Medicare Advantage Puzzle

The fitter at our Costco just outside Houston has been wearing hearing aids since he was 5. Costco seems to be doing a great job of finding and retaining capable personnel. I’m relatively new to Costco, but the hearing aid business likely will keep me as a member.

I’ve checked out a number of MA plans that say HA benefit but usually ther’s restriction on where you can use your benefit eg Truhearing by Humana. I’m in Pennsylvania so that may be why my plans are more limited than California and am hoping to find benefit I can use at Costco.

UnitedHealthcare® Medicare Advantage, UnitedHealthcare® Part D, AARP® MedicareComplete® and AARP® MedicareRx members all MA plans use HealthInnovations program, seems to work with you supply a hearing tes (they will set up) they recommend then you order online. No brands mentioned.

Don’t wait, look into your local lions club and see what they can do for you.

I think Epic is a service provider, not a hearing aid manufacturer. What you seem to be saying is that you can get some version of Oticon thru Epic for $400 (each or pair?). Certainly worth looking into.

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Agreed Nancydrew. I’m in PA, with Aetna. My coverage is limited to a specific provider and contributed about 1/4 of the total cost. Costco would have been much less costly.

My Medicare Advantage healthcare provider offers 1500 dollars toward a pair of new aids per year. I had to use audiologists that are in network and visited a few of them. One offered Phonak Naidas B70 UP a pair for 4,000 dollars, after 1500 dollars discount, my cost would be 2500 dollars. Its still expensive and don’t like going back and forth to audiologist for adjustments. I have found a pair of used Naidas on eBay for less. I want to use a used pair and l can program these myself until Phonak comes out with UP aids with the Marvel platform or better.

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As a former ins. co. adjuster, allow me to add this to the discussion: When you choose so-called “Medicare Advantage” sold by private insurance companies, instead of conventional Medicare A & B with C & D, just in order to get those “fringe benefits” like a little help with hearing aids, eyeglasses, etc. just think about what you are giving up that you would have had with government Medicare - the right to choose your own doctors, specialists, hospitals anytime and especially in the event of a major medical or life-threatening illness. With so-called “Medicare Advantage” the insurance company only lets you pick from their so-called “network” - local doctors and hospitals that the ins. co. wants to throw their business to, and doctors and hospitals drop in and out of those “networks” from one year to the next. Your favorite doctors may be on the list the year you join and long gone from that network when you later need them the most, because the ins. co. decided they were not being “good boys and girls” in towing the ins. co.'s idea of “conservative treatment.”


As the original poster of this thread I feel somewhat compelled
to add some additional information that I’ve come by as I’ve researched
this labyrinth issue; NateS, above, makes some excellent points common
to all Medicare Advantage programs but did not add for balance the fact
the MA plans cap Part B expenses…this is not done with Medicare Parts A & B
and unless one has a very expensive Supplemental Plan you are on the hook
for 20% to infinity…but back to HA’s and Medicare Advantage; turns out my
new audiologist who started me out on this task was right about UnitedHealth Care
(nation’s largest insurer BTW) getting into the Hearing Health business beyond
their legacy co-pay offerings; they threw in with Epic Hearing HealthCare and are
offering what they call UnitedHealthCare Hearing; I just got an official plan listing the
HA’s offered and sure enough their base level aid starts at $400 just as I was told; plans
include Entry Essential Standard Advanced and Premium going from $400 to $2025
per aid and include all the majors (Oticon Phonak Starkey ReSound Widex Beltone);so
for me to replace my aging Agil Pros with Oticon OPN’s or S would be $4050 if i accept
this at face value; whereas ,like others, I can visit Costco and get fitted with the new KS9 for
under $2000/pair; it appears likely this initiative is a market driven response to DIY and the
success of the Costco model in making premium or almost premium aids available to the
masses and UnitedHealthCare wants to capitalize on this market while still maintaining
rather high margins on the upper end of the HA product spectrum

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I’m confused.
What should I do?

Nate - I find your post very interesting and in fact fell into the trap you so clearly identified. I recently signed up for Kaiser Permanente thinking benefits/discount for hearing aid purchase, dental work, etc. were a major plus. Well after signing up I soon realized “picking your own doctor” is a complete farce since the good doctors (those educated in U.S with several years of experience) are almost impossible to find in the Virgina/DC/MD area. Furthermore my assigned family doctor whom I’ve yet to meet just notified me he was leaving Kaiser Permanente and being replaced by a doctor from Syria that got his medical degree in Damascus. Yikes

So in your post are you actually saying I might be better off using Medicare directly and then paying off the percentage of medical cost (medicare doesn’t cover) then using a Medicare Advantage Plan through Kaiser Permanente? From what I’ve seen from K.P. so called family physicians or internal medical physicians are a complete joke.

Yet scubajwd also brought up a good point saying - "but Nate did not add for balance the fact
the MA plans cap Part B expenses…this is not done with Medicare Parts A & B and unless one has a very expensive Supplemental Plan you are on the hook for 20% to infinity.

Both of you guys make excellent points - so is there any middle ground anywhere to find the “perfect” coverage once you turn 65.

This is indeed a complicated decsision. People handle it in different ways. Do you have a trusted family member or insurance agent who can help you through it?

Hi Laura - I plan to look into Humana as far as supplemental Medicare coverage but would you be able to share (approximately) how much your premium coverage is per month? You sure do get a wide range of premium payments from various Medicare Advantage plans.

So you haven’t even met your Kaiser doctor and have decided you don’t like him and that the system is a joke? I worked for Kaiser in California for years and some of favorite doctors were foreign educated. I can’t think of any from Syria, but definitely remember some great doctors from Iran and Pakistan.

Kaiser proudly pushes their medical coverage by saying “new customers” can pick their own doctor. I was assigned a doctor two months ago (I’m a new customer) and did not care for his medical background, nor his older age. I’d like to find a doctor that will be around for a while. In any case when I tried to pick two other doctors within Kaiser I was told they were not accepting new patients. Then I found out my assigned doctors was leaving and being replaced by another Kaiser doctor that got most of his medical education overseas. If you want to use doctors from Iran, Pakistan or Syria - good for you. I personally prefer checking where a doctor got his/ her medical training/education and prefer that to be in the U.S. I also want a doctor whose native language is English due to my hearing loss. Most people with mid-range to severe hearing losses don’t do well with foreign accents thus my reason to see a Doc that is “home grown”.

I agree with you that Costco is a much better choice for most cases; but I respectfully disagree with you about the 20% deductible. With what I recommended as my comparison of Medicare Advantage vs
“conventional Medicare A & B with C & D” because “C” also known as “Medigap” or “Supplement” is, relatively speaking, dirt cheap compared to what you get in return, as it covers both the annual deductible AND the 20% in full. My Suppl covg. started out at $132 month back when I retired and now, with gradual increments, at age 83 it is up to only $203 monthly and rare is the year in which they pay out less than that.
And the superiority of Supplement over “Medicare Advantage” is that there is no second-guessing by the “C” carrier - they must and do pay the full remainder of all claims paid by Medicare; in addition, “balance billing” by the doctor or hospital is forbidden, nor are they permitted to charge the patient for services denied by Medicare.
And it is so simple: There are NO claim forms: The providers bill Medicare and Medicare processes, pays and passes the unpaid portion on to the Supplemental carrier who pays the unpaid balance.
When you want to pick your own doctors and hospitals, there is really no comparison to the combination of govt. Medicare A & B when C & D are added; but there are no sales agents pitching it - all the salespeople are working on commission for the so-called “Advantage” plans, so nobody tells senior citizens that. They have to dig it our for themselves.
“Medicare Advantage” is like a casino - “The House always wins.”

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No, youbegone I am not saying that I recommend getting genuine govt Medicare and then paying the balance. See my original and followup posts. It is my contention that original govt Medicare A & B plus purchasing C (“Supplement”) and D (Rx) is in my humble opinion and based on my experience in the insurance industry and claim adjusting completely superior to Medicare Advantage for the reasons I explained. Won’t cost you more; may cost you less; and you get the doctors you choose in good health and when disaster strikes.
Remember, the Supplement © policies are sold by the same health insurance companies that want to sell you Advantage instead - the reason being that under a C policy the ins. co. is NOT the “Boss” - they MUST pay the full 20% and deductible of all claims approved by govt. Medicare. Unlike their Medicare Advantage policies, they have NO say in approving or denial or haggling over what they will pay. So naturally they’d rather sell you an “Advantage” policy, but all that glitters is not gold.

“Advantage” is a great name for these policies, as long as you understand that the advantage is with the ins. co., not with the insured patient.

I’m not knocking health insurance companies as great investments - When anybody asks my opinion, I say buy their stocks, but not their Advantage policies. :slight_smile:

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My rate is either $135.00 or $137.00 monthly. Not sure exactly. This is what SS deducts from my SS check monthly.
The plan I chose is a PPO not an HMO.
This is an Advantage plan not a Supplemental plan.

The monthy amount deducted from your SS check is for Medicare. Is there a separate amount for your Advantage Plan? (Many are avaialble at no extra cost)

It is for Medicare part B which is thru Humana.
It is the Advantage plan