Partially OT - Medicare Advantage or Supplement?

Quilting brings calm

I’m interested in the group’s thoughts on Medicare Advantage versus  a supplement.

I am posting in the spouse forum because I think the age range here is more relevant  

It’s off topic because it concerns my spouse rather than my PWD

It’s time to decide whether to keep my spouse on my retiree insurance, which becomes a Medicare Advantage in a year and a half ( my 65th birthday) or enroll him in a supplement in July  with me following in that direction when it’s time.  Part d also of course.  Until my 65th birthday, we could both be on the same plan as current employees.  However Medicare would be primary for him beginning in July. 

My group Advantage plan would allow us to see any doctor that accepts Medicare, not just those in a  network.  It’s got prescription copays that stay through the donut hole. Might cover 1 prescription that Medicare part  D doesn’t. But would not cover another that part D won’t either.  It’s got co-pays  and deductibles for medical care with an out of pocket of $7000 or so.   However it’s a state employee retiree plan so it could change every few years and certain things might not stay as good.  

I would prefer us both going to a Part D and a Part G supplement while we can do it with no health questions. Hence my thoughts to move him in July.  I’ve heard bad things about  Medicare Advantage pre approvals etc.   My spouse has a lot of health issues, including diabetes, diabetic retinopathy, macular degeneration, severe sleep apnea and restless leg syndrome. Pulmonologist currently trying to get insurance to approve a BPAP since CPAP isn’t doing the job. Although  he hadn’t been hospitalized for a long while, he usually ends up in the ER a couple times a year. I anticipate he will be hospitalized more as he ages.   The prescription donut hole ( coverage gap) concerns me though.  Our prescription costs would be noticably higher with the part  D. He takes a lot of prescriptions and we could be in that gap. 

So tell me your perspective.  

Mint

Quilting I am making similar decisions soon as I go on Medicare toward end of year.  

Have decided to go with original Medicare, supplement and drug plan for many of the reasons you mentioned.   I’ve been on market place insurance since I retired three years ago.  Original Medicare etc. will cost me about what I pay each month now but I will no longer have the $7000-8000 deductible I carry now, can go to any doctor I choose to which I can’t now. I’m stuck in one health system right now.

Will be interesting to hear what others have to say.

Crushed

DW and I are in the  FEHB with Kaiser Due to poor benefits coordination Medicare part b is almost completely duplicative of Kaiser  In addition there is IRMA which I have to pay because the withdrawals from DWs  IRA count as income.   So we do not have  medicare part B or D   We of course have part A which would cover hospice.  DW is a DNR  If I am traveling Kaiser will pay all expenses.  

Personally I have found Kaiser physicians excellent and the facilities are convenient.   

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harshedbuzz

QBC-

My mom's pension plan moved her supplement to a MAP in early 2020. She's a retired teacher. In her situation, I have seen no difference in her co-pays, pool of doctors, the ability to get sexy new medications or testing covered. Hers doesn't cover some of the extras they sometimes do like transportation. They even send a NP to the house once a year to do a health and safety screening. DH is on a traditional supplement.

HB

toolbeltexpert

I recently turned 65 and went with original Medicare and a supplement dw has same except she has plan f. No longer available. Makes more sense for us.

Ed1937

We had an advantage plan about 10 years ago, and had so much trouble with it, the next time we were able to get back to regular medicare, that's what we did. The plans might be much different now, but we really got a bad taste in our mouths with the first try. Nothing but problems.

Crushed

Victoria2020 wrote:

I always vote for choice in medical care. Being able to see who you want and when is priceless-

Of course "choice" is a luxury of being in a well served area .  I live within a mile of NIH Walter Reed  and the Johns Hopkins affiliated Suburban hospital.   But even here lots of folks complain about having to wait.      We have lots of "Doc in a Box" operators 

 

But most specialists here are connected to hospital networks and in network patients get priority 
So insurance may give the illusion of choice
  

Quilting brings calm

Just a little more info on the prescription issue:   Both of the following are covered under my current employee plan, but that would only be for another 18 months. The Advantage plan is through United.  the ‘medication’ neither Part D or the Advantage plan would cover is Dexcom.  A continuous glucose monitoring meter sensor and transmitter ( not a pump)   He is  type 2 with an insulin pen at night only( that’s why it’s not covered). . That would be  almost $500 a month cash.  The other medication that Part D won’t  cover but Advantage might at tier 3 is also $500 a month cash for restless legs. We already have to get the doctor involved to cover it on my current plan.    It appears to have a manufacturers coupon available that we should be able to get reducing that.  I would need to get both of those at  a separate pharmacy and pay cash.  Separate pharmacy so it doesn’t get added to the amount calculated  to put him in and past the coverage gap. 

My brain tells me his medical issues will only escalate and getting the total coverage on everything but prescriptions is the safe  bet.  Because those two prescriptions  are newer brand name things and could get covered under part D eventually,  My anxiety looks at the prescription cost and cringes.  The monthly insurance cost itself would be about the same either direction. 

Crushed:  we live in central Illinois.  Two hospital town, one massive freestanding clinic, lots of doc in boxes operated by hospitals. Clinic and Blue Cross not playing nicely right now( not my circus). 

    For those that already answered- does that change your mind?  I’m also still interested in everyone else’s  opinions, so please comment even though I’ve replied now.  

Mint

Live in a more rural setting.  One medium sized hospital and one smaller one.  Not everything available here between the two of them.  Live between two large cities.  People I know with original Medicare seem to be satisfied with it, specifically because they are free to make choices and they can travel and don’t have to worry about network.  Also doctors here in town hop between the two hospitals sometimes.  I want to be able to stay with a doctor if I like him.  If I lived in a different area might possibly feel different.    Understand it is easy to get in an advantage plan later if you want to but that reverse is not true.  

I do know a lady from a lower income bracket who switched to advantage and prefers it. They are with Humana.  Imagine not all Advantage companies are the same.  Says she pays less up front and likes that because she feels she only pays out if she uses it.  She frequently is having to come up with payment plans so not sure how much she saves in long run.

I only take one drug and it is cheap.  When I was working was on several dermatology drugs for awhile.  Expensive and got much cheaper by using GoodRx rather than my insurance. Lots of people at work used GoodRx over insurance. There is also a newer website costplusdrugs.com that is supposedly cheaper too for some drugs.  Have not used it.

  

jfkoc

My thinking has always been that insurence is for the worst scenario (sp). I check every year but stick with F and D.  My Drs are not in a"network". I am surprised that there is an Advantage plan that all Drs are in.

David J

I have subsidized retiree insurance through my long term employer. The cost is so low that I would not consider changing. When I retired the insurance plan was a supplement from United Health with part D. After a few years, it was replaced with a Medicare Advantage plan from Aetna. The Advantage plan has been excellent for us and still less expensive than other options. They pay for any doctor that accepts Medicare. I think there is slightly more cost to me if I go out of network, but we are smack dab in the middle of a healthcare conglomerate, and there are few doctors out of network.

Bob in LW

My SO and I both have a Kaiser Medicare advantage plan, and it has worked well for us.  I have learned that some Kaiser areas have different policies.  For instance, when I was in Northern California, they charged a monthly premium in addition to the Medicare premium which is deducted from Social Security.  When we moved to Southern California, there was no monthly premium, and lately many of the services have no copay.  If you live in an area served by Kaiser, and are considering their Medicare advantage plan, be sure to check all of the details first.

Jo C.

When a person signs up for Medicare Advantage, with a physician group through a particular insurance company such as SCAN, Humana, United, Aetna, and many, many more different groups, they often do not realize how the care is provided in these community based Advantage groups. 

Multiple different physician groups contract with the big insurance companies and agree to the terms set forth by Medicare Advantage programs through said large insurance companies.  The individual physician group is paid "X" amount of fixed dollars per patient that has signed up for their care through them.   That is; each patient, is worth a certain number of fixed dollars.   If the money is not spent on patients, then that is profit for the physician group.   If the money must be spent out of the pot on patient care, then not so much profit and if they go into loss, it comes out of the physician group's own pocket.

When one signs up for a particular physician group, that is where care is provided. One does not get to go to every single physician group signed up to an insurance company; one goes only to the specific group they signed up with.  One must make a choice.
 
That fixed dollar amount is why Utilization Review and monitoring of patient care is a priority and done so tightly and why some groups mandate prior authorization for certain types of services such as CT and MRI scans, skilled care, home health and more.  There is usually also tight utilization of durable medical equipment need with prior authorization and more in many groups.   This utlization monitioring is especially so when hospitalization is involved - there is absolute focus on saving and keeping "bed days" down as that is the most expensive outlay for the physician group.  A patient must receive care at the hospital the physician group contracts with. If an emergency, the patient gets to the nearest med center, but once stable is usually transferred to the contacted facility.

 These physician groups do their own contracting for specialists such as Neuro, Cardiovascular, GI, etc.  They contract  rates paid to the specialists because it must come out of the aggregate money they get for each patient "life."  Therefore, they are also conscious of contracting with those providers who are cost effective for themselves.  An enrolled patient cannot just go to any specialist they wish.  (Can, but it would be paid out of pocket.)

 As for the Part D medication. Each managed care group has their own "tiers" of meds with increased costs in different tiers.  NOTE:  What meds are provided by one group may well not be covered in another; also, meds change and they do.   Some meds are dropped altogether and other times some drugs will be moved up into a higher cost tier.  It happens and has happened to my LOs.

Also; those physicians who maintain a tight control on utilization which holds down costs are often given generous annual bonuses as a reward.   Personally, I feel that is a dynamic that should be forbidden, but there it is anyway.

Say a person has decided to have Plan X as their Advantage program.  In our area, there are SO many different physician groups contacted with Plan X - about 60 nearby.  Each different group will have their own medication tiers and available meds; each will have its own contracted specialists, etc.

My mother and step-dad were in an Advantage Group; it had some advantages in that the cost of care was not high and they did not need a Medicare supplement. (Illegal for a company to offer or provide a supplement if a patient is on an Advantage program.)  However; it was a bloomin' headache in prior authorizations, adequate physicians, access time was not good, and specialist consultants were certainly not always top drawer. In one instance, I paid out of my own pocket for my LO to be seen by an out of plan specialist as the in-plan specialist was so deficient. 

One size does not fit all - what works well for one person may not be a good fit for someone else.  Just be cautious and check everything out in detail.  For ourselves, we opt for regular Medicare; want the openness and freedom of choice which can mean a lot especially when it comes to specialists and med centers; but that is just us.  We are blessed in that DH worked for an entity for 35 years. He was grandfathered into a generous plan that is no longer available for new hires.  It gives fully paid private insurance plans with 35 years or more employment as well as no need for Part D; the entity carries its own pharmacy program which is much more open and generous.  We pay about $15 for a three month supply for most meds.  A few times we had to pay $50 for a special med for a three month supply.  I do know how blessed we are and am so very, very thankful.  We carry Medicare and a private Blue Cross Plan; not a supplement.
 

We did not have to sign up for  Medicare, we could have gone private insurance only; but one never knows what will happen to benefits in the future, so we took Medicare because if one does not sign up for Medicare when one is first able to do so, then there are financial penalties that go up each year for not having signed up early, and it can be VERY expensive and it never goes away; the penalties stay for a lifetime.

As said, one size does not fit all and no two groups will be or stay identical.  One can change an insurance plan once per year during open enrollment time and the media outlets are rife with ads for the various plans.   The other time one can change is if one moves from a service area and a few other stringent reasons.  Can't just do it because . . . .

Here is a link that describes IRMAA which Crush mentioned, which some folks must pay if their income is in a certain range and there are multiple different ranges and IRMAA costs:

https://www.medicarefaq.com/faqs/irmaa/?nowprocket=1#:~:text=IRMAA%20is%20the%20Income%20Related%20Monthly%20Adjustment%20Amount,as%20a%20provision%20to%20the%20Medicare%20Modernization%20Act.

It can be a difficult decision to make . . .

J.

Vitruvius

My story, just my humble experience:

Prior to Medicare we had Kaiser as an HMO. It's a little different than the Medicare Advantage plan you are referring to. Kaiser is a "closed system" you can only see Kaiser doctors at Kaiser facilities except under extremely unusual cases where an outside specialist might be approved. 

For over 40 years Kaiser was fine for us and our children. We never had anything complicated, just a few minor operations and Kaiser worked just fine. I worked past Medicare age so when I finally retired we both took Kaiser's MA plan.  Just about this time DW was showing signs of trouble and that's when the limitations of the MA plan became apparent. 

I had been trying with limited success for months to get DW properly evaluated under Kaiser  but they were terrible to deal with in trying to get a proper diagnosis, hampered by the pandemic just starting to impede health care and by what turned out to be her rare form of dementia, Semantic Dementia (SD). With one month left to make a one time only change from a Medicare Advantage plan to a Medicare Supplement plan (without underwriting), I decided to make the change.  (I was told a person with suspected dementia will not pass underwriting.)  This was a great change. Within two weeks I was able to have DW assessed at an Alzheimer’s Center associated with a state teaching hospital, by professors of Neurology and Neuropsychology who specialized in dementia. They were fantastic. 

We have not had any problems finding appointments with highly regarded doctors in my area, but sometimes I did call more than one office to find a close in date. Once established with them appointments have not been a problem. 

My father had a Medicare Supplement plan and in his final years had bills of hundreds of thousands yet payed absolutely ZERO for medical care other than prescription copays which for him was very small. I find it has been the same for us so far, zero cost above the plan cost. 

Drugs have been different with Plan D. DW's oral meds are free or very low cost. However under Kaiser my dermatology meds were very cheap, but with Plan D rather expensive so I have used GoodRx (don't get me started about how ridiculous this is).

All told a supplement plan has worked best for us YMMV. As I understand you can always move to an MA plan from a supplement plan even years later without underwriting should you decide, however once the MA "trail period" ends you can not move to a supplement plan without underwriting. 

Last Dance

My wife and I both stared out with original Medicare and a supplemental plan, we had it for 4 years, then switched over to an advantage plan from who Humana and now I'm on advantage plan from United Healthcare. the reasons we switched from original Medicare with a supplement to an advantage plan was the cost of supplemental plan every year would go up and the older we got the higher it got. The other reason was because we are both blessed with good health, we really did not need a supplemental plan. This is just my personal feeling but because of your husband's health I would at least for now go on original Medicare and get a supplemental plan because no matter what his health conditions are they have to accept him with no underwriting and keep him, but if you switch to a different plan he will need to go through underwriting, and after re reading all his health issues my feeling is he will never be accepted for a supplemental plan, or if he is they would not cover a lot of his health issues.

Joydean

We are still with regular Medicare. I know so much of all the different advantage plans depend on what state and even county person lives in. My DH is also on VA, which is what is helping us a great deal. We do not have part D because neither of us were taking any medication until DH because of Alzheimer’s. I now take 2 meds for stress, which with GoodRx is not bad.

Quilting brings calm

Jo C-  after reading your reply, I went digging thru available info on my future retiree Advantage plan.   Hidden in the fine print- out of network doctors are not obligated to treat us.  Sounds like the contract thing you mentioned. Also some of the ‘extras’, such as hearing aids, are only covered in network 

I priced out our drugs, A/B deductibles, A/B out of pocket  maximum  on that Advantage plan.  Yes our out of pocket would be cheaper under that plan- but as Ed mentioned, the aggravation would be higher.  I guess I just have to hope that the not covered prescriptions under Medicare become covered at some point to reduce our overall costs     

Iris L.

Vitruvius wrote:

, however once the MA "trail period" ends you can not move to a supplement plan without underwriting. 

What, exactly, is underwriting? 

This is why I am afraid to join an Advantage plan, in case I don't like it.  I won't be able to return to my supplement, which is provided by my employer which is an insurance company.  

I was thinking about this exact topic this morning. Thanks everyone for posting.

Iris

JJ401

Insurance — just thinking about it makes me queasy.

In the early 90s, my first husband had a managed care plan at work. He became ill and we wanted a second opinion, from the nationally known for this, hospital about an hour north of us.  It was denied as it was not in network and in network there was a doctor who would treat. Fortunately, he was double covered through my insurance at work and they paid.

So when DH2 and I needed to choose a Advantage or Supplement, I knew I didn’t want an Advantage (aka managed) plan. We went with a Supplement and have been happy with it.

Our Part D, which we need as prescriptions are not bundled like an Advantage plan, is fine for generics, but if it’s not generic is hit or miss. We’ve often found GoodRX cheaper. 

But, most of my friends have an Advantage plan and are happy with it. 

It’s a very personal choice. What you need to remember is that while you are not locked in and can change, Supplements can charge a premium to change to them and, if not chosen at the beginning, you may be excluded for medical reasons (you cost too much). I don’t think you can be excluded from Advantage plans.

Many local senior centers have a person on staff who can go over your available options. They can’t choose a plan for you, but they can help you with comparisons and clarify things for you. If you’d like someone local to talk to, try your local senior center.

Vitruvius

Underwriting in a nutshell with quotes from medicare.gov website:

Note: Medigap and Medicare Supplement plan are the same thing.

"The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the first month you have  Medicare Part B (Medical Insurance) and you're 65 or older. It can't be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems."

"If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements."  In other words they can decide that you have too high a risk of being an expensive patient. 

"Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy."  In other words even if they decide to accept you they can change you more than others who signed up during the original open enrollment period.

More info here:

https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

Iris L.

I gather that medical underwriting is akin to one's credit report.  I have a great credit report but my medical credit report is fair--systemic lupus, hypertension, sleep apnea and to top it all off, cognitive impairment nos.   I suppose I have to stay with my supplement.

Iris

Quilting brings calm

Iris-  I would suggest you stay with your supplement for the same reasons  I am becoming convinced that we should go that route:   You can see the doctors you want, you don’t need  pre-approvals to go to rehab, etc.  No co-pays, and only the deductibles your supplement requires.   My mom has a plan F.  I haven’t written a check on her medical behalf ( except for prescriptions, hearing aids and eyeglasses) since I took over her care.  That includes multiple ER visits, a hospital stay, a month long rehab stay, home health visits ( 3 different stints in a little over 2.5 years).  My step-dads old union changed the retirees to a Medicare Advantage.  His  differs because that union covers  whatever remains as if it was a plan F.  He was 80 when that happened, so there was no point in me looking for a different option. Due to the underwriting issue for him. 

Still losing sleep over the stuff the part d won’t cover, but it is what it is. 

Iris L.

My now deceased elderly neighbor had Kaiser, they did not diagnose his Parkinson's Disease until after I told his wife to ask specifically about PD.  Also they refused a hospice referral that I had suggested when he was hospitalized and released him home, within a few hours he fell because he was not at all ambulatory, and was hospitalized at a different hospital, and from there sent to rehab and hospice.  I am not impressed with Kaiser for the very ill patient, perhaps they are okay for well outpatients.

Iris

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ElaineD

If you do not choose a Medicare Supplement when you begin Medicare, you will have to have a physical to be accepted into a Supplement plan later on.

We had Advantage Plans, which can change yearly, vary from state to state, and usually do not cover the cost of going to the Mayo or other specialized medical centers.

We were lucky that Blue Cross ended the Advantage Plan we had and this was considered a qualifying event and allowed us to get a Supplement Plan without an entry physical.

I have VERY expensive treatments, including IVIG  every four weeks for life.  The treatment is billed at $17,000 every month.  Of course Medicare doesn't 'approve' the full amount. But even so, my share was over $500/month with our previous Advantage Plan.  

Now I never pay any medical bill.  I was in the hospital for four days in April, all covered by Medicare plus the Supplement.

We also have to  buy a separate Drug Plan, but that is peanuts compared to money we have saved with our Supplemental Plan,

elained

Quilting brings calm

Wow- I posted this six weeks ago and I’m still frazzled about it.  You can tell I have issues, right? 

However - we go back to the insurance agent tomorrow afternoon and have decided to get my spouse a Part G plan and a Part D plan. The four cheapest Part G plans were all attained age ( of course) and were American Benefit, Aetna, Accendo, And Blue Cross.  I don’t know anything about American Benefit and Accendo.  Blue Cross is currently in a battle with the extremely large  clinic in town, thousands of patients affected. The clinic is now out of network,  doesn’t affect the Medicare patients, but still discomforting. 

An Aetna company is what my Mom has. A plan F.  I have been extremely satisfied with what they’ve covered for her without a hint of an issue.  Her plan is not cheap though- she’s 84 and it’s almost $400 a month.  However, it is an F and I know those rates skyrocketed, especially when F closed to new Medicare patients. 

So- this Aetna plan G is $130 a month for my 65 year old husband.   For an 85 year old, it would be about a little less than twice that according to some  documents put out by the SHIP agency of Illinois.  

Then there is the part D.  The cheapest overall ( premium, deductible and drug costs) is WellCare Value at $11 a month premium.  If we don’t like them, we can change for next year. 

My spouse thinks he can get off one of the medications Medicare doesn’t cover.  His neurologist told him today he is on entirely too much medication.   Kicked him over to the sleep apnea doctor he is seeing because that doctor can treat his restless leg issue as part of the sleep apnea treatment.  

Thoughts  from anyone regarding one Part G or D insurance company over another 

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Quilting brings calm

FYI- that SHIP agency document also stated that BLUE CROSS has a guaranteed issue plan for  Medicare  eligible people who are past the six months after age 65 criteria.  So if you live in Illinois and are wanting to change, that’s an option

 https://www2.illinois.gov/aging/ship/Documents/NorthernCentralMedSupWeb.pdf

Edited to add ( after our appointment).  I agonized and agonized and probably drove  my spouse to the brink of frustration today.  He always defers to my judgement about this kind of stuff.  Eventually we decided we just had to push through the panic about the cost of the prescriptions because he needed to get out of the constant pre-approval process, and the in-network vs out of network especially as he gets older and sicker.   You might be sitting there thinking  I must be nuts to panic so much- here is why:  he will hit the coverage gap quickly  and blow through it to the catastrophic coverage.  However there is a strong possibility that some of his prescriptions will get changed or removed.  Hopefully one of the not covered ones 

douggieohare

Personally, I think enrolling in Medicare Advantage could have some benefits. For starters, you'll have more flexibility to see any doctor that accepts medicare , which is a big plus. And, with copays that stay through the "donut hole" and coverage for certain prescriptions, it could be a good option.

That being said, I understand your concerns about the potential changes to your state employee retiree plan and the higher costs associated with Part D. But, if you're able to enroll both in Part G  and Part D supplement, that could be a good way to go.

Quilting brings calm

Since this was commented on today,  bringing it to the top, here’s an update: 

We’ve had trouble with the changeover due to my former employer’s third party benefits organization.  First they delayed the cancellation of my spouse from my doctor and hospital coverage.  Medicare A/B  itself was okay, but the Medicare supplement plan didn’t show up in the Medicare  system for about six weeks and his ( supposed to be cancelled)  insurance under me was listed and pre approvals for a BPAP machine were sent to them.  

Prescriptions were paid through the Medicare part D plan for July and August.  Then in September the part D plan denied coverage because another prescription policy was active.  You guessed it- that same third party benefit   company forgot to cancel the prescription coverage through CVS/Caremark. The pharmacy didn’t tell  us that part d denied coverage- they billed two prescriptions in September through my insurance though they had been told not to.  That was several hours on the phone to straighten out( third party benefit company, CVS/caremark company, the part d insurance company  and the Medicare people themselves).  We refused the medication that brought it to light, and the other is being rebilled through part D by the pharmacy’s home office. The part D plan covered two new prescriptions this week, so I believe it’s fixed 

However he has not been able to get off either of the part d non covered prescriptions, and that’s going to cost us several extra hundred a month  in addition to the covered prescriptions copays and deductibles.  I wish I had kept him on my insurance  and accepted the Medicare Advantage limitations when my insurance switches over to it next year. Although it’s possible that these two prescriptions wouldn’t be covered then either.  We’d still have that third party benefits company in our hair too. 

I have the opportunity to put him back  on my  retiree plan every year at open enrollment and we are discussing  that.  My former employer’s open enrollment is next spring for July 1st. The insurance agent  we used to enroll him in the supplement advised against it because we would have then  used up the one time’ no health questions, no underwriting’ opportunity that everygets the first six months after they turn 65.  So the possibility of coming back to straight Medicare supplement later would be more difficult with his health issues.  I let her know last month I wasn’t happy about the change  over issues.  Not that she had any control over it