Content starts here
CLOSE ×
Search

Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Reply
Periodic Contributor

Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Hi,
AARP's Medicare Supplemental Medicare Insurance sounds great... but I decided that before I purchase it I should read the reviews.

I was astounded!

 

Consumer affairs reviews were the worst I have EVER seen for any product or service from any company. People were talking about outright misrepresentation of services, copays, non-existent customer service. Representatives simply hanging up on customers, drug formularies not covering many common medications. Increasing co-pays. A litany of misrepresentation and worse.


Now I understand the Internet. You will always find people more willing to badmouth a product or service than to praise it... but I looked for positive reviews and found none...

 

http://www.consumeraffairs.com/insurance/aarp_medicare.html

 

Is it really this bad? If so why does AARP tolerate this if they are, as they claim, an organization that exists to promote the best interests of senior citizens?

 

Have I simply been looking for reviews of AARP United Healthcare supplemental insurance in the wrong places?

 

Can anyone here describe their own experience with this insurance? I live in California... but will be moving to Arizona...

 

If not AARP/UHC insurance, can anyone here recommend a company for Medicare supplemental insurance with which they have had a positive experience?

 

Thanks

 

93,370 Views
130
Report
Honored Social Butterfly


@Roxanna35 wrote:

What I want to find out is where  can I see the questioner that you have to answer when you apply for a Medicare Supplemental plan. To  be able to see illegibility to a Supplemental program? any ideas? have bee looking in the Internet and cannot find anything that I can see on this issue.


Suggest you see a local expert on the subject then talk to your Insurance Agent. You will not get complete advice from anyone in here.

0 Kudos
31,088 Views
0
Report
Honored Social Butterfly


@Roxanna35 wrote:

What I want to find out is where  can I see the questioner that you have to answer when you apply for a Medicare Supplemental plan. To  be able to see illegibility to a Supplemental program? any ideas? have bee looking in the Internet and cannot find anything that I can see on this issue.


Medigap coverage is ONLY supplemental coverage to Medicare.

 

It is sold by private insurance companies and thus unless you buy it when you have (Medicare ruled) GUARANTEED ISSUE RIGHTS, they don't have to sell it to you.  PERIOD.

 

They can choose to deny you.

They can choose to underwrite you.

They can choose to underwrite you, approve you and charge you more.

They can choose to underwrite you, approve you, charge you more and not cover any pre-existing condition for a set time period.

 

UNLESS you have Medicare-ruled GUARANTEED ISSUE RIGHTS, it is up to the individual health insurer as to what they want to do with you - yea/nay/or with price and other conditions.

 

If you are thinking this is similar to the ACA in denying you because of a pre-existing condition - think again, because MEDIGAP coverage is NOT full insurance, in fact, it is not even health insurance - It is supplemental coverage to original Medicare.

 

I am assuming that you told your agent that you wanted to change your coverage to original Medicare but ONLY IF you could get approved for a supplemental Medigap plan, knowing beforehand what price and conditions you might have to abide, if approved at all.

 

You have the right to go back to original Medicare if you want because that is just another choice in how you want to receive your benefit.  A Medigap policy is outside of this realm of coverage because it is supplemental, meaning something extra.  

Original Medicare = Medicare Advantage, they are one in the same.  Medigap is NOT, it is something extra.

 

 Medicare.gov - When can I buy a Medigap ?

 

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.

 

. . . . Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

 

. . . . If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below. (See the above link)

 

. . . . During the Medigap open enrollment period, an insurance company can't use medical underwriting. This means the company can't do any of these things because of your health problems:

Refuse to sell you any Medigap policy it sells
Make you wait for coverage to start (except as explained below)
Charge you more for a Medigap policy

 

In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. You're guaranteed the right to buy a Medigap policy:

When you're in your Medigap open enrollment period
If you have a guaranteed issue right
You may also buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health.

 

. . . . If you buy a Medigap policy when you have a guaranteed issue right (also called "Medigap protections"), the insurance company can't use a pre-existing condition waiting period.

 

. . . . The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a pre-existing condition.

In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.

 

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

 

When you get Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the coinsurance or copayment.

 

I have already given you the link to Medicare - Guaranteed Issue Rights -

 

To answer your question, a Medigap insurer, if you do not have guaranteed issue rights, can ask you detailed questions on your health conditon(s).  And they can make their own decisions about whether or not to cover you at all or with stipulations in price, may cost more, and in coverage for a specified amount of time.  It is up to them if you do not have guaranteed issue rights or Medigap Protections.

 

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
31,037 Views
25
Report
Honored Social Butterfly

Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 

no name
0 Kudos
31,095 Views
24
Report
Honored Social Butterfly


@Roxanna35 wrote:

Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
30,851 Views
21
Report
Honored Social Butterfly


@GailL1 wrote:

@Roxanna35 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 

no name
0 Kudos
30,694 Views
20
Report
Honored Social Butterfly


@Roxanna35 wrote:

@GailL1 wrote:

@Roxanna35 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
30,742 Views
19
Report
Honored Social Butterfly


@GailL1 wrote:

@Roxanna35 wrote:


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.

no name
0 Kudos
30,950 Views
11
Report
Honored Social Butterfly


@Roxanna35 wrote:


 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
26,543 Views
10
Report
Honored Social Butterfly


@GailL1 wrote:


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 


In the beginning they use one of those expensive ones, but eventually changed to Avastin, apparently I do better on Avastin. than with the other two.
The foundations that I am dealing with is called Gooddays. and they have been generous with me.
Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare? 
Yes, even this insurance does  cover Avastin.
You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.
I have seen the bill and there is a test that they do before they put the injections to see if there is any change in my eye. and then they put the injection. so is the injection plus the test and the doctor's visit. The insurance covers it all except for my copay for an specialist. Now, there is no progression for a very long time. as it is, I am going only about every 10 weeks and he wants to space it even more. I guess I was lucky, because I saw the eye doctor every six months because of diabetes, he was the one that saw that I could have a problem and immediately sent me to the retina specialist. I guess it was treated very early. is only in one eye and I can  see quite well under the circumstances and my other eye is not affected, and I have very good vision on that eye. I still can drive without a problem which is very important for me.

no name
0 Kudos
27,307 Views
9
Report
Honored Social Butterfly

Gail.

After reading your last post, I do realize that I know very little next to nothing about Medicare and how it works

If they are not health insurances those companies, what in the heck are they.? I am really not sure that I want to go to a simple medicare patient. I have always had the feeling that Medicare only patients are somewhat discriminated by the doctors themselves. is just a feeling, besides, Medicare only pays 80% of the bill and at least the other Insurances to cover more costs than the 80% and the drug prices are a lot better than if I just got a stand alone prescription drug  program. I don't have the advantage of negotiating like they do.
I realize what you are saying that the doctors have the last shot. in all of this, but, if they accept Medicare patients, and Medicare supplemental  why I as a PPO Medicare Advantage person they cannot bill my Medicare directly they do it for other patients. and bypass my PPO Insurance.

That seems somewhat a little lopsided.  and perhaps that is also not too fair to the consumer.
Perhaps, Medicare needs to be waken up of their dream land and start thinking about their rules a little. 

no name
0 Kudos
28,852 Views
7
Report
Regular Contributor

Gail, you are confused.  The doctor is not allowed to choose if he files with a supplement or an advantage plan no more than he is allowed to choose which insurance carrier he files with.  Advantage PPOs are a whole different world than supplements are.  YOU choose which you have and you and he are committed to using ONLY the one you choose. 

 

IF you choose a supplement, then by law, if a doctor takes Medicare, they have to take a supplement.  IF you choose an advantage plan, then the advantage plan has networks (supplements do NOT have networks) and a doctor can choose if he wants to be part of that network and accept their network reimbursement payments.  You choose, the doctor has to go by the rules of the plan you choose. 

0 Kudos
28,887 Views
6
Report
Honored Social Butterfly


@ykaplinsky wrote:

Gail, you are confused.  The doctor is not allowed to choose if he files with a supplement or an advantage plan no more than he is allowed to choose which insurance carrier he files with.  Advantage PPOs are a whole different world than supplements are.  YOU choose which you have and you and he are committed to using ONLY the one you choose. 

 

IF you choose a supplement, then by law, if a doctor takes Medicare, they have to take a supplement.  IF you choose an advantage plan, then the advantage plan has networks (supplements do NOT have networks) and a doctor can choose if he wants to be part of that network and accept their network reimbursement payments.  You choose, the doctor has to go by the rules of the plan you choose. 


You would have to keep up with all of rker321's post - but in my post I assume you are referencing, I said,

A doctor can decide which insurer they want to deal with and how much they want to deal with them.

A doctor even accepting Medicare assignment in original Medicare can still limit how many of this type of patient they accept into their practice.  The doc makes the call.

 

I understand what the subject of this thread is about (supplemental coverage) but sometimes threads just get off topic - it has very much so with the coversation between me and rker321.

Sorry.

 

You are right that once an original Medicare doctor (accepts assignment) elects to treat you, they will bill Medicare (CMS) for your sevices, Medicare (CMS) will pay 80% of their negotiated fee for the service and then send it on to your supplemental (Medicap) plan to pay their share since it is supplemental coverage.

 

You are right that if a doctor is within your Medicare Advantage plan's network, and he treats you, he will bill and be paid according to the fee schedule which the specific Medicare Advantage plan has with him.

 

However you are missing the point here and that is IF the doctor elects to treat you, IOW - he accepts you as a patient.

 

In a Medicare Advantage PPO plan, an out of network doctor can decide not to accept you as a patient - they have that choice.

 

In original Medicare, with or without a supplemental plan, even if a doctor accepts Medicare assignment, they still have the right to limit their practice scope to the number of Medicare patient which they treat.  That is why there is a selection, or use to be, on the Medicare Find a Doc site that says. "Accepting New Medicare Patients" - or if you call them for an appointment, they could tell you right then that they are not accepting any new Medicare Patients.

 

rker321 can tell you her specific circumstance but basically it involves a MA PPO of which an out of network doc has decided not to accept any patients that have coverage from a specific insurer - He was a long standing doc of rker321 which she had used in this MA PPO out of network capacity for a good while.  From my understanding it is really the result of the doc not liking the insurer for payment reasons, it seems -

 

The rest of this subject discussion is about possible a MA Medicare beneficiary going back to original Medicare and the circumstances underwhich they could get a supplemental ( Medigap) plan to "supplement" their original Medicare benefit - IF they can at all.

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
27,977 Views
5
Report
Honored Social Butterfly

Hey guys,  as a Medicare Advantage PPO recipient. I can choose to go out of network but before I do. I have to contact that doctor and ask if they are willing to bill my Medicare Advantage insurance. and of course  pay a lot more money for my co payment.
Having said that, when I just changed insurances, I made sure that I contacted the doctors that I knew were out of network to see if they would bill my Medicare Advantage plan, and they do. otherwise I would have had to choose another insurance carrier.

Having said that, I think it really sucks that If I choose a doctor out of network and they don't want to deal with my Medicare Advantage plan, and they already accept medicare patients, that they should be able to bill Medicare directly for the services that I incur. But apparently, it doesn't work that way, But, I have the intention to put a complain to Medicare  and see  what happens.

 

 

no name
0 Kudos
28,147 Views
4
Report
Honored Social Butterfly


@Roxanna35 wrote:

Hey guys,  as a Medicare Advantage PPO recipient. I can choose to go out of network but before I do. I have to contact that doctor and ask if they are willing to bill my Medicare Advantage insurance. and of course  pay a lot more money for my co payment.
Having said that, when I just changed insurances, I made sure that I contacted the doctors that I knew were out of network to see if they would bill my Medicare Advantage plan, and they do. otherwise I would have had to choose another insurance carrier.

Having said that, I think it really sucks that If I choose a doctor out of network and they don't want to deal with my Medicare Advantage plan, and they already accept medicare patients, that they should be able to bill Medicare directly for the services that I incur. But apparently, it doesn't work that way, But, I have the intention to put a complain to Medicare  and see  what happens.

 

 


Medicare.gov - Your Medicare Coverage Choices

 

You pick either Original Medicare or Medicare Advantage - once picked that is your way of getting your Medicare benefits.  Between the two choices, everything is different - the amount they pay the provider, your copays, your coinsurance.  They do not co-mingle.

 

Medicare and You - video on Understanding Your Medicare Choices

 

In your previous post you said - I am just answering here for convenience. 

@Roxanna35 wrote:

If they are not health insurances those companies, what in the heck are they.? I am really not sure that I want to go to a simple medicare patient. I have always had the feeling that Medicare only patients are somewhat discriminated by the doctors themselves. is just a feeling, besides, Medicare only pays 80% of the bill and at least the other Insurances to cover more costs than the 80% and the drug prices are a lot better than if I just got a stand alone prescription drug  program. I don't have the advantage of negotiating like they do.

 

Supplemental Medicare Insurance is supplemental insurance, it is not health insurance; simply,  it only picks up what the main insurance does not pay.  It ONLY works with original Medicare NOT Medicare Advantage plans.  Compare it to perhaps gap insurance in the auto insurance industry.  Gap insurance, more accurately called gap protection, covers the difference between what you owe on your car and how much the car is worth.

Su

 

Medicare.gov - What is Medicare Supplemental Insurance (Medigap)

 

Look, rker321, I am sorry that your out of network doc has put you in this situation.  The dispute is actually between this doc and your Medicare Advantage PPO insurer - you are just collateral damage.  I can understand your problem but there is little you can do about it - However, you do have choices - Pick another Medicare Advantage plan, PPO, if that is your need, in your area where your docs are either in network or if it is a PPO, that they will work with you within the PPO as out of network.

 

You could change your choice of how you get your Medicare benefit from Medicare Advantage to Original Medicare but that will probably be either without supplemental coverage or a very expensive supplemental plan if an insurer decides to underwrite you.

 

I understand your fight here but honestly because a doc does have the right to pick his patients in this regards - limit in number or limit by insurer - I just don't know how this could be fixed.  Whatever excuse they give, it works out the same because original Medicare and Medicare Advantage plans are Medicare - just different ways of getting your benefits just in different ways.

 

Sounds like you have already made your decision - Hope this MA plan works better for you.

 

Good Luck -

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
28,198 Views
3
Report
Regular Contributor

Prescription drug copays differ from company to company and differ year to year. if you do not know how to check your coverage for the coming year, contact an independent insurance agent for help. The supplemental from UHC is great coverage and if you have to be underwritten to get it, AARP UHC is the easiest to get.
0 Kudos
20,676 Views
0
Report
Honored Social Butterfly

Gail  thank you for your response.
I wish that I had know more about Medicare and Medigap  than I even know today, I would have fought with the Dr.s  for not actually providing me with a Pre Diabetis diet mainly because my Diabetis 2 is and has always been extremely contained and very mild. Instead they put me inmediately on pills, creating a pre condition that has  had implications in the future. 
I wish that I had know about the injections for my Macular Degeneration and what they ask you in any questionair plan which is  if you actually receive injections.  and I would have probably delayed the process or applied for a supplemental before the diagnosis was made.
There are lots of things that due to ignorance that I have done, have had consequences probably my fault.
I do fully understand what you are saying about the doctors, I still think that they are also gaming the system in their favor and not in favor of the patients. Because they do want those supplementals and they have to accept the original Medicare patients. 
I guess that is life and the system that we have in the US.  more than ever, I feel that we really need a National Health Care system. too many things are done these days that are not right or fair.

 

no name
0 Kudos
24,501 Views
1
Report
Regular Contributor

There was a misunderstanding posted in a comment here.  Doctors DO NOT have to take Medicare.  If they take it, they also have to take a Medicare Supplement.  They do NOT have to take a Medicare Advantage. 

0 Kudos
24,494 Views
0
Report
Honored Social Butterfly


@Roxanna35 wrote:


 


Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?

You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.

@you wrote:

"Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?"

 

YOUR Medicare IS the Medicare Advantage plan which you have chosen, I believe, a Medicare Advantage PPO.

 

A doctor can decide which insurer they want to deal with and how much they want to deal with them.

A doctor even accepting Medicare assignment in original Medicare can still limit how many of this type of patient they accept into their practice.  The doc makes the call.

 

Don't like any Medicare Advantage plan, go back to Original Medicare.

 

Original Medicare and Medicare Advantage plan (Part C of Medicare) cover the SAME benefits just in a different way.  They are both under the umbrella of "Medicare".

 

@you wrote:

". . . . .perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental "

 

A Supplemental (Medigap) insurer has no cost exposure - they do not decide on the price or payment of anything !   They don't say what is covered or set any prices.   In General, they pay the 20% of the Medicare approved cost which Medicare does not pay.

Supplemental Insurance is NOT health insurance - it is "supplemental" insurance.

 

They can deny you coverage based on their own determination of the amount of services which you may use in original Medicare because you have a pre-existing condition and you do not have any Medicare determined rights that they have to sell you a policy at all OR sell you a policy even at the going price - they can deny you a supplemental plan, or underwrite you, charge you more and limit coverage for pre-existing condition for a specified amount of time..

 

At this point, we are waaaaaay off-topic and I am having my doubts that you understand Medicare and all its parts.  Nor do I think you understand what Medigap (supplemental) coverage actually is.

You seem to keep thinking that it is health insurance; it is not.  It does not work with a Medicare Advantage plan at all.

 

You have your choice of keeping a Medicare Advantage plan (Part C), any of them offered in your area, or going back to Original Medicare but perhaps without a supplemental plan or perhaps one that might be pretty costly, if an insurer will underwrite you.

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
20,641 Views
0
Report
Regular Contributor

After reading some of the complaints of AARP supplemental plans not paying for things like Whooping Cough vaccinations, I am amazed at how many new enrollees (or maybe even ones who have had the ins for a while) don't understand how Supplemental Insurances work. It is Medicare that decides what is approved, how much to charge and then the Supplemental coverage like Plan F pays the difference since Medicare will pay 80% and the rest is the responsibilty of the indivdual (therefore the ins covering the 20%). Plus this is the key which is apparant is not understood.  MEDICARE DOESN'T APPROVE EVERYTHING LIKE THE WHOOPING COUGH OR SHINGLES VACCINE. It would be very smart before one gets such vaccines to ask if Medicare covers the shots, procedures etc.

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. (This is not being political but only truthful) For me having Plan F for a few years has been a Blessing as you will understand once you have a Hospital surgery for over $100,000 and never see a bill. That's when it pays to get the great insurance AARP provides)

19,403 Views
6
Report
Periodic Contributor

There are not many Hospital Surgery Stays that will cost Insurance Company or Medicare 100k. Hospitals grossly over bill [$25.00 for Advil Etc.] so as not to miss out on anything and get Max out of Medicare or Ins. Co. A 100k bill will be reduced between 3k-10k[check it out] out of pocket 600 to 2k for Patient still less than yearly premium for Supplement. A couple could be paying 5000 yearly for Supplement policy premiums. If you just need 'Upkeep' with an occasional problem in 10 years Medigap Policy Might pay 3k to 5k on average total for excess cost after medicare pays but they will have paid 50k in premiums Thats why Insurance Buildingd have Italian Marble Floors in Bathrooms.
0 Kudos
25,346 Views
2
Report
Regular Contributor

Not true as a total shoulder replacement like the one I had where I was in surgery for hours ran over $100,000 and I am not talking for medications. This was very spcialized surgery which is becoming more and more common. This wasn't a car accident but where I simply feel in my house onto my shoulder and totally broke it! Yet thanks to plan F I never saw one bill at all!!!I I am very very happy with Plan F and when we travel I have seen other doctors Nationwide and always get great service and No Bills!

26,850 Views
1
Report
Periodic Contributor

So us the bill.[I know better] If you check your Medicare the Hospital may have Billed 100k, like I said they Grossly over Bill but check what Medicare actually paid and that is what Medigap pays 20% on. Again its not what is billed it is what Insuance pays. Most people don't get this and Hospitals and Insurance companys like it that way. All Insurance Sales is based in FEAR. So again show us where the Insurance [Medicare and Supplement] actually paid 100k total NOT the Bill from Hospital and Doctor. You can find out what I am talking about with minimul research [most don't bother] also you can find out what Medicare actually on your Medicare Page online and Medigap claims page.

0 Kudos
26,814 Views
0
Report
Social Butterfly


@alexiss12 wrote:

 

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. 


@alexiss12 

There was NO “monies”….”taken out of Medicare” NO “benefit cuts” because of Obamacare. This was disingenuous teaparty propaganda spread to discredit the ACA.

 

Obamacare achieved $716 billion Medicare savings through reduced physician and provider reimbursements. Just one example it required Durable Medical Equipment (DME) providers to be contracted with CMS to get paid from Medicare which helped to reduce a lot of fraud among the many DME providers. Waste and fraud were cut not benefits.

 

 Obamacares gave all Medicare beneficiaries, no cost preventative care and the gradual closing of the “donut hole for part D.
There were NO benefit cuts.
There were no “monies”…..“taken out of Medicare”.

19,748 Views
1
Report
Gold Conversationalist


@ReTiReD51 wrote:

@alexiss12 wrote:

 

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. 


@alexiss12 

There was NO “monies”….”taken out of Medicare” NO “benefit cuts” because of Obamacare. This was disingenuous teaparty propaganda spread to discredit the ACA.

 

Obamacare achieved $716 billion Medicare savings through reduced physician and provider reimbursements. Just one example it required Durable Medical Equipment (DME) providers to be contracted with CMS to get paid from Medicare which helped to reduce a lot of fraud among the many DME providers. Waste and fraud were cut not benefits.

 

 Obamacares gave all Medicare beneficiaries, no cost preventative care and the gradual closing of the “donut hole for part D.
There were NO benefit cuts.
There were no “monies”…..“taken out of Medicare”.


Retired is correct. There was no money "taken out" of the Medicare trust funds by the Patient Protection and Affordable Care Act (PPACA) of 2010 as amended. What PPACA did was direct that the Centers for Medicare and Medicaid Services (CMS) spend a large percentage less on acute care hospital benefits, skilled nursing facility (SNF) benefits, and home health care benefits than CMS otherwise would have if PPACA had not been passed. The number that hospitals, SNFs and the VNA will not get equalled around $400 Billion for the years 2011 to 2020 and will equal close to a trillion dollars for the years 2018 to 2027.

 

The money did not go anywhere. It stayed in the Medicare Part A Trust Fund. But absolutely crazy government accounting rules let Congress say that the money was "saved," thereby allowing the Congress to pass PPACA under reconciliation (meaing it could not be filibustered even though a Republican had won Ted Kennedy's Senate seat taking away the Democrats' previous filibuster proof margin in the Senate).

 

The theoretical effect on people on Medicare is that hospital, SNF and VNA services got worse in proportion to the amount their income was cut. Some people (reasonably in my opinion) claim this theoretical poorer service at hospitals, SNFs and by the VNA to be a benefit cut.

 

-- The DME example given by Retired was small potatoes.

-- A few additional preventive tests were moved from the category of having a co-pay to having no co-pay (but race, age and frequency limitations were added). This benefit was smaller than small potatoes because the major preventive service used by people on Medicare, by a wide margin, is a flu shot and that has been available without a co-pay since the Bush administration - Bush 41

-- The slow reduction of the co-pay for the relatively few people affected financially by the donut hole has simply moved drug policy premium and drug co-pay costs on to the 80% of us that were never affected by the donut hole and the 15% of us who enter the donut hole but whose donut hole expenses were/are paid for by Medicare, Social Security (but even that's really Medicare), state pharmacutical assistance programs, Medicaid, and donut hole insurance riders either bought individually or received as a perk for former employment 

24,260 Views
0
Report
Honored Social Butterfly


@alexiss12 wrote:

After reading some of the complaints of AARP supplemental plans not paying for things like Whooping Cough vaccinations, I am amazed at how many new enrollees (or maybe even ones who have had the ins for a while) don't understand how Supplemental Insurances work. It is Medicare that decides what is approved, how much to charge and then the Supplemental coverage like Plan F pays the difference since Medicare will pay 80% and the rest is the responsibilty of the indivdual (therefore the ins covering the 20%).

 

Plus this is the key which is apparant is not understood.  MEDICARE DOESN'T APPROVE EVERYTHING LIKE THE WHOOPING COUGH OR SHINGLES VACCINE. It would be very smart before one gets such vaccines to ask if Medicare covers the shots, procedures etc.

 

 


Yes, I find it rather concerning to read some of the post here about just basic stuff.

I also find that sometimes when a question is asked they do not identify how they are getting their Medicare Benefit - original Medicare or Medicare Advantage.

It makes a difference in how things are covered - Medicare Advantage plans cover the same thing as original Medicare, just in a different way.

 

Actually, Medicare does specify which "shots" are covered based on the recommendation from the CDC on this age group.  However, they ALSO specify which "part" of Medicare covers different ones.

Part B or Part D - special conditions of the individuals' health might even change this on some vaccinations/immunizations.  You are right, it is Best to look up each one on Medicare.gov or call Medicare on the one you are getting to find how the how, when and where so you are assured of proper coverage. 

 

If the "shot" is covered by Part D - your prescription drug coverage - normally, unless there is a specific health condition, you do not want your doctor to give it cause he does not file prescription drug coverage claims - the pharmacist does.

 

Yes, for those with original Medicare - Medicare (CMS) controls the prices of Part A and Part B services as long as you are using a provider that accepts assignment or can bill Medicare - If they don't accept assignment, they may balance bill you or bill you for the whole amount and then for the later you have to file a claim with Medicare to recoup the amount Medicare would have paid - which will not be the total amount even if you have supplemental (Medigap) coverage too.

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
19,621 Views
0
Report
Honored Social Butterfly


@Roxanna35 wrote:

Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 


Here is some more info on the application for Medigap coverage from Medicare 

 

 Medicare.gov - Buying your Medigap policy

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
19,753 Views
0
Report
Honored Social Butterfly


@Roxanna35 wrote:

Gail!!!!!!!  I just want to see the eligibility questions. for a Supplemental. or are they secret to the general public?  just the questions Gail  just the questions.? 


These are private companies so there is no reason why the general public has to have access.  Medigap policies are sold by area to a select group of people - not the general public.

 

Do like john258 said and contact an independent agent in your area and he probably has access to all the insurers in your area that offer a Medigap policy.

 

There are qualifiers -

age and/ or other access to Medicare

original Medicare - Parts A and B

your status as an enrollee - Medigap Open enrollment period or Guaranteed issue rights - if neither, you health history and probably the right to get some medical records.

 

There Are also things that are illegal -

Medicare.gov - Illegal Medigap Practices

 

Why is what's on the application so important to you ?

 

Like I said, you are not being denied Medicare - you have Medicare.

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
19,720 Views
0
Report
Honored Social Butterfly

AARP and UHC have an affiliation agreement.  No big secret there.

Same is true of their other affiliates.

As the Medicare link says additional benefits can also be added and these, if any, have to be weighed against a person's needs and cost.

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
32,316 Views
3
Report
Regular Contributor

NO...their Medicare Supplements are FANTASTIC.  Even docs comment on how great our insurance is.  It is the ADVANTAGE plans that have had problems...NOT the Supplements.  But even the Advantage plans are upgrading and more and more doctors and hospitals are now taking them again. 

25,805 Views
2
Report
Newbie

Yes, it is. They gladly collect a premium and delay paying even a one-night stay claim.They'll ask for multiple examples of itemized bills and never pay. Avoid it-it's a waste of money and only will aggrivate you.

0 Kudos
25,037 Views
1
Report
cancel
Showing results for 
Show  only  | Search instead for 
Did you mean: 
Users
Need to Know

"I downloaded AARP Perks to assist in staying connected and never missing out on a discount!" -LeeshaD341679

AARP Perks

More From AARP