Medicare Advantage is truly Medicare Disadvantage. I am a retired physician on Medicare. I offer my opinion on why traditional Medicare with a supplement is superior to Medicare Advantage.
In the Medicare Advantage program, the US government gives an insurance company about $1000 per month. This is to take care of any health care needs of the enrollee for that year. As we all know, insurance companies exist to make a profit. With Medicare Advantage, the health insurance corporation starts out by paying their agents over $600 commission to enlist a new enrollee. That’s how valuable these customers are to them. They offer extras such as dental and eye care insurance along with gym memberships and even groceries. This is meant to entice customers to join.
The insurance company enlists a local network of medical personnel and hospitals to care for these patients at reduced fees. We know these as HMO’s and PPO’s. They work on a gate keeper system. This means that to see a specialist you must first contact the primary care provider who is commonly a nurse practitioner or a family practitioner. They will decide if your problem merits being seen by a specialist.
If you are a person who enjoys travel and you travel to another state, those out-of-state doctors will not be in your network. 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. Your Medicare Advantage plan has them in its network. That is where you will be going, not M.D. Anderson or the Mayo Clinic.
When you need more expensive treatments for your health problems, as often as not your insurance company will deny you access. Then you must go through the appeals process which may or may not agree to your request. According to some reports some insurance companies routinely deny costly care. They offer it only after an appeals process reverses their profit-based decision.
In contrast, a Medicare participating doctor will see any patient who has signed up for traditional Medicare. Any hospital that participates with Medicare will glady accept the patient.
One big difference between the two programs is the cost. Traditional Medicare with a supplement (to pay the 20% that Medicare does not cover) costs the patient more per month than Medicare Advantage.
As the saying goes, “You get what you pay for”.
