What's a common trick in Medicare marketing that hides restrictions on doctor choices?
Answered by 12 licensed agents
Answered by Diana Salisbury on April 16, 2025
Broker Licensed in OH, IN & MI
Answered by Melonie Wood on April 2, 2025
Agent Licensed in FL & AL
Answered by Misty Bolt on May 26, 2025
Agent Licensed in TN, AL, AR & 45 other states
HMO- besides the rare exception, you have to see the providers on thier list or there is no coverage.
PPO- the plan has a list of providers that are in-network but you can see the provider of your choice. If they are not in the network, you pay a higher co-pay. Sometimes much higher (this may be the "trick")
POS- is an HMO with an out-of-network option. It is slightly different than a PPO in that the "in-network list" is often smaller and you often need a referral to see out-of-network providers
PFFS- you can see any provider as long as they are contracted with Medicare.
Always review the provider list for plans you are considering. Most people don't want to chnage doctors so be sure yours is on the list. Don't bank on an exception.
Answered by David Bell on April 17, 2025
Agent Licensed in ID, AZ, CA & 8 other states
recovery due to a new prescription. The most frustrating problem
today is the "over-use" of "PRIOR AUTHORIZATION" specifically by
your insurance company. This is NOT your doctor's fault. This is
extremely prevalent due to greater dollar restrictions nowadays.
When being interviewed by a competent Medicare agent, it is an
essential topic to discuss "P.A."! This is not something that any
agent can anticipate since it has become an overwhelming cause
for complaints specific to "MAPD" (in-Network) Advantage plans.
Be sure to recall that you have two choices with the RX copays
that are a part of Medicare: A) you can use your Advantage plan
as a means for the purchase of a drug at a "preferred" pharmacy,
or, B) you can use any US online discount website which will
feature better copays for certain drugs. Moreover, their cheapest
copay also may be at a pharmacy which you don't usually use.
Thus, if it is a much better price, you must notify your doctor to
re-send this new Rx to the "other" local drug store. It is a quick
double-check with these discount online websites to fill in the
long horizontal search box on the landing page. Be certain that
you use their drop-down menus to specify the dosage and the
frequency of the drug's (usual) 90-day use.
Answered by Steven Bleicher on April 14, 2025
Broker Licensed in AZ
Here's a more detailed explanation:
Misleading Network Information:
Insurance agents may exaggerate the network of doctors a plan includes, falsely stating that a beneficiary's current doctor is in-network.
Failure to Check Network:
Some agents may not verify the network status of a beneficiary's doctors before enrolling them in a plan, according to Medicare Agents Hub.
Deceptive Marketing Materials:
Mailers and advertisements can be designed to resemble official government communications, making it harder for beneficiaries to distinguish between official information and marketing materials.
Financial Disappointment:
When beneficiaries switch to a Medicare Advantage plan and discover their doctor is not in-network, they face the unexpected cost of paying out-of-pocket for those services.
Limited Access to Specialists:
Medicare Advantage plans may have limited access to certain specialists, such as dermatologists or cardiologists, compared to Original Medicare.
Answered by Fred Manas on May 4, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by David Christian on April 9, 2025
Broker Licensed in CA & TX
Answered by Jack Mayer on April 14, 2025
Agent Licensed in CA & NV
Answered by Ellen Diehl on April 8, 2025
Broker Licensed in GA
Answered by Bud Griffin on June 14, 2025
Broker Licensed in TX
From my experience, the more common thing that happens is, you search to see if a provider is in the plans network and they don't show up, so you presume they aren't in the network. You may even call Customer Service and ask them, and they search and don't see the provider. But lo and behold, they actually are. But the only way you find out is through the insurance companies provider relations department...which may be hard for a consumer to reach. But I do this all to often to find out, and in most cases a doctor that is not listed or "printing" as they say, is actually in the network.
If you have any doubt, the providers billing department should or better be able to answer the question correctly whether they are in the network with the particular plan you are interested in. Which brings up another point...a provider may not be in all of the insurance companies plans networks, so be sure to check your specific plan.
I hope that helps.
Have a GREAT day!
Chris Prang | The Medicare Analyst
Answered by Chris Prang on May 12, 2025
Broker Licensed in VA, AZ, CA & 13 other states
Answered by Charles Mitch Winstead on April 9, 2025
Broker Licensed in NC, FL, ME & SC, TX, VA & WI
Tags: Agent Interview The Medicare System
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