Critique of UHC/hmo-pos

[policy doctor]

I confess I don't always read every line and tittle in these enrollment books.

However, I did read the out of network POS in the new AARP complete plans and noticed a lack of coverage for skilled nursing and home health care. Bad enough the copay went up to 40% for out-of network benefits, but these are eliminated.

Question...I thought these plans had to offer every single benefit that medicare does, if not better; so how do they get away with this?

Or am I misreading this? Looks like they're focusing on the hmo benefits side.

 

[GreenSky]

They do have coverage but in-network only. You are indeed misreading the benefits.

The POS side does not include all the HMO benefits.

Rick

 

[Josh]

I confess I don't always read every line and tittle in these enrollment books.

However, I did read the out of network POS in the new AARP complete plans and noticed a lack of coverage for skilled nursing and home health care. Bad enough the copay went up to 40% for out-of network benefits, but these are eliminated.

Question...I thought these plans had to offer every single benefit that medicare does, if not better; so how do they get away with this?

Or am I misreading this? Looks like they're focusing on the hmo benefits side.

POS benefits are generally a POS.

If folks really want out of network care they should go with a PPO.

 

[Guest]

I confess I don't always read every line and tittle in these enrollment books.

However, I did read the out of network POS in the new AARP complete plans and noticed a lack of coverage for skilled nursing and home health care. Bad enough the copay went up to 40% for out-of network benefits, but these are eliminated.

Question...I thought these plans had to offer every single benefit that medicare does, if not better; so how do they get away with this?

Or am I misreading this? Looks like they're focusing on the hmo benefits side.

that is the "hmo" part of the plan, home health care, dmc and skilled nursing are in network only.

 

[AllGold]

(In-network coverage already mentioned.)

The other gotcha is an MA plan only has to be "actuarially equivalent" to original Medicare. That means specific benefits can be worse than Medicare as long as the coverage overall adds up to what Medicare covers.

You often see that in the hospital copay where a $255/day for 7 days copay (potentially up to $1785) can be quite a bit higher than Medicare's Part A deductible.

 

[policy doctor]

Thanks for the replies. And I was referring to OUT OF NETWORK.

 

[Todd King]

Thanks for the replies. And I was referring to OUT OF NETWORK.

I just recently heard somewhere that is was only available IN NETWORK.

 

[Josh]

Thanks for the replies. And I was referring to OUT OF NETWORK.

Subaru has a car/truck out. It's not a particularly good car and it's not a particularly great truck, but it's a better truck than a car and a better car than a truck. That's what the POS benefit is. It adds cost which hurts it from being as good of an HMO as it would otherwise be, but it lets you go out of network even though the benefits are limited.

 

[somarco]

Subaru has a car/truck out. It's not a particularly good car and it's not a particularly great truck, but it's a better truck than a car and a better car than a truck.

Doesn't this belong in the Automotive section?

Where is a moderator when you need them?