GUEST POST from Don: Medicare Advantage?

MEDICARE ADVANTAGE?

Rules of thumb are there to help you make good decisions without straining your brain.  There is a rule of thumb which helps steer me right:  “If something is heavily advertised or promoted, it probably is not in my best interest.”

They are pushing it for a reason (pick one)
politics
agenda
profit
they have a warehouse full of them and they need suckers to buy them

So … I noticed that Medicare Advantage Plans (Medicare Part C) are SUPER-HEAVILY promoted (even on the Medicare website).  It made me ask, “Advantage to Whom?”

OK.  What are the customer advantages?  
Let’s be clear.  There are MANY plans, some regional, and by many different providers.  Trying to generalize that mess may be impossible.  
(* = These may not always be true.)
*lower premium costs
*extra benefits (dental, vision, and hearing)
*carry one card (instead of 3)

RISKS (Not all plans have every risk mentioned below, either.  If you are interested in a particular Part C Plan, check for these things).

1. Foreign Travel and cruises:  Original Medicare pays 50% of medical care in foreign locations (Italy, for instance).  Most Advantage plans pay ZERO.
2. Visiting or Moving to another state:  Original Medicare covers you everywhere in the USA. Certain Advantage plans are strictly regional.  They may have network providers in Wisconsin, but not New York.  If you are going to visit family in New York you should check your plan before going.
3. Dental Care, etc.:  Original Medicare does not cover this.  However, your Advantage plan may not include any “in network” dentists nearby either.  You may have to go to Milwaukee.  The dentist you have been going to see may not be “in network.”
4. “Your” Doctor:  Your doctor may not be an enrolled provider this year.  Maybe he/she will be next year.  Advantage plans have a higher turnover of network providers.
5. Gatekeepers:  Some Advantage plans make your primary care provider a gatekeeper.  If you think you need a cardiogram, you doctor may not.  With Original Medicare you can seek your own Specialists without getting a referral from your primary physician.
6. Costs:  While the promotion of Advantage Plans is that they are less expensive, this is not always the case.  A Kaiser study found that about half of Advantage enrollees would end up paying MORE than those on Original Medicare for a 7 day hospital stay.  This is also true for those with chronic conditions or major health needs.  The real Advantage goes to the most healthy.
7. Getting RID of the Advantage:  A January 3, 2024 report by NPR was about “Older Americans say they feel trapped.”  If you acquire a chronic condition or a major issue (cancer, liver disease) it may be difficult to find an Original Medicare plan provider which will accept you if you want to switch.
8. Living outside a major metro area:  Your rural area may have no enrolled providers.  Rural members are twice as likely to switch back to Original Medicare.

SUMMARY

Hey!  You might find one of these plans to be to YOUR advantage.  It could happen.  It does happen often enough that the option has not gone away.  Yet, the risks are hefty.  You are trading freedom for lower cost.  For some, that is perfect.

As with all choices, you should know the risks.

-marriage
-buying a car
-choosing a new home
-roller skating on ice
-Medicare Advantage

Think this choice through carefully.

I used my rule of thumb and went with a traditional plan with my own choices for supplemental insurance and Part D.   I won’t have to check my plan details if I travel to Maine or Tennessee or anywhere in the USA.

[PLEASE NOTE that Don is always open to discussing the thoughts and opinions he shares here and welcomes comments as shared in the comment section. He doesn’t use other social media platforms and won’t see whatever you’d like to share with him if you post it elsewhere.
ALSO, Don is always open to offer his thoughts on various topics. If you have a specific request, you can let him know in a comment; he reads – and replies to – them all. ~ Sherry]

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2 thoughts on “GUEST POST from Don: Medicare Advantage?

  1. I have a medicare advantage PPO, so I don’t need my doctor’s permission to see a specialist, which is something I often do.

    I had my gall bladder out in December, my primary didn’t even know about it until I told him 4 months later at a regular appointment!

    Quite frankly, I manage my health care myself, not my primary care doctor, who I mostly only use for colostomy supplies.

    1. Thanks, GoatsLive.
      Yes, there are literally scores of plans. It is impossible for anything said (even by Medicare) to apply to them all. Yet every advantage plan has at least one of the downsides mentioned. My goal was not to discourage people from signing up for it, but to do due diligence with eyes wide open.

      Good for you in finding one of the better plans.

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