...and then again in October, there is NO out-of-pocket that I have to worry about...unless I am in the hospital beyond 365 days. If that is the case, I'd rather be dead anyway.

But, with the AARP MedicareComplete Choice Plan 1 (PPO), there IS an annual out-of-pocket maximum, i.e., you could pay up to $6,700 annually, before UnitedHealthcare pays everything. That is for IN-network. For out-of-network, the maximum out-of-pocket is $10,000.

So, you see, it is sort of a pay-me-now-or-pay-me-later situation. Certainly MA's $18 a month premium is very good. But, you have the co-pays (e.g., to see an in-network general practitioner would be $5) and you have the maximum out-of-pocket amount to deal with. With Plan F and Plan G, you pay a higher monthly premium, but that is pretty much all that you pay, with the exceptions of being a very long stay in a hospital, a long (over 100 days) in a nursing facility, and foreign travel.

By now, I think you can see why the insurance companies are pushing the MA plans. The government gives them a stack of money for each person who signs up. They can then charge a small premium but also require copays (and worse...co-insurance for some out-of-network) and have the out-of-pocket maximum.

So, to recap, if you can afford it and IF your dad can get back on the Plan F, I would definitely do that. But, if he cannot get back on the Plan F, then I would go with AARP MedicareComplete Choice Plan 1 (PPO) and just do your very best to make sure he can go to in-network providers.

I should add that, if you are going to try to get him back on Plan F that he will probably have to go through the underwriting process, which is just a fancy way of saying that they might have the right to bump up the premium costs for him if he has pre-existing conditions. However, since he was taken off Plan F without his consent, you might be able to "make some noise" and get him back on Plan F. If I were to guess, I would guess that it was the underwriting issue that whoever put him on MA did so to avoid the pain and hassle of trying to deal with the underwriting of Plan F.

I wish you all the best.

There are many Medicare Advantage plans such as Blue Cross and Aetna. What each plan covers depends on which level of plan you purchase. You also need to find out which Advantage Plans are accepted from your physicians and local hospital. For example, I discovered that United Health, which is the biggest Advantage plan, does not participate with the hospital that I use.

If you go online to the medicare.gov site, you can find a lot of information. You can also Google for things like "Blue Cross Medicare Advantage plans" and find out which ones are available in your ZIP code.

One problem with the Medicare supplemental plans, by contrast, is that they have pre-existing condition causes. Hence, they are not a good choice for anyone with a lot of health issues.

I would also add AARP which is additional coverage to Medicare. I think the Medicare Advantage Plan is another version of like the AARP. I think your Dad stills needs to be on the main coverage which is Medicare and then to supplement with extra insurance to cover like most of the expenses. The co-pays are covered but there may be towards the end of the year in which you reach a donut hole with prescriptions where you have to pay more copay on prescriptions. That is my experience with my 93 year old Dad who has Type 2 Diabetics and some heart issues in which he needs to take blood thinners.

This is medicare enrollment period so you can change your dads plan till December 15th. Here is the link to an online resource. You also can go for free to a medicare insurance advisor. The medicare advantage plan is less costly than traditional medicare, I have been on an advantage plan for the last 6 years. I really like. The down side is the least costly is HMO. which means that you will have to go to a provider that is on your insurance plan. But you can see if they are onthe insurance plan before you sign.
https://www.medicare.gov/find-a-plan/questions/home.aspx

Would just calling Medicare help?

So if you just shut down dealing with insurance you need to find a Medicare insurance broker. They are insurance agents that work only with Medicare and supplemental insurance and prescription plans. To many changes for most people to keep track of. You or someone you can trust and is willing needs to address this. Maybe the company that facilitates the pension and insurance has someone you can meet with face to face to help you understand and get it sorted out. He may be on a plan that suits his needs.

They exist, I know, I used one to get my dad set up. I also recommend looking at Plan G, this covered my dad for everything he will ever need, except scripts that is an added insurance plan, he can go anywhere and know he has coverage, advantage plans only cover services provided in the county of residence unless it is a rural area and medical facilities are in a near county.

Unfortunately you have two choices, suck it up and get it figured out or stop worrying and leave it alone. If you are going to worry yourself sick, deal with it, a good insurance rep can explain in simple terms as well as provide an explanation of benefits booklet.

You do need to check if he can go back to a supplemental, in AZ you are stuck with the advantage plans once you choose that route, unless they cancel your insurance for any reason, except non-payment of premiums. Screwed up considering there are none. My dad was cancelled for moving out of state, huge blessing, at that point he had the same choices he had when he 1st went on Medicare.

JoAnn - MediCARE Advantage plans are contracted through CMS - Centers for MediCARE and Medicaid. Advantage plans get partially underwritten by CMS and when this was first done it was envisioned that they would be off Medicare underwriting within 5 years which hasn’t happened and never will imho until the US goes single payor route.

Here’s my take on this as an old health planner...... the reasoning behind Advantage is - In theory - if folks move from traditional original MediCARE to Advantage Plans, there should be less overall costs both paid to health care providers and less administration costs. So less costs to CMS eventually. The Advantage plans have to have a very narrow in network groups of hospitals, docs, etc and everything an enrollee does is totally within that network in order for there to be cost containment. If your in a big city with large competing health care systems, multiple hospitals, all sorts of specialty hospitals or care centers, then an Advantage can work.

But if you tend tend to travel widely, or go out of state often, or live in a rural area, Advantage plans are not an “advantage” as your likely going to be out of network if you get really sick.

LKdrymom - I’d suggest you call whomever administers his pension and get the list of supplemental plans that they already have in place to use and draw the premium out of from his pension. Pick one of these and add on a Plan F and let it be taken from his pension automatically. If you can change the mailings to you that would be good to do.

The snafu that happened could have been an administrative error but it could possibly be due to a phone call from your dad complaining about $ deducted from his pension. He called and complained so they took him off the employer provided supplemental for retirees. My dad was a Fed so he & mom got FEHIB BCBS and taken from his retirement (for feds it’s an annuitant).... dad died in the 1980s and mom started getting phone calls starting in the late 1990s to switch her FEHIB supplemental to whatever Advantage plans that came into the market and the calls are very persuasive telling them how much $ they will be saving and keeping that the “government is taking from them”...... “and all you need to do is to call and cancel your supplemental and go with their Advantage plan”. Mom almost did it too but FEHIB has a form that has to get done to either cancel or suspend and I caught it in time so no change. On retrospect, I should have realized that this was a red flag that mom’s cognitive ability was faltering. Your dads 91, he may seem able to be ok on his ADLs but there’s probably cognitive problems or dementia creeping in for him. If you don’t have a solid DPOA, MPOA, a valid will and access to all his banking as a signatory and POD to you that done and relatively current, then really dear you need to get these done ASAP. Use the ClusterF on the health insurance as the reason to either do these or get everything updated. At 91, its only going to get more difficult over time to get him to do things. If he owns his home, speak with him about what he wants to do with it should he needed to move due to a fall. One issue for those of us who have parents in their 90’s - nonagenarians - is that they have outlived any study for aging. So they could just as easily live another 10 months or 10 years. Yeah it’s scary horrifying! So Happy Halloween 🎃!

If they are nonagenarians, they are likely to outlive their $ and will eventually file for Medicaid. My family is filled with nonagenarians & women having healthy babies in their 40’s. I had a kid in middle school when mom was in her 90’s and dealing with NH drama for her. Whomever said juggling is a lost art hasn’t had a kid in school and a parent in a NH at the same time. Really use this insurance issue to get with an elder law atty, update dads legal and come up with some sort of plan for dad and his finances.

Here is the United Health Care MA website. Put your zip code in and look at the plans offered in your area. Print them out if you want. Then call the toll free number and find out which one your Dad is in. And talk to them about what it covers and the price. Some are zero premium like mine is. This may be not as bad as you think, but you need some facts first.

https://ma.uhcmedicaresolutions.com/aarp-medicare-complete-09?msg=nonzero&lang=en&WT.mc_id=8005594&mrcid=ps:google:ma%7CCORE%7CBrand%20UHC:Medicare:09.06.18:8005594&gclid=EAIaIQobChMIz5quzfKw3gIVENbACh3UtAeMEAAYASAAEgLLD_D_BwE&gclsrc=aw.ds

I am completely overwhelmed when it comes to insurance matters. Quite frankly I don't want to be this involved in his life. Every day is a new crisis or problem. I fix something and the following week it is broken again. I don't have the time to devote to this. While he is 91 I am only 51 and have a full time job and a home and my own set of problems. I do my best to take care of his needs but it is a never ending black hole of needs and problems.

When they first dropped him I tried to look into just getting him some other supplemental insurance and I kept hitting dead ends. When can I go to look into getting getting back on medicare and a decent supplement that will cover the 20%?

My Mom was on a Medicare Advantage plan for years (prior to Medicaid and the NH). It was a great plan for her. I just signed up for the same plan starting next month when I’m Medicare eligible. There are many different MA plans, with varying premiums and copays. Mine includes the Part D drug plan. All MA plans cover what Medicare covers and some much more. It superceeds Medicare and she will use her MA card instead of her old Medicare card. (Don’t throw out her old card though, I just put it away in a drawer, just to be safe)
You need to find out the exact company and name of the new policy to find out what it covers. I’m not sure how “someone” signed her up for a new policy. Are you POA or guardian?

Just a heads up, Medigap policies don't cover prescriptions.

Also, your Office of Aging maybe able to help you make a good selection. Like said, its now open enrollment.

I thought Medicare Advantages had a contract with Medicare. So you sort of covered by Medicare. What I never liked about MA was they were HMOs so you had to use their drs. I think they r now PPOs, save if in network.

Hi ... You say his supplemental plan messed up and dropped him. How did that happen? Like someone else said usually that's for non payment of the premium ... Would really be interested in the reason something like that might happen.

I don't think you can go from an advantage plan to a supplemental in the same state, check that out.

Also, deductible and co-pays are not the first 6k, it is a percentage of the bill, last time I looked it was 20%.

Let us know what happens, this is a nightmare thought for lots of people.

Right now is the open enrollment window for changing your MediCARE.

I’m surprised that your dad is not being inundated with various Medicare gap and advantage plan offerings.
To me the first big decision is..... is it best for him to:
- go with traditional original MediCARE and then get a supplemental plan (a “gap” plan). Often folks have a supplementary plan that is carried over from their employer as an option they can use and gets paid from their retirement. Like if they have civil service or union or federal pensions / annuitants, they can have a MediCARE supplemental that is often wide coverage and the premium is relatively low and automatically taken from their pension. These work cause they have a huge # of folks within their insurance pool. My mom had this via federal BCBS based on my dads retirement.
OR
- go with an MediCARE Advantage plan. Advantage Plans can work but to me you have to look at the plan carefully. How advantage plans work & are able to contain costs is that your dad will be limited to seeing the doctors, hospitals, clinics and services that participate with the Advantage plan he had picked in order to get a low or zero copay. Problem is often that specialists he needs are not within the Advantage plan. Or all the docs at the clinic he’s used to going to are not participating with the Advantage plan that he has. So seeing any MD or getting services at these are considered out of network and his copay will be significant. You need to look at his health and try to figure out what he’s likely going to need. If he needs a nephrologist and there’s only 1 in the plans that are cheap, that’s probably not going to work.

There is realistically no plan that has it where they can go to any doctor anywhere and have it totally covered with no copay or premium paid. Till this country does single payor health system, that’s not gonna happen. Really You have to look at what services he’s likely to need and get him onto a plan that has those docs or hospital system within the plan and get the premium to be what he can afford.

Call Healthcare Options. There is a time period to select another plan from Oct. 15th to December 15th.
If you do not choose a plan, one will be selected for you..
If it is not what your father needs, change it.

Medicare Advantage plans are not all alike. My mother was in a Medicare Advantage plan the last 20 years of her life, and she was hospitalized pretty often, and she never had huge copays. Under my plan, a different Medicare Advantage, the maximum annual out of pocket is $6500 per year, but that's not a deductible, it's a maximum of all copays put together. If I went in the hospital, I'd pay $225/day for the first seven days only. After that, the plan would cover everything. The copays for office visits are low, as are the copays for most prescriptions (at least the ones I'm on).

The bottom line is, you need to get the brochures for your father's plan and read up on the coverage before you get too upset.

Uh-oh. Who are “they”? Did he use an insurance broker who spoke with him and together they decided on a plan? The insurance company cannot assign coverage to your father without his consent. They cannot switch him on their own from regular Medicare to an Advantage plan. Chances are, he heard the $0 premium and went for it. These plans have super high out of pocket costs. Should he be hospitalized, he will have to pay at least $6,000 before they cover anything.

Why was he dropped? Usually it’s for non-payment of premiums. It’s very odd that they just cancelled his insurance out of the blue.

Get on the phone to the insursnce company tomorrow and find out why he was suddenly switched to Advantage. If he gave permission, there isn’t much you can do. But if it was their own mess up, which I tend to doubt, insist they they put him in a supplemental or they’ll be speaking with your attorney.