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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 1 of 17

Gee,  are my posts so obscure that they are so difficult to understand?

I wanted to  go from an MA to a supplemental but didn't qualify because of my Macular degeneration. 
I understand that they consider that a pre-condition, (which I don't happen to agree with that) But have to accept it.
and yes, I will go down on the insurance agencies because they are what  I  have said they are.
Now going back to my own actions:   have been speaking to an agent and now seeking coverage just for the days that my MA doesn't cover which are the first 6 days of hospitalization. and that in a way will extend my own coverage. without going to a Supplemental.
So you now can continue to argue with   each other and I will find out in the meanwhile how much will I have to pay for that coverage and let anyone here know if they are interested.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 2 of 17

GailL1 wrote:

john258 wrote:

rker321 wrote:

Gail  you are saying that my MA doesn't cover me if I need hospice services?
I am now in contact with an agent to actually obtain insurance for the amount of copay, that I have in case of a hospitalization which is in my plan 6700.00 and then I am covered 100%
Due to my macular degenerations I cannot apply for a supplemental but I am trying to see as to homw much insurance I can buy to save my assets.
In a way, is a round about way of being covered almost 100% without having a Medigap.


You are now seeing why I tell all. Never take advice on what type of coverage you need from anyone in here. Go to the local expert and if possible see the Insurance agent after that. Your state might offer the service (mine does), or local agency in your city or town. AARP should be able to give you some places to go (state or local office). Two years ago we went through what you are talking about with my sister. Her son is a lawyer and he was able to get her into long term care and protect her assets. There are a lot of state and local laws and regs to be used you just need the right person who knows them for your area. Get the advice and help you need for your area I am sure there are people near you who would love to help. That can not happen from posters in here.


I don't believe you have followed rker321 's post in this thread and therefore you do not understand what she is talking about - she isn't trying to get into a nursing home and thus does not have to find a lawyer to help hide her assets so some other taxpayer sucker can pay for her days in a nursing home. -

 

But actually she is doing exactly like you said - seeing a local health insurance agent to sell her some type of plan to cover her deductible and copays which she has to pay in her Medicare Advantage plan. 

 

She wanted to switch from Medicare Advantage plan to Original Medicare and buy a supplemental (Medigap) policy - but she has no more guaranteed rights and they have denied her application for a supplemental plan.  She doesn't want to go back to original medicare without a supplemental plan.

 

So now she is looking into this other type plan with her local expert. ?????????????????????????????????????????????????????????????????????

 

rker321 - again just FYI

CBS Moneywatch 08/2017 - Big changes expected in many 2018 Medicare Advantage plans


Now another article. How sad.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 3 of 17

john258 wrote:

rker321 wrote:

Gail  you are saying that my MA doesn't cover me if I need hospice services?
I am now in contact with an agent to actually obtain insurance for the amount of copay, that I have in case of a hospitalization which is in my plan 6700.00 and then I am covered 100%
Due to my macular degenerations I cannot apply for a supplemental but I am trying to see as to homw much insurance I can buy to save my assets.
In a way, is a round about way of being covered almost 100% without having a Medigap.


You are now seeing why I tell all. Never take advice on what type of coverage you need from anyone in here. Go to the local expert and if possible see the Insurance agent after that. Your state might offer the service (mine does), or local agency in your city or town. AARP should be able to give you some places to go (state or local office). Two years ago we went through what you are talking about with my sister. Her son is a lawyer and he was able to get her into long term care and protect her assets. There are a lot of state and local laws and regs to be used you just need the right person who knows them for your area. Get the advice and help you need for your area I am sure there are people near you who would love to help. That can not happen from posters in here.


I don't believe you have followed rker321 's post in this thread and therefore you do not understand what she is talking about - she isn't trying to get into a nursing home and thus does not have to find a lawyer to help hide her assets so some other taxpayer sucker can pay for her days in a nursing home. -

 

But actually she is doing exactly like you said - seeing a local health insurance agent to sell her some type of plan to cover her deductible and copays which she has to pay in her Medicare Advantage plan. 

 

She wanted to switch from Medicare Advantage plan to Original Medicare and buy a supplemental (Medigap) policy - but she has no more guaranteed rights and they have denied her application for a supplemental plan.  She doesn't want to go back to original medicare without a supplemental plan.

 

So now she is looking into this other type plan with her local expert. ?????????????????????????????????????????????????????????????????????

 

rker321 - again just FYI

CBS Moneywatch 08/2017 - Big changes expected in many 2018 Medicare Advantage plans

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 4 of 17

rker321 wrote:

Gail  you are saying that my MA doesn't cover me if I need hospice services?
I am now in contact with an agent to actually obtain insurance for the amount of copay, that I have in case of a hospitalization which is in my plan 6700.00 and then I am covered 100%
Due to my macular degenerations I cannot apply for a supplemental but I am trying to see as to homw much insurance I can buy to save my assets.
In a way, is a round about way of being covered almost 100% without having a Medigap.


You are now seeing why I tell all. Never take advice on what type of coverage you need from anyone in here. Go to the local expert and if possible see the Insurance agent after that. Your state might offer the service (mine does), or local agency in your city or town. AARP should be able to give you some places to go (state or local office). Two years ago we went through what you are talking about with my sister. Her son is a lawyer and he was able to get her into long term care and protect her assets. There are a lot of state and local laws and regs to be used you just need the right person who knows them for your area. Get the advice and help you need for your area I am sure there are people near you who would love to help. That can not happen from posters in here.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 5 of 17

rker321 wrote:

Waait  guys,  what this agent is proposing is not to get rid of my copayments, but only to cover my first 6 days of a hospitalization. 
Apparently there a those insurances, but will find out a lot more next week.
After reading all the links provided, I have one word for all the Insurances  "THOSE BASTARDS"
They should all be buried in the deepest ocean that we can find.
No wonder they don't want any government to actually study what other countries have done, It would not be beneficial to them.

But, like I have said and wil say it again. We, finally have the government that we deserve.


Well, rker321, that is a completely different explanation about what your agent is offering than what you gave before.

 

Why would you be coming down on the insurance industry - it is like any other vendor, it offers products and the consumer has the choice of buying or refusing.

Some things have value;'some things don't.

 

I guess you should do like john258'said and seek local help and make your decisions based on your understanding and value to you.

 

Good Luck - may the force be with you.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 6 of 17

Waait  guys,  what this agent is proposing is not to get rid of my copayments, but only to cover my first 6 days of a hospitalization. 
Apparently there a those insurances, but will find out a lot more next week.
After reading all the links provided, I have one word for all the Insurances  "THOSE BASTARDS"
They should all be buried in the deepest ocean that we can find.
No wonder they don't want any government to actually study what other countries have done, It would not be beneficial to them.

But, like I have said and wil say it again. We, finally have the government that we deserve.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

130 Views
Message 7 of 17

GailL1 wrote:

john258,

 

You are talking about the standard payment model which is completely different than the "Risk-Adjustment" system of payment from Medicare to Medicare Advantage plans.  

 

This explains it further

 

According to the American Academy of Actuaries, “[h]ealth risk adjustment is the process of adjusting payments to organizations (usually health insurance plans) based on differences in the risk characteristics of people enrolled in each plan.”

 

By adjusting payments to compensate organizations for the relatively higher medical costs associated with an ill individual, plans should, all other things being equal, be indifferent between enrolling the sicker person or the relatively healthier one.

 

Medicare Advantage (MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under MA, private health plans are paid a per-person amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll in their plan. The Centers for Medicare & Medicaid Services (CMS) risk adjusts the payments to MA plans. The size of the adjustment depends on the demographic and health history of each plan enrollee. The payment adjustment takes into account the severity of a beneficiary’s illness, the accumulated effect of multiple diseases, as well as interactive effects—instances where having two or more specified diseases or characteristics results in expected health care expenditures that are larger than the simple sum of the effects. The payments are not adjusted for short-term illnesses because they are assumed to be poor predictors of future health spending.

 

Congressional Research Service - Medicare Advantage Risk Adjustment. March 2012

 

You might recall that recently UHC being called upon to justify how they were assigning their risk adjustment beneficiaries to Medicare.

 

Modern Healthcare 02/2017 - DOJ joins Medicare Advantage fraud lawsuit against United Health

 

 

 

 

 

 


I understand your first post but it makes no sense in here as most will not. Look at the reply right after you. That person now needs local help to clear up what you posted. My post was to try and clear up the mess you caused with detail that means nothing, but makes you feel good. Keep your posts in the real world so that people will not get confused and could be hurt if they follow what they think you tell them.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

130 Views
Message 8 of 17

rker321 wrote:

Gail  you are saying that my MA doesn't cover me if I need hospice services?
I am now in contact with an agent to actually obtain insurance for the amount of copay, that I have in case of a hospitalization which is in my plan 6700.00 and then I am covered 100%
Due to my macular degenerations I cannot apply for a supplemental but I am trying to see as to homw much insurance I can buy to save my assets.
In a way, is a round about way of being covered almost 100% without having a Medigap.


You really need to understand your Medicare coverage, even if it is through a MA plan.

 

Medicare.gov - Medicare Advantage Plans Coverage

Original Medicare picks some defined services like hospice.

 

You are talking about "gap" insurance ( insurance for insurance) and I did not know it was offered for a Medicare Advantage plan, I am only aware of it for private or employer health care plans AND usually for those who do not have their premiums subsidized by government with the rationale that if you can afford gap insurance, you could afford to pay more of your regular premium.

 

I caution you to understand it completely and determine its value to premiums.

Here is a couple of links to read and understand.

 

NPR 09/2016 - Gap Insurance Takes Sting Out of High Deductible Health Plans

 

Huff Post Blog 10/2016 - Gap Insurance for Deductibles - The Insurance Industry's Latest Profiteerin...

 

Normally, your deductible or any deductible is not paid all in one swoop - it accumulates throughout the year and partly into the next year.

 

I would like for you to also be aware of another type of Medicare Advantage plan that your agent might suggest to  you since you have mention your concern about the deductible and out of pocket cost just in case the gap insurance doesn't work out for you.  Just FYI -

 

Medicare.gov - Medicare Medical Savings Account (MSA) Plans

 

Read it all including the embedded links.

 

Let us know how it all works out.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

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Message 9 of 17

Gail  you are saying that my MA doesn't cover me if I need hospice services?
I am now in contact with an agent to actually obtain insurance for the amount of copay, that I have in case of a hospitalization which is in my plan 6700.00 and then I am covered 100%
Due to my macular degenerations I cannot apply for a supplemental but I am trying to see as to homw much insurance I can buy to save my assets.
In a way, is a round about way of being covered almost 100% without having a Medigap.

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Valued Social Butterfly

Re: A QUESTIONS ABOUT HIPPA

167 Views
Message 10 of 17

john258,

 

You are talking about the standard payment model which is completely different than the "Risk-Adjustment" system of payment from Medicare to Medicare Advantage plans.  

 

This explains it further

 

According to the American Academy of Actuaries, “[h]ealth risk adjustment is the process of adjusting payments to organizations (usually health insurance plans) based on differences in the risk characteristics of people enrolled in each plan.”

 

By adjusting payments to compensate organizations for the relatively higher medical costs associated with an ill individual, plans should, all other things being equal, be indifferent between enrolling the sicker person or the relatively healthier one.

 

Medicare Advantage (MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under MA, private health plans are paid a per-person amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll in their plan. The Centers for Medicare & Medicaid Services (CMS) risk adjusts the payments to MA plans. The size of the adjustment depends on the demographic and health history of each plan enrollee. The payment adjustment takes into account the severity of a beneficiary’s illness, the accumulated effect of multiple diseases, as well as interactive effects—instances where having two or more specified diseases or characteristics results in expected health care expenditures that are larger than the simple sum of the effects. The payments are not adjusted for short-term illnesses because they are assumed to be poor predictors of future health spending.

 

Congressional Research Service - Medicare Advantage Risk Adjustment. March 2012

 

You might recall that recently UHC being called upon to justify how they were assigning their risk adjustment beneficiaries to Medicare.

 

Modern Healthcare 02/2017 - DOJ joins Medicare Advantage fraud lawsuit against United Health

 

 

 

 

 

 

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