Great health insurance agent

[Irish mist]

Originally Posted by SailinAway

Here in New Hampshire we have the advantage of being situated in the middle of a very strong network of practitioners. My Harvard Pilgrim Advantage plan covers Concord Hospital, Dartmouth Hitchcock, and Boston specialists, among others. I've had two joint replacements with this plan. One was $1200 and the other was $600 everything included, even physical therapy. Full cost of one joint was about $75,000. Harvard Pilgrim was in agreement with all of my doctors' recommendations. There were no "gatekeepers" opposing my treatment. HP and the clinic handled everything from start to finish. There was one simple bill at the end. HP partners with Concord Hospital and Dartmouth Hitchcock, so they're unlikely to disagree with doctors at those facilities.

The cost of the Advantage plan at the time was $360 a year. Plus the cost of Medicare Plan B. Last year Harvard Pilgrim did away with the requirement for authorization before seeing a specialist. Any problems I've had have been bureaucratic, possibly related to an individual, not problems with the plan itself. Customer service has been 90% positive. The other 10% was a pain, to be honest, but I've encountered such problems with every insurance company I've even been with.

There are gatekeepers with your advantage plan. Yours approved all of your care in this instance.

A link the professor left in this thread explains the issues with advantage plans.

[SailinAway]

Originally Posted by Irish mist

There are gatekeepers with your advantage plan. Yours approved all of your care in this instance.

A link the professor left in this thread explains the issues with advantage plans.

I misspoke. I meant to say that there was no opposition from Harvard Pilgrim to any treatment ordered by my doctors.

[Irish mist]

Originally Posted by SailinAway

I misspoke. I meant to say that there was no opposition from Harvard Pilgrim to any treatment ordered by my doctors.

Advantage Plans are cost-saving, there is no doubt about that and work well, especially when you are young and healthy. My concern is that many people don't know that once you enroll in an Advantage Plan in most states, not all, if some health issues arise, you will be subjected to medical underwriting and not be allowed back into original Medicare.

If you enroll in original Medicare at 65 you are guaranteed to be let in regardless of pre-existing conditions.

[SailinAway]

Originally Posted by Irish mist

Advantage Plans are cost-saving, there is no doubt about that and work well, especially when you are young and healthy. My concern is that many people don't know that once you enroll in an Advantage Plan in most states, not all, if some health issues arise, you will be subjected to medical underwriting and not be allowed back into original Medicare.

If you enroll in original Medicare at 65 you are guaranteed to be let in regardless of pre-existing conditions.

All this has always been a head-scratcher for me despite hours of research. I enrolled in Plan B plus an Advantage plan at 65. Isn't Plan B "original Medicare"?

[Irish mist]

Originally Posted by SailinAway

All this has always been a head-scratcher for me despite hours of research. I enrolled in Plan B plus an Advantage plan at 65. Isn't Plan B "original Medicare"?

A & B are original Medicare which pays 80% of your bill. The supplement you enroll in, which pays the other 20% can either be a traditional Medigap policy, or the Part C Advantage Plans...which are private plans paid with Medicare money.