Sneak Peaks and Rumors

[Bob_The_Insurance_Guy]

Medicare Advantage Plans do not cover cataract surgery. That's why.

 

[Chazm]

Medicare Advantage Plans do not cover cataract surgery. That's why.

Wow I don't know what horrible plans are offered there but I can't think of a plan that doesn't cover it in FL

Maybe you got bad info from your rep because it should be covered

 

[bluediamond]

MA plans are suppose to cover everything that is covered by Medicare as far as I know, I also don't know of a plan that will not cover cataract surgery, plus give's you a free pair of glasses afterwards.

 

[yogooglethis]

Medicare Advantage Plans do not cover cataract surgery. That's why.

Medicare and of course MA as well cover cataract surgery.In fact i use this very common outpatient surgery quite often as an example of low the 20% co insurance amounts too when compared to commercial insurance medical rates at an outpatient center or at a doctors office.I have seen the bills many time and typically on a MA plan in North Florida it's between 150.00 - 200.00 per eye whereas on original medicare it's typically between 175.00 and 250.00.Funny thing is when a MA plan has a flat co pay of 250.00 instead of 20% co insurance the cataract surgery always end up costing 250.00 instead of the typical 175.00 when paying 20% co insurance.

I still recommend a MA for a t65 client who is healthy and leaning towards MA over Med supp but is concerned because they plan to have cataract surgery as soon as they start medicare .I explain that they will still pay 200.00 in premium with the med supp/pdp combo whether they have the surgery or not and with the MA their share of cost will most likely be less than 200.00 for the surgery.

 

[Chazm]

Medicare and of course MA as well cover cataract surgery.In fact i use this very common outpatient surgery quite often as an example of low the 20% co insurance amounts too when compared to commercial insurance medical rates at an outpatient center or at a doctors office.I have seen the bills many time and typically on a MA plan in North Florida it's between 150.00 - 200.00 per eye whereas on original medicare it's typically between 175.00 and 250.00.Funny thing is when a MA plan has a flat co pay of 250.00 instead of 20% co insurance the cataract surgery always end up costing 250.00 instead of the typical 175.00 when paying 20% co insurance. I still recommend a MA for a t65 client who is healthy and leaning towards MA over Med supp but is concerned because they plan to have cataract surgery as soon as they start medicare .I explain that they will still pay 200.00 in premium with the med supp/pdp combo whether they have the surgery or not and with the MA their share of cost will most likely be less than 200.00 for the surgery.

Wellcare here in Orlando is $15/ per eye

I wonder how many clients Bob told that MAPD won't cover their cataract surgery?

 

[Nikita]

Medicare and of course MA as well cover cataract surgery.In fact i use this very common outpatient surgery quite often as an example of low the 20% co insurance amounts too when compared to commercial insurance medical rates at an outpatient center or at a doctors office.I have seen the bills many time and typically on a MA plan in North Florida it's between 150.00 - 200.00 per eye whereas on original medicare it's typically between 175.00 and 250.00.Funny thing is when a MA plan has a flat co pay of 250.00 instead of 20% co insurance the cataract surgery always end up costing 250.00 instead of the typical 175.00 when paying 20% co insurance.

I still recommend a MA for a t65 client who is healthy and leaning towards MA over Med supp but is concerned because they plan to have cataract surgery as soon as they start medicare .I explain that they will still pay 200.00 in premium with the med supp/pdp combo whether they have the surgery or not and with the MA their share of cost will most likely be less than 200.00 for the surgery.

With my turning 65 clients who want to have cataract surgery immediately, they will often go on a med supp for a few months and also have any other procedures done that they have been putting off and then they often switch over to MAPD at the next AEP.

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Medicare Advantage Plans do not cover cataract surgery. That's why.

WOW where on earth did you get this from? MA plans absolutely DO cover cataract surgery! Also, I disagree with your math on the earlier illustration. The cost of the med supp for the 5 years would not be $186 for that whole time. Most med supps start out much lower and then gradually increase. You can also shop around and get a lower rate if you do your home work.

Here in Iowa, the cost for a Plan F for the first 5 years is closer to $5000.

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Wellcare here in Orlando is $15/ per eye

I wonder how many clients Bob told that MAPD won't cover their cataract surgery?

Hope he has good E & O coverage....that's a whopping big mistake

 

[yogooglethis]

With my turning 65 clients who want to have cataract surgery immediately, they will often go on a med supp for a few months and also have any other procedures done that they have been putting off and then they often switch over to MAPD at the next AEP.

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WOW where on earth did you get this from? MA plans absolutely DO cover cataract surgery! Also, I disagree with your math on the earlier illustration. The cost of the med supp for the 5 years would not be $186 for that whole time. Most med supps start out much lower and then gradually increase. You can also shop around and get a lower rate if you do your home work.

Here in Iowa, the cost for a Plan F for the first 5 years is closer to $5000.

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Hope he has good E & O coverage....that's a whopping big mistake

good thing the DOI and MA carriers don't conduct pop quizzes on agents selling medicare health plans!

 

[taterpeeler]

stop picking on him.... you aint getting E&O claims for having the policy pay better than the agent said.... a policy paying better than so said aint getting him ion trouble... JS

 

[yogooglethis]

stop picking on him.... you aint getting E&O claims for having the policy pay better than the agent said.... a policy paying better than so said aint getting him ion trouble... JS

Nor sure if your being sarcastic but my response to that is - your right no problem if MA unexpectedly pays a claim for cataract surgery that policyholder wasn't expecting but what about those who consumers who were considering both a med supp and ma but when they heard their insurance adviser say that ma plans don't cover one of the most common outpatient procedures covered by medicare they fork out the premiums for a med supp/pdp combo either because A. they had an impending cataract surgery or B. they surmised after hearing this that ma plans must not be that good because if it doesn't cover cataract surgery what else doesn't it cover the the original medicare covers

 

[Chazm]

I don't like picking on anyone because there's plenty of times where I'm not 100% on something so I usually just wait for someone else to respond.

His response was so "as a matter of fact" saying "that's why" when I asked him why is it a must when having cataract surgery. He must have felt pretty confident about wrong info