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Pittsburg, Kansas | I don't imagine the Advantage plans have any big fans from the companies that have to get paid by the private insurance company. Those insurance companies have contracted with the government to provide all the benefits of Medicare for a fixed dollar amount per person. So those insuance companies negotiate with providers for the best prices they can get for the services they have to buy to provide the services they are obligated to provide. There is incentive for the insurance companies to negotiate the best prices they can get. I don't imagine that makes them popular with providers.
At least that is my understanding, which could be wrong.
Of course with the supplemental insuramce programs it would also somewhat apply the same. But I have to wonder if the insurance company is more able to raise the premiums on the supplemental insurance to cover their costs plus profit whereas their profits are more dependent on controlling costs with the Advantage plans.
That is just the way it works in my mind, which could be wrong. Lots of room in Medicare to pad the accounts recievable for the medical system to order every test and procedure the program will cover. With the Advanrage plans the insurance company is obligated to cover everything Medicare covers but they are likely to be more picky about eliminating unneeded costs.
Of course that is the way the plans are supposed to work. The private insurance companies are supposed to provide the same services as the government Medicare program but at a lower cost to the government. That was the reason they were created and are allowed. I suspect the savings they provice to the government comes out of the profits health providers make. That would not make the plans particularly popular with providers. More like a necessary evil to them.
Our Advantage plan has had some modest increases in things like specialist visite and other minor changes. Unless I missed it, nothing major. for this year. Next year could be different of course. Medical costs are a big part of what is bankrupting this nation.
Advantage plans are certainly not the best choice for everyone. But wife and I have about 25,000 in a savings account from the premiums we saved by not needing supplemental insurance that instead of spending we put it in savings for when we need to pay some of the pretty substancial copay should we get sick pretty often or pretty badly (full disclosure - we have not used any of that money from that account for the copays during my accident so probably more like 15-20,000 of that is actual savings from conventional Medicare and supplemental insurance policies). So far so good, though I may have a different story if our health deteriorates in the future. I can't say we have had any particular problem with our Advantage plan. They have paid what they were suppse to pay for my motorcycle/deer accident.
I look at it essentially like a high deductible insurance policy. We save on the premium costs every month in exchange for needing to pay some hospital and specialist costs if we get sick. If we were sick all the time or needed constant care, the savings on the premium probably would not cover the added costs we would have. We are essentially betting we are going to be slightly more healthy than average.
Edited by John Burns 10/25/2024 11:48
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Medicare enrollment for 2025
