Medicare Advantage Plans

Has anyone looked into the 2008 plans?  I am thinking about changing plans from Aetna this year to someone else.  Does anyone know one that guidelines for Weight loss surgery being easier than Aetna?

It is my understanding that all the advantage plans HAVE to cover exactly what medicare does so therefore the qualifying factors are the same for all companies.  That said I will tell you that after reading the long medicare criteria for weight loss surgery myself I realized that because of the wording the criteria is really up for interpretation by the particular case worker that reviews any given case.  The difference in insurance companies would be in what amount of money you would pay.   My doctor submitted my history and stats and I was immediately approved despite my doctor thinking I needed to lose 10% of my body weight.  I have lost that much in the past but I was at my highest weight ever when I was approved.   I have Healthnet.  My doctor didn't take it but went ahead and made the exception so I could have the procedure.  She decided ot accept what they paid.  

That is the case somewhat.  They do have to cover it because Medicare makes them.  But they can place there own rules as to what you need to do.  I think it's BS but this is what Medicare told me.  They also said I could drop my advantage plan and they would cover 80% now.  The problem is I do not have the 20% to pay and this is where the other plans come in. 

If you go to SSA.gov and read the guidelines for insurance companies being able to offer medicare advantage I think you will find it states that all companies MUST COVER what medicare does using the SAME criteria as medicare.  In other words they must be identical to medicare.  The differences in the insurance companies to each other and to medicare is in costs i.e. deductables, co insurance and premium charges.  Now, the drug formularies are different since medicare doesn't have its own drug formulary All medicard part d is through other ins. companies.  Go and read on the ssa.gov page. quoted from the site "These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan, but it is important to check with the plan because the costs for services will vary. " and further:

"Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare. With Medicare Advantage Plans:

• Some of the plans require referrals to see specialists.
• In many cases, the premiums or the costs of services (co-pays and deductibles ) can be lower than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
• The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
• They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
• They generally offer extra benefits, and many include prescription drug coverage.
• In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
• Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
• You don’t need to buy a Medigap policy.

You can contact medicare to get the text of the actual medicare guidelines for wls.  I had it and read the entire thing.  It has all the same stuff you hear about...the 10% weight loss (up for interpretation as it is actually 10% of the amount one needs to lose, so if you are 100 lbs overweight then you have to lose 10 lbs) 6 mos. medically supervised weight loss program. bmi of 40 or above unless there are co morbidities such as diabetes, ventricular insufficiency, heart disease, osteoarthritis etc.   A letter from a doctor stating medical necessity, age factors up to age 66, 5 year history of obesity.  Those are the medicare guidelines.  If your insurance is refusing you and you have medical necessity then youi can appeal.  I would make sure you get to an office that has plenty of success with ins. approval because your appeal process is time consuming and you want to make sure you have your history and medical records in order the first app.