Karl Auerbach

Wow, US medical insurance is so bad that today I discovered that my Medicare coverage was cancelled. How is that even possible?

It had everyone at the doctor's office wondering.

The answer is that I was on a Medicare Advantage plan - which I now know is something that every person should avoid. And they simply change me to a new medical provider - at a new location with new doctors and no records - without ever telling me.

You know who created the Medicare Advantage program - Republicans.

That's the same people who created various "health savings plans" in which those savings vanish at midnight each December 31.

I will be getting out of that "Advantage" plan at the next registration period, but that means that I'll be going the rest of the year without medical insurance, even though I am paying monthly for it.

Sheesh, the R-party really knows how to screw the public pooch.

Jul 17, 2024 at 2:23amWeb
Show threadKarl AuerbachJul 17, 2024

I want to thank everyone who has commented on this thread. Some of those comments have been really informative and useful.

So to everyone: Thank you!!

Show threadNonya Bidniss 🥥🌴Jul 17, 2024
@karlauerbach I'm sorry. MA plans are scams.
Show threadPetesmom *has moved*Jul 17, 2024
@karlauerbach Talked parents into getting rid of their “advantage” plans pre pandemic. Nothing but a con. And killed my mom slowly & painfully. Literally.
Show threadGiddey_upJul 17, 2024
@karlauerbach They shouldn’t allow these huckster insurance companies to use the word “Medicare.” I discovered the problem the same way when they kept kicking my primary care doctor off their coverage. I went to true Medicare with the best medigap plan I could afford. No more arguments, no more copays, no more surprises.
Show threadSteve BellovinJul 17, 2024
@karlauerbach Ugh. (Takes notes, since I'll soon be on Medicare, too.)
Show threadCurt OlsonJul 17, 2024
@karlauerbach My wife and I are getting to the age where we are realizing we have no idea how to navigate the US health care system, right at the time we are starting to need a few things. The insurance side if things is truly horrible, and the processes the insurance industry forces often make no sense and take forever to work through. Still lots of great health care workers providing great care ... if you can run the insurance gauntlet to get to them. We seem to have combined the worst aspects of everyone's ideas, so no one gets a win ... maybe health care shouldn't be so political and should be something we just do, because it's something we all need at some point. Ugh.
Show threadDr. SundancerJul 17, 2024
@clolsonus @karlauerbach The only reason it's political is because private companies are in competition with a service the government provides, and the private companies are trying to use the law to gain a competitive advantage. It's the same thing with mail delivery, education, etc.
Show threadM. DoucetJul 17, 2024

@clolsonus Are you in MN? (The cities mentioned in your profile suggested it.) If that's so, don't panic! You should know that there is free expert help available through your state's MNsure program: https://www.mnsure.org/help/find-assister/find-assister.jsp

They will help you figure everything out, give candid advice, and can even fill out forms on your behalf if you need them to, so don't worry! 😊

Assister Directory / MNsure

Search the Assister Directory to find an enrollment expert (

MNsure
Show threadPNW DebJul 17, 2024
@karlauerbach But you can go to the provider they changed you to for the rest of the year, right? I would be pissed too, but if they switched you, you still should have medical coverage.
Show threadKarl AuerbachJul 17, 2024

@DebR In the next half hour I am going to be trying exactly what you are suggesting. However, it is apparently optional on the provider (in my case United Health Care) whether they will make the change or not.

I am sure that after my vituperation on the phone yesterday that my record will come up with a red banner saying "danger, danger". ;-)

Show threadPNW DebJul 17, 2024
@karlauerbach 🤣🤣🤣Good luck!
Show threadKarl AuerbachJul 17, 2024

@DebR Thanks for the good-luck - it made a difference: Because our county has had a lot of disasters (we seem to face the wrath of the gods far too often) there seem to be some rather hidden gates that open in the procedures to make changes.

This is the first time that I can actually say that I may have been the beneficiary of a natural disaster. ;-)

Show threadJeff Barnes ✅🗺️🏔️🌹Jul 17, 2024
@karlauerbach You may be able to switch to a supplement plan mid year if you pass underwriting.
Show threadJoe Hill 🇵🇸🇺🇦Jul 17, 2024
@karlauerbach
I love my Medicare Advantage plan. Copays have gone from $30 to $15 since 2021. Rx have gone from $5 to zero. PT has gone from $40 copay to $20. They’ve added vision and dental. And they’ve covered about $10K of back treatments that were only covered 80/20 under Medicare.
Show threadgunthrJul 17, 2024
@Joe_Hill @karlauerbach my father was of the same opinion. The difference was that his plan was through a state university. With that kind of volume, I imagine their plans are much better than your average Medicare Advantage plan.
Show threadKarl AuerbachJul 17, 2024
@gunthr @Joe_Hill My sister gets health coverage through an extremely large university insurance system - I am in envy of it.
Show threadbouriquetJul 17, 2024
@Joe_Hill @karlauerbach Mine with a large national company was good when I first got it, but prescription copay for anything other than the most basic generics was mediocre. A gallbladder removal with days of hospital care (due to anti platelet meds) was paid without issue, with the usual copays to surgeons, radiologists etc. Then rates for 2024 went up.
Switched this year to a regional New England plan, much better prescription coverage, lower copays.
Gotta shop around.
Show threadAndrew Benedict-NelsonJul 17, 2024
@bouriquet @Joe_Hill @karlauerbach yes, good plans exist, but it's often impossible to tell if it's a good plan or not until it's too late.
Show threadKarl AuerbachJul 17, 2024
@Joe_Hill My advantage plan was good - while it lasted. But they kept shrinking the the "network" of providers to the point where the largest medical provider in our region (and about the only provider in our region) was no longer "in network". Same for dental coverage.
Show threadcobalt going beige todayJul 17, 2024
@karlauerbach my Bull Crap/Bull Shit insurance is Medicare Advantage. In 2019 it was great. Now as of 2024 I no longer like this plan that seems to exist by denying treatments and some of my meds, delaying decisions and increasing my co-pays. I’d love to get the standard Medicare but fear the underwriting questions would block me.
Show threadskryJul 17, 2024
@cobalt @karlauerbach I’m pretty sure they have to cover you with basic Medicare if you want to switch, but you might have to pay more for supplemental than you would have originally, and you might have to switch during open enrollment near year end. An insurance broker in your area could run some numbers for you and discuss your options.
Show threadKarl AuerbachJul 17, 2024
@skry @cobalt You are correct, I still have various kinds of base medicare and out-of-network coverage. But some of that would have forced me to move to another doctor, another system of records, different facilities, and so on - all of which would disrupt medical relationships that I've built over multiple decades.
Show threadIvey Janette McClellandJul 17, 2024
@karlauerbach And they eventually want to end Medicare altogether in favor of HSA's and forcing retirees back into the workforce just to afford expensive employer healthcare plans. I have Medicare and only have the Advantage because I can't afford the costs of Medigap and the Part D prescription premium.
Show threadThe Great Llama Jul 17, 2024

@karlauerbach @meganL
Oh yeah, I've heard about that. Total con job where they switch you from Medicare to a private plan without being upfront about it.

The "advantage" definitely doesn't go to the patient.

Show threadBardMoss the Bodhi Linux GuyJul 17, 2024
@karlauerbach
I understand that the system is set up to be abused, but I have not experienced a problem with my Humana Gold Medicare expanded plan. I have some limits as to where I can go and what I can do, but it pays for everything that Medicare does not cover, including Medicare premiums.
Show threadMar :🌻Jul 17, 2024
@karlauerbach I learned that one the hard way, but I was lucky enough to get out of it while open enrollment was still going.
Show threadShirley EugestJul 17, 2024
@karlauerbach
Medicare Advantage locks you in like nobody's business. If you are in California, you might still be able to get some coverage this year, depending on when your birthday falls. (CA Senate Bill 407)
You still can't switch for improved coverage until the next election period, just a different insurance provider.
Find a decent Medicare broker for good advice on how to fix your situation.
https://cahealthadvocates.org/medicare-advantage/enrollment-disenrollment-in-medicare-advantage-plans/
Enrollment & Disenrollment in Medicare Advantage Plans - California Health Advocates

If you want to join a Medicare Advantage (MA) plan, you must have Medicare Parts A and B. Your Part B premium will continue to be taken out of your Social

California Health Advocates
Show threadKarl AuerbachJul 17, 2024

@EugestShirley You are giving excellent advice, thanks. I was just on the phone with a broker and I am much more informed now than I was an hour ago.

Again, thank you!

Show threadJürgen HubertJul 17, 2024
@karlauerbach The American "healthcare" system is not the _only_ reason why I would not want to live in the USA, but it's near the top.
Show threadChris Farris Jul 17, 2024
@karlauerbach HSAs don't go away. You're thinking of the Flexible Spending Plans (FSAs).
Show threadKarl AuerbachJul 17, 2024

@jcfarris I think you are correct - this medical stuff is a sea of acronyms. It is easy to drown in 'em.

We, through the small corporation we own, wanted to pay into those health accounts on behalf of our employees and also to help our employees cover any gaps in health insurance. The IRS beat us up for even having that thought.

Show threadPaul CoenJul 17, 2024
@karlauerbach And the GOP wants to end Medicare and 100% replace it w/MA because if they do that, they end the example of a single-payer system that Medicare provides, and the end a system that COULD be the basis for an expanded system.
Show threadJL Johnson Jul 17, 2024

@karlauerbach you are thinking of flexible spending account (FSA.) HSAs roll over year to year, and you can take them with you to other employers. The interest rate on mine is a very generous 0.01%.

Meanwhile, the federal funds rate is >5%. My Goldman Sachs rate is 4.5. It’s still robbery.

Show threadЄвгенJul 17, 2024
@karlauerbach Do check out the resources and podcast archive of An Arm and a Leg <https://armandalegshow.com/> Supported in part by Kaiser Health News. (Kaiser Foundation, NOT Kaiser Permanente)
Home - An Arm And a Leg

An Arm And a Leg
Show threadOfficial Kakistocracy Jester 🪓Jul 17, 2024
@karlauerbach the The Republican strategy is, and always has been, to make government suck so they can campaign on, “Look how much the government sucks!” It’s an infinite loop.
Show threadMartin SeegerJul 20, 2024
@karlauerbach Whenever I read about the US health care system, my mind wants to use it as base material for a horror movie 😢
Show threadKarl AuerbachJul 20, 2024
@masek The actual care here is (or at least can be) really good. It is the supporting mesh of for-profit businesses and limited government support that is the problem.
Show threadMartin SeegerJul 21, 2024
@karlauerbach Agreed
Show threadOld ManJul 25, 2024
@karlauerbach
their entire reason for existing is to privatize everything and get all the money for themselves