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Saturday, June 8, 2019

How good is Kaiser's Medicare Advantage plan?

Cheryl and I are fixin' to find out first-hand.

What are the Pros and Cons of Switching to a Medicare Advantage Plan?

Medicare Advantage, also known as Medicare Part C, makes it possible for people with Medicare Part A (hospital insurance) and Part B (medical insurance) to receive their Medicare benefits in an alternative way. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and provide at least the same level of coverage that Medicare Part A and Part B provide.

You may be wondering which is the better choice: sign up for a Medicare Advantage plan or Original Medicare. There isn’t a simple answer because Medicare Advantage plans have key features that many people find attractive and other characteristics that may not match with your personal preferences and/or lifestyle…
Among the upshots of our recent move from the CA Bay Area to Baltimore was being involuntarily disenrolled from our SilverScript Medicare Part-D Rx coverage ("out of service area"), and seeing a huge premium increase in our high-deductible MediGap Part-F plans (mine was about 30% compared to last year).

During the Christmas holidays, through our future daughter in Law Eileen, we'd come to know Dr. George Brouillet, orthopedic surgeon and former President of the Maryland Medical Association. He provided us with a list of area internal med docs to check out.

None of them were taking new patients. So much for "unrestricted choice of doctors" vs "HMO."

We discussed taking a closer look at Kaiser Permanente. I'd covered a number of their HIT Conference presentations across the years, and then we got caregiver in-your-face close-up looks once Danielle was diagnosed in March 2017 (she'd signed up for KP the year before via "Covered California")

We attended a KP pitch presentation, and watched a version of this:

We ran the comparative numbers once home. No longer need Rx Part-D or our Humana Medigap monthly premiums. Net financial benefit, though, quickly becomes inscrutable.
Our KP sales rep was candid to say that we could compare their plan to that of their principal competitor--Johns Hopkins.
Kaiser is on Epic, as is Muir (where I've been a patient since 2013), so records interop transfer should be "relatively" straightforward.
BTW, KP's Maryland Advantage plan is essentially a hybrid Staff + Network "capitated/risk" HMO model. No "medical underwriting."
After a rough initial start (incompetent, indifferent Primary who should count herself lucky I didn't come after her license), Danielle's KP care was uniformly top-shelf, notwithstanding that Kaiser lost their shirts on her.

We signed up. We shall see how our experiences shake out. Stay tuned.

More to come...

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