SIGforum
Medicare Advantage Plans - anybody have one - pros and cons please
February 09, 2026, 11:10 AM
HRKMedicare Advantage Plans - anybody have one - pros and cons please
quote:
This year I am trying a Medicare Advantage plan from Humana endorsed by USAA
Was in line at the Publix Pharmacy picking up a script and heard the Pharmacist telling the lady next to me that Humana was the best company on MA plans they deal with of all the plans.
My 88 year old dad is on the MA Humana plan, yes he gets a few freebees like money on a HSA type credit card he can use for any medical items, last year it paid for brand new progressive glasses.
His local doctor is a former Navy doc, not part of any large group and takes the coverage, so until he retires he's got a good primary, and last year when he had to have 3-4 days in the hospital, ambulance to the ER, and after tests, two stints installed and there was zero issues with approvals.
Two friends I ride with both are on MA plans and said their coverage is less expensive than the company plans they had (both still work, over 65) and less expensive.
Full Medicare coverage, A, B and D can run you over $500 a month.
February 09, 2026, 11:48 AM
shovelheadAnother update from my experiences with a MA plan.
The hospital portions final tally was about 200k. My deductibles, co-pays, out of pocket total was $1650.00 My cardiac rehab program is in hospital, about 6k a month from November through February is 100% covered.
That’s the latest.
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————————--Ignorance is a powerful tool if applied at the right time, even, usually, surpassing knowledge(E.J.Potter, A.K.A. The Michigan Madman)
February 09, 2026, 12:16 PM
Genorogersquote:
Originally posted by shovelhead:
Another update from my experiences with a MA plan.
The hospital portions final tally was about 200k. My deductibles, co-pays, out of pocket total was $1650.00 My cardiac rehab program is in hospital, about 6k a month from November through February is 100% covered.
What company is your MA plan with ?
That’s the latest.
February 09, 2026, 12:27 PM
GenorogersHey shovelhead....I screwed up the above post and I think I know what I did wrong but couldn't edit.
My question is what company is your MA plan with ?
February 09, 2026, 12:27 PM
shovelheadquote:
Originally posted by Genorogers:
quote:
Originally posted by shovelhead:
Another update from my experiences with a MA plan.
The hospital portions final tally was about 200k. My deductibles, co-pays, out of pocket total was $1650.00 My cardiac rehab program is in hospital, about 6k a month from November through February is 100% covered.
What company is your MA plan with ?
That’s the latest.
Health Alliance Plan, aka HAP
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————————--Ignorance is a powerful tool if applied at the right time, even, usually, surpassing knowledge(E.J.Potter, A.K.A. The Michigan Madman)
February 09, 2026, 12:32 PM
GenorogersGot it, thanks shovelhead.
May 25, 2026, 03:52 PM
m1009Jumping in with my own question here please. Am gonna retire in a few months. I deferred part b since my employer ins has been pretty good. So, will be getting part b here very soon. Stil up in the air a bit on adv ve trad Medicare. I work for a health org, and I see denials from all ins plans.
What Ive seen is tons of denials from UHC, asking for records a LOT. Plus, each adv plan has to renegotiate a contract for however long with the hospital, drs etc. Say every few years. I don’t know how this affects patients with these plans as I only see the provider side.
I don’t have much trust in them currently, but maybe on the plan holder side it’s ok. Usually they deny claims saying it’s denied under the contract so the patient can’t be billed.
But, my question is, has anybody ever been dropped from one of those adv plans?
Like, suddenly you end up needing more care than originally and they decide you’re too much trouble. Or they switch your plan benefits? I’m going to talk to an ins guy here soon, but wanted any input from current adv plan holders. Indiana resident by the way.
May 25, 2026, 04:22 PM
shovelheadUpdate to the update.
I’m referred to a pulmonologist in about a week and I’ll see how much my out of pocket will be for my CPAP machine.
Just had oral surgery last week, wisdom tooth removal. Delta Dental was included in my Advantage plan, it cost me about $1050 out of pocket for the first visit/assessment and the second visit for the procedure.
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————————--Ignorance is a powerful tool if applied at the right time, even, usually, surpassing knowledge(E.J.Potter, A.K.A. The Michigan Madman)
May 25, 2026, 07:28 PM
m1009quote:
Originally posted by shovelhead:
Update to the update.
I’m referred to a pulmonologist in about a week and I’ll see how much my out of pocket will be for my CPAP machine.
Just had oral surgery last week, wisdom tooth removal. Delta Dental was included in my
Advantage plan, it cost me about $1050 out of pocket for the first visit/assessment and the second visit for the procedure.
Keep us posted shovelhead please. And good luck to you.
May 25, 2026, 09:48 PM
shovelheadFWIW I’m pretty satisfied with Health Alliance Plan. It is a part of the Henry Ford Health system (Henry Ford Hospital et al) but there is no requirement to use them.
This has been the second year I’ve had them.
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————————--Ignorance is a powerful tool if applied at the right time, even, usually, surpassing knowledge(E.J.Potter, A.K.A. The Michigan Madman)
May 25, 2026, 10:03 PM
cparktdquote:
Originally posted by pace40:
The general consensus of Medicare Advantage Plans is that they suck, don't cover anything
Strongly disagree. I love my Blue Cross of Tennessee Advantage plan. I have never needed a referral, to any specialist or surgeon. There does happen to be a large hospital and many doctors that take it in network with in ~30 miles of me so there is that.
Wife and I both have had surgeries, mine was totaL of about 40K, I PAID $650 bucks total plus only the one initial my share of an emergency room visit... I'll take that any day! It covered us really well, IMO, with no hassle billing... they collate all your bills form all sources.. labs, anesthesiologist, radiologist, etc., etc. and send only one final bill.
My former DR, now retired, advised only two companies... he had the same as I got for his family.
My dentist I really like but he does not take it, or hardly any Insurance, I just pay him cash on delivery day of and he give me a 20% discount.
I have diabetic, blood pressure, thyroid, and cholesterol medicine. it pays for virtually all of that.
Some people spread happiness wherever they go… some whenever they go. May 26, 2026, 02:41 AM
oldbill123quote:
Originally posted by shovelhead:
Update to the update.
I’m referred to a pulmonologist in about a week and I’ll see how much my out of pocket will be for my CPAP machine.
.
Ask for an autoset machine. Airsense 10 or 11 Autoset. That way you can let the machine self adjust. I prefer 10, but my DME would not provide a new 10
May 26, 2026, 05:48 AM
pace40quote:
Originally posted by cparktd:
quote:
Originally posted by pace40:
The general consensus of Medicare Advantage Plans is that they suck, don't cover anything
Strongly disagree. I love my Blue Cross of Tennessee Advantage plan.
Had a BC/BS Advantage plan for years and was very happy with it. I, like you, lived within a large network of coverage. However, once I started being treated for cancer, the preauths and denials began to increase. To the point where treatment dates from last September are still being resolved. My plan was discontinued for 2026 which allowed me to switch back to regular Medicare with a plan G supplement. Glad I did and won't be going back to an Advantage plan. More expensive premiums yes, but zero issues with preauths or payments and total out of pocket is the Part B deductible of $283.
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Pace
May 26, 2026, 08:24 AM
Calif PhilI am shopping for a plan right now and have been told that if you live where there is a large population with plenty of healthcare providers, MA is fine, if you live in a rural area like I do with limited health care then a Plan G is better, that is what I am going to go with.
May 26, 2026, 08:38 AM
Rey HRHquote:
Originally posted by pace40:
Had a BC/BS Advantage plan for years and was very happy with it. I, like you, lived within a large network of coverage. However, once I started being treated for cancer, the preauths and denials began to increase. To the point where treatment dates from last September are still being resolved. My plan was discontinued for 2026 which allowed me to switch back to regular Medicare with a plan G supplement. Glad I did and won't be going back to an Advantage plan. More expensive premiums yes, but zero issues with preauths or payments and total out of pocket is the Part B deductible of $283.
You hit the biggest pain point with Medicare Advantage plans. Medicare Advantage plans are great until the bean counter decides and overrides what treatment you and your doctor decide is necessary.
Regular Medicare doesn’t have that review process (for now).
"It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946.
May 26, 2026, 10:38 AM
BytesThe wife and I researched Advantage plans really well. We visit our kids in Texas and Hawaii very often. None of the plans we researched were in network in Texas or Hawaii. We went with a supplement and have been happy so far with our setup.
May 26, 2026, 12:54 PM
Sigfan Roy5 months into my Medicare Advantage plan with Humana and things have been very good. Had appointments with my dermatologist and primary care doctors - both covered with no issues with my plan. Had to go in for an illness last week with my primary care provider and had no issue there either.
Plus, I switched to a dentist covered by the new advantage plan, had a comprehensive exam and cleaning and that only cost me a $20 copay. Also, my monthly cost for the implanted heart monitor has been covered as well.
So my out of pocket costs are the monthly medicare premiums (minus the $65 from the advantage plan) and the single $20 co pay for the dental visit.
TriCare for Life as the secondary covers all of my medical copays except the prescription costs through express scripts for 90 day supplies.
So far I have been very pleased with my Medicare Advantage plan.
----------------------------------------------------------------------Roy is not my real name.
May 26, 2026, 07:39 PM
m1009Well, I guess I will have a better idea myself after Thursday.
May 27, 2026, 06:30 AM
pace40quote:
Originally posted by Rey HRH:
You hit the biggest pain point with Medicare Advantage plans. Medicare Advantage plans are great until the bean counter decides and overrides what treatment you and your doctor decide is necessary.
Regular Medicare doesn’t have that review process (for now).
It was very odd to see the change. I was on the Advantage plan for 5 years with zero issues. I'm a heart failure patient and with all the testing and prodding, I thought I would have a problem but didn't. As soon as the Big C crept in, delayed preauths and denials started. Glad they abandoned the coverage and I was able to get back on regular Medicare and supplements without the underwriting reviews.
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Pace