As a retired physician on Medicare, I thought I’d share my opinion on why traditional Medicare with a supplement is superior to Medicare Advantage. Let’s start with the name, Medicare Advantage. It’s actually a misnomer and should be called Medicare Disadvantage.
Essentially the US government gives an insurance company about $1000 per month to take care of any health care needed by an enrollee for a year. As we all know insurance companies exist for one reason, to make money. With Medicare Advantage, they start out by paying their agents over $600 commission for an enrollee. That’s how valuable these customers are to them. They offer extras such as dental, optical, gym memberships and even groceries in order to entice customers to join.
Then they enlist a local network of medical personnel and hospitals to care for these patients at reduced fees. Outside of Medicare these are called HMO’s and PPO’s. They work on a gate keeper system. This means that to see a specialist one must first contact the primary care provider who often is a nurse practioner or a family practioner.
If you are a person who enjoys travel and you go to another state, those doctors will not be in your network and you must start dealing with the insurance bureaucracy in order to be seen for an unscheduled medical situation.
One of the biggest disadvantages comes about when you develop a serious medical condition, like cancer. Naturally you want to go to the best specialists and specialty centers in the country in order to get treated. Then you find out that there’s a doctor in your town with an oncology shingle outside his or her office and your Medicare Advantage plan has them in its network. That is where you will be going.
When more expensive treatments are needed for medical problems, as often as not you will be denied access. Then you must go through the appeals process which may or may not accede to your request.
In contrast, traditional Medicare patients can be seen by any doctor who participates with the Medicare program, which is most physicians. He can be admitted to any hospital that participates with Medicare.
The big difference between the two programs is the cost. Traditional Medicare with a supplement (to pay the 20% that Medicare does not cover) costs more per month than Medicare Advantage.
As the saying goes, “You get what you pay for”.
