Are there any pitfalls that I should be aware of with Medicare Advantage?

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Are there any pitfalls that I should be aware of with Medicare Advantage?

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I am considering changing my 86 year old Mom to a Medicare Advantage program. It seems cheaper that what she is paying now. She is currently on Part A, B and gap coverage. Are there any pitfalls that I should be aware of?

Medicaid

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Blue Cross in Illinois offers both HMO and PPO options for their Medicare Advantage plans. The $0 premium is an HMO. Their best PPO is $111 a month.

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Just got info on Blue Shield Medicare Advantage and its says its an HMO. You have to pick a primary.

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JoAnn29
Thanks for mentioning that, "There r all kinds of ads saying that Medicare Advantage needs to b revamped." I think I'll start looking to see what information I can gather so I can decide whether I should switch from it.

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There is a reason I didn't pick MA for my Mom, can't remember what it was other than she didn't need the perscription plan. There r all kinds of ads saying that Medicare Advantage needs to b revamped. I know a friend who needed a specialist, Medicare approved but MA didn't. Was the only one in her area. She switched insurance at open enrollment. I always thought MA worked with Medicare. In my experience, have always found network doctors to be subpar. That is medical, dental and eyeglasses.

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All my doctors in this area refuse to take any Medicare Advantage patients.

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I disagree with the statement "Medicare Advantage is like an HMO. You can only user their doctors and hospitals." Under the Medicare Advantage plan I have had for years there are in-network and out-of-network doctors and hospitals. There is a fixed co-pay for providers in both of these categories. The patient is free to select an out-of-network supplier at a fixed percentage higher fee.

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Yes, Mom has AARP United health and haven't had any problems. Last hospital stay cost Mom $500. Then 20 here 20 there. She has the Medigap because shehas state prescription plan.

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I put my mom on an advantage plan when we moved her here. (The same one I am on.) Quite a few doctors/specialists in our area stopped taking Medicare patients when Obamacare kicked in. We don't have to have referrals, we just go to any doctor we want. Most are in the plan's network. My 92 yr old mom is in pretty good health, but I wasn't, and I still got excellent care. Sure, we have co pays and premiums, but I think it is well worth it. This coming from a person who did insurance billing for a living.

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Medicare Advantage is like an HMO. You can only user their doctors and hospitals.

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I have Medicare Supplemental through AARP United Health Care Plan F and I pay a monthly premium. EVERYTHING IS TAKEN CARE OF, EVEN WHEN I HAD TO USE IT OUT OF STATE. NO BILLS!

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On a very tight budget (below $1000/mo. income), I was delighted to plug into a low or no-pay Medicare Advantage plan! However, when adjusting an upper shelf in one of my kitchen cabinets, I was exerting such pressure on the shelf clips - my feet slipped backwards, I fell off the counter and seriously broke my ankle. The deductibles and co-pays for surgeries and hospitalizations soon exceeded the $$$ I thought I had "saved"! I was 72. I've been back on a Medicare Supplement/Gap policy ever since - even though the Select Plan F is now near $200./month.
We need to work on reducing the COST of health care in America - via pressure on legislators and any other means at our disposal. The more our Insurers pay out, the higher our premiums will become! Check medical bills and report questionable charges being made to Medicare and Insurers.

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Hope this doesn't come off rude, but I would say that ur Mom was turned down because of her age. A valve operation takes hours to perform. Both my Dad and MIL had them. I would think with AFib problems it would be dangerous. They don't like putting the elderly under. They lose memory and if dementia is already a problem, it can get worse. She has madeca 100 celebtrate that.

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Last year we took a medicare Advantage plan for my Mom (now 100).
Basically same care she received before.
The only problem is she was refused a referral to a heart specialist (past heart surgery - valve replacement) and related afib in 2000). because she is stable and has been for some time.
She is comfortable with her primary care Dr. - but I am considering moving her back to Medicare with supplement. Don't like having to go to primary care - waiting for referral (which comes from some board within the medical group - which even though her Dr. was making the referral - they deemed it "medically unnecessary".
However, it has cut down on Dr.'s visits and so far with no negative effects for her.
It just depends on person's health - certainly if they are in poor health and seeing specialists - (the Advantage Plan and waiting for referrals (which takes several weeks here) and maybe getting turned down and having to appeal and still getting turned down) might be more of a bother than it is worth.
Problem is the cost of supplement here is close to $400 a month as opposed to $0 for Advantage Plan.

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There are pros and cons to medicare advantage plans. Most have an out of pocket maximum so that you know in the worst case what the maximum amount you have to pay will be. The premium is often cheaper than a supplemental plan. However, the network of providers is more restrictive than regular medicare & it seems like the insurance co is more closely monitoring the patients use of resources. I think the biggest plus to a medicare advantange plan is that many of them don't have the 3 day hospital admission before going to a rehab facility requirement. There is a growing problem with people being held in the hospital for "observation", instead of actually being admitted. Some time the observation lasts for days. The patient is then transferred to a nursing home for rehab but hasn't met the hospital stay requirement & medicare won't pay for the cost of the nursing home stay.

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My mom has United Health Care and we are so glad she does. We have never gotten a bill ever. The cost per month is a known factor so we can stay on budget with the little money she has left. It would make me crazy to worry everytime we took her in that we might get a bill. Small term savings can and often due lead to big future bills. As others have said at her age it is a bit risky.

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Medicare Advantage can be okay for younger people who have few health problems, however for someone who is 86 I would recommend traditional Medicare Parts A and B plus a supplemental policy Plan F. Then there are no co-pays. The co-pays can add up very quickly if there's a hospitalization or if there are a lot of doctor visits. There are other traditional plans (supplemental) that are cheaper than Plan F but there are co-pays. In my opinion, Plan F is worth every cent.
Carol

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I am 84, and have had a Medicare Advantage plan since age 65. I would not recommend enrolling an 86 year old person in it. As the person who posted the first comment said, the savings are greatest in the earlier years when a person is less likely to incur larger chargers per doctor visit or hospitalization.

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My mom had the advantage program, but went back to regular medicare (with part A and B) and added United Health Care Supplement F that I pay on her behalf monthly. The pitfall I see is spending more money in the long run or in a shorter time if a health crisis arises. If your mom is in good health, maybe you can keep the costs down, but that's risky I think. My mom has a slew of health problems and visits many doctors regularly. She's also had a number of procedures that have been very costly. So far the supplement pays for whatever Medicare doesn't and she hasn't gotten in a bill in over two years. Medicare advantage seemed cheaper at the time, but it cost her a whole lot more given her health issues and that's why she changed.

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Are there any pitfalls that I should be aware of with Medicare Advantage?

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