My partner has Medicare Part A and Part B

[tavalon]

He went to our usual doctor at the end of last year and was told that they no longer accept Medicare but would continue to see him if he signed up for a Medicare Advantage plan. I've been doing research and apparently this is happening all over the country and yet, Medicare denies that it's happening (one article stated that they had heard "anecdotal stories" about people being pushed to change to MA plans). They say that 91% of physicians accept Medicare. This isn't anecdotal in our situation. The really amazing thing is that I'm fairly young and a health care provider and yet, I'm confused by all of these different plans. And it's clear that there is much room for scamming Medicare recipients.

Have any of the rest of you, anecdotally, of course, had this issue?

[sinkingfeeling]

1. Medicare Advantage is the top item driving up Medicare costs to the government. MA is now costing

14% more than total government paid Medicare.


http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_mafacts.pdf
http://www.commonwealthfund.org/Content/News/News-Releases/2009/May/Extra-Payments-to-Medicare-Advantage-Plans-to-Total-11-4-Billion-in-2009.aspx

New York, NY, May 4, 2009—Private Medicare Advantage (MA) plans will be paid $11.4 billion more in 2009 than what the same beneficiaries would have cost in the traditional Medicare fee-for-service program, according to a new report released today by The Commonwealth Fund. This new analysis, The Continuing Costs of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009, estimates that since MA was enacted in 2004, $43 billion in extra payments have been made.

[tavalon]

2. It's fairly clear to me that this is a bit of a scam

We're thinking about just having him pay cash for his doctor visits but then, it's frustrating that he's paying his monthly premium for part B that he isn't able to use. He also doesn't like doctors much and this one impressed him so I don't think he wants, nor do I want him to go doctor shopping. There are all sorts of alerts going off in my head around this MA stuff. It looks like crap, smells like crap and is, in all likelihood, crap.

[pinto]

3. None here. I have A & B, have had no trouble with access. Even

for specialists. :shrug:

I have heard some docs are refusing to take *new* patients with Medicare, but haven't heard of any refusals for established patients.

[tavalon]

4. Yep,

I was in the waiting room and the receptionist came to me and gave me a brochure to help us decide which plan to get for him because they weren't accepting medicare anymore. That day was pretty crazy because the doctor sent him to the emergency room for a peritonsillar abscess. But now I'm finally getting around to researching this and I'm not pleased.

[sinkingfeeling]

5. What the doctor is refusing is fee-for-service Medicare, but if he's willing to accept MA, then he's

probably taking a kick-back in the form of higher payments from the insurance companies that sell it.

[Old Codger]

7. For me

I have A & B , I had an MA was paying 170 a month for it, I also pay the difference between what they charge and what medicare pays, it was quite a bit more with the MA than without it... also we have only one MA provider here so no choices , either use them or none at all.. part of they way the insurance companies have gamed it to cut out any possibility of real competition...

[DURHAM D]

6. Don't pick a Medicare Advantage plan - pick a Medicare Supplemental

(also called Medigap) plan. The doctors and hospitals are aware that Part A & B only pays 80% of the cost and without a medicare supplemental plan the patient might not pay the other 20%.

[enough]

8. I have been looking into this, and seem to find that the Medigap plans are

more expensive at each coverage level than Medicare Advantage. Especially since you have to pay for the Part D (prescription drug) plan separately from Medigap.

If you have any information about this, I would really appreciate it. I dislike being on Medicare Advantage, because I do believe that it's bad policy for the country. But so far I haven't been able to find a Medigap program that is affordable.

Any advice appreciated!

[DURHAM D]

10. Because I read DU I knew that Medicare Advantage was not

the way to go so I threw away the box of information I received. Than I went through the Medicare Supplemental information - stacks and stacks of it. Every supplemental plan from every private insurer offers the same coverage under, for example, Plan F - which is what I decided I wanted. So it just became a cost comparison across all the insurers for Plan F and there are big cost differences from company to company for the same exact plan. I created a spread sheet for this purpose.

Because I spend time in three different states I called the various insurance companies to make sure that there would not be a problem with receiving treatment/tests in any of the states. Also, I will be moving to another state later this year so my spread sheet included the cost for Plan F in the other state. There is a pretty big cost variation from state to state and I also found that one of the insurance companies I was interested in does not even offer Plan F in my destination state so that ruled them out.

It is a long process to sort through it and frankly I referred to it as my "new full time job".

As for Part D - I don't take any prescriptions so I was not about to pay the $40 government plan. I spent a lot of time on Part D and viewed it as a completely separate issue. So, I found a plan for $15.30 a month in my current state and the same plan will be less in my destination state.

There are really no short cuts - its a lot of work to figure it out.

Good luck.

[DURHAM D]

12. Also -

I believe that with Medicare Advantage they give you a list of doctors to use - like an HMO. With Medicare Supplemental plan you pick your doctor.

[enough]

14. I've been appalled by how much time and thought is required to sort through

all the various options and plans. It's almost as if they're making it difficult to figure out on purpose, so you'll eventually just throw up your hands and make a choice based on some clever advertising. It's all so irrational and inefficient -- a graphic demonstration of the stranglehold private insurance has on our government.

[DURHAM D]

17. You will also receive info that looks like official communication from

SS about Medicare. The private insurers design it to look like it is official government communications so you will need to look closely at it before you pitch it.

Don't throw up your hands and buy anything because of clever advertising. Eventually it will all start to make sense. Some states have a senior help line to assist you in sorting through the various plans. However, some private insurers try to masquerade as a government help line. I repeatedly used the internet to determine if something/someone was legitimate or phony. I don't know what seniors do if they don't have internet access - probably buy the wrong shit.

Ok, I get tired and angry just thinking about the process I went through last October/November.

[enough]

18. I'm not personallly in danger of falling for any scam, but I really worry about

the true elderly who don't have anyone to explain it all to them (as I did for both my very aged parents), or who don't have the time or literacy (or eyesight) to deal with it.

[tavalon]

9. But if they don't take Medicare, why would they take it with a medigap?

[DURHAM D]

13. I can't answer that. nt

[NNN0LHI]

11. Sounds like the doctor is getting greedy

I would find a different doctor who was more concerned with my health and less concerned with money if it was me.

Don

[tavalon]

20. It was the front office staff

My doctor, our doctor doesn't involve herself in that end, as far as I can tell. It's a group of about 15 doctors. I'm realizing that since he was on my insurance until last year, he's technically not a new patient so hopefully we can convince them to accept Medicare.

[dysfunctional press]

15. i'm 48, disabled, and on medicare a,b & d.

when we moved a couple years back, i had to get a new dr., and yes- the first two offices i called were no longer accepting any new medicare patients, but the third one did...i didn't like the dr., though...and switched to a different dr. in a different office- and i found him on the first call.

my 'supplemental' insurance used to be through my wife's insurance at her job- but when she lost that job, i lost my supplemental 'gap' coverage. and since i'm disabled, NOBODY will sell me the coverage, and nobody is required to- so...i'm on the hook for the 20% not covered by medicare...a catastrophic health problem would/could still bankrupt us.

[Cleita]

16. In my area the doctors are refusing the Medicare advantage plans in

favor of traditional Medicare with a medigap insurance policy. My primary care did suggest a Medicare Advantage when I complained about the cost of prescription drugs to her. I said something about her practice being the only one who still accepts them, but she said they would only for old patients like me and they don't accept any new ones. I then asked what would happen if I had to see a specialist, would they accept it, or would the labs for lab work? She said probably not so we both decided maybe it wasn't such a good idea just to save drug money. So I don't know what's happening in your area. Here no one wants them. Those who have signed up for them have found that the list of providers they give them aren't honest. It turns out those providers won't see them as new patients.

[gleaner]

19. No, I have Medicare ....

And I have never been pushed to get Medicare Advantage or been refused treatment because I use Medicare as the fee for service plan it was intended to be. I can see why this would be of concern to you.

Maybe it would be a good idea for your Partner to find another doctor right away. Call your state Medical Board and check on the legality of what the doctor did. If the state agrees that he acted illegally, file a complaint. The best way to stop actions like this is to shed light on them so that doctors who do it don't have a wall of secrecy to hide behind.

Call your Congressman and discuss the issue with them and ask them to investigate through Medicare. It's worth a shot. The most important thing though is to get your Partner a doctor he can depend on and trust. If it were me, I would have a hard time trusting this particular doctor again, and that is not good if your medical needs depend on him.

Take care, and remember that we really need to stand up for ourselves or things like this will only get worse. Good luck.