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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 341 of 638

@NancyR150749

Our healthcare insurers - including Medicare, Medicaid, CHIP or even the VA Health System does not run by "should be"   a preventive measure available to all Medicare Part B participants.

 

It has to be proven by a scientific method and then the cost of it has to outweigh the cost of not having it and whatever results both ways.  That is what determines best practices for anything.  Healthcare is no different.

 

So then there has to be a change to  MEDICARE - put your fight where it really would count for all beneficiaries - doubt it would make a difference but that is based on the financial problems of Medicare.  I am sure they would love to add it, dental and vision too, if they could afford it - but somebody has to pay - Want your Part B premiums to go up even more than they already do?

 

OR join a Medicare Advantage plan where this sort of extra coverage is part of the overall concept.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 342 of 638

@ChristineS148307 wrote:

Maybe I missed it, but I don't see anywhere that someone has argued that those without a Medigap plan should not get the Silver Sneakers benefit!  This is simply people who already have the benefit of Silver Sneakers lamenting that they will lose it.  You are creating a false narrative! 

 

 


That is exactly what you and others are saying when you vie for these extra programs in a Medigap plan.  The place for these extra programs is in a Medicare Advantage Plan - where you can pick and chose the plan that meets your needs and wants - that is the place for these extra benefits.

 

Traditional Medicare provides coverage for a wide array of medical and (Part B) drug benefits, but, with its deductibles, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, many people on Medicare purchase Medigap supplemental insurance to help cover their out-of-pocket costs - That's it - the purpose of this GAP insurance..  When these extra programs are mixed within a Medigap plan, which have very specific plan coverage for the gap, the cost for all seniors having them is escalated under that insurer.  You don't really believe that you get something for nothing, do you?  From a private insurer???

 

Medigap plays a major role in providing supplemental coverage for people in traditional Medicare, particularly among those who do not have an employer-sponsored retiree plan or do not qualify for cost-sharing assistance under Medicaid. Medigap helps beneficiaries budget for out-of-pocket expenses under traditional Medicare. Medigap also limits the financial exposure that beneficiaries would otherwise face due to the absence of an out-of-pocket limit under traditional Medicare.

 

Traditional Medicare should be a place where everybody has the same coverage, paid in the same way, with the same rules about what is covered and what is not - it is a government ran healthcare system - there is no choices within it - it is dictated.  I don't care if people buy a Medigap to cover their own GAP in coverage if they can afford one.  It is these extra benefits being included within the Medigap coverage that I have a problem with - especially when it is billed as "free" - and for which all of you seem to have taken up arms.

 

Some are saying that it is preventive care - well it is not sanctioned preventive care by Medicare.

Some say UHC had no right to cancel it - well on all the paperwork I have seen it plainly states that these benefits can be cancelled at any time - fitness, dental, vision.

 

Federal law requires Medigap plans to be standardized to make it easier for consumers to compare benefits and premiums across plans. Adding these extra programs to some Medigap plans takes away this standardization.

 

Medigap is not subject to the same federal guaranteed issue protections that apply to Medicare Advantage and Part D plans, with an annual open enrollment period. As a result, in most states, medical underwriting is permitted which means that beneficiaries with pre-existing conditions may be denied a Medigap policy due to their health status, except under limited circumstances.

Evidently this isn't happening since so many of those commenting here don't seem to have a problem changing plans without a guaranteed issue circumstance.

 

If you want extra programs within your Medicare benefit - then pick the type that can offter the extra programs - GAP insurance is not the place for extra programs OR change Medicare rules so that it is medically necessary and then EVERY beneficiary can get the same shot at it improving their health with the comraderie that goes along with it.  Then the Medigap insurers would pick up all beneficiaries out of pocket for such a service.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 343 of 638

But gym memberships should be a preventive measure available to all Medicare Part B participants.  I am 65, and not overweight or obese and do not have additional cardiovascular disease (CVD) risk factors.  I exercise regularly in a gym and eat healthy.  I take these proactive steps to maintain my good health.  Behavioral counseling should also be available to all Medicare Part B participants, as some folks need motivation/help to adopt healthy lifestyles.  Prevention measures are far less expensive than costly medical procedures and pharmacetical drugs!

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 344 of 638

But gym memberships should be a preventive measure available to all Medicare Part B participants.  I am 65, and not overweight or obese and do not have additional cardiovascular disease (CVD) risk factors.  I exercise regularly in a gym and eat healthy.  I take these proactive steps to maintain my good health.  Behavioral counseling should also be available to all Medicare Part B participants, as some folks need motivation/help to adopt healthy lifestyles.  Prevention measures are far less expensive than expensive medical procedures and pharmacetical drugs!

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 345 of 638

GaiL1 - why do you keep accusing people of being discriminatory against those who don't have a Medigap plan? 

 

"If a senior cannot afford the premiums of a Medigap (Medicare Supplemental) plan at all - aren't you being rather discrimatory - this senior gets the benefit because they have a Medigap plan while this other (poorer) cannot afford a plan." 

 

Maybe I missed it, but I don't see anywhere that someone has argued that those without a Medigap plan should not get the Silver Sneakers benefit!  This is simply people who already have the benefit of Silver Sneakers lamenting that they will lose it.  You are creating a false narrative! 

 

While one can certainly explore the whys, wherefores and fairness (or not) of the differences in plans/options/affordability, etc., that is a different issue and belongs on a different topical thread.  It is a worthy debate but you are creating it yourself and I don't see anyone arguing with you about the unfairness of the plan differences.  That's not what this is about despite your attempts to change the subject.

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 346 of 638

@ChristineS148307

 

Not condesending and not lecturing - just stating the truth and I will continue to say it.

 

 

The share of all Medicare beneficiaries with Medigap coverage varies widely by state—from 3 percent in Hawaii to 51 percent in Kansas in 2016 (Figure 3, Appendix Table). In 20 states, at least one-quarter of all Medicare beneficiaries have a Medigap policy. States with higher Medigap enrollment tend to be in the Midwest and plains states, where relatively fewer beneficiaries are enrolled in Medicare Advantage plans

 

 

Potential medical conditions for which a Medigap Insurer may deny coverage
without guaranteed issue protections

 

  • ALS (Lou Gehrig’s Disease)
  • Alcohol/drug abuse
  • Alzheimer’s disease or other dementias
  • Chronic lung/pulmonary disorders (e.g. chronic bronchitis, COPD, cystic fibrosis)
  • Cirrhosis
  • Congestive heart failure
  • Diabetes (insulin dependent)
  • Emphysema
  • End Stage Renal Disease (ESRD)
  • Fibromyalgia
  • Heart disease
  • Hepatitis
  • Immune disorders (e.g. RA, MS, Lupus, AIDS)
  • Kidney disease requiring dialysis
  • Mental/nervous disorder
  • Myasthenia gravis
  • Organ transplant
  • Osteoporosis (if severe/disabling)
  • Stroke
  • Advised by a physician to have surgery, medical test, treatment, or therapy
  • Implantable cardiac defibrillator
  • Use of supplemental oxygen
  • Use of nebulizer
  • Asthma requiring continuous use of 3+ medications including inhalers
NOTE: Uninsurable health conditions vary by plan. This list is not an extensive list of all possible conditions/reasons for denial.

SOURCE: Kaiser Family Foundation collection and analysis of numerous insurance companies’ 2016-2017 Medicare supplemental underwriting manuals/guides.

 

see more at the link:

https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-sta...

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 347 of 638

@johngraves01

So if the benefit of a fitness program or health and fitness program for ALL seniors is scientifically proven as a preventive measure, why does Medicare not cover it under Part B? 

That's all I am saying - because if it is a valuable preventive care - then everybody should have it, right?  Not just the ones that have access to a Medigap plan that offers it as an extra program.

 

This is the only preventive protocol which is covered under this health and fitness heading - as you can see it does NOT cover everybody and it does not recommend an action other than behavioral counseling interventions.

US Preventive Service Task Force: Healthful Diet and Physical Activity

 

reference the link for all the details. 

Final Recommendation Statement Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling

Recommendation Summary
 
Summary of Recommendation and EvidencePopulation Recommendation  - Grade   B
Adults who are overweight or obese and have additional CVD risk factors

The USPSTF recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.

 

 

If a senior cannot afford the premiums of a Medigap (Medicare Supplemental) plan at all - aren't you being rather discrimatory - this senior gets the benefit because they have a Medigap plan while this other (poorer) cannot afford a plan.  Not all beneficiaries of Traditional Medicare can afford a Medigap plan - some just pay their 20% and deductibles out of pocket and keep down their medical cost.  Others with very low income are supplemented with Medicaid - sure doubt if Medicaid furnishes fitness programs.

 

If this program is important to you, it is available in many Medicare Advantage plans - don't like the plan offering in a particular year - you are free to change your Medicare Advantage plan during the annual open enrollment to whichever one has what you want.

WOW - Just look at what they are offering in 2019 - Avalere Press Release on 2019 Medicare Advantage...

As a result of additional flexibilities granted to Medicare Advantage plans by CMS, Medicare beneficiaries will have access to new types of supplemental benefits through Medicare Advantage,”  “Our research finds that almost half of all Medicare Advantage plans will offer new types of supplemental benefits in 2019.”

 

Supplemental benefits are additional services offered by MA plans that are not covered under Medicare Part A, Part B, or Part D,

 

Beginning in 2019, MA plans are permitted to cover a broader array of items and services as supplemental benefits so long as they are used to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency department visits. Previously, many of these services designed to improve patients’ day-to-day lives could not be covered as supplemental benefits under Medicare.    

 

Some higlights of a selection to be offering from various MA plans in 2019

  • At least 40% of plans will offer new types of supplemental benefits, such as nicotine replacement therapy (NRT), at no additional cost to beneficiaries. 
  • transportation to physician visits,
  • coverage of over-the-counter drugs,
  • adult day care services,
  • and other supplemental services that promote beneficiary health and wellness. 
  • caregiver support services (e.g., counseling and training courses for caregivers).
  • Other supplemental benefits offered for the first time include in-home support & personal care services,
  • home safety devices & modifications (e.g., shower stools, mobility ramps, night lights, etc.)  
  • social worker phone line,

 

 
* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 348 of 638

You've got that right.  AARP/UHC has reduced benefits (i.e. Silver Sneakers) while increasing their rates for 2019.  This has pushed me into looking for another gap plan, from another insurer.  There is one more point that the moderator (and AARP/UHC) seem to be missing: Silver Sneakers (i.e. going to the gym and working out) is PREVENTATIVE health care. You strenghten your heart, and can work on strengthening your ankles and knees.  By doing so, you can help retain balance and the possibility of falls.  It costs UHC a lot more to cover Part B overages for broken limbs (or worse) than it does to cover a subscriber's gym membership!  Just like going to the dentist and having your teeth cleaned helps maintain oral health, going to the gym helps keep the rest of the body working properly. Many gyms also offer nutrition classes, yoga, and other classes that help keep Seniors healthy.  That's what the Silver Sneakers program accomplishes. That reduces the cost of healthcare for everyone. 

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 349 of 638

Wow, I've been watching all these posts and observe GaiL1's posts becoming more and more condescending to those complaining about losing Silver Sneakers.  I would respond only for myself that I, too, am unhappy with the way this went down-they were NOT as forthcoming about their plans when they should have been.  I too, realize that there is no guarantee that I will get Silver Sneakers forever.  I, too, got my insurance with AARP/UHC because of the Silver Sneakers offering.  I do NOT think it is free.  I know that I paid a higher in premium because of that benefit.  But now they are taking that benefit away AND increasing my premium at the same time.  Please spare me your lecture on how the various insurance plans work and your inability to understand why people are unhappy.  I get all of that.  I'm more unhappy at the tone of your emails that imply that the rest of us are morons and selfish, of which I am neither.

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 350 of 638

We have all of the above for preexisting.

lobbying is a good idea but I doubt any expansion under the current administration. 

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