Medicare Question

[Hopes]

At minimum they must cover the same benefits. But they are free to charge what they want.

Here's an easy example:

Medicare Pt A Hospital deductible is $1,340.
MAPD hospital charge $325 each of 1st 6 days.

The difference is the MAPD includes all services including physician charges. However it is possible the person pays more under the MA plan than Medicare.

Rick.

Certainly, in this case, without the MAPD the OOP costs for a 6 day hospital stay would surpass the Pt A deductible by several thousand dollars.

This is the way I've understood it but I see so many discussions about how MAs don't pay as good as OM.

I tend to think this would, primarily, be the case if there are multiple hospital stays or if the person has an acute/chronic/critical illness which would run up costs to an MAPD's MOOP.

Is my thinking flawed?

 

[vic120]

Certainly, in this case, without the MAPD the OOP costs for a 6 day hospital stay would surpass the Pt A deductible by several thousand dollars.

This is the way I've understood it but I see so many discussions about how MAs don't pay as good as OM.

I tend to think this would, primarily, be the case if there are multiple hospital stays or if the person has an acute/chronic/critical illness which would run up costs to an MAPD's MOOP.

Is my thinking flawed?

However, on the other side of things MA has a max out of pocket to protect, OG Medicare does not.

 

[Yagents]

Another way to frame the question. Is Medicare prone to more quickly approve a claim with taxpayer money vs a for profit company that is supposed to follow OM guidelines, but could be more inclined to decline claims more often?

 

[LostDollar]

Re: good as or better than

I can think of at least five involved groups:
Government
Health Care Providers (catchall here for hospitals, drug cos, drs, etc)
Insurance Carriers
Medicare Beneficiaries
Independent Insurance Agents

Each of those groups could have formally appointed and self appointed spokespersons.

Each of those groups has a lot of singular or individual players.

That is a lot of different perspectives for what is the "goodest" option.

 

[LostDollar]

Private health insurance companies are awarded contracts to process Medicare A/b claims. There are about 12 depending on geolocation

I hadn't thought about this before. So does that mean when I look at my Medicare Summary Notice I am seeing claims processing documents prepared by the MAC for my state's area?

 

[Hopes]

Your thinking is flawed

You do not get to say my thinking is flawed without saying why.

 

[somarco]

If you want to compare OOP with original Medicare vs MA then you have to factor in a supplement plan. Otherwise you are comparing a plan with unlimited OOP (as in Part B) to a plan that at least sets a cap (in most cases) on your OOP for health care.

MA plans are attractive to some consumers because of the low premium (in some cases $0) plus that add-on sizzle (dental, vision).

They forget that there really is no free lunch.

Those with MA plans generally pay 60% or so of the cost of routine care. The MA carrier really doesn't pay much until claims start to climb.

But the MA vs original Medicare + Medigap shouldn't stop at just the financial consideration. The network providers can prove to be an issue with someone who has a chronic and/or expensive condition that crosses from one calendar year to the next.

Many patients would prefer to keep their same providers but that isn't always possible.

In ATL Piedmont Hospital got into the MA business a few years ago. It was a great plan but you had to use Piedmont affiliated doctors.

The plan crashed and burned after 2 or 3 years and everyone had to find a new plan. Those who wanted to keep their providers often chose original Medicare and a supplement plan because they didn't want to be left out in the cold again.

Provider continuity is important, but only when the beneficiary looks beyond the dollars and sense of one path vs the other.

 

[gregj]

Those with MA plans generally pay 60% or so of the cost of routine care.

Hmmm. Can you document this? I haven't seen out of pocket cost figures that high. While "average" cost figures generally have little utility in health care (the distribution of costs is too severly skewed), most beneficiaries, most years, have pretty low absolute spending on routine care.

Your comments on how management of 1/more chronic conditions can/should weigh into evaluation of plans nails it

 

[gregj]

in 2014 98% of TVH patients with Medicare Advantage spent less than Medicare Supplement patients.*

does the asterisk signal that the reader should, at least, ask whether the data for each plan has been adjusted for membership and/or case mix?

 

[Chazm]

Depends on your location, in FL, the Villages, looks like MA is cheaper


The Villages® Health and Medicare Advantage



The average Medicare Advantage patient of The Villages Health (TVH) pays $832 annually in comparison to the $3,000 that a TVH Medicare Supplement patients pays. Another way to think of this is that in 2014 98% of TVH patients with Medicare Advantage spent less than Medicare Supplement patients.* Medicare Advantage patients had better quality of care and more time with their doctors. TVH believes that Medicare Advantage provides better care and better value.

FL is a different animal, especially the villages.
They don’t even take straight Medicare a lot of the time and require you to get a mapd. It’s nuts.