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Valued Social Butterfly
Posts: 8,450
Registered: ‎08-18-2008

Re: Beware of Humana Advantage Plan

Message 11 of 45 (3,931 Views)

drawpoker said . . .

 

. . . . traveler,  if it will make you sleep better for the next year,  start checking into what Plan F costs now among the many companies licensed to sell these Medigap plans in Illinois.  It will give you a good ballpark idea,   as unlike the under-65 health market,   the over-65 market for Medicare supplements is not expected to have any major premium increases in 2015,   according to all reliable reports.     

_________________________________________________________________________

 

Reliable reports?

 

The amount of increase in premiums can be based on (3) methods per Medicare so I think that will depend on the methods that is used.  I beleive the method is regulated by the state as well as any premium increase based on that method. 

 

Medicare.gov - Cost of Medigap policies

 

Also the other factors that affect your cost - same link bottom of page.

 

As an aside, another reason why some Medicare eligible individuals have to go with a MA plan rather than a Medigap policy is because of their status, i.e. being disabled and less than 65 years of age.  Some states don't require that Medigap be offered to those less than 65 years of age.

Valued Social Butterfly
Posts: 8,450
Registered: ‎08-18-2008

Re: Beware of Humana Advantage Plan

Message 12 of 45 (3,876 Views)

Prosecco62 wrote:

Both of the hospital networks have been pro-active on health care changes through the years and were ahead of the curve on many things.  There is a medical school here and most of the physicians around here are associate professors and have the residents rotating through their offices.  It's a real forward-thinking group of docs in this area and most of them do not order more tests than are necessary.  I had an immunization last fall in addition to my flu and pneumonia & there was some question that I might have to pay out-of-pocket for it.  They gave me the word and I agreed but when my statement came, Humana had paid it.  I was, again, pleasantly surprised.

 

I think Humana's success is due to emphasis on preventive care and the ability to negotiate costs downward through volume.


Along the line of your thinking on this and how MA plans have changed through the years, here is a recent NYT article by health economist, Austin Frakt, which seems to solidify your points.

 

NYT 08/18/2014 Medicare Advantage Is More Expensive, but It May Be Worth It

 

 

Valued Social Butterfly
Posts: 1,696
Registered: ‎06-25-2013

Re: Beware of Humana Advantage Plan

Message 13 of 45 (3,884 Views)

"All right. If it's that simple, what the heck is all the fuss?  (As I've stated before, this is a subject area for which I have remained blissfully ignorant, but I'll need to get up to speed next year)."

 

The fuss is people who signed up with Medicare Advantage plans (which restrict you to using providers that are within their networks) are finding out that their favorite docs are being dumped out of the network by the insurance company.   (in the case of the OP here,   Humana )   This has been happening now in 10 states so far and it has affected many hundreds of thousands of senior citizens who can't get out of these plans until what is called Open Enrollment (Oct-Dec) every year. They must either switch doctors,   which no one likes to do,  or pay the doctors themselves.   

 

People who bypass the MA in favor of traditional Medicare usually buy one of the ten (10) Medigap plans sold by many,  many insurers.  Traditional Medicare lets you see any bleeping doctor who accepts Medicare (most do).   The amount you pay out of pocket depends on which Medigap plan you bought. 

 

Plan F is the Cadillac.   You shouldn't have any out of pocket.   Gail is correct that in some states,  (FL and NY come to mind) Plan F is very,  very expensive.  If I lived in one of those states I would be paying more than double what I am paying monthly for mine.   

 

traveler,  if it will make you sleep better for the next year,  start checking into what Plan F costs now among the many companies licensed to sell these Medigap plans in Illinois.  It will give you a good ballpark idea,   as unlike the under-65 health market,   the over-65 market for Medicare supplements is not expected to have any major premium increases in 2015,   according to all reliable reports.     

Valued Social Butterfly
Posts: 1,696
Registered: ‎06-25-2013

Re: Beware of Humana Advantage Plan

Message 14 of 45 (3,888 Views)

Sounds like someone is just playing with words.  

 

From January: 

"This means that in 2015, the rates that the feds pay these plans is slated to go from an earlier 1.7 percent increase to a new, -2.0 percent decrease"

 

From April:

"On Monday, CMS announced that payments to Medicare Advantage plans in 2015 will increase by 0.4%,

 

By my reasoning,  if you tell people they were going to get a 1.7 percent increase,  then tell 'em,  no,  sorry,  final word is    ----it's going to be a 0.4% increase,  well,   that is still a DECREASE over what they were told they were going to get it.   Cuts.   They can't get around T H A T,   no matter how much they talk.   

 

 

 

 

Valued Social Butterfly
Posts: 8,450
Registered: ‎08-18-2008

Re: Beware of Humana Advantage Plan

Message 15 of 45 (3,890 Views)

retiredtraveler wrote:
---------------------------------------------------------------------------------------------------------------------------------------

 drawpoker wrote:  "...So,  Don't sweat it  -   just buy a Plan "F"  (assuming no change in that Plan)....".

-----------------------------------------------------------------------------------------------------------------------------------------

 

   All right. If it's that simple, what the heck is all the fuss?  (As I've stated before, this is a subject area for which I have remained blissfully ignorant, but I'll need to get up to speed next year).


The biggest problem around this simple solution is that some people cannot afford Plan F premiums, especially as they get older.

 

Another area of confusion for a lot of seniors is Medicare D plans, especially picking a separate one and making sure that it is what they need from year to year as their medication needs may change.

 

I think a lot of people just pick an all inclusive MA plan and then just put it on auto-pilot.

 

 

 

Valued Social Butterfly
Posts: 8,450
Registered: ‎08-18-2008

Re: Beware of Humana Advantage Plan

Message 16 of 45 (3,101 Views)

drawpoker,

Sorry about the Medscape link.  I sometimes do forget which ones I have to sign up to view and which ones, I don't.

 

Regardless of the shocking type title, it was really just saying that all the big ones are thinking about this process of restructuring their provider list - as my quote from the article indicated.  It is the same type reasoning being used under some of the ACA exchange plans to produce cost savings - narrower networks.

 

On your Forbes January 2014 article - it is rather outdated since at the time the cuts were only proposed and not finalized.  CMS did a reversal in April 2014.

California Healthline 04/08/2014 CMS Eliminates Proposed Medicare Advantage Cuts for 2015

 

From the link . . . .

"On Monday, CMS announced that payments to Medicare Advantage plans in 2015 will increase by 0.4%, reversing its earlier proposal that would have cut the reimbursements".

 

There are many different CMS formulas used to compute different aspects of the program.  This is but one. 

 - There is another formula which gives a bonus (reward) to those MA plans which measure on the upside of the star quality means.

 - There is another formula which gives them a bit more reimbursement for certain beneficiaries who are more sick than others.

 

The administrative workings of Medicare are like a spider web - rules, formulas, cost measure research, waivers, bonuses, testing of any changes and all done during different times of the year and then culminated in a final rule book in Sept. of each year - our fiscal budget ends on Sept 30.

You have MEDPAC gather data an making suggestions to CMS at least quarterly during the year.

We will have in a few years the advent of the IPAB which will begin their measure of the program and making suggestions for cost savings to Congress.  Then we have our legislators who seem to constantly be in election-mode and find it had even to determine what is fair pay rate for doctors.

 

Personally, to me, it has gotten so very complicated that it takes the role of mathematicians, budget analysis and talking heads to determine how the system is ran, blending government with private providers, including health insurance companies.

 

Most beneficiaries don't care too much about this, they just want their treatment.  Most never even look at their Explanation of Benefits from CMS.  They become aware when they try to get something then find out that it is not covered - be that a provider, procedure or durable medical equipment. 

 

And then, of course, you have all that fraud going on which makes the system that much more cautious. 

 

You seem to understand both the Medicare and Social Security program workings better than most. 

 

 

 

 

 

 

Trusted Social Butterfly
Posts: 7,006
Registered: ‎02-14-2008

Re: Beware of Humana Advantage Plan

Message 17 of 45 (3,112 Views)

 "...So,  Don't sweat it  -   just buy a Plan "F"  (assuming no change in that Plan)....".

 

   All right. If it's that simple, what the heck is all the fuss?  (As I've stated before, this is a subject area for which I have remained blissfully ignorant, but I'll need to get up to speed next year).


“The world is a book. Those who do not travel read only one page.”
Valued Social Butterfly
Posts: 1,696
Registered: ‎06-25-2013

Re: Beware of Humana Advantage Plan

Message 18 of 45 (3,116 Views)

"Man. I can't remember all this. ....... have 1 year to medicare/supplementary... can't keep up with all the changing info on how to purchase supplementary insurance. "

 

 

   traveler,  am putting you into the Good & Plenty of Money category.   Officially.    

 

So,  Don't sweat it  -   just buy a Plan "F"  (assuming no change in that Plan).   All you have to do is check closely among ALL available insurers to insure  (lol)  you are not overpaying for that choice.   

 

Now,   don't you feel 100% better..............lol  lol  lol 

Valued Social Butterfly
Posts: 1,696
Registered: ‎06-25-2013

Re: Beware of Humana Advantage Plan

Message 19 of 45 (3,123 Views)

@ GailL : You may not realize that Medscape does not allow access to articles without registering.  So I did not read the article titled "message to doctors,  cut costs or we will kick you out".   Suspect I have a fairly good idea of what the thrust is,  though 

 

@ Pro - I found this Forbes article from January which mentions Humana specifically. Also it explains better about just how the cost- per-beneficiary formula goes.   Looking at  just how much preventive care can be doled out while staying within budget is just a small part of the overall picture.   Of course,  as you say,  the more preventive type care given out,  the less the total costs later on would seem to be for that particular insurer.   But,  apparently,   this is going to be changing soon,  as the Forbes writer has researched how the elimination of the MA plans that catered to the "special needs",  sickest of all,  is going to mean transition into the regular MA models. 

 

Interesting that the writer concludes Humana is the one to watch,  evidently  it is regarded as the one who will be the bellweather to guage just how the MA insurers are going to react to these 2015 changes  (cuts in money coming from the government).   Not UHC,  Aetna,  or MutualofOmaha.

 

The whole subject of MA plans and the formulae invovled in just how they are paid by the government is completely mind-boggling.    Really a 3-Excedrin headache when you get into it,  I think people have to have a solid background in math or science to understand it all.   And I have neither.  

 

(Yes,  am familiar with the Raleigh-Durham-Chapel Hill area which has always had excellent medical care and facilities.  Also,   Pinehurst-Southern PInes area,  (where your's truly dwelled for many years) also was superior, in terms of hospial quality and physicians,) 

 

http://www.forbes.com/sites/scottgottlieb/2014/01/06/more-cuts-in-store-for-medicare-plans-heres-the...

Trusted Social Butterfly
Posts: 7,006
Registered: ‎02-14-2008

Re: Beware of Humana Advantage Plan

Message 20 of 45 (3,127 Views)

"....As a general rule,   altho of course there may be exceptions,   seniors sign up for a MA over traditional Medicare because it represents saving some money.    For people who can afford a Medigap policy,   they don't have these hassles of networks,   HMO,  PPP rules.  Go to any **bleep** doctor who takes Medicare) .....".

 

   Man. I can't remember all this. I'm going to be posting this winter for you to answer questions. I have 1 year to medicare/supplementary and I just can't keep up with all the changing info on how to purchase supplementary insurance.   Smiley Sad


“The world is a book. Those who do not travel read only one page.”