How does out of network coverage work with Medicare Advantage?

[maxherr]

My client in SC with Original Medicare and his Plan G got the care he needed for neck cancer at Sloan Kettering....no problem.

This client would also have gotten the same treatment at Sloan Kettering with an MAPD PPO . . . they obviously accept Medicare patients and charge fees based on the CMS-approved rates (with or without the 95% of 115% of the approved rate add-on chargeable by non-approved providers). Those rates don't change based on the kind of insurance a Medicare beneficiary has.

 

[maxherr]

Dear GA Medicare Expert . . . you would be in big trouble for using that title here in CA and a few other states.

 

[Chazm]

Our PPO here has a $3,350 MOOP in or out of network and charges the same copays either way. $8k-12,000 in MOOP? I’ve never seen that. But, scare tactics and all.

 

[rmhaire]

Our PPO here has a $3,350 MOOP in or out of network and charges the same copays either way. $8k-12,000 in MOOP? I’ve never seen that. But, scare tactics and all.

Then don't come to South Georgia. Zip Code 31721

Aetna Freedom Plus PPO $ 8,950 In/Out
Humana Choice PPO $ 8,700 In/Out

 

[Chazm]

Then don't come to South Georgia. Zip Code 31721

Aetna Freedom Plus PPO $ 8,950 In/Out
Humana Choice PPO $ 8,700 In/Out

Still not 12k.

Also, we have some very bad PPOs here in FL as well. They are old PPOs that companies don’t want to cancel but encourage to move off of. Med Supp only agents don’t know about that.

 

[rmhaire]

Still not 12k.

Also, we have some very bad PPOs here in FL as well. They are old PPOs that companies don’t want to cancel but encourage to move off of. Med Supp only agents don’t know about that.

Problem is the two I quoted were two of the higher ranked for 2024.

Went back and found another one. Humana Choice R3392-004 Regional PPO.
$13,300.00 In/Out

Matched your 12k and raised you 1300.

But I have heard that our Supps are a lot cheaper than yours.

 

[goillini52]

Our PPO here has a $3,350 MOOP in or out of network and charges the same copays either way. $8k-12,000 in MOOP? I’ve never seen that. But, scare tactics and all.

In my area UHC has a PPO with an In Network $8,850 MOOP / $13,300 Out of Network. Molina has an HMO with a $8,300 MOOP. BCBS has a PPO with an In Network MOOP of $7,550 / $13,300. BCBS has another one at $6,900 / $13,300 and Humana has one at $6,700. Not a scare tactic.....but it is scary.

 

[rmhaire]

In my area UHC has a PPO with an In Network $8,850 MOOP. Molina has an HMO with a $8,300 MOOP. BCBS has a PPO with an In Network MOOP of $7,550. BCBS has another one at $6,900 and Humana has one at $6,700. Not a scare tactic.....but it is scary.

Geography plays a large part.

 

[Chazm]

In my area UHC has a PPO with an In Network $8,850 MOOP / $13,300 Out of Network. Molina has an HMO with a $8,300 MOOP. BCBS has a PPO with an In Network MOOP of $7,550 / $13,300. BCBS has another one at $6,900 / $13,300 and Humana has one at $6,700. Not a scare tactic.....but it is scary.

Like I mentioned above, my area has plans with high MOOPs as well. They are old plans that no one buys. Companies just don’t kill them off.
Instead of showing the highest MOOPs, you should talk about the lowest MOOPs

 

[somarco]

Instead of showing the highest MOOPs, you should talk about the lowest MOOPs

And access to health care . . .