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Monday, August 20, 2012

Medicare Advantage


I wondered if I should write this post. I am admitting that I fell for a scam by my federal legislature and one insurance company. With all the political spin and misinformation currently being throw into the faces of the population I wanted to tell one true story.
Medicare Advantage, first created by Congress in 1997 and later changed by President Bush and the Republican Congress in the 2003 “Medicare Prescription Drug, Improvement and Modernization Act” has been cut by President Obama, removing over $700 billion dollars from Medicare. The concept of the 2003 law, as explained to the public, is that the Government would give an insurance company extra money, the insurance company in turn would provide more coverage than basic Medicare. I signed up for Medicare Advantage expecting better coverage than basic Medicare. After 8 months on the program I can report that this claim of improved coverage is false. I have less coverage and more out-of-pocket expenses than I would have with basic Medicare, or the revisions of President Obama. The difference is in the small print provided by the insurance company.
I have type 2 diabetes and have used the same general practice doctor for over 9 years. When I signed up for Medicare Advantage (with UnitedHealtcare) I ask if I could go to my doctor, who I specified by name and address. The answer was yes. When I received my medical ID card my doctor’s name was printed on the front. At my first visit to the doctor this year he did not accept the Medicare Advantage insurance. He accepts Medicare but is not part of the Medicare Advantage program. I had to pay full cost for the office visit. Calling UnitedHealtcare I was informed that I can go to any doctor I wish, even doctors in foreign lands, which is my choice. They will not cover these doctors, but I can certainly go to them. Additionally the copays for diabetic medicine are much higher than basic Medicare.
All I have related this experience to feel that I was lied to by the insurance sales person. The salesperson was technically correct. I had asked the question wrong. I am not trained in the proper legal phrasing of questions and this puts me at a substantial disadvantage. I am an engineer and attempt to answer questions fully and concisely. This is a failing strategy when dealing with the professional Medicare scam artist.
The changes that President Obama introduced will reduce my “donut hole” and medication copay cost, this would have saved me over $2,400 this year. My Doctor is covered, saving me another $600. For me $3,000 is a lot of money.
President Obama cut the Medicare Advantage program which reportedly saves over $700 billion dollars for the government. I don’t know about that claim but I do know about my personal check book. I wish Medicare Advantage had been cut this year as that would have saved me thousands of dollars and provided better medical coverage.

4 comments:

Alice said...

But...there are some states, or maybe just one
state where the Advantage plans work pretty well...where most doctors accept these plans.
One of them is Florida which has asked for and received a waiver allowing them to continue on the Advantage plans.

Paul Howard Clark said...

I live in Texas. Our Governor prefers free market solutions. I also feel that the insurance company deliberately mislead me.

Alice said...

The problem is that you didn't ask the right questions...then again how do we know what to ask?
We luckily had an honest agent who explained the advantage plans to us. I'm in the "donut hole" this year and I'll be happy if the new law closes the donut hole but one thing I am worried about is one of the other aspects of the new law. It's fine with me if the advantage plans end but the planned cuts in Medicare will also cut the amount they pay the doctors and I'm afraid some of my doctors won't accept regular Medicare if that happens.

Paul Howard Clark said...

Alice, maybe you could send me a private email about this honest agent, I desperately need an honest agent.