There are actually two questions rolled into one here.
The horrors of
HMO:
HMO stands for
Health Maintenance Organization and is based on the premise of having all your medical records under the supervision of one
Primary Care Physician who is, if you will, the gatekeeper for all of your medical procedures and whatnot. Every thing is housed, if you will, under the companies physical location, under your Primary Care Physicians name. It makes it easier for them to access your files, and also easier to spot something that may be important, and warn you about it, before it grows into something severe.
The assumption has long been that
HMO's are run by business people, and that is who makes your decisions, not the doctors, nor you, the patient. For every example I can show you, that that is not the case, I can also show you a case that backs up that assumption.
For those that don't like
HMO's, the assumptions are:
- I don't have any access to "good" doctors, only those that work on salary, because they don't have the expertise to go out on their own
- I feel like cattle, going into their building and waiting in a huge room, with God knows who, waiting for my name to be called
- They don't pay any claims, and make me jump through hoops just to get what I want. I have a friend, who is not in an HMO, and her doctor is the best in the city, and doesn't have any of these problems.
For those that like
HMO's, the assumptions are:
- They take good care of me. I don't always get to choose my own doctor, and there is high turnover, but, I don't care. As long as there is someone there to treat me, I'm okay with it.
- They do all my paperwork for me, so I don't have to keep up with my own receipts
- They have classes, special events, and a nurse on-call line I can call anytime of the day or night. They even have after hour clinics I can go to.
HMO's, like every other kind of health care service, is not for everyone. You have to determine the personality of the person, and based on that, you would either suggest they go into an
HMO system, or stay clear of it. For someone who has been going to several specialists their adult life, unless those specialists are in the
HMO network, they would be the wrong people to put into an
HMO, no matter how much money it is saving them.
They have built a relationship with that physician, and moving them, strictly based on money is harming them, and your reputation.
Now, the Horrors of Part C: Part C of Medicare has taken on many incarnations - Part C, Part C+, Part C Plus Choice, and now Medicare Advantage. Basically, it's the anti-MedSupp. Just as with Medicare Supplement plans, the federal government is privatising the administration of the medicare part C.
CMS did a horrible job of educating the Medicare Beneficiaries, the Physicians who accept Medicare, and the
FMO's and agents who are out selling the products. These are government employees, who never had to offer a service to an end user, and make them satisfied, in their lives. These are mirmidons, who just go in and out of their respective offices and cubicles everyday, with no sense of cause and effect.
Medicare Advantage Plans are nothing more than another option for Medicare Beneficiaries to take advantage of. Simply put,
MA's are nothing more than Major Medical Plans for seniors.
The big mistake is not the plans themselves, but the poor, inadequate, or non-existent training required to properly sell these plans.
Because there are no medical questions, other than ESRD, people are assuming that they are being taken out of Medicare. Actually, what is happening is they are being "transferred" to another provider in the Medicare system, and that paperwork is nothing more than authorization to do so. Because it is made that easy, agents,
FMO's, and to a certain extent, insurance companies, are a bit laxidasical (sp?) in moving Medicare Beneficiaries into these plans.
That's a shame.
They feel that since there is no premium to collect (in most cases), that it's a no-brainer, and best for the Medicare Beneficiary.
WRONG
Where Medicare Supplement plans ask for payment now to cover costs later, Medicare Advantage Plans ask for no money now, and offer you "predictable" costs on the tail end. You know how much your doctor visits are, your dental visits are, your frames for your glasses. You know you have to buy your own hearing aids, but you know how much the tests are.
If they were not a viable option, I seriously believe that CMS would not have approved them for sale. Unlike the Zero Premium Life insurance scam, Medicare Advantage Plans were approved on a state by state basis, so that CMS could see what is and is not working. It's not an easy process these insurance companies have to go through to get their products approved in certain states.
Bottom line: As long as unethical agents bait and switch, misrepresent, and arm-twist, then you will always hear horror stories. If it is something you can believe in, and would sell to your mother and father, without losing sleep five years from now, then sell it. Otherwise, move on to another product.
HMO Part C: The Good and Ugly
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