MA compared to Original Medicare

[Slick]

We've debated this, in Medicare, but not on Medicare.
Meaning, when admissions asks who your insurance is. If you have a MA, you don't have Medicare.

Scott,
With a $5,500 MOOP, I guess it would be a lot harder to hit

I've only had/seen cardiac patients with recurring admissions and surgeries hit a $2,500 MOOP.

 

[retread]

Please, not another debate on what the meaning of "is" is! The first word in Medicare Advantage is "Medicare"! Not to beat a dead cat, but Medicare Advantage plans ARE Medicare. The wording you are looking for comes from CMS: You are no longer in the Original Medicare plan.

Look at the plan designations. Original Medicare is H0001-001. Now look at your MA plan's H number. End of discussion.

 

[Winter_123]

Thanks all for the replies here. Good info.

Winter

 

[Guest]

You said it!! That is a naive question!! Every MA company has a booklet comparing their plans to original Medicare....and they are laid out in columns so all you have to do is read across. Now if you can't do that, I suggest another line of work.

That was a nasty reply. All the guy wanted was to get some basic information. I suggest you take your bad attitude to another insurance forum because I don't see this as a good venue for you. We try to help each other here.

Al

 

[Slick]

Please, not another debate on what the meaning of "is" is! The first word in Medicare Advantage is "Medicare"! Not to beat a dead cat, but Medicare Advantage plans ARE Medicare. The wording you are looking for comes from CMS: You are no longer in the Original Medicare plan.

Look at the plan designations. Original Medicare is H0001-001. Now look at your MA plan's H number. End of discussion.

I'm sure we all agree here, it's just which side you are looking at. Providers are the ones that define Medicare different from Medicare Advantage and they will continue to do so until CMS deems accepting MA mandatory of all Medicare providers.

 

[Cenla Agent]

New to MA's question:

What is the most concise way to describe or understand what an MA does compared to Original Medicare-Parts A and B?

Obviously, some companies are offering a few more benefits beyond original medicare. But, in general it looks like MA's nickel and dime you more up front on hospital costs etc (whereas the original medicare deductible might have convered it all for shorter hospital stays). In return, the MA's offer require no payment past a certain number of hospital days and also cap the entire out of pocket somewhere around 2800-3500 give or take.

So, the naive question is, where are the areas where clients are most likely to run beyond the MOOP level if there is no cap? I could see the dollars piling up fast for hospital stays beyond 15 days (for example) which would otherwise covered by an MA but 15 days would cover the vast majority of stays. What are the other areas where clients have major exposure that an MA covers. How would you reply back to a client that says that they think that people are more likely to have a short hospital stay where the MA's pay less and the MOOP does not do much for them because they would have to go through a pile of co-pays, deductibles, and excess charges to get there.

Other than longer hospital stays, I don't have a feel for where the dollars pile up fast in a way that could really be helped with an MA. Sure the doctors visits add up and all of that but still you would have to do a lot to reach the moop. And then there a lab tests etc. Could someone offer up a couple scenarios that would help me to understand this better.

Thanks for any info.

Winter

These are good questions, Winter.

To think that the Medicare Part A deductible pays everything for a hospital stay is to fundamentally misunderstand Medicare. Part A in general only pays for the hospital bill itself. Any charges incurred with other providers while in the hospital are covered under Part B, where the patient has to pay 20% with no cap after meeting the Part B annual deductible. BTW, don't feel bad, this is not commonly understood except by those who are in that market or by those who have experienced it firsthand.

I cannot think of any scenario at all under any MA plan I've ever seen where it will cost more under a MA for an inpatient hospital stay that is covered by Medicare than it would with Original Medicare. It is possible for some other benefit to cost more with an MA depending on the circumstances, but not a single inpatient hospital stay.

 

[Cenla Agent]

Unless it's someone who just can't afford the premium (if there even is one), an MA is almost always a better option than Original Medicare so long as the plan is widely accepted. Of course a Medicare Supplement is even better for those who can afford and qualify for one. An MA is also a good option for someone who is stuck in a very expensive Supp. they are having a hard time paying for and can't get another one for health reasons.

 

[Winter_123]

These are good questions, Winter.

To think that the Medicare Part A deductible pays everything for a hospital stay is to fundamentally misunderstand Medicare. Part A in general only pays for the hospital bill itself. Any charges incurred with other providers while in the hospital are covered under Part B, where the patient has to pay 20% with no cap after meeting the Part B annual deductible. BTW, don't feel bad, this is not commonly understood except by those who are in that market or by those who have experienced it firsthand.

I cannot think of any scenario at all under any MA plan I've ever seen where it will cost more under a MA for an inpatient hospital stay that is covered by Medicare than it would with Original Medicare. It is possible for some other benefit to cost more with an MA depending on the circumstances, but not a single inpatient hospital stay.

Alright, I do appreciate all the good info. Could you take a look at the scenario below and tell me where I am going wrong:

Looking at the Secure Horizons 2007 plan for my state, I see that the client pays $295 a day for the first nine days. With original medicare the deductible for days 1-60 is 992. So it would appear that an original medicare client could get a 9 day stay for 992 but it would cost a Secure Horizons MA client $2655. Your point is that an MA may appear more expensive if we focus on just one line item but since a 9 day hospital stay (decutibles plus copays) would likely exceed the moop that the MA as a total package comes out better for the client. Is this correct or no?

Also, are we saying that Part A just covers essentially room and board and institutional hospital costs. I undertand that Part B covers other providers who may be involved but suppose the doc is a direct employee of the hospital and performs surgery. Is that still part B or is that part A.

Thanks again.

Winter

 

[GreenSky]

I cannot think of any scenario at all under any MA plan I've ever seen where it will cost more under a MA for an inpatient hospital stay that is covered by Medicare than it would with Original Medicare. It is possible for some other benefit to cost more with an MA depending on the circumstances, but not a single inpatient hospital stay.

Well, I can certainly think of at least one instance.

If you have a Secure Horizons Direct plan, the PFFS. You could be paying a per-diem for every day as an inpatient until you hit the policy maximum of over $3,000.

It is possible to have a 10 day hospital stay with no surgery and have physican bills of maybe $50 per day (20% of allowable). With Medicare this just cost you $500 for Part B and $992 for Part A. With SH Direct, it just cost you $2,750 (depending on plan).

Also, under Medicare the Part A deductible is paid once in 60 days. Under an MA plan, if you are re-admitted within the 60 days, you pay another charge.

Rick

 

[GreenSky]

Also, are we saying that Part A just covers essentially room and board and institutional hospital costs. I undertand that Part B covers other providers who may be involved but suppose the doc is a direct employee of the hospital and performs surgery. Is that still part B or is that part A.

For someone who admits to not really understanding the difference, you know more than most!

Part A does not cover professional services in the hospital. Hospitals still bill the physician separately. You don't pay for interns, etc. (I think), but the "real" doctor always charges.

Why would the hospital not want to bill "their" doctor separately. Since Medicare pays more money, they would not want to include it in Part A.

Rick