Probably a valid description of all medical insurance.
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The link you gave apparently has been removed from the MedCity News website.
I did find this:
I think my view of medical insurance is hoping I don’t get sick or have a serious accident, but knowing I have insurance is reassuring and can prevent me from going bankrupt. There is shared risk. The insurance company knows some people will need expensive treatment, but because the risk is spread out, it works out ok.
Having a known hearing loss and buying hearing aid coverage is thinking that the “insurance” will get you a better deal than you could get on your own. In this situation there is no real shared risk. Likely everybody who bought hearing aid insurance plans on getting hearing aids. The only way for it to save people money is through getting a volume discount.
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Nate, I think it is difficult to make these comparisons because of the different plans by different companies in different state. I agree about the balance billing issue, but my Advantage plan guarantees that I will never have to pay more than $3000 of balance in a year so I have at least that in a separate savings account. I haven’t come anywhere near that amount despite having six modest surgeries in a year at a cost to my Advantage insurer of about $20,000 each, and my balance billing being less than $100 each. Anyway, I forwarded your comment to a friend who is joining Medicare this year and has to think about all those issues you raised, for which he and I thank you.
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fyi blue cross insurance use true hearing as a vendor - watch out - they sent me to an underqualified vendor, and they only allow 3 fitting visits, during which she didn’t know what she was doing.
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Out here in Washington State, the Advantage programs will provide a $ discount, but it is still a lot cheaper to go to Costco, because the private audiologists jack up their prices accordingly.
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The original article is back up. I think they needed to take it down to make an edit …
Something else to consider . . .
From today’s New York Times:
“In your recent discussion of limitations of Medicare Advantage plans, you did not include information about improper claims denials and the difficulty people have pursuing appeals. That certainly should be part of your coverage.
A report last year by federal investigators did find that Advantage plans have a pattern of inappropriately denying patient claims. The Office of Inspector General at the Department of Health and Human Services found “widespread and persistent problems related to denials of care and payment in Medicare Advantage” plans. The report examined appeals filed by patients and health care providers from 2014 through 2016, and found that Advantage plans themselves overturned the denials in 75 percent of cases.
However, very few claim denials are appealed — just 1 percent during the three-year period reviewed in the inspector general’s report.
The Advantage payment model reimburses plans a preset amount per patient; that may be incentivizing plans “to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,” the report concluded.
“We see plenty of denials by Advantage plans that shouldn’t be denied, and wouldn’t be if the patient had been enrolled in original Medicare,” says David Lipschutz, associate director and senior policy attorney at the Center for Medicare Advocacy.
Among the most common problems, he says, are early hospital discharges, denial of care in a skilled nursing facility or home health care.”
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There are advantages and disadvantages to any insurance model. One of the big issues with the fee for service model that traditional Medicare uses is that it encourages too much “care.” Overtesting is rampant. I’m sure there are many reasons for it, but getting paid more if one does certainly doesn’t discourage it. Such a model encourages more PSA tests, more prostate biopsies, more heart testing, etc. Many people think “Good, they’re looking out for me,” but there are real downsides to overtesting. I encourage everybody to make their insurance purchasing decision carefully, but I wouldn’t rule out an Advantage plan (or a supplemental plan for that matter).
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Your point is well-taken, but there is a built-in disincentive for over-testing in govt. Medicare. It may exist in Advantage too. That is, that govt. Medicare has standard pre-requirements for prescribing testing based on age, prior health and symptoms. You can usually look these up on the internet. If those requirements are not met, the claim submitted by the medical provider is denied and both the provider and the patient receives a notice that they are not to be billed for the unpaid charge and are not to pay it if billed.
This provides a substantial disincentive to the doctor not to order unnecessary tests.
Ocasionally, I get notices of such denials of payment for tests, and I never hear any complaints from the doctor, whose attitude seems to be something along the lines of “If I think it is important and should be done I will order it. If they pay it that’s okay and if they don’t that’s okay too.”
Are any of you here in this topic familiar with AARP UnitedHealth advantage plan? Specifically what do they offer on terms of hearing aid purchase assistance.
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I am lucky I have a service related hearing loss and I get my aids from the US Veterans Administration. I am 72 and my Medicare Advantage Plans says it covers hearing, but when I dig deeper into it what is really says is it covers hearing test. I get most of my care from the VA clinics but I do have coverage to go to local doctors and clinics as I choice. And the VA wants to know about all of my health insurance so they do bill against my Medicare Advantage plan I am sure. I not only get my aids, but also my glasses, and medications from the VA system and it has worked well for me for almost 15 years now.
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Each Medicare Advantage plan is specific to the area where YOU live, so if I look up the info for me (central coastal California) it almost certainly will not be the same for you.
Here is a direct link to the AARP United Health Care Plans. Just enter your zip code.
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My memory is fuzzy as I retired over 6 years ago from a HMO with Medicare Advantage plans that also occasionally had patients in a VA hospital. Pretty sure VA didn’t get reimbursed for anything unless there was some reason we couldn’t have cared for the patient. About our only interaction with them was arranging home care or discharge to a skilled nursing facility.
I am not sure about all but I do get reports from my Medicare Advantage plan and I see there where the VA system as sent bills to it. The big one was when I go glasses from the VA and the bill went to my Medicare plan. And I know I have had some test for stomach issues that have been billed to my Medicare plan.
I clearly don’t know what’s going on in your particular situation, but I do know there is a big difference in billing for services to an insurance company and getting paid for them. How most Medicare Advantage plans work is that they agree to take care of you if deal with them. They have to pay for other care in case of emergency, but they want to bring you back into their system asap. If you decline, your responsible. However in your case with the VA it doesn’t matter.
I do not know all for sure but my plan was set up for me by a local rep that knows I go mostly to the VA, and I have been told by some other Veterans in this area that they go outside of the VA to get some of the services that the VA provides for me. It is a small clinic in a small city, and I have been sent to local hospitals for test instead of to the VA hospital that is about 50 miles from here. And I haven’t had copays to cover except for the ones I pay to the VA for my medicines.
I have the same plan as you. I paid about $2200 7 years ago for Phonak Audeo (forget exact model) and about $2100 for Phonak Audeo Direct a couple years ago. First ones w. BT tech. Being first w. that tech, they are much more “sketchy” than the newer Marvel series. We don’t get dental.
What we do get is coverage for virtually anything medical. Every year wife has to determine if at least a particular doctor is on a plan she wants to choose. What a hassle.