Why doctors are leaving Medicare Advantage Networks

[Emile]

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[hlthe2b]

1. How many hours each day do most DUers have to watch these videos?

Can't you just give us a short summary, Emile? Please?

[Emile]

3. Your doctor and local hospital can dump your Advantage plan with a 30 day notice.

Doctors and hospitals dropping Advantage plans because of late payments and healthcare denials.

[hlthe2b]

4. Thank you, Emile. Much appreciated....

[Emile]

5. No problem.

[leftyladyfrommo]

2. I just received a letter from NKC Health system that they will

no longer accept United or Cigna. Their denial rates were too high.

I have Humana abd it's still acceptable.

[DinahMoeHum]

6. This is why I chose classic Medicare. . .

. . .and not Medicare Advantage.

[a kennedy]

7. Thank you......received a letter from my advantage plan dumping my County.....

I’m just gonna be Classic Medicare too.

[moonscape]

20. Same, for however long

it lasts. They want to turn Original Medicare into Advantage …

[Emile]

8. We buried my older brother in April because his Advantage plan denied

a life saving surgery for his leukemia. He needed a total thyroidectomy, removal of the entire thyroid. Something about the thyroid gland was messing up his medication for his leukemia. They kept denying his surgery even after his doctors pleaded his case.

[littlemissmartypants]

15. I'm so sorry, Emile. 💧❤️

[Emile]

18. Thank you. I know I miss him dearly.

[jmbar2]

9. My local healthcare network just dumped Medicare Advantage plans

They're merging with a nonprofit network of medical providers bailing out of Advantage plans. I'm still on classic - glad I never got sucked in.

[frogstar0]

10. Why would anyone join an advantage plan?

I understand the initial rollout, before we saw how the companies screw everyone. Free stuff and all. Side note who could have predicted that they would screw everyone? But now that so many of them are denying coverage, etc why go to them? For reference I am not on Medicare but could be and will be as soon as I retire. I plan on using traditional Medicare. It is bad enough, not potentially putting my life in the hands of an insurance company.

[haele]

16. Because Medicare Advantage makes a lot of promises

On relatively (subjective term, of course( inexpensive procedures and products that Medicare doesn't typically cover (OTC, some Dental, some Vision) that someone who is generally healthy would be interested in. It's also a bit more attractive to those used to HMOs or connected medical service groups, or people who want to keep a GP or specialist that doesn't take Medicare.
For people who have chronic issues, it's not so good.

[anciano]

11. Original Medicare is straightforward and flexible.

[MineralMan]

12. I have an Advantage plan from Allina/Aetna.

Allina operates a number of multi-specialty clinics in the area where I live, along with several hospitals. Those are the places I go for healthcare. All are in my network and for typical things I can get a same-day appointment with my chosen primary care physician. I've been going to the same one now for 20 years.

If I need a specialist, there is one in any specialty at one of the Allina clinics in the area. Generally, appointments are readily available within a week.

That is the reason I chose that Advantage plan. So far, it has worked out very well. My wife, too, is in the same plan, and she sees doctors more often than I do. Same story. Whatever she needs, an appointment is readily available.

Neither of us has needed hospital services since we got on this plan. But, all of the Allina hospitals are network, and several others in the area are, as well.

I can't see any reason to change.

[ihaveaquestion]

13. Similar story for me until last year ...

when my Med-Advantage insurance provider, Blue Cross/Blue Shield, couldn't agree with the major provider in my area on reimbursement rates. It was never resolved and I had to switch insurers. Luckily, I was able to sign up with another company and it's been fine so far. It was somewhat traumatic though and I considered switching back to straight Medicare, but it's not that easy. There's a fine or fee or something for the switch and it wasn't worth it.

It's all f*ed up and I can't wait until the country finally wakes up and accepts that universal healthcare is the way to go.

[MineralMan]

17. Where I am, Allina is one of the largest healthcare groups.

That's why I chose the Allina/Aetna Advantage plan. No arguments about providers. There are Allina Clinics, Urgent Care clinics, hospitals and imaging facilities all over the Twin Cities Metro area. My wife was with another Advantage plan, but it just shut down its Medicate Advantage plans, so she is switching to the plan I have. Most of her providers are already Allina anyhow.

You do have to do your homework, I guess. I was a Blue Cross/Blue Shield member for a long time, but when they dropped my plan, I switched instead of choosing a different plan with them. Glad I did now. It's getting even more sketchy here. there was about a 6% jump in my small premium for 2026. No big deal.

[Ms. Toad]

22. When you don't sign up originally for a supplement,

In most states, the plans can be based on your actual health (rather than the lower community-based price) and they don't have to accept you.

[Rebl2]

14. I am

on regular Medicare and have a supplement plan though postal service—blue cross. Remember when congress passed a plan at the urging of President Biden, that once you spend $2000.00 for medication, you pay nothing the rest of the year? Well I take Humira, a biologic drug. Pretty expensive. I paid my co-pay in January this year and haven’t paid for any of my medications since. My blue cross plan is a PPO and like I said am on regular Medicare. Thank you President Biden.

[Tree Lady]

19. We were warned many years ago

Which is why I went on regular one even though they offered more goodies with advantage to get you to sign up.

[ProfessorGAC]

21. The "Free" Stuff Has To Be Paid For Somehow

Those goodies aren't really free. Somebody has to get paid for those services.
The dentist doesn't work for free because they are Part C patients.
The companies have to cut some expenses to cover that "free" stuff.
It appears denial of services is the easiest path.
Pretty simple business actually.