I think it’s better. Of course the Republicans are doing everything they can to ruin Medicare. I probably should get a Medigap. Let us know how that turns out.

that the way that Magats will kill Medicare is by morphing it into Medicare Advantage plans.

Medicare Advantage plans gut Medicare.

I asked people at the hospital that I went to for a procedure and they all said they love dealing with Medicare, no pre-approvals, everything is cut and dried.

I went to 2 different hospitals, 2 different networks, switched 3 of my specialist doctors with zero problems on Medicare.

I'm scheduling my second knee replacement before the shit hits the fan being as I am 78.

I still have original Medicare, but know that the day will come where I have to consider MA. I'm not for restricting that option, but I am for original Medicare adding some benefits, even if limited to a thousand dollars or so-- dental, OTC cards, etc. And, there are MA plans that will cover more of the cost of costly meds. Those plans cost more, but exist.

It is far more affordable!

Until, like this poster, it’s not.

The horror of it is that private companies were allowed to use the name “Medicare” in their marketing promotions when their products are not actual Medicare. (Thank you Joe Namath!). It’s a scam. It’s the old HMO crap resurrected.

There was a bill to deny them using “Medicare” in their product naming and promotions, but I don’t know what happened to it.

something away from people just because you prefer traditional Medicare. Heck, try to get traditional Medicare improved.

coverage. I do reevaluate every open enrollment period.

She said the exact same thing. Traditional Medicare does not second-guess medical professionals. Advantage plans do. She constantly has to fight with Advantage plans to get the needed days covered, medical devices, etc.
We took her advice and went with a traditional plan with a supplement. My husband had a knee replacement and everything was covered, including physical therapy, except maybe $150 to the surgeon.

Further, Medicare audits providers exhibiting a billing pattern that is questionable, often 3, 4, 5 years after services rendered, prompting providers to be careful.

Every few days, one reads of Medicare audits where a provider billed millions of dollar over 4 years, when no patient was even seen. Medicare doesn't catch it and we get ripped off.

MA on the other hand often has only 12 to 18 months to recoup questionable services. So they deny upfront. Most denials are overturned quickly once the doc send in records. If you don't think providers -- including Marcus Welby -- don't cheat, you are mistaken.

And, home health gets audited too.

KFF:

Key Takeaways:
"Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023, reflecting steady year-over-year increases since 2021 (37 million) and 2022 (46 million) as the number of people enrolled in Medicare Advantage has grown. The determinations represent requests for approval that providers are required to submit before providing a service. Substantially fewer prior authorization reviews for traditional Medicare beneficiaries were submitted to CMS – just under 400,000 in fiscal year 2023 – though the number of people enrolled in Medicare Advantage and traditional Medicare were similar in these years.

"In 2023, there were nearly 2 prior authorization determinations on average per Medicare Advantage enrollee, similar to the amount in 2019. In contrast, in 2023, about 1 prior authorization review was submitted per 100 traditional Medicare beneficiaries – a rate of about 0.01 per person — which reflects the limited set of services subject to prior authorization in traditional Medicare.

"In 2023, insurers fully or partially denied 3.2 million prior authorization requests, which is a somewhat smaller share (6.4%) of all requests than in 2022 (7.4%). Though there were substantially fewer prior authorization reviews for traditional Medicare beneficiaries, a larger share was denied – 28.8% in 2023. Denial rates varied across the limited set of services subject to prior authorization in traditional Medicare.

"A small share of denied prior authorization requests was appealed in Medicare Advantage (11.7% in 2023). That represents an increase since 2019, when 7.5% of denied prior authorization requests in Medicare Advantage were appealed. A relatively small share of denied prior authorization reviews was appealed in traditional Medicare (6.4% in 2022) as well.

"Though a small share of prior authorization denials were appealed to Medicare Advantage insurers, most appeals (81.7%) were partially or fully overturned in 2023. That compares to less than one-third (29%) of appeals overturned in traditional Medicare in 2022. These requests represent medical care that was ordered by a health care provider and ultimately deemed necessary but was potentially delayed because of the additional step of appealing the initial prior authorization decision. Such delays may have negative effects on a person’s health."

https://www.kff.org/medicare/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/

It is only feasible if your plan was funded as part of retirement coverage. Otherwise you have to catch up on the medigap insurance back to age 65. These plans can be a trap. The allure of lower initial costs can trap someone.

If you get a supplement when you first go on Medicare then there is no medical underwriting; that is, they don’t check for prior conditions. After that initial enrollment window, however, the insurer can do medical underwriting and deny coverage if they so desire. Connecticut, Massachusetts, Maine and New York so not allow underwriting at any time, but that means their supplements are more expensive.

There are also some qualifying events that bypass underwriting such as your plan being withdrawn from your area.

In my case, the Advantage plan was leaving my State and would not be available in 2026. I took advantage (lol) of that and switched

Did you enroll for part b or some other part? Or are you just on plan Medicare, which I understand covers only hospitals, not regular doctor visits and meds?

I ask because I have to decide what to do by early next year when I plan to retire from FT work and won't have insurance from my employer anymore.
In case you didn't see it, John Oliver covered the problems with Advantage plans. Here is a link,

And usually have a drug plan (Part D). You pay Part B premiums when on an Advantage plan.

Plain Medicare doesn't cover dental. It does cover vision checkups but not glasses.

I got Medicare - which covers 80% of most doctors bills, and hospital care; a separate drug plan with no monthly premiums and low drug costs; and a separate medigap plan which covers the 20% Medicare doesn't cover.

Hope this clears up any confusion.

is what you pay for during your working years. When you hit 65 Part B (doctors, labs, tests, etc.) kicks in and you will have to pay whatever the Medicare portion is. Usually, this is taken out of your Social Security check unless you opt to pay monthly or quarterly. I think 2026 the cost is around $206 per month. You can suspend Part B coverage if you are still working and getting medical coverage from your job. You HAVE to let Medicare know that you want to do this as Part B starts automatically when you turn 65. If you have original Medicare, you will need a supplement ~ those are Plan A-Z and offer different coverage. Different companies offer these plans and the costs can vary but the coverage is the same. They don't cover hearing, eyes, dental or prescription. You will have to get separate coverage for those. Prescription coverage is Part D.
The Medicare Advantage (Medigap) is Part C. Those are the ones that have ads on TV 24/7. Hope this helps.
If you are still working, check with your HR person. They can or should be able to help you.

At least as far as I know. But you can go online to medicare.gov and find out from the 'horse's mouth'.

Please get your info from your state SHIP or other authoritative source.

I am not a Medicare expert, just an old gal. There is a lot I don't know, so please let me know what you think is incorrect and I will respond.

But to the information you were given, from those trying to be helpful, but incomplete and sometimes misleading.

Please define the acronym so I can look it up for my state.
Thanks.

State Health Insurance Assistance Program, a national program that offers free, one-on-one assistance

So, if you have it once and cancel because of the expense, you can't go back if you have had any significant disease, including cancer and you also have to get a rx plan. The first few years I was on Medicare, I was very healthy and didn't like paying for the supplement and the prescription plan and not using either. I switched to an Advantage Plan and prompty had 2 head traumas within 6 weeks - not good. I nearly died from an impinged spinal cord - very scary. Anyway, I can;t go back because of my cancer history so will have to manage. Hubs got a supplement because his heart dr. is with Mayo and they don't take Advantage plans. Hope we can afford to continue this. I wish I had never switched, but Humana has been fast with auths. and no problem so far.

I was able to switch because of the qualifying event - my plan left the State. I purchased the medigap plan from Fidelity. Representative never asked me about my health or prescriptions. He told me, that because I had a qualifying event, he wasn't allowed to

so I contacted the company recommended about 3/4 of the way through this video and they were amazing. Was on the phone with a guy who explained all the options and arranged a callback a few days later to make sure everything worked out.

The company is called Chapter.

https://www.democraticunderground.com/132280784

She lives in a small community and options to switch to different providers still covered by her insurer were nonexistent. MA can cancel your insurance at will. Original Medicare cannot.

Original Medicare, MediGap (Plan G recommended), and the Plan D.

Talk to a Medicare broker to get the best MediGap and D plans for you. Vet the brokers, BTW. Ask for referrals. Ask your friends.

do lots of research and get the best plan you can.

My 95 year old mother has Kaiser Medicare Advantage, and since she's always lived and will always live in their area of coverage as well as being on Medicaid, it's been terrific for her.

Kaiser is one of the few good ones, and she's one of the few Advantage success stories I've heard of.

nt.