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Medicare Advantage and HAs (it's "open enrollment" time

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Cause the Government give Medicare advantage ~ $1000 per month per enrollee. They make their money that way

Cause the Government give Medicare advantage ~ $1000 per month per enrollee. They make their money that way

Is that a confidential number or is it freely available; e.g., on the Medicare and Medicaid Services website?

It's called the "capitation rate" and it's public. The base rate isn't the whole story, since the companies can get additional money depending on the complexity of an insured's medical situation. This was in the news a few months ago when it came out that one of the companies was sending nurses to insureds' homes to examine them and come up with additional diagnoses.

In reply to @x475aws

@x475aws said:

It's called the "capitation rate" and it's public. The base rate isn't the whole story, since the companies can get additional money depending on the complexity of an insured's medical situation.

Thanks for the clarification. I'm a retired physician; we always accepted whatever our patients had for coverage. The fact that Medicare pays the providers of Medicare Advantage plans a healthy stipend certainly clarifies why it can be less expensive to the patients than traditional Medicare. I was surprised to learn, however, that one glaring exception is dialysis treatment for ESRD (end-stage renal disease). Prior to 1972, dialysis was prohibitively expensive for all but the wealthy, but then the Medicare statute was amended to make anyone with permanent kidney failure eligible for Medicare. The specifics of that have been amended a few times, but the current status apparently is that the patient with a Medicare Advantage plan is responsible for 20% of the "monthly capitation rate" paid to the dialysis clinic. I've now been retired for just under a decade. Back when I was a practicing nephrologist I don't know if that was the rule, but it would have been about $500 per month, pretty much obliterating and "advantage" to being on a Medicare Advantage plan.

In reply to @jimrobertson

Be VERY VERY CAREFUL. I’m a Federal retiree. One year, I switched my medical insurance to the Medicare Advantage option for the upcoming year. They forced me to buy my hearing aids at the place that charges $ 6,000 x $ 10,000 a pair and would only reimburse me my usual $ 1500.00. They also forced me to switch pharmacies that were charging me a double co-pay. I booted that bunch of robbers as fast as I could.

Not all "Advantage" programs are created equal, even different depending on who is funding them. My Kaiser Senior Advantage comes from my retired teacher's employment, and comes with a $2500. per benefit every three years, BUT it is mandated that I go to HearUSA for fitting, HA purchase, and servicing. With the newer HA just out, my co-pay after the above benefit is $1000. for the Signia MaX 5, $2000. for the Phonak Eon Sphere 70, and $2600. for the Phonak Eon Sphere 90, per pair. When I telephoned one of Dr. Cliff's recommended Hearing Up clinics to see what fitting alone might be, I couldn't get past the "interview" that pretty much hung up on me when I said I had an Advantage Plan. I'm grateful for my benefit, but wish there were more choices to go shopping.

If one can afford it, is the answer not always traditional Medicare, medigap if still eligible and want that coverage, and then Costco for aids or private if one wants and can afford? MA seems so rarely better (maybe for some who are often abroad). The hoops for hearing aid coverage with MA are rarely of meaningful value. Commerical plans for employees are a different story as aids can be fully covered in some cases.

This was written up by my Healthcare provider and I think it sums it up very nicely.

ATTENTION MEDICARE & MEDICARE ADVANTAGE PLAN MEMBERS

Medicare Open Enrollment is open now through December 7! Changes generally take effect January 1, 2027.

At Trinity …., we strongly encourage patients with Medicare Advantage to consider Original Medicare, paired with appropriate supplemental and prescription coverage as necessary.

Why consider switching?

✅ Choose any doctor or hospital nationwide that accepts Medicare.

✅ Generally see specialists without referrals.

✅ Most services do not require prior authorization.

Medicare Advantage plans can have restrictive provider networks, referral requirements, prior authorization delays, and changing benefits or provider participation.

Verify your plan’s 2027 availability and local provider network before renewing. Almost all Medicare Advantage plans are leaving or have already left our County!!

Before switching, confirm Medigap eligibility, premiums, and Part D coverage.

Some patients worry about the cost of hospital stays with regular Medicare, but rest assured that you will still have great coverage, especially with the right supplement!

Interesting read this thread. I have original Medicare and a Part D plan (for quite a few years)- have looked at Medicare Advantage but not too keen on them (my pharmacist relative says better off with Medigap- Part C isn't always good (noteably the Rxs and their rules :P ). They suggested Medigap- but unfortunately it looks like I'd have slim pickings- I'm under 65-->costs go waaaay up - I'd also be limited in which Medigap plan I could get (I think, been a while since I did some reading on Medigap & Part C plans). Plus I'd have to pay the high premium of the medigap plan (the younger you are the higher the cost... mainly those on SSDI) AND Medicare Part B AND Part D. So something like 700-800+ . Yikes.

Fun- will likely just stay with Original Medicare and a Plan D- mostly healthy. Only big issue is my vision and that's relatively stable for now; and make my hearing aids last another 12 years :joy: .

In reply to @user490

@user490 said:

If one can afford it, is the answer not always traditional Medicare, medigap if still eligible and want that coverage, and then Costco for aids or private if one wants and can afford?

Probably NOT always (especially if you're clairvoyant and can see ahead for at least the next 12 months). For example:

  1. I don't know why or how Costco chooses to employ or contract with audiologists in some warehouses, but hearing fitters in others.
  2. Costco doesn't typically have the latest technology, and at the moment that's the chips that promise enhanced understanding of "speech in noise, and EVERY restaurant that my spouse and I like unfortunately would be a wonderful testbed for finding out how much that might help me.
  3. I'm a retired nephrologist. One of the real REVOLUTIONS in health care financing in the USA occurred in 1972, when Congress made dialysis available to people who were not wealthy by making them eligible for Medicare no matter their age (they also coined the awful term and abbreviation ESRD (END STAGE renal disease) for Medicare Part B that would cover the treatments. (One paradox NOW is that in MA plans, the patient is responsible for 20% of that cost, which depending on the MA's "out of pocket maximum" could easily be $10,000 per year.

But IF one does one's homework before switching from traditional to MA for just one year, in order to qualify for coverage, it might be possible to save some money and PLAN to return to Traditional Medicare near the end of the year, because the right to do so DOES exist, but ONLY for that first year. I must admit that I'm embarrassed by the fact that I practiced for almost 40 years and didn't know a good bit of this, but I'm learning fast, because I must decide by 12/7 whether to take that path myself.

Actually, Costco typically does have the latest tech. The Jabras trail the Resounds by 4-6 months, and Resound typically does new tech every 2 years, so Costco sells top of line Resounds for 18 out of 24 months. It seems the same for Philips (4-6 months behind European release) and Rexton (4-6 months behind Signia). Soundgear AMP and Sennheiser look like they're a level behind the bran, and, of course, Costco doesn't seel the latest Phonak or Widex at all.

I believe Costco outsources optometry, but their audi staff are employees. They hire what the market offers. IME, the audis stick around for 2-3 years, then move to higher paying positions in something like a hospital practice.

In reply to @x475aws

@x475aws said:

How much do people really save, disregarding those who have coverage not available in the open market, like benefits from past employment or union membership?

Well, if I don't need dialysis, don't need new specialists during the year, and DO get a "deal" on Phonak Eon Sphere 90s as a MA member, for my spouse and me it could be as much as $10,000 for the year (as compared to Traditional Medicare with a "innovative plan G" supplement, even a bit more if we stay in Plan F for our supplements.

In reply to @philbob57

@philbob57 said:

Soundgear AMP and Sennheiser look like they're a level behind the bran, and, of course, Costco doesn't seel the latest Phonak or Widex at all.

I believe Costco outsources optometry, but their audi staff are employees. They hire what the market offers. IME, the audis stick around for 2-3 years, then move to higher paying positions in something like a hospital practice.

I'm considering the Phonak Eon Spheres, and I don't think the Sonova-manufactured brand(s) they DO sell have the and "spherical" speech recognition features. I know the Sennheisers are made by Sonova; I don't know about any of the others.

And, during the decade I've worn , I've not encountered a Costco Warehouse with audiologists on staff (Missoula and Bozeman in MT, Las Vegas in NV.

In reply to @jimrobertson

You'd have to break that down to be meaningful. First, by person versus a couple. Second, medicare premiums vary with income. Third, you may have expensive supplement plans based upon age, state, plan, etc. Or perhaps you're not saying you save $10k as a couple. Are supplements worthwhile if you're paying so much?

In reply to @Nancydrew

Somehow I have come to believe Costco Hearing aids are not top of the line aids. No one told me that but that's my takeaway. So now seems like an appropriate time to ASK H.A. users their feeling or experience. Does Costco offer some competitive top notch H.A.s?

'Top of Line' is quite different from 'top notch'. A brand has only one TOL at a time, but the previous TOL aid may still be top notch.

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