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Medicare Avantage plans

Posted Dec 12 2008 6:18pm

Medicare Avantage plans

Definitions, Health and Medical HintsComments

Medicare Advantage plans have come on the scene within the last 2-3 years to help deal with the immense overhead of Medicare billing in the US, at least as I understand it. My past experience with Medicare is that they were often backlogged, meaning slow to pay bills, and dealing with them to resolve billing issues was often an exercise in frustration. Some medical offices would even refuse to bill Medicare, leaving the patient to do this, because the cost of delayed payments and dealing with them was too costly for smaller offices. In other cases, the offices would send the benefit claims, but require up-front payment of bills, and then instruct Medicare to send you (the patient or bill payer) a check for the amount covered. Larger medical facilities usually don’t have a problem, but if there is a dispute, the patient generally has to call the Medicare offices to resolve it. There are a number of Pros and Cons to these plans, so generally you will have to review the issues and see what decision is best for you. Unfortunately, in my opinion, this is not as simple as you might hope.

Blue Cross/Blue Shield (or in my case Blue Cross of California) was one of the first companies to instate a Medicare Advantage (or replacement) policy*. When first introducing the policy, Blue Cross set up seminars that people could attend free of charge, to get an explanation of the policy benefits, and to ask questions. Representatives would also help you fill out forms and get additional information. As far as I know, they are still doing this, so best to check out their website at http://bluecross.com/ or check your local area for an office you can call for more information. At the time I was investigating (about 2 years ago), they were not offering the Medicare Advantage plans in all states.

The policy in California was called Freedom Blue, and for $7 per month, you could get a full coverage PPO style health plan. This made it a very affordable plan for older people who do not have health plan coverage through their spouse or former workplace. Another option was that you could have your plan premiums automatically deducted from your Social Security payments, meaning one less bill to worry about.

One of the distinct downsides of these plans, that I have found, is that many medical facilities are not aware of these plans or how they work. On several occasions, in spite of my instructions to the contrary, facilities would bill directly to Medicare (which would say they are not handling the patient) and then turn around and bill us for the full amount with a note saying that Medicare denied charges. I would then have to call them back and explain the whole thing again, and even then, some places would continue getting it wrong. It was quite a headache at times. Hopefully this will get better in the future, but keep this in mind if your state or area has just begun accepting this kind of plan.

In the case of Blue Cross, they will explain that this particular plan is a low-cost solution that is best for people who are still in relatively good health that are seeing doctors only occasionally for checkups. In my Mother’s case, it might not have been optimal since she was dealing with Diabetes, and a number of other health problems. We had tried it in an attempt to circumvent other problems we were having dealing with Medicare and her primary physician.

You will have to explore these options for yourself at length, but I would say that it is best designed for people who need some medical and prescription help, but are still doing well, and are active, but don’t have any regular health coverage.

(*information about insurance companies and their policies are not endorsements, but are simply accounts of my experience. I recommend you check several different policies and companies before making a choice.)

Medicare Advantage plans have come on the scene within the last 2-3 years to help deal with the immense overhead of Medicare billing in the US, at least as I understand it. My past experience with Medicare is that they were often backlogged, meaning slow to pay bills, and dealing with them to resolve billing issues was often an exercise in frustration. Some medical offices would even refuse to bill Medicare, leaving the patient to do this, because the cost of delayed payments and dealing with them was too costly for smaller offices. In other cases, the offices would send the benefit claims, but require up-front payment of bills, and then instruct Medicare to send you (the patient or bill payer) a check for the amount covered. Larger medical facilities usually don’t have a problem, but if there is a dispute, the patient generally has to call the Medicare offices to resolve it. There are a number of Pros and Cons to these plans, so generally you will have to review the issues and see what decision is best for you. Unfortunately, in my opinion, this is not as simple as you might hope.

Blue Cross/Blue Shield (or in my case Blue Cross of California) was one of the first companies to instate a Medicare Advantage (or replacement) policy*. When first introducing the policy, Blue Cross set up seminars that people could attend free of charge, to get an explanation of the policy benefits, and to ask questions. Representatives would also help you fill out forms and get additional information. As far as I know, they are still doing this, so best to check out their website at http://bluecross.com/ or check your local area for an office you can call for more information. At the time I was investigating (about 2 years ago), they were not offering the Medicare Advantage plans in all states.

The policy in California was called Freedom Blue, and for $7 per month, you could get a full coverage PPO style health plan. This made it a very affordable plan for older people who do not have health plan coverage through their spouse or former workplace. Another option was that you could have your plan premiums automatically deducted from your Social Security payments, meaning one less bill to worry about.

One of the distinct downsides of these plans, that I have found, is that many medical facilities are not aware of these plans or how they work. On several occasions, in spite of my instructions to the contrary, facilities would bill directly to Medicare (which would say they are not handling the patient) and then turn around and bill us for the full amount with a note saying that Medicare denied charges. I would then have to call them back and explain the whole thing again, and even then, some places would continue getting it wrong. It was quite a headache at times. Hopefully this will get better in the future, but keep this in mind if your state or area has just begun accepting this kind of plan.

In the case of Blue Cross, they will explain that this particular plan is a low-cost solution that is best for people who are still in relatively good health that are seeing doctors only occasionally for checkups. In my Mother’s case, it might not have been optimal since she was dealing with Diabetes, and a number of other health problems. We had tried it in an attempt to circumvent other problems we were having dealing with Medicare and her primary physician.

You will have to explore these options for yourself at length, but I would say that it is best designed for people who need some medical and prescription help, but are still doing well, and are active, but don’t have any regular health coverage.

(*information about insurance companies and their policies are not endorsements, but are simply accounts of my experience. I recommend you check several different policies and companies before making a choice.)

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