My medical provider is forcing me to use a certain Medicare advantage insurance plan, is that legal? - AgingCare.com

My medical provider is forcing me to use a certain Medicare advantage insurance plan, is that legal?

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The Village Health demands we use United Health Medicare Advantag or they will refuse to have us as patients.

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Medicare Advantage plans are different than plain Medicare in that Advantage plans include a private insurance segment while Medicare is completely federal.
The plain Medicare supplements must provide certain things to be considered viable for that Medicare plan. I’d be wary of any type of pressure to sign up for a particular plan.
I'm not a Medicare expert but my guess would be that Advantage plans - like any private plans - may have more leeway in deciding who they cover. Plain Medicare (Plan F is the most expensive supplement but great since there are no co-pays) will supplement whatever Medicare covers as long as the facility takes Medicare.
Advantage plans generally cover more things such as vision and sometimes dental but there are copays and you are dealing with a private insurer with more clout in the final page than with straight Medicare so you need to choose carefully. As was mentioned, doctors may have to sign up for providing care for each plan. I'm not sure how that works.
All of the Medicare and Medicare Advantage choices can be complicated so making these choices is easier with someone who knows your state and federal laws as well as all of the possible plans. The problem is finding someone who can help but doesn't have something to gain by steering you toward a certain plan.
There were some excellent answers here. As always, I learned just from reading.
Thanks to this wonderful group of people.
Carol
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The health care industry is organized by insurance companies. For physicians to be able to receive any payment from an HMO/PPO or medical advantage insurance company they must be a member of that plan. Insurance plans limit which doctors can be a member, mostly to control cost. So when your doctor says that you must be a member of a certain plan - it is probably because she or he is not an authorized physician. Of course, a person can pay a physician directly - but that would be costly. It is important every open period for medicare to assure that your providers continue to be a member of the plan. If keeping your physician is important than you will need to change your plan. Of course there may be a trade-off on cost and benefits. There are agencies that can help you do this analysis.
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You might also consider making a switch to basic Medicare so you can choose your own providers as well as supplementary or gap insurance.
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Ms. Randall is right. It's not just Medicare. I wanted to keep my PCP but she didn't accept the insurance I had. I didn't see her for a year.. The following year, I went to her website and made sure she accepted the plan before I signed up,for it. There was no real forcing or demanding, it's just the way it is. If you want to continue seeing a certain doctor, you need to sign up for a plan they accept or change doctors.
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Health care in the US is basically a closed system with access available to the consumer AND also the providers as per whatever insurance payor they have.

Reg - for you what probably as happened is that the Village has entered a negotiated payment agreement with United as a member or preferred provider. So the doctors, therapist, hospitals, etc. at village are all affiliated providers with united and have accepted to be paid at whatever rate United has set to be market rates for your area.

Your doc may do private pay alongside being with United.....it will be quite a bit of $ if your just used to only doing a copay. But please keep in mind that even if you do private pay say for your internist, if your internist writes orders for tests or that you need a consult with a cardiologist....that the lab & cardiologist have too entered an agreement with United. Thats why its considered a "closed" system. So your private pay costs could be huge and you may have to pay up front before you even see the MD.

If your very rural or small town / city, the options for care will be very very limited. So may need to travel to a big city where there is a health science center affliated with a medical school to find providers who take all the various insurance payors and have benefits staff who know how to bill & code for each insurance carrier.

The only solution imho is universal single payor health insurance......which seems to be beyond the current political will to ever happen in the US. Think carefully when you vote in November as to whomever you are voting for would be supportive of universal health care system.
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Reg, you probably signed some acknowledgements and other forms when you signed up with Village Health. And probably buried somewhere in size 2 font in those contracts are the rights to restrict your medical providers.
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Medicare Advantage Plans are different from Medicare in that they have Net-works. Some Doctors refuse to join a Net-work but will join others. I'm not sure for the reasons, But with that kind of attitude you may want to find another doctor
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Again, Ms Randall, you're right. That's why I didn't see my doctor for a year. It all boils down to finances. If money is no object and Reg can continue on with the physicians they have on board, that's wonderful. However, in my case, I could never afford the out-of-pocket costs to keep my doctor. As it is, my lousy insurance coverage and high deductible that I have now still preclude me from visiting specialists and having surgery that would make my life easier and less painful. Sometimes it's just a lose-lose situation.
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MsRandall: My Medicare and Medicare Supplemental was set up pro bono by an insurance agent who came to the house a few years back. He reviewed which doctors I saw and I signed up for Medicare Supplemental Plan F. In this case, the OP resides in an active retirement community, which may have some bearing on it. The only time I have ever had to ask a doctor "do you accept Medicare patients?" is to by GYN and that was a yes.
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Igloo: I agree on your comment that The Villages active retirement community has already established what their residents' Medicare Supplemental Plan will be.
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