Medicare Advantage

[RuthM940163]

Why is there not somewhere you can call for general information on a plan you are interested in without having to give your personal information.  If you don't like the plan after getting the information and want to check out another one, just think how risky this is to keep giving out your personal information to a sales person you don't know.  This is not good for members.  You should be able to ask general questions, even specific one about the various plans without first having to divulge personal information.  When I refuse to give it, the person just hangs up on me.  I have some general questions about a plan I may be interested in.  Who can I call just for answers ONLY.

[somarco]

As others have mentioned, you CAN call 800-MEDICARE.

But you are talking to a contract worker through a General Dynamics subsidiary.

https://www.gd.com/Articles/2019/06/21/general-dynamics-awarded-cms-benefits-coordination-and-recove...

You are NOT talking with Medicare.

These reps can answer general questions with a modicum of knowledge, but depending on the complexity of your question, you may not get the answers you want or need.

And like many "customer service" centers, you can call 3x and get at least 3 different answers to the same question.

Good luck!

[EliteInsPartners]

You're calling private carriers that are for-profit, not Original Medicare that's funded by the federal government. You can call Medicare or CMS, and they will not ask for any personal information. That is not the way it works with Medicare Advantage carriers. That's the difference between contacting a federal employee vs a licensed agent. If you want information on a specific Medicare Advantage plan, you can try to Google it first. If you can't find what you're looking for, then the only other option is to speak to a licensed agent who will request some personal information. Which yes, as @GailL1  stated, is needed to give you accurate information.

[GailL1]

Medicare Advantage plans and their insurers are PART of Medicare -  they are also funded from Federal Medicare funds.  They are paid a per beneficiary amount by Medicare; in fact, they are paid more for those that might be sicker.  If the MA plan is even more rich in design, you pay a premium.  

They actually make their profit in this area by controlling medical cost better than original Medicare - not by denying services cause they have to cover everything that Medicare covers; just in a different way.

They control cost by many of the same methods that other countries use, that private and employer plans use, including FEHB,  to control their cost - (some examples)

• having copays, coinsurance and deductibles
• having to have a referral to a specialist
• working with network of providers
• utilizing a step type therapy in some disease treatments or management

Sure the would like to have your business but the plans are pretty straight-forward and plus they can offer other benefits to beneficiaries that original Medicare does not cover.  Some offer Dental /Vision / Hearing - some even offer other benefits that are more beneficiary-need based.

I did not know that Medicare or CMS answered questions from consumers about Medicare Advantage plans - thought at the Medicare.gov -  "FIND A PLAN" pretty much covered that information.

I like LOCAL Medicare Insurance Brokers - they write for many different companies and all types of Medicare plans and their knowledge of the Medicare system is usually superior - they also can help you if you hit a snag - cause they are local to you and not a big bureaucracy.

States have a division called SHIP (State Health Insurance Programs) - these are usually volunteers that can answer questions about Medicare plans in their state, since many things are regulated by the various states in some Medicare plans.  I find these folks try hard BUT sometimes their knowledge is very lacking.

[EliteInsPartners]

Given your knowledge and background, I'm curious about what your opinion/thoughts are on the 30 billion Medicare Advantage carriers have overbilled Medicare over the past 3 years. I know this is not new information, just something I wanted to get other experts' feedback on since you said "they actually make their profit in this area by controlling medical cost better than original Medicare."

[GailL1]

@EliteInsPartners 

This really isn't the thread to get into such a deep discussion - might be better to start a new thread if you want to get into the specifics of how Medicare (government) works.

I will only say that when the Federal government or any level of government develops a program; in this case, Medicare Advantage or Medicare Part C, they design it to meet their specifics and should put in all the checks, balances and reporting they need to make the program work as they have intended it to work.  They control it, they audit it, they are the authority.

With that said - Medicare (government), in this instance, also has to pay these private Medicare Advantage insurance provider enough in total to keep the program working as it should. 

So whether they are paying them

• the correct capitulated cost per beneficiary based on the annual bidding process by area - because healthcare cost are higher in some places than another or
• the correct added amount for those that are sicker  and how these sicker are identified and documented by the insurer
• the correct amount for the plans star rating bonus

It is all up to Medicare (government) to make all these things work as they were intended to work in the program.  They are not only the payer but they are also the controller of the program. 

Over the years, the payment methodology has been modified to achieve different policy goals .  This isn't any different.  The big think is to keep this part of Medicare - Medicare Advantage - working because it works for many beneficiaries - it works for their pocketbook and it works for their healthcare. 

Every year, more and more beneficiaries are deciding to go this route rather than original Medicare.  I think this will continue as long as everybody continues to be happy - beneficiaries who choose MA plans and the Medicare Advantage insurers.

The problem you are speaking about here - is just logistics and it is up to Medicare (government ) to fix it without adversely affecting the overall scope of the Medicare Advantage program. No different than any other government/private industry partnership cause it has to work for both entities to be overall successful.

[EliteInsPartners]

Thank you so much for your detailed response! This is great information. 

[GailL1]

RuthM940163 

What sort of general questions do you have about specific plans?

They have to know your state (zip code) because Medicare Advantage plan are area specific - they have providers that are built by area for their network coverage.

Medicare.gov plan finder for Medicare Advantage Plans will help you find the ones available in your area - but they will also want to know if your get any extra help - because that also makes a difference in the plan that you are eligible for -

Medicare.gov - FIND A 2021 MEDICARE PLAN 

OR  Medicare.gov 

They do ask you to create an account for your best selection experience.

OR just for that "general" info about Medicare Advantage  - you can go to

Medicare.gov - Medicare Advantage Plans 

Again WHAT KIND OF GENERAL INFO ARE YOU LOOKING FOR?

Is it an AARP UHC Medicare Advantage plan that you are looking at or another company that services your area?