They put my father on a Medicare Advantage Plan. Now what?

JoAnn - MediCARE Advantage plans are contracted through CMS - Centers for MediCARE and Medicaid. Advantage plans get partially underwritten by CMS and when this was first done it was envisioned that they would be off Medicare underwriting within 5 years which hasn’t happened and never will imho until the US goes single payor route.

Here’s my take on this as an old health planner...... the reasoning behind Advantage is - In theory - if folks move from traditional original MediCARE to Advantage Plans, there should be less overall costs both paid to health care providers and less administration costs. So less costs to CMS eventually. The Advantage plans have to have a very narrow in network groups of hospitals, docs, etc and everything an enrollee does is totally within that network in order for there to be cost containment. If your in a big city with large competing health care systems, multiple hospitals, all sorts of specialty hospitals or care centers, then an Advantage can work.

But if you tend tend to travel widely, or go out of state often, or live in a rural area, Advantage plans are not an “advantage” as your likely going to be out of network if you get really sick.

LKdrymom - I’d suggest you call whomever administers his pension and get the list of supplemental plans that they already have in place to use and draw the premium out of from his pension. Pick one of these and add on a Plan F and let it be taken from his pension automatically. If you can change the mailings to you that would be good to do.

The snafu that happened could have been an administrative error but it could possibly be due to a phone call from your dad complaining about $ deducted from his pension. He called and complained so they took him off the employer provided supplemental for retirees. My dad was a Fed so he & mom got FEHIB BCBS and taken from his retirement (for feds it’s an annuitant).... dad died in the 1980s and mom started getting phone calls starting in the late 1990s to switch her FEHIB supplemental to whatever Advantage plans that came into the market and the calls are very persuasive telling them how much $ they will be saving and keeping that the “government is taking from them”...... “and all you need to do is to call and cancel your supplemental and go with their Advantage plan”. Mom almost did it too but FEHIB has a form that has to get done to either cancel or suspend and I caught it in time so no change. On retrospect, I should have realized that this was a red flag that mom’s cognitive ability was faltering. Your dads 91, he may seem able to be ok on his ADLs but there’s probably cognitive problems or dementia creeping in for him. If you don’t have a solid DPOA, MPOA, a valid will and access to all his banking as a signatory and POD to you that done and relatively current, then really dear you need to get these done ASAP. Use the ClusterF on the health insurance as the reason to either do these or get everything updated. At 91, its only going to get more difficult over time to get him to do things. If he owns his home, speak with him about what he wants to do with it should he needed to move due to a fall. One issue for those of us who have parents in their 90’s - nonagenarians - is that they have outlived any study for aging. So they could just as easily live another 10 months or 10 years. Yeah it’s scary horrifying! So Happy Halloween 🎃!

If they are nonagenarians, they are likely to outlive their $ and will eventually file for Medicaid. My family is filled with nonagenarians & women having healthy babies in their 40’s. I had a kid in middle school when mom was in her 90’s and dealing with NH drama for her. Whomever said juggling is a lost art hasn’t had a kid in school and a parent in a NH at the same time. Really use this insurance issue to get with an elder law atty, update dads legal and come up with some sort of plan for dad and his finances.

Medicare Advantage plans are not all alike. My mother was in a Medicare Advantage plan the last 20 years of her life, and she was hospitalized pretty often, and she never had huge copays. Under my plan, a different Medicare Advantage, the maximum annual out of pocket is $6500 per year, but that's not a deductible, it's a maximum of all copays put together. If I went in the hospital, I'd pay $225/day for the first seven days only. After that, the plan would cover everything. The copays for office visits are low, as are the copays for most prescriptions (at least the ones I'm on).

The bottom line is, you need to get the brochures for your father's plan and read up on the coverage before you get too upset.

You have a lot of good answers here. I'll just add that after several weeks of going back and forth on the Medicare Advantage (MA) issue, I decided to stick with Plan F. Like your dad, I have my plan with AARP UnitedHealthcare. Although the premiums are more expensive, the plan has always been very good to me. Except for the monthly premiums, I have never paid a cent for anything, and that has included colonoscopies and heart tests. It's a great plan.

Be aware that in 2020, Plan F (with any company) will end for NEW enrollees. What that will mean is that Plan F premiums will probably go up significantly. At that time, I will decide if I can afford it, or if I will switch to Plan G. Plan G is pretty much Plan F, but Plan F covers the Medicare B annual deductible (currently $183) but Plan G does not.

If I cannot afford Plan F or Plan G, then I will probably have to go with UnitedHealthcare's MA. In this case, what I would get is what is called AARP MedicareComplete Choice Plan 1 (PPO). Currently, the premium on this insurance is $18 a month (my monthly premium payments for Plan F for 2019 will be $187.01 per month...older people will pay more...I guess...but it is only a guess...so ask at 1-800-523-5800). NOTE: As others have said, there is an MA HMO. I would NEVER get the HMO. Yes, the monthly premium is, at this time, zero ($0), but it is too restrictive in terms of where it can be used.

So why would I stick with Plan F, if it is more expensive? I can pretty much handle regular doctor bills (I will be 69 in January), as I rarely have to go to the doctor. The big thing for me is if have some major medical event, as with a hospital stay. With Plan F, there is NO maximum out-of-pocket amount. What this means is if I have to go to the hospital in February then go back in in, let's say May...and then again in October, there is NO out-of-pocket that I have to worry about...unless I am in the hospital beyond 365 days. If that is the case, I'd rather be dead anyway.

But, with the AARP MedicareComplete Choice Plan 1 (PPO), there IS an annual out-of-pocket maximum, i.e., you could pay up to $6,700 annually, before UnitedHealthcare pays everything. That is for IN-network. For out-of-network, the maximum out-of-pocket is $10,000.

So, you see, it is sort of a pay-me-now-or-pay-me-later situation. Certainly MA's $18 a month premium is very good. But, you have the co-pays (e.g., to see an in-network general practitioner would be $5) and you have the maximum out-of-pocket amount to deal with. With Plan F and Plan G, you pay a higher monthly premium, but that is pretty much all that you pay, with the exceptions of being a very long stay in a hospital, a long (over 100 days) in a nursing facility, and foreign travel.

By now, I think you can see why the insurance companies are pushing the MA plans. The government gives them a stack of money for each person who signs up. They can then charge a small premium but also require copays (and worse...co-insurance for some out-of-network) and have the out-of-pocket maximum.

So, to recap, if you can afford it and IF your dad can get back on the Plan F, I would definitely do that. But, if he cannot get back on the Plan F, then I would go with AARP MedicareComplete Choice Plan 1 (PPO) and just do your very best to make sure he can go to in-network providers.

I should add that, if you are going to try to get him back on Plan F that he will probably have to go through the underwriting process, which is just a fancy way of saying that they might have the right to bump up the premium costs for him if he has pre-existing conditions. However, since he was taken off Plan F without his consent, you might be able to "make some noise" and get him back on Plan F. If I were to guess, I would guess that it was the underwriting issue that whoever put him on MA did so to avoid the pain and hassle of trying to deal with the underwriting of Plan F.

I wish you all the best.

Call Healthcare Options. There is a time period to select another plan from Oct. 15th to December 15th.
If you do not choose a plan, one will be selected for you..
If it is not what your father needs, change it.

Uh-oh. Who are “they”? Did he use an insurance broker who spoke with him and together they decided on a plan? The insurance company cannot assign coverage to your father without his consent. They cannot switch him on their own from regular Medicare to an Advantage plan. Chances are, he heard the $0 premium and went for it. These plans have super high out of pocket costs. Should he be hospitalized, he will have to pay at least $6,000 before they cover anything.

Why was he dropped? Usually it’s for non-payment of premiums. It’s very odd that they just cancelled his insurance out of the blue.

Get on the phone to the insursnce company tomorrow and find out why he was suddenly switched to Advantage. If he gave permission, there isn’t much you can do. But if it was their own mess up, which I tend to doubt, insist they they put him in a supplemental or they’ll be speaking with your attorney.

My Mom was on a Medicare Advantage plan for years (prior to Medicaid and the NH). It was a great plan for her. I just signed up for the same plan starting next month when I’m Medicare eligible. There are many different MA plans, with varying premiums and copays. Mine includes the Part D drug plan. All MA plans cover what Medicare covers and some much more. It superceeds Medicare and she will use her MA card instead of her old Medicare card. (Don’t throw out her old card though, I just put it away in a drawer, just to be safe)
You need to find out the exact company and name of the new policy to find out what it covers. I’m not sure how “someone” signed her up for a new policy. Are you POA or guardian?

This is medicare enrollment period so you can change your dads plan till December 15th. Here is the link to an online resource. You also can go for free to a medicare insurance advisor. The medicare advantage plan is less costly than traditional medicare, I have been on an advantage plan for the last 6 years. I really like. The down side is the least costly is HMO. which means that you will have to go to a provider that is on your insurance plan. But you can see if they are onthe insurance plan before you sign.
https://www.medicare.gov/find-a-plan/questions/home.aspx

Which is more advantageous for your dad, an Advantage plan or Medicare with a supplemental really depends on the details of your dads medical needs, including prescription drugs, doctors and to some degree the state he lives in maybe. It's true they messed up they should fix it and it may be that because of some of the rules the only way they could fix it and hold his business was this Advantage plan but it isn't that big a deal right now because we are in that time period where you can select and change plans (to start in January) so it would e wise anyway to talk to someone about your dad's needs, what he qualifies for, how much each would cost and select a plan. Medicare and probably your state have people you can call who review it all with you and help you figure it out. Don't call the Advantage plan or old supplemental (many insurance companies offer both types and it works with his Medicare benefits) if you can help it, call Medicare or the state office set up for just this purpose you can find the number online or in the paperwork that was probably mailed to him.

What I know about an advantage plan is they can charge you for oxygen where if you are on Medicare and a supplement plan, the Medicare part B covers oxygen.  Medicare does not cover you in an Advantage program...they only work with the plan.

We had an elderly neighbor who had an advantage plan and had oxygen and it cost her $600 a month for her oxygen, so the next year she switched to a supplement and she never paid a dime for her oxygen as it was covered under Medicare part B.

I would check that out because as we age our needs will only get worse most likely and I am looking for big ticket items.  We are taking the BCBS Medicare supplement that pays for everything including the deductibles for Medicare part A and B.  No co pays, no specialty fees and we do not have a network and they cover for any place that accepts Medicare.  It is $219 a month but absolutely no deductibles for hospital stay either. 

I would call your local agency for the aging.  They will help you decide what is best for the price you pay.  It is a pay now or pay later between supplement and advantage policies but at least this way we know exactly what we pay for medical for the year....no surprises.  Medications are covered under a separate policy as is dental...supplement plans are ONLY medical.

I wish you the best as I know it can be very confusing so you need help and not from a sales rep for various policies who will receive a commission or some form of payment for selling you a policy. Prayers to you and your dad.

FIND OUT WHO "THEY" ARE AND START ASKING "THEM" THE QUESTIONS!

DR COPPERTINO