It’s that season again; all the multiple barrage of ads about Medicare Advantage Plans.
“Call now to see if you are eligible.”
“If you have Medicare Parts A & B, you do not automatically get Part C benefits.”
Both ads are misleading. It isn’t if you are eligible for an Advantage plan, it is if THEY are eligible to sell you one in your zip code. Unless an insurer has doctors under contract and hospitals under contract in that area, they are not allowed to sell the plan in that area. AND you have to call every year because it is a revolving door of doctors and hospitals leaving every year – doctors HATE Advantage – Part C plans. Why? Because those plans make doctors get prior approval before ordering tests and procedures causing delays and obstacles in providing care.
The ads imply that Part C-Advantage plans are an addition to Medicare Parts A & B. In fact, if you choose a Part C plan, which is a private insurance company plan, you lose Medicare Parts A & B, and if you don’t like the Part C plan, it may be very hard to change back AND you lose the option to buy supplemental plans. The hook they use to entice people to give up regular Medicare is “free” things like dental, hearing aides and glasses. But not all Advantage plans offer those and the small amount they pay is negligible. Free rides to appointments and Meals on Wheels are things ALL seniors can get if they are needy and indigent. Most Plan C Advantage plans are HMO or PPO, which means you just use only the doctors or hospitals within their network. The network may be small and restricted and the doctors may be overbooked. And if you travel or see a doctor outside the network you must pay for it. Also the plans all have co-pays for services and some have deductibles where you pay first dollars.
So far about 40 percent of Medicare recipients have chosen Plan C Advantage Plans which are private insurers like Humana or Aetna or Blue Cross. Both the 47 Plan of Trump and The 2025 Project plans include forcing all Medicare recipients onto private insurance plans and doing away with traditional Medicare.
I will just give my and my husband’s experiences and my experience as a doctor having practiced and dealt with insurers for 30 years. We both have regular Medicare Parts A & B and we both bought supplements for things Medicare didn’t cover and the 20 percent extra. We each had about $185 a month deducted from our Social Security checks for Medicare. I understood if we had very low incomes that would have been free. We each bought a supplement only eligible to buy when we first went onto Medicare. I paid about $190 a month, my husband (10 years older) paid $220 a month. We had both chosen higher cost plans because we traveled and wanted international coverage. My total cost $375/mo. His total cost $405/mo. He used insurance a lot – two strokes, a cardiac procedure, prostate cancer, high blood pressure etc. I used it very little. Neither of us ever paid a dime extra for care. No co-pays, no deductibles, nothing. I once had to see doctors on a cruise ship, about $3,500. I paid in cash but my supplement reimbursed me in full.
I would encourage everyone NOT to get back in league with private insurers and their restrictions and ever changing rules. If you do or have gone to an Advantage plan and want to return to regular Medicare, you will find you have lost the window to buy a supplement and if you want one it will be higher priced or unavailable. It’s best to stay with regular Medicare Parts A & B, buy the best supplement you can (I have the AARP-US Healthcare one) and add Part D if you need a lot of drugs. It’s the lowest cost overall, has the widest choice of doctors and hospitals without restrictions or pre-approvals and doesn’t change. No need to do anything every year.
And think about it. Who is paying for those thousands of TV ads? You are if you buy an Advantage plan. The cost comes out of restricted care.
Lisle Hamilton is a resident of the Village of Sanibel.