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<blockquote data-quote="JD8" data-source="post: 3282184" data-attributes="member: 24"><p>I don't doubt they want you to go to the gym, they don't want to pay and certain carriers have been sued because of this. In fact Cigna got kicked out of the pool not too long ago, and multiple lawsuits have been filed in Florida on various carriers for restricting patient access to care. </p><p></p><p>Typically, where people see the issues is when they get really sick and need specialists. Usually with cardiovascular or cancer issues. I remember when I did benefits that one of my first clients almost died because he had an aggressive case of prostate cancer and he needed to go to the Mayo to get treatment. His Advantage plan said they wouldn't pay for it and he needed to get treatment locally/in network. In which the doctors locally were the ones saying he needed to go. He went and paid out of pocket. Another client I worked with had to be put on dialysis, it was a nightmare dealing with his MA plan to get approval to go to get it done closer to where he lived. If you need a type of drug that's off the beaten path? Good luck. I have horror stories for days. </p><p></p><p>In contrast.... for $3000-5000 you could have the best coverage money could buy for a senior. Traditional Medicare + Plan F or G and plenty of money left over for a gym membership and nearly 0 out of pocket expense. Couple that with the fact you can go wherever Medicare is accepted and aren't managed by limited networks and benefits and you don't have near the same co-pays and deductibles. I mean if you're hitting your out of pocket max what's the point? Why pay more in the end to limit your coverage?</p><p></p><p>Good luck, I'm glad it's working for you, but for many that eventually get sick, it does not.</p></blockquote><p></p>
[QUOTE="JD8, post: 3282184, member: 24"] I don't doubt they want you to go to the gym, they don't want to pay and certain carriers have been sued because of this. In fact Cigna got kicked out of the pool not too long ago, and multiple lawsuits have been filed in Florida on various carriers for restricting patient access to care. Typically, where people see the issues is when they get really sick and need specialists. Usually with cardiovascular or cancer issues. I remember when I did benefits that one of my first clients almost died because he had an aggressive case of prostate cancer and he needed to go to the Mayo to get treatment. His Advantage plan said they wouldn't pay for it and he needed to get treatment locally/in network. In which the doctors locally were the ones saying he needed to go. He went and paid out of pocket. Another client I worked with had to be put on dialysis, it was a nightmare dealing with his MA plan to get approval to go to get it done closer to where he lived. If you need a type of drug that's off the beaten path? Good luck. I have horror stories for days. In contrast.... for $3000-5000 you could have the best coverage money could buy for a senior. Traditional Medicare + Plan F or G and plenty of money left over for a gym membership and nearly 0 out of pocket expense. Couple that with the fact you can go wherever Medicare is accepted and aren't managed by limited networks and benefits and you don't have near the same co-pays and deductibles. I mean if you're hitting your out of pocket max what's the point? Why pay more in the end to limit your coverage? Good luck, I'm glad it's working for you, but for many that eventually get sick, it does not. [/QUOTE]
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