We have several true life stories in regards to Medicare Advantage Programs. The first true life story happened in my own family. Jeff, the insurance broker we used for many years, called us on the telephone one day to tell us about a new Medicare Program. Jeff asked me if I would like to come to his office to discuss the new insurance program, and to see if it was something that would be beneficial to my parents.

During the appointment with Jeff he discussed how little the monthly premiums would be compared to what my parents were already paying. He also told me with the Health Net Advantage program, my parents did not need a supplemental insurance. I asked Jeff how Health Net could possibly afford to offer this insurance for such low monthly premiums? I went on to ask Jeff, if Medicare pays 80% of a medical bill, then why wouldn't my parents need a supplemental insurance? Jeff told me with the HealthNet Advantage plan, there was no need for a supplemental insurance. He said, my parents would have to stay within the network for doctors and hospitals. My parents would have a $5 co-pay for the primary care doctor and a $15 co-pay with a specialist such as a cardiologist.

Jeff did his best to make the Health Net Advantage plan sound like it was the answer to everyones prayers. I finally asked Jeff, Is the Health Net Advantage plan similar to the managed care plan my parents had a number of years ago called American Progressive? Jeff replied, Your parents did like that insurance plan and so did many of my other clients. He also said, the Advantage plan isn't exactly the same as American Progressive. The Health Net Advantage has a co-pay if you have to have an MRI or a CT Scan. American Progressive did not have that.

I told Jeff, Last year my father had to have home oxygen for several months until his lungs improved. If my father needs home oxygen again, will the Health Net Advantage plan cover the cost of the home oxygen equipment? Jeff replied, "If Medicare paid for it in the past, then I am sure they will pay for it again. I asked about other home medical equipment as well as visiting nurses, physical therapists, etc. Once again Jeff replied, "If Medicare paid for it in the past, then I am sure they will pay for it again. Jeff added, the only time your parents would not save any money is if they were at the doctors office every week and had one to two doctors co-pays every week.  Or if they needed CT Scans or MRIs every month.

At the end of our meeting, I told Jeff I will discuss the plan with my parents and get back to him on their decision.

I wasn't completely convinced a Medicare Advantage plan of any kind was the answer for my family. That is when I picked up the telephone and called Health Net. The woman I talked to at Health Net avoided my questions and basically told me, if I wanted detailed information, I should speak to their representative in my area. The woman gave me the name of the Health Net representative who just happened to be Jeff, the insurance broker my family used for years.

It was around this time when Health Net had ads on television and the radio about how wonderful their Medicare Advantage program was. Of course the ads gave very little information about co-pays or staying within the network. This is when I decided to go on line to take a look at the Health Net web site. Unfortunately, I was not able to get into the web site. There must have been so much traffic going to the web site, the screen kept freezing. I tried several more times over the next week to go to the Health Net web site, but kept having similar luck. I even tried calling Health Net one more time, but was told once again to talk to Jeff.

Even though my parents and I kept wondering about co-pays, my parents decided Jeff never steered us wrong in the past, so they would give Health Net a try.

It wasn't long after my parents enrolled in the Health Net Medicare Advantage plan when my father had to have home oxygen once again. Even though my parents signed up in November, the new insurance plans did not go into affect until the first of the year. That is when everything began to hit the fan!

It was around January 4th of the New Year when we received a telephone call from the company who was supplying the home oxygen equipment for my father. The man who owned the company was not happy with my family because Dad had the new Health Net Advantage plan and his company was not in the Health Net network. This meant, his company would not get paid by Medicare for the equipment my father was using. This also meant my father could continue to use the equipment for a short time until my fathers doctor could order home oxygen from a company that was in the Health Net network.

I called my father's primary care doctor right away, but they didn't know who would be in the Health Net network. I was told I had to call the various companies to find this information out. Instead of doing that, I called Dad's pulmonologist. The nurse at that doctor's office knew of a company that was in the Health Net network, and she changed everything around for Dad. Because of the Advantage plan, my father would also have a monthly co-pay for the oxygen equipment. This is a far cry from Jeff telling me, "If Medicare paid for it in the past, then I am sure they will pay for it again."

The next telephone call we received was from the visiting nurses who were coming to the house to check on my parents. They were not in the Health Net network and would not be coming out to the house any longer. We had to contact Dad's primary care doctor and have him order another visiting nurse association. It was at that time we found out there would be a co-pay for the visiting nurses, any physical therapy, occupational therapy, speech therapy, aids, etc.

That same day we received an explanation of benefits from Health Net. I called Jeff to complain about what was happening. It was at that time he told me, with an advantage plan, there is a co-pay with everything. I replied, this is not what you told me back in October when you wanted to sell my parents the policy! I did specifically ask you about expenses, but you avoided the issue. I also informed Jeff, I would be fighting the insurance company and all of the co-pays my parents were racking up. Jeff replied, this is considered a he said she said situation. I told Jeff, this is not a he said she said situation. I specifically asked you about the expenses. You never mentioned all of the co-pays and staying in the network for home equipment, visiting nurses, etc.

My father had an emergency that same week and had to go to the Emergency room by ambulance. It wasn't long after his EMERGENCY ride to the hospital we received a bill in the mail for $50 co-pay. Once again I called Jeff. He said, I get calls like this every day of the week. I do tell people the same thing when I go over the new insurance plans with them. I do give people the same information. It is not my fault if you do not understand the policies.

Jeff picked the wrong thing to say to me. I demanded my parents be changed over to Medicare as a Primary with a very good supplemental. It may cost a bit more per month for the premiums, but I know my parents are covered. I know my parents won't have any co-pays. And I know my parents do not have to worry about staying within net work.

The nurse at one of my father's doctors offices told me about her youngest son. He managed to talk his older sister out of a dollar. The nurse is convinced her youngest son is either going to grow up to be a stock broker, an insurance sales man, or a career criminal. She said they all know what to say to a person to get money out of you.

Then next story is about my father's brother who is a physicist. My Uncle is a very smart man to say the least. He too found out the hard way, his insurance broker sold him a bill of goods, and so did the company he signed up with for a Medicare Advantage plan. My Uncle suffered a minor stroke and the bills started to pile in after that. He went to another area of the country to live with his son and daughter-in-law. They were able to change insurances for him because my uncle was living in a different area of the country and the insurance he originally signed up for was not accepted there. Not within the network.

The final story is about a woman I used to work with. She was healthy but suddenly was diagnosed with breast cancer. Rose found out the hard way about the Medicare Advantage plan she signed up for. She had so many co-pays, she went through most of her life savings to pay her medical bills. So instead of retiring in four years, she now has to keep working.

The moral to these stories is, BE VERY CAREFUL WHAT YOU SIGN UP FOR! ASK THE INSURANCE BROKER TO PUT ALL EXPENSES IN WRITING BEFORE YOU SIGN UP WITH THE PLAN. IF HE OR SHE DOES NOT KNOW WHAT THE EXPENSES ARE, THEN ALL I CAN SAY TO YOU IS, LET THE BUYER BE WARE!