Are Medicare Advantage {HMO} Plans a Scam?

From personal experience with one plan by one of the leading [if not the leading] company in the business, I would be scared to give up basic Medicare which covers 80% of most health care costs at the Medicare reduced price and that is all health care providers are allowed to charge if they accept Medicare. If you sign up with a HMO or Advantage plan you lose Medicare.

And why do you think these for profit Insurance companies can offer more? - IMHO it is becuase they are disingenuous if not crooked.

These companies contract out their services with Medicare on a yearly basis - And even though they are supposed to cover at least as well as Mecicare,
- After a claim is filed it is to their advantage ot find an excuse not to pay it.

When my 94 year old mother was placed in a hospital that was clearly listed as 'in network' by the plan - They would not pay, claiming a year later that the hospital was 'out of network' - And every time I called them up on her behalf they would say all is well and then send me a new billl for double the amount - Starting a 65K and then doubling it on each billing statement until is was about $400,000.00 !!!

Continuous complaints to Medicare whose jurisdiction they are still under, were futile - Like I say they just kept doubling the bill.
Ultimately I used a process server to file a dispute with the company [I did not trust a certiied letter aas I'm sure they would still claim they never got it] - Stating the rules and laws they were violating - Ulitmately they agreed to pay the hospital and no bill was ever issued to my mother.

Now what I would be worried about in signihg up for one of these HMO, Advantage plans is - Can you imagine being sick and then having to deal with an insurance company that will make you sicker

a reply to: AlienView

The whole US medical system is very bad. There are examples from other countries that are doing it far better and much cheaper (and covering everyone).

The usual excuse of law suits drove medical costs out of sight but there is little evidence to that. What there is evidence of is for profit corps that own medical increase profits every quarter.
The costs CAN NOT COME DOWN in a for profit system, CAN'T.

a reply to: seasonal

True!

Until recently I qualified for both Medicare and Medicaid - Excellent insurance and free.

But you must be low income and have no more than a few thousand dollars in resoorces.

So the people who qualify as being poor - get better health care then the middle class.

We live in an economic system that favors the very rich first - And then the very poor.

The Middle Class is screwed !

a reply to: AlienView

I'm sorry....but I do not understand HOW you are losing Medicare?
Medicare Advantage plans pick up some costs that flat Medicare does not pay.
The different Advantage plans have policies, restrictions and networks beyond what is offered by flat Medicare.

HMOs suck.
They are quite restrictive as to what they will cover and how you qualify....you usually need to go through a Primary.
Horrible experience....IMHO.
But they do offer cheaper premiums usually.

When signing up for a Medicare Advantage Plan, I'd do some homework....and avoid HMO plans, although that may just be my bias showing....due to the crappy HMO plans under obamacare.
www.ehealthinsurance.com...
www.medicare.gov...

a reply to: AlienView


Whatever new healthcare plan our government passes, I wouldn't be surprised after a few years the public will start complaining about it. It will eventually lead to the same Universal Health Care system most other democratic countries have implemented. Insurance companies have to make their profits, so of course they will deny as many medical procedures and only cover a select number of nursing homes.

What I don't like is how the elderly is required to have the nursing home put a lien on their house and their entire savings have to be used-up before medicare kicks in. People work their entire life to own a home and then it's taken away by the nursing home! Leaving nothing to pass on to their children in the form of inheritance. Some countries cover entire nursing care costs for their elderly. Our healthcare system is set-up so the elderly die with no assets.

All I can say is that my companion had Blue Cross Insurance and she had to only pay, I think, the $140 initial deduction. After that every medical bill was paid in full, even a med flight to a major hospital and 13 days in intensive care before she died.
Not a single bill did her children receive from any medical provider.

a reply to: AlienView


When seniors trade-in regular MEDICARE for MEDICARE ADVANTAGE, they're taking a big gamble.

Because Medicare Advantage is subsidized heavily by the Federal Government, and ObamaCare took $500 million from the program to help support that scam, doctors and hospitals come and go frequently. Your Doctor/Hospital can be in a given PPO/HMO Medicare Advantage medical network TODAY....and be totally out of that network next week. It's brutal!

When people call me asking about Medicare Advantage, I advise them of the pitfalls. If they still want one anyway, I refer them to another brokerage. Due to the government subsidizing M.A., plans cost $0 to $50 a month here in Illinois.. hence their appeal.

a reply to: DontTreadOnMe

An HMO is synonymous with Medicare Advantage - They are run by private insurance companies that theoretically are still under Medicare rules - But once someone signs up for one of these plans they no longer have Medicare insurance

- they then have a private insurance company that is supposed to be giving them at least as much coverage as Medicare
- and the companies say the are giving you more - In some small way they usually do.

- But when it comes time to pay bills, as I showed above, my experience was the company looked to dishonestly claim it was not responsible for the amount do the hospital and apparently used the patient in the middle to convince the hospital to take less money than they were actually do.

This particular insurance company, maybe the biggest was charged under RICO [Racketeer influenced and Corrupt Organizations] statutes back in
2007 ? by several hospitals in New York - Apparently they won the case and have grown richer and more powerful than ever.
As I believe they may be number one today - And highly rated - Even though if you look at complaints against this company they are numerous and scarry.

They used to say 'crime doesn't pay as well as politics'.

Some might say today: "Crime does not pay as well as health insurance" !

a reply to: carewemust

Am I missing something then?
Medicare only pays 80% for many things.
And there is no maximum out of pocket, correct?

So, I hear what you are saying about doctors dropping MA plans...but in many areas and with some MA plans---especially the PPOs, the networks are quite extensive, with many doctors.

originally posted by: DontTreadOnMe
a reply to: carewemust

Am I missing something then?
Medicare only pays 80% for many things.
And there is no maximum out of pocket, correct?

So, I hear what you are saying about doctors dropping MA plans...but in many areas and with some MA plans---especially the PPOs, the networks are quite extensive, with many doctors.

That is correct. Medicare pays 80% for doctor services after our $140 deductible... and 100% for hospital services, after your $1,300 deductible.

Everyone gets a Medicare Supplement to cover the 20% that Medicare doesn't pay. Costs between $70 and $160 a month.

Medicare Advantage plans come with QUALITY RATINGS assigned by Uncle Sam. If you get a "5-star" plan, you have the best.

What I dislike the most is the $3,000 to $5,500 Out-of-Pocket liability that comes with Medicare Advantage plans. People who buy MAA plans, do so because the plans are CHEAP. People who want the cheapest, usually have meager incomes. When the $1,100 hospital/surgery bill comes to their home, they'll call ME, all pissed-off. I don't want or need that.

a reply to: carewemust

But....those doctor services can add up...and there is no Maximum out of pocket for straight medicare, is there????
Don't those services also cover tests and outpatient procedures?
And, with Advantage, if Medicare Part A covers hospital stays, where does the $1100 bill in your example come from?

Another thing:
Are Medicare Part D plans worth it?

Thanks..

a reply to: AlienView

Power to the people who have lobbyist representing them in Washington.

The corporations ARE the government.

originally posted by: DontTreadOnMe
a reply to: carewemust

But....those doctor services can add up...and there is no Maximum out of pocket for straight medicare, is there????
Don't those services also cover tests and outpatient procedures?
And, with Advantage, if Medicare Part A covers hospital stays, where does the $1100 bill in your example come from?

Another thing:
Are Medicare Part D plans worth it?

Thanks..

CORRECT. There is no limit to your out of pocket FOR PHYSICIANS and SERVICES with regular Medicare. If you have a $50,000 operation, you will pay 20% of that, which is $10,000. A $180,000 triple-bypass...you will pay $36,000.

Most everyone on Medicare buys a Medicare SUPPLEMENT plan. That plan pays the 20%.

When you have private-company Medicare Advantage....you no longer have government Medicare. Therefore you don't have Medicare Part A or B.

Medicare Prescription plans (Part D) are worth it if you spend more than $100 a month in medications. The cost for a good one is about $60 a month. But you have to keep in mind that there is a government penalty added to the cost of your Prescription drug plan, if you don't buy it on your 65th birthday. That penalty is 1% of the plan's cost per month.
Example: The $60 plan at age 65, will cost you $90 a month, if you wait until age 70 to buy one. (1% of $60 x 12 x 5)

The OP is seriously misinformed. Medicare Advantage Plans are an add on to regular Medicare. You do not lose Medicare when you sign up for a Medicare Advantage plan,you enhance it.

originally posted by: dfnj2015
a reply to: AlienView

Power to the people who have lobbyist representing them in Washington.

The corporations ARE the government.

Sometimes and in some ways this is true - And at any rate the government is the largest employer & corporation in the USA

- For my money, and as I said earlier, I don't always have a problem with this - The combination of Medicare and Medicaid
that many low income/resources Ameircans qualify for and have - is better insurance than most of the Middle class can aford and is free for those who qualify.
- It is comprehensive - And yes it is partially administered by private corporations - But this government healtcare
is better by far than anything private insurance companies can offer.

Why? - Becuase it is 'non-profit' !

Howerver profit is a big incentive - So the compromise must be found between affordable heatlcare for all and profit
to keep the system going .

And apparently Obamacare was a poor compromise - it was disliked by many rich and poor interests - Same might be said of Medicare advantage [HMO] plans.

I don't know about their health care system today - But somehow China synthesized Socialism with Capitalism and made
it work.

originally posted by: sligtlyskeptical
The OP is seriously misinformed. Medicare Advantage Plans are an add on to regular Medicare. You do not lose Medicare when you sign up for a Medicare Advantage plan,you enhance it.

You are absolutely wrong - FACT IS HMO OR ADVANTAGE PLANS TAKE THE PLACE OF MEDICARE- They pay for coverage
but are under government regulation. Supplement plans are add-ons.

But you knew this already didn't you

a reply to: carewemust

I have a medicare advantage plan and pay nothing for dr visits and minimal for specialist. Have to admit I haven't gone to a dr in 4 years. When I signed up I was told that the gov pays 6-8 hundred per month per patient. They are making good on me. Admit I have not been hospitalized and there is a thousand or two co pay for hospitalization. Maybe I am missing something since I don't frequent Dr.

I used to audit Docs and the one I go to would not pass. I just don't care or trust enough to change

originally posted by: liveandlearn
a reply to: carewemust

I have a medicare advantage plan and pay nothing for dr visits and minimal for specialist. Have to admit I haven't gone to a dr in 4 years. When I signed up I was told that the gov pays 6-8 hundred per month per patient. They are making good on me. Admit I have not been hospitalized and there is a thousand or two co pay for hospitalization. Maybe I am missing something since I don't frequent Dr.

I used to audit Docs and the one I go to would not pass. I just don't care or trust enough to change

If Medicare Advantage is working for you to this point, there's no need to change. Just be sure to glance over your annual benefits summary when it arrives in the mail each year. The deductibles and Co-Pays change annually.

Since 2015, it has cost the government more to insure a person in Medicare Advantage, than traditional Medicare, due to rapidly increasing enrollment in Medicare Advantage. Here's a fact sheet that gives a high-level overview of how Medicare Advantage works, and the trends: www.kff.org...

You don't lose Medicare dude, I work for an MA you must have A & B to have MA and it covers what original medicare covers. I mean if you'd rather pay %20 than a co-pay that's really on you. it can't all be positive. plus the plan I work for offers part D at no extra premium so. I will get an MA when I qualify, research the provider directory before you do anything that is the members responsibility. not the plans. i'll agree and say HMOS's suck limited and authorizations are a pain in the A$$. you have to check the benefits well and it is a gamble.
a reply to: AlienView

a reply to: carewemust

So, you recommend Medigap?