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Orange Blooded [2477]
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Paw Master [17208]
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I thought Bammycare fixed everything.***
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May 12, 2025, 8:27 AM
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Oculus Spirit [39704]
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Tacitly supporting something by bringing up analogous thing you oppose***
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May 12, 2025, 8:35 AM
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Ultimate Tiger [37813]
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It's kinda like "explain it to me like I'm a 5th grader"***
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May 12, 2025, 8:55 AM
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Clemson Sports Icon [52777]
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Well Dang. I just signed up for Aetna which will kick in on 8/1.
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May 12, 2025, 8:32 AM
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No rise in cost, plus free drugs, no doctor co-pays, hospital covered, pays for as many gyms as you want to join, $45/quarter for OTC stuff (band-aids, Ibuprofen, Pepto, etc) plus more.
Why would I not sign up?
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Orange Immortal [65617]
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When I was trying to decide last year, I wound up going with
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May 12, 2025, 10:11 AM
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traditional Medicare (A&B) instead of Medicare Advantage (C) for the following reasons:
More widely accepted (no network limitations). Go to any provider who accepts medicare, which most do.
Prior authorization not required for most services.
There are trade-offs either way; no right or wrong choice. It depends on the individual and their situation.
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Game Day Hero [4301]
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Re: When I was trying to decide last year, I wound up going with
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May 12, 2025, 1:57 PM
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I will add…I am the POA for a dementia patient in a care facility. He had three hospitalizations last year with subsequent stays in rehab until the facility would allow him back. On these advantage plans, you get 21 days a year in rehab…then it’s at least $200 plus per day out of pocket until you reach your out of pocket max. He would have been much better off with traditional Medicare a and b. Just a word to the wise.
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Oculus Spirit [39704]
TigerPulse: 100%
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Re: Medicare Advantage
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May 12, 2025, 8:42 AM
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From the inside, I can confidently relay to everyone that the common enemy of healthcare providers and patients is the for-profit private insurance industry. Hospitals have buildings full of people whose job it is to maximize every cent they can extract in reimbursement by upcoding. Patients don’t help the situation, because everyone wants answers and solutions to problems that frequently don’t have solutions. They want the xrays, CT, MRI, and three surgeries for their back pain that they have because people get back pain. Insert any other chronic idiopathic condition you wish. Doctors go along with this because 1) we get paid by productivity and 2) if you don’t meet patients’ expectations we literally get low starred google reviews and 3) defensive medicine is necessary due to the outrageously litigious nature of our industry.
Meanwhile, reimbursement for preventative care measures is spotty. I can do a 30 minute operation that reliably cures hypertension and diabetes, but many payors don’t cover this because their cost equivalence calculations are short-sighted.
From an outside perspective, this is market capitalism. Insurance companies are publicly traded, and are beholden to their shareholders to maximize profit to increase the value of the company.
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Orange Phenom [14344]
TigerPulse: 100%
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This, plus..
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May 12, 2025, 9:56 AM
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first of all I am not in favor of a single payer model
however
Esp in primary care, bundling of charges is a quagmire. One payer may bundle a certain lab/procedure in with this diagnosis, another wants a separate charge and second diagnosis but doesn't pay as much for the primary diagnosis, multiply this by a crazy number, and you are left with maximizing charges and codes so you don't leave anything on the table because there is no way to remember who wants what linked to what specific diagnosis depending on the insurer.
And no, not trying to gain maximum profit as a provider, but in some situations if you don't code correctly you end up losing money on lab tests, overhead, etc.....
rant over
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Athletic Dir [1102]
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Re: Medicare Advantage
May 13, 2025, 6:01 AM
[ in reply to Re: Medicare Advantage ] |
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Even the large nonprofit ones that aren’t publicly traded seem to behave the same way. At least one big one does.
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Ring of Honor [22211]
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Research and consider Plan N. Workshops & consultants can detail advantages
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May 12, 2025, 9:06 AM
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Not cheapest but more flexibility…
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Valley Legend [12661]
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Re: Medicare Advantage
May 12, 2025, 11:10 AM
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these are great conversations
cigna blows, but less than united
the real scam is in California and NY
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TigerNet Champion [121188]
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Re: Medicare Advantage
May 12, 2025, 12:15 PM
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you are putting a private company in between you, the government, then your doctor. Single payer is optimal because it cuts down on massive bureaucratic costs of managing 50 healthcare systems, puts the decision for your care into the hands of your doctor, while removing the profit incentive, upends the perpetual model of "disease management", and focuses on outcomes.
Every other developed nation has significantly lower costs, we are the only one that is a for-profit model only. Just simply lowering the age requirement of Medicare, say 5 years every year, would be a responsible way to give people a choice over what is essentially a single-payer system, and private insurance. I am not saying get rid of private insurance, but offering a single payer system would ultimately create more competition in the markett. If it were not a threat to private insurance, Insurance carriers would not spend millions lobbying against it.
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Valley Legend [12661]
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Re: Medicare Advantage
May 12, 2025, 12:55 PM
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"it cuts down on massive bureaucratic costs" by giving it to a giant bureaucracy to manage
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Oculus Spirit [39704]
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Re: Medicare Advantage
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May 12, 2025, 1:03 PM
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This is actually factually correct though, the US has the highest healthcare administrative costs and burden in the world, driven by the fractious labyrinth of payors. I am not pro-single payor.
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