20% COPAY with medicare advantage plan- HELP

Furious and worried. I'm not sure which of these is worse for me right now.


After 4 years, both of my leads have failed. 

I'm on medicare advantage with no other insurance. 

it will be a complicated surgery to remove and replace both leads, and the doc wants to also replace the PM.

I have not been able to get a cost estimate of the surgery and equipment from anyone. Not Humana, not the hospital, not the doctors.

I live in Nevada. Can someone please let me know what their cost was if the circumstances are similar? I don't hink I can afford to have this surgery done.

Thank you 





Change Your Plan Now!

by Swangirl - 2019-08-13 19:59:40

Advantage plans are terrible for people like us. It looks like a cheaper way to go on the surface but it often is more expensive.   It gives us no choice to shop around and find competent doctors when we are facing something difficult.  It locks you into a medical group that may or may not have the expertise to do the best for your situation.

I think you can switch now back to regular Medicare and a regular supplement.  Get Plan F.  Yes the premium is going to be around $200 a month but that is a small price to pay.  There are only a few circumstances that determine when you can change plans.  The usual one is to wait for open enrollment.  But there are a few others that are not well known such as switching from an Advantage plan to regular Medicare.    

The easiest is to contact an insurance broker.  They are not allowed to charge you a fee but get their payment from the insurance company.  Or go to Medicare.gov and see what you can do there to return to regular Medicare and get out of this plan.  I wish you the best!



by Swangirl - 2019-08-13 21:38:20

When you have an Advantage Plan you are not on regular Medicare.  The Advantage Plan Group has total control over what they will do for you.  You have no other options unless you change plans.  Calling Medicare will NOT help you.  They will refer you back to your Advantage Plan.  

Thank you all

by chunt - 2019-08-13 21:52:04

I'm so dismayed. 

Check on This

by Swangirl - 2019-08-14 01:42:10

Chunt, you can call Medicare at 1-800-MEDICARE and find out if you have any options, whether it's too late to switch plans.  If that doesn't get you anywhere, call your plan and find out what the yearly maximum is for your Advantage plan.  It may not be as bad as you imagine, although many plans can have out-of-pocket maximums as high as $10,000, yours may be more reasonable.  

Open Enrollment period is usually October to December for coverage that will begin in January 2020.  Ask your doctor how urgent your situation is and whether you could postpone your surgery four months until January when you would have better coverage.  

Find out your deductible

by cedric1 - 2019-08-15 17:48:39

While Medicare pays 80 percent of approved charges, 20 percent could be substantial.  With your Medicare Advantage Plan there is an annual out of pocket limit.  This is the important part.  If your annual out of pocket maximum is say $4000(example), then you would be responsible up to that point and the Medicare Advantage Plan would pay any difference, so in the example, your out of pocket costs would not exceed $4000.

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