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Old 11-18-2022, 05:36 PM   #6
SailinAway
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Quote:
Originally Posted by Irish mist View Post
A caution on "advantage plans". If you leave your original medicare Medigap plan for an advantage plan, and then try and go back to your original medicare Medigap you may be subjected to underwriting...which means if you are deemed to have health issues you can be rejected. Advantage plans have gatekeepers that look to save them money hence the often narrow networks you can use for treatment. Also, advantage plans have deductibles as high as 7k. Unless the advantage plan has a PPO attached I would not use one. Just my 2 cents.
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.
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