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In reply to the discussion: The Medicare Advantage trap: What they don't tell you [View all]Progressive dog
(7,269 posts)71. About Medicare and pre-clearance
Medicare and Prior Authorization
Medicare rarely requires prior authorizations. However, to contain costs, the Centers for Medicare & Medicaid Services has authorized Medicare to require prior authorizations for certain hospital outpatient procedures, durable medical equipment and pre-approval for inpatient rehabilitation and home health services.
https://health.usnews.com/medicare/articles/medicare-require-prior-authorization
Medicare rarely requires prior authorizations. However, to contain costs, the Centers for Medicare & Medicaid Services has authorized Medicare to require prior authorizations for certain hospital outpatient procedures, durable medical equipment and pre-approval for inpatient rehabilitation and home health services.
https://health.usnews.com/medicare/articles/medicare-require-prior-authorization
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Thank you for posting this. I tried to read this article on Rawstory but there is a paywall.
OMGWTF
Saturday
#1
I don't understand why they are allowed to call it a Medicare plan. It should be called privatized senior insurance.
Walleye
Saturday
#2
Yep, my advice is stick with it, maybe get a supplement if it looks feasible, but not a Medicare advantage
Walleye
Saturday
#6
I am 81 and have used only real Medicate, including through cancer treatments for
Trust_Reality
Saturday
#8
The problem is Medicare Advantage plans are allowed to interpret and decide - and they have the final say
dalton99a
Saturday
#9
I can't say enough good things about the combination of Medicare and Tricare for Life
Susan Calvin
Saturday
#74
Because it is literally authorized and governed by Part C of the Medicare statute.
Ms. Toad
Saturday
#81
If Congress passes specific legislation authorizing a Medicare W, and the president signs it, then yes they would.
MichMan
Wednesday
#154
All private insurers whose plans comply with the Medicare Part C rules (as an alternative to original Medicare)
Ms. Toad
17 hrs ago
#163
Not quite accurate to say that: "(regular) Medicare always pays". Occasionally they don't.
marybourg
Saturday
#7
someone has to pay for the 24/7 tv commercials, the annoying calls, and the mailings
rampartd
Sunday
#126
Wish I had Kaiser here. When I lived in Atlanta, I had Kaiser. They really pushed you to get preventive exams, vaccines,
Silent Type
Saturday
#36
I have Kaiser Senior Advantage and have been happy with it. Both my parents also had Kaiser
skylucy
Saturday
#78
No, I get tons of emails from CMS/Medicare to look at my open-enrollment options
erronis
Saturday
#21
First off, Clinton signed legislation for Part C. And it is not true that Medicare pays for anything a doctor
Silent Type
Saturday
#26
I started buying insurance in 2001. It was horrific. My daughter had to have extensive
Henry203
Saturday
#47
Over half of Medicare eligible beneficiaries choose MA plans, primarily because of cost. I do agree a Public Option
Silent Type
Saturday
#38
So you think 31 million people are stupid? Maybe if original Medicare met their needs,
Silent Type
Saturday
#48
Actually, it might be an opportunity if your MA plan is eliminated. Then, you have a guaranteed right to return to
Silent Type
Sunday
#132
Plenty of people do fine on MA, as DUers have posted, even though cancer, heart disease,
Silent Type
Wednesday
#157
I think anyone campaigning on eliminating people's MA plans would face a lot of resistance
MichMan
Saturday
#45
Totally agree. Maybe someone in Congress will realize that if they put those benefits in original Medicare and
Silent Type
Saturday
#52
Glad your wife has survived. As others here on DU and elsewhere have posted, there ain't much evidence of
Silent Type
Wednesday
#147
Hospitals and doctors bill those huge amounts to insurance, even Medicare, knowing that they will have
Silent Type
Wednesday
#150
If you want quality care from Kaiser, it is. No one makes you sign up. Did your friend
Silent Type
Wednesday
#158
Got it. In 2013 we didn't have pre-existing condition protection. Sorry about you daughter though.
Silent Type
Wednesday
#160
My Medicare Advantage is just fine, thank you. I will be damned if I am going to pay 100, 200 a month more
valleyrogue
Saturday
#40
Is that the amount you have ACTUALLY paid in a year or the amount you could POTENTIALLY pay
Sucha NastyWoman
Sunday
#119
I haven't read the link yet, but I have only regular Medicare and had surgery that required follow-up PE and
Vinca
Saturday
#53
The fact that they push this "advantage" so hard indicates how profitable it must be for them.
patphil
Saturday
#59
If you have original Medicare plus a supplement the insurance company that sold you the supplement MUST PAY their part
Sucha NastyWoman
Saturday
#62
What percent of the eligible population does not have original Medicare, with or without a supplement?
LAS14
Saturday
#64
I am on an Advantage Plan. How can I get out and use traditional Medicare?
Evolve Dammit
Saturday
#65
Think I missed this years "enrollment period. December 7. Went with an advantage plan as it is free (no monthly premium)
Evolve Dammit
Sunday
#125
My Friend F 72y/o Will Be Retiring Soon And Will Be Looking For A Medicare Plan.....
global1
Saturday
#68
I have had a Kaiser Medicare Advantage plan for the past five years. Never denied anything.
Sibelius Fan
Saturday
#76
Even though I pay more monthly for a supplement its more cost effective for me in the long run
indigovalley
Sunday
#129
they drive me crazy (close to the title of a great 80s song btw) when I watch American streams
Celerity
Sunday
#107
Correct, Clinton signed it into law; Bush just changed the name of it after it was already implemented
MichMan
Sunday
#144
The commission an agent is paid by the insurance companies for selling a policy can be twice as much
Sucha NastyWoman
Sunday
#127
I have a question - my friend tells me he signed up for a Medicare Advantage plan
walkingman
Sunday
#140