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Thread: Medicare Advantage Plans

  1. #1

    Medicare Advantage Plans

    Has anyone had trobule when switching from original Medicare to a Medicare Advantage Plan? I recently switched to one in September and have had nothing but trouble. At least 3 of my medicines I can't get anymore, due to them not being covered (despite my doctor's writing letters of medical necessity), I had to switch medical suppliers, and I can't even see one of my doctor's anymore, due to the new insurance.

    I am wondering if it is worth it to stay on the Medicare Advantage Plan. Do things eventually smooth out over time? Also, has anyone had trouble with them covering Botox injections for neurogenic bladder, or even surgeries? Just wondering before I have to have Botox injections again and my feeding tube changed again.

  2. #2
    Senior Member skippy13's Avatar
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    I have the Blue cross, Blue shield Advantage plan. I am open to changing docs, but didn't need to because my docs were all on the plan.

    A year ago June I had a mastectomy reconstruction revision with no trouble at all and less than 200.00 out of pocket.

    I was going to get a new wheelchair with ZERO deductible, but had some issues after the surgery which made me put off ordering until later. The following year they had instituted a 10% deductible on DME, so I missed the window by a couple of months but got a nice new TiLite.

    It is not cheap insurance, in fact it is the most expensive plan they offer at 125.00 per month over and above part A. To me it is worth every penny because I have a lower out of pocket on major issues and really end up saving a ton of money that would normally be out of pocket. If you have questions about specific treatments that you may need now or in the future, you can call the insurance companies customer service lines and get answers to your questions. They will probably tell you what is covered even if you are not a subscriber at the time.

    I have never had a denial or problem with them. I guess it just depends on what outfit you choose to go with.

    Reaearch all of the options at the Medicare site and also go to the companies websites. Really dig in and compare cost vs. benefits. Sometimes you do get what you pay for and sometimes you do not. Ultimately it comes down to your personal health issues and what is covered.

    If you are not happy with the plan you now have, you can pick another one till the 7th of December.
    Anything worth doing, is worth doing to excess

  3. #3
    Senior Member ChesBay's Avatar
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    I was contacted about switching to "United Healthcare Advantage program" . I requested some info, looked it over, but I am going to stay put. The HMO Point of Service (HEMPS) Plan concerns me. The HMO part makes me reluctant to consider change.

  4. #4
    Senior Member skippy13's Avatar
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    I would definitely avoid any HMO plans. Even though it is not supposed to be, it seems that they get paid better for NOT rendering service.

    BC/BS is a PPO type of plan. That means that you can pick any doctor for anything, as long as they accept medicare.

    I have never been turned down (even by specialists) with BC/BS. Not even once.
    Anything worth doing, is worth doing to excess

  5. #5
    Senior Member jschism's Avatar
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    I have a great medicare HMO, have had no problems, but have a good network to go with it. You get a booklet every year listing the insurances offering medicare HMO's and the costs/coverages of various plans. Sounds like you should've read it more carefully or weren't well informed.

  6. #6
    Well, after having more and more trouble getting 3 of my medicines (one of which is life-sustaining), and not being able to see my ostomy nurse at all, I decided to go back to Original Medicare and Medicaid for insurance. I will be able to go back to Medco for my medicine and not have any more problems with not being able to see certain specialists, like my ostomy nurse. Plus, I can still go to physical therapy for the remainder of this year, despite already using up the alloted hours for PT that Medicare allows a year, mainly because we are still doing evaluations for certain medical equipment (standing frame).

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