Perhaps ALL those added benefits are gonna bite the dust - SOON

[GailL1]

  I found this article to be very interesting from the Medicare Advantage viewpoint to the Medicare Supplemental (Medigap) viewpoint.  

NCHealth News - 12/06/2024 - Medicare Advantage is popular with NC seniors, but the program has come... 

  Maybe we just need to get back to the basics of Medicare - 

• only cover what is deemed to be covered by Medicare (CMS) [medicslly necessary].  No more gym memberships of whatever type - premium or sub-premium or ground roots.  No more dental, vision or hearing coverage.  Got a problem with this coverage - change the law.  No more OTC benefits or Part B premium rebates, unless one is approved for a Medicare Savings Program.
• no more Medigap coverage unless it comes with an adequate high deductible - perhaps like the High Deductible plans - < $ 2800 or so.  No more 1st dollar coverage or even after the Part B deductible.  Coverage is the same, deductible would be the same - or perhaps we could have one where the deductible is higher to give some options.  
• Medicare Advantage plans would have to end their negotiations with providers and services to be NO LOWER than what Traditional Medicare pays.  This should help keep providers in their networks.  
• Medicare Advantage plans can also work with a disclosure form like Traditional Medicare uses - The Advance Beneficiary Notice of Non-Coverage.   Medicare.gov - Your Protection 
• If either Medicare Advantage or TraditionalNo more  Medicare determine a need for prior approval, it should go to an unbiased 3rd party for consideration - the denier should present the medically unnecessary evidence of coverage best practices with the denial request.  Same would be true of ending a Rehab session earlier than the plan of care calls for - and yes, there should be a written plan of care included, signed by the patient or their designate when admitted for rehab.  
• Personally I am a fan of managed care - it has always served me well and kept down my medical cost and for those of other to whom I had oversite.  I believe that we should have to have a referral from our primary care physician to see a specialist if they so deem it to be necessary.  A lot of stuff one’s personal care physician can handle and if they see the need for a referral, they can get you in to see the referred specialist faster.  So we should do away with self-referrals.  But on the other hand, a person should be able to pick their own personal care physician and since we have a shortage, we should be able to get a specialist who agrees to act as our personal care physician but in those instances where they are only performing what a PCP does, that is what Medicare will pay them for this service - not their special rate.  

Here’s my beginning list - add to or discuss any of them - I am all ears.

[SpringIsHereVA]

[Wednesday 3/5/25] @GailL1 , I finally made time to read your post.

Having gym memberships, eye and dental was wonderful but I do understand WHY they are going away. Costs.

Personally I now make sure to walk every day and floss. Two things I had been VERY LAZY about, but has PROVEN to work.  👍

As MORE goes away, it will be up to us to find ways to STAY HEALTHY is my very humble opinion.

Great discussion as usual.

Take care,

Nicole  👵

---

[*** @GailL1 wrote:

  I found this article to be very interesting from the Medicare Advantage viewpoint to the Medicare Supplemental (Medigap) viewpoint.  

NCHealth News - 12/06/2024 - Medicare Advantage is popular with NC seniors, but the program has come... 

  Maybe we just need to get back to the basics of Medicare - 

• only cover what is deemed to be covered by Medicare (CMS) [medicslly necessary].  No more gym memberships of whatever type - premium or sub-premium or ground roots.  No more dental, vision or hearing coverage.  Got a problem with this coverage - change the law.  No more OTC benefits or Part B premium rebates, unless one is approved for a Medicare Savings Program.
• no more Medigap coverage unless it comes with an adequate high deductible - perhaps like the High Deductible plans - < $ 2800 or so.  No more 1st dollar coverage or even after the Part B deductible.  Coverage is the same, deductible would be the same - or perhaps we could have one where the deductible is higher to give some options.  
• Medicare Advantage plans would have to end their negotiations with providers and services to be NO LOWER than what Traditional Medicare pays.  This should help keep providers in their networks.  
• Medicare Advantage plans can also work with a disclosure form like Traditional Medicare uses - The Advance Beneficiary Notice of Non-Coverage.   Medicare.gov - Your Protection 
• If either Medicare Advantage or TraditionalNo more  Medicare determine a need for prior approval, it should go to an unbiased 3rd party for consideration - the denier should present the medically unnecessary evidence of coverage best practices with the denial request.  Same would be true of ending a Rehab session earlier than the plan of care calls for - and yes, there should be a written plan of care included, signed by the patient or their designate when admitted for rehab.  
• Personally I am a fan of managed care - it has always served me well and kept down my medical cost and for those of other to whom I had oversite.  I believe that we should have to have a referral from our primary care physician to see a specialist if they so deem it to be necessary.  A lot of stuff one’s personal care physician can handle and if they see the need for a referral, they can get you in to see the referred specialist faster.  So we should do away with self-referrals.  But on the other hand, a person should be able to pick their own personal care physician and since we have a shortage, we should be able to get a specialist who agrees to act as our personal care physician but in those instances where they are only performing what a PCP does, that is what Medicare will pay them for this service - not their special rate.  

Here’s my beginning list - add to or discuss any of them - I am all ears. ***]

---

[CarolynBI]

I am glad you can afford $2500 a year for the deductible. On top of $2000 for med. On top of around $450/mo for all my premiums (B, G, D) I can't. I have medigap G and I am willing to pay more now so that if I need care I can afford the care at the time I need it. Many places cut off care if you can't pay your bills in a timely manner and then sue you. I sure can't afford nearly $10,000 a year (premiums plus D max out of pocket plue  the out of pocket/deductible you suggest.  If I need to use my heath care more than minimally. I'd end up homeless. Or be banned from the health care system for failure to pay in a timely manner. I certainly am not going to sign up for an advantage plan as I don't live in an area with much choice for health care and all of it here is bad - mostly joint commission D rated, one is C-. I have to travel to get better health care for some things and some of the places I use like MD Anderson Cancer Center doesn't accept most advantage plans. That just isn't affordable for many of us. Apparently your point of reference is not the same as someone who has coming in less than 200% of the poverty line. You may not understand the reality of that and some of the choices we need to make between needs and needs to make sure we break even each month. We'd have to do without  some of our health care, or housing...