If you choose a Medicare Advantage plan, you're helping to kill true Medicare

[wackadoo wabbit]

I know, I know. This sounds like complete hyperbole. But it's actually true.

Medicare Advantage was devised as a way of privatizing Medicare. Medicare Advantage is not true Medicare; it's actually private health insurance.

Newt Gingrich once said about original Medicare, "“We believe it’s going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.”

Medicare Advantage plans were devised to enable that to happen.

Here, don't take my word for it:

https://www.commondreams.org/views/2021/09/08/medicare-advantage-profit-scam-time-end-it

https://medicareadvocacy.org/medicare-is-being-privatized-where-is-the-outcry/

https://www.dailykos.com/stories/2020/9/14/1977397/-Beyond-the-Medicare-Advantage-Scam

https://www.forbes.com/sites/forbesfinancecouncil/2021/02/24/why-are-medicare-advantage-plans-so-heavily-advertised/

https://www.statnews.com/2019/04/03/medicare-advantage-nudging-aside-old-medicare/ (read to the end)

If you're currently on a Medicare Advantage plan, you can switch back to original Medicare during the open enrollment period.

[rsdsharp]

1. You can switch back only if you can pass the physical.

[dweller]

4. What physical ?

No one takes a physical to get Medicare at 65, you just sign up.
Why a physical to return to it ?

Maybe the answer is in the links in OP, will check them

✌🏻

[SharonAnn]

9. Medicare Supplemental Insurance Part B may require physical on return to Medicare

And a company may deny that coverage on return.

It’s only at original signup at 65 that the MUST accept everyone.

[LiberalFighter]

12. Original Medicare is managed by Medicare not by an insurance company.

Medicare Advantage plans are managed by an insurance company.

[tritsofme]

33. Right, but original Medicare doesn't make sense for most folks without a supplemental plan

From a private insurance company, that covers all or a portion of the 20% that Medicare does not pay.

[Demsrule86]

61. That is not true. You can switch during the medicare open enrollment and they can't even

ask health questions. I posted it above directly from Medicare.

[Politicub]

83. You get one bite at the apple (with few exceptions) to sign up for

a Medigap plan, without medical underwriting, when you become eligible for Medicare.

People can sign up for them later in life, but they are subject to disparate pricing based on their health condition. This can be hundreds of dollars more than someone else at the same age pays.

[PortTack]

19. Maybe for a supplemental..not for just Medicare

[rsdsharp]

25. No maybe about it. Good luck with that 20% on your dime.

[Demsrule86]

60. That is not true. As for keeping true medicare...I can't afford it. You have to pay for a Medigap

policy and your pharmacy with additional premiums. My Advantage plan pays $99.00 of Part B and provides vision, dental, pharmaceutical benefits, and a fitness program.

"When Can I Switch to Original Medicare?
The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked. The second way to leave your Medicare Advantage plan is if you’ve had it for less than one year (that is: you’re entitled to a “trial right”)."


https://medicareguide.com/medicare-advantage-to-original-medicare-180767

[Walleye]

2. I had Medicare advantage for about a year. Did not like it

Now I just have Medicare and can’t decide whether to get a supplement or not. So far Medicare has been pretty good except for chemotherapy. Very expensive. Fortunately our state has a Medicaid cancer treatment program that helped me out. I didn’t quite understand what the Medicare advantage was when I got into it. It wasn’t long before I realized that they were trying to privatize Medicare. Dropped it went back to original Medicare

[Politicub]

82. Unfortunately, and this applies to my husband as well, your medicare

Supplement plan will require medical underwriting now. There are strict rules about when you can sign up for them unencumbered, and you are outside of the window. I think you can move to another state and have another chance.

My husband has an advantage plan. Medicare does a poor job of explaining medical underwriting and eligibility windows, so we didn’t grok the nuance of how you are stuck with Advantage. Unless, of course, you have hundreds extra per month to pay for an underwritten supplement.

We couldn’t afford a supplement, anyway. The law is indeed tilted toward private insurers.

Bernie’s vision for Medicare for All would have fixed this issue. But what is have now is far better than nothing.

[Walleye]

87. Agreed. I'm leaning toward not getting a supplement plan. It's expensive

I hate dealing with the insurance companies. Medicare has been very fair so far I can afford reasonable fees, it’s just, of course, at my age I worry about a catastrophic medical bill, but I think Medicare does take care of a lot of it so I have not made up my mind. Being old and sick is stressful enough, then they pile all this insurance stuff on top of it.I think the insurance companies count on the fact that it’s all so confusing, we never know where we stand

[moonscape]

89. I highly recommend MediGap if you

can at all afford it. I have been in cancer treatment/maintenance for 6 years, had 7 surgeries, months of in-patient rehab, infinite labs, images, etc and have had zero co-pays. I have Plan F but G is the same just with Part B deductible. My friend who couldn’t afford F got high-deductible F (there is a h-d G also) and her premium is just a few hundred/yr. Should she get into stratospheric bills like I have had, at least after her 2-3k deductible she also would be free of co-pays.

I was so healthy until one day by surprise I wasn’t.

Can’t recommend MediGap enough.

[Walleye]

90. What insurance company do you have?

The problem is the people who are set up to give information about these things usually have a vested interest and I don’t trust

[moonscape]

91. My MediGap is through HealthNet. But the

thing is, with MediGap, the company doesn't matter in the same way it does with Advantage, and different companies service different states/areas. They are mandated to cover what Medicare doesn’t. The only choice factors come down to premiums, whether they are based on attained age or community pricing, and how often they tend to raise rates. I used a broker who specializes in Medicare and also did my own research.

[PoindexterOglethorpe]

3. Well, gosh.

I have an Advantage plan and so far it's been very good to me. Every year the benefits improve, oddly enough.

Nearly a year ago I had a heart attack, spent three days in hospital, got a stent, and only paid about $700 of a $70,000 or more bill. I have no complaints.

[wackadoo wabbit]

5. That wasn't my point

While generally Medicare Advantage plans are not good for the consumer, I suspect that in some instances they are. So what?

If Medicare Advantage plans, which are actually private insurance plans, exist to weaken and ultimately destroy Medicare, are you OK with supporting that? Maybe you are. It's not for me to judge. You do you.

I'm just putting the information out there, since it seems that very few people on here know about it.

[brooklynite]

8. "are you OK with supporting that? Maybe you are. It's not for me to judge."

Sounds like you've judged.

[DURHAM D]

10. Doesn't seem like he has judged. He is just trying to inform

regarding a complicated matter.

otoh - Sounds like you have judged. Why?

[JanMichael]

92. That's his MO. nt

[PoindexterOglethorpe]

15. So what? I think that the Medicare Advantage plans are good

for many consumers. For some reason, here on DU, the Advantage plans get trashed on a regular basis. I honestly don't understand.

It's sort of like the way annuities are routinely trashed here, which I likewise don't understand. I happen to have two annuities, and they are paying me a regular income well above what it cost me to buy them.

Similarly, my Advantage plan has done well by me. Whenever I take a look at original Medicare, I see far fewer benefits than I have. What am I missing?

[marybourg]

22. The fact that the insurance companies are getting more taxpayer

dollars per patient than regular Medicare is getting. It was only supposed to be for a few years until they got started, but they’ve been able to hold on to it through heavy lobbying. If they manage to kill regular Medicare, do you think they’ll continue to be generous to their patients — or to their CEO?

[notinkansas]

36. Take a look at Thom Hartmann's 'Hidden History of American Healthcare'.

I was more interested in his and Wendell Potter's takes on the private insurance companies and on Thom's explanation of the disadvantages of the 'advantage' plans than the actual history. Even though they call themselves 'Medicare Advantage', they are not Medicare. The last thing we need is to be back in the clutches of the private insurers because they have destroyed Medicare.

[yellowdogintexas]

39. you are required to stay within your network.

Going out of network in an Advantage plan will cost you an arm and a leg. Sometimes the network will be small because the physican payments are low, and that makes if hard to even find local providers

Traditional Medicare has no networks. I know that if I am in KY or AZ I will find physicians and facilities with no network requirements.

[PoindexterOglethorpe]

47. Ah, yes. The network.

When I was in a health care plan, at my work or at my husband's work there was always a network. Always. Maybe I'm naive, because I haven't had to access health care outside of the state I currently live in, but most health care plans have exactly these limitations. What exactly am I missing?

I also recall a time when my husband's work place changed health care plans, and we had to scramble to find a new primary care doctor. We did so, but it was a chore, to say the least. And even though we liked that doctor well enough, when his company went back to a plan that included the old doctor, we immediately went back to that practice.

So don't pontificate about doctor choices, because I've been through them many times over the years.

[Demsrule86]

69. Many Advanage plan have emergency coverage when you are traveling...I did not see any

current Medigap policy that did...this was a concern for me.

[Demsrule86]

63. I think so too.

[jimfields33]

28. My neighbor retired from New Jersey teacher and they put all retirees on an

Advantage plan. Some don’t have a choice. This may be just his district I’m not sure. But he’s on it regardless.

[JustABozoOnThisBus]

52. Maybe the district did that, or maybe the local union?

Either way, if the number of choices is reduced to "one", look for kickbacks/corruption.

Not that a New Jersey union or school district could be corrupt, of course.

[dsc]

54. that is how it works here in NC

[PoindexterOglethorpe]

78. That doesn't sound right.

It's Medicare, and the individual has various choices for it, including Advantage plans. I don't understand how all retirees could be made to have an Advantage plan. The neighbor should contact Medicare directly if they don't want to be on an Advantage plan, or not on that specific one.

[jimfields33]

80. Oops. Rereading this. It's for the secondary.

[Karma13612]

17. Same here!

And I think it’s easier to find providers who accept Medicare advantage instead of regular Medicare.

I even get dental and zero premiums!!

I guess I can see the concern about diluting Medicare, but I’m getting more benefit from my premium to Medicare than I would with basic MCR.

[radical noodle]

29. I've never had any doctor that didn't accept my Medicare

or my supplement. However, I have had doctors tell me they would not take Medicare Advantage. I wonder why the difference?

[yellowdogintexas]

40. networks. If the physican does not accept the contract offered by the network

you have to see him out of network. The claim will be based on the out of network rules for your plan.

I have also had no issues with providers accepting Medicare B; also if they accept Medicare B they will roll it right over to your supplemental plan. Those supplemental plans exist to pick up the percentage not paid by Medicare. If Medicare allows it, the supplement will cover it.

There was a time when Medicare and Supplements were all we had. Prescription drugs were included in many supplemental plans (they cost more but it saved money in the long run) Advantage plans took care of that along with PartD.

[radical noodle]

58. My experience with networks has never been good

I found myself always on the hunt for new doctors because my previous doc had not been able to negotiate with my network for another year. I haven't run into that since I turned 65.

[Demsrule86]

71. Or you find a new doctor...

[Grasswire2]

6. The best choice for everyone is a MEDIGAP plan, rather than an ADVANTAGE plan.

Why?

Because the benefits are STANDARDIZED by law. There's no weasel language.

No matter who the provider is, the benefits are standardized.

The only caveat is that you have to choose MEDIGAP at your eligible date, and if you drop it, you have to go through a process to be allowed back in.

[Casady1]

13. correct

I am on supplemental and so is my wife. She has had operations this year. the first two cost $600K. I paid $205.

[House of Roberts]

18. How does one tell which plan is actually a Medigap plan?

I am inundated with what all appear to be Advantage plans in my mail, plus all the TV ads.

[radical noodle]

31. Look for a Medicare supplemental plan

Most insurance companies have them... Anthem, Humana, etc.

You can go to the Medicare.gov website and enter and you'll find a link to Medigap info on the first page. You don't actually buy the plan through Medicare, but through an insurance company.

I will say that I have seen a Medicare Advantage Plan collapse. A neighbor had one that he bragged on all the time. He had a surgery scheduled to remove a cancerous growth but at the last minute his doctor called and said they couldn't do the surgery because he no longer had insurance... the company had folded. He had to scramble to find another policy. I'm sure that doesn't happen often, but I was shocked to learn that it could happen at all.

[Grasswire2]

79. all about Medigap here at this link

[link:https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap|

[yellowdogintexas]

41. you can wait but the premium will be a bit higher. Mine was but not by very much

If you leave Part B and your supplement, switch to Advantage then decide to switch back, I believe the supplement can make your application go through underwriting, just in case you have any health issues.
I had to answer a lot of health questions when I applied for my supplement but there is nothing in my medical history that would raise any sort of red flag.

[PoindexterOglethorpe]

48. My Advantage plan has no additional payment.

Humana is happy with my Medicare payment, doesn't charge me extra, and I'm very happy with what I get from them.

[Karma13612]

51. My first year I sat down with a local

Consultant thru the local county Office of the Aging who compared plans with me. Got enrolled in an advantage plan as it was cheapest at $10 per month beyond the MCR premium. Not happy with the plan. Bungling and poor online premium payment interface. Name was WellCare.

Year two I went with an Aetna PPO advantage plan with zero additional premiums, dental (no forms, no prepay and reimbursement scheme), and our local healthcare system loves it. In the eye practice, the plan didn’t cover the refraction so I was billed for that at $35. You also can order OTC stuff by online interface-$30 allowance every quarter.

I understand that I need to be responsible and help support MCR for the future, but I also have to preserve my fixed-asset retirement pension.

And quite honestly over the course of the first 2 years, neither consultants pointed out specific gap plans that would be helpful or explained the differences. Could this be a State level thing?? We are in NYS and they are strict about junk insurance.

[PoindexterOglethorpe]

93. Different Advantage plans are available in different parts of the country.

Every year at this time I get a lot of mailings from all sorts of providers wanting me to switch to their Advantage Plan. It can be a huge hassle to read through various lengthy brochures and descriptions, I know.

[Demsrule86]

72. No, they can't...I posted above...

[Demsrule86]

66. If a procedure is covered under Medicare than it is covered period. And let me tell you

if you get cancer with regular Medicare, you are screwed. My neighbor had to remortgage her house.

[leftstreet]

7. DURec

[zebrapa]

11. If you choose a Medicare Advantage plan, you're helping to kill true Medicare

True.

[mvd]

26. That's why I support strengthening original Medicare so much

Some Medicare Advantage plans may be good and some bad - but we can always rely on good old Medicare.

[yellowdogintexas]

43. yep. Lowest cost per claim, lowest error ratio, fastest claim turnaround in the industry

It has been there since 1967, just chugging along and all its systems and processes are time tested.

As a former Medicare claims analyst I am a loyal supporter of the plan - even back in the 70s when it was new I told everyone I knew that I thougth everyone should have it.

Medicare was intended to be the prototype for a national health plan, actually.

[Demsrule86]

73. No I can't. Good old Medicare requires a medi-gap policy with high premiums and high

out of pocket costs from what I saw...also no help for Medicare Part B. Some here had the decent Medigap plans that ended last year by the way...and what I saw this year was mostly expensive crap. I chose Advantage because I could afford it...and it helped with Part B.

[yellowdogintexas]

42. Absolutely plus you are just giving your $$ to a 'for profit' plan.

Part B increases are limited to cost of doing business - office space, computers, supplies, raises for employees, etc. There are no gazillion dollar salaries here. Or expensive advertising either.

[Demsrule86]

77. Medi-gap plans are sold by private insurers.

I don't see the difference.

[Timewas]

14. For me

I tried an advantage plan for a year, what happened in that year was they both tried to be the secondary payer and left me holding the bag. Every medical bil I received ended up costing me a lot more than they ever had for same service on straight medicare...That was every one not just occasional but all of them...Plus employer was paying 176 month for the advantage plane... dropped it and got back to normal after that.. Never again, Medicare pays the bills well for me

[yellowdogintexas]

44. Both? How did you end up with a secondary payer? justwondering nt

[Timewas]

53. I have no idea

Was the same battle over every bill... No one had a logical answer so I just gave up on it ..Never again..

[former9thward]

16. Why in the world would I switch back?

I get vision, dental and hearing with my medicare advantage plan and I do not pay a dime more than the regular medicare. Vision, dental and hearing is what people say they want and you are saying I should dump it? No thanks.

[wackadoo wabbit]

23. I'm just going to cut and paste my response from above

While generally Medicare Advantage plans are not good for the consumer, I suspect that in some instances they are. So what?

If Medicare Advantage plans, which are actually private insurance plans, exist to weaken and ultimately destroy Medicare, are you OK with supporting that? Maybe you are. It's not for me to judge. You do you.

I'm just putting the information out there, since it seems that very few people on here know about it.

[notinkansas]

37. Advantage plans are strictly private insurers who get reimbursed by Medicare.

And they tend to drop customers who become seriously ill (expensive). It's my understanding that if that does happen, said customer may find it difficult to go back to real Medicare.

[Ms. Toad]

81. Medicare Advantage plans cannot drop you based on your health.

They can, however, drop you if your premiums are not timely paid.

[Politicub]

84. You are spreading disinformation. Advantage plans cannot drop you.

They can be a pain in the as because of their limited networks. But insurance companies offering them can’t decide not to cover you.

[notinkansas]

96. You may be correct about that.

But they can deny coverage, which could result in life threatening situations. And given that they are for-profit companies, being at their 'tender mercies' is a pretty vulnerable place to be.

[PortTack]

20. This absolutely true!

Medicare is a bit more expensive, but the hoops I hear about DR choices, and referrals with the advantage plans...no thx

[Ron Green]

21. One risk pool is a health care system. Multiple risk pools is an investment scheme.

We have enough investment schemes in this country; we need a health care system.

[yonder]

38. Thank you.

Insurance companies have the resources to drown people in complex options AND the experience to work that complexity to their **advantage. That's what they do.

We are about to jump off the employer subsidized system into this new world and are strongly leaning toward Medicare with a Medigap supplement.

**no pun or connection was intended but upon seeing that I get this mental picture of oak-paneled corporate boardrooms where insurance fat cats are laughing their asses off at this inside joke.

[yellowdogintexas]

45. your mental picture is fairly accurate. They are going to get theirs no matter what.

I recommend Part B with a supplement. Unless your employee benefits roll your plan over to be your secondary coverage. Then you don't need a supplement.

[yonder]

49. I dont think that's available for us but will look into that.

[Demsrule86]

65. Many here who support Medicare have plan F or C - good plans which are unavailable for

new Medicare recipients who don't get Part B paid and all the goodies that these former Medigap policies had. The Medigap plans available have darned expensive premiums with high out-of-pocket costs, no pharmaceutical benefits, and no help with Medicare B.

[Politicub]

85. I'm jealous of the people who were grandfathered in to the sweet plan F

The plans available now have pretty sizable deductibles and monthly premiums.

[IBEWVET]

24. A lot of our doctors won't take advantage

Our preferred doctors do not take it. it is like HMO's you have to go to the doctors in there network and get permission before going. We have traditional medicare and a supplement. we pay for the supplement and no other charges and almost every doctor takes medicare. If you are struggling to pay bills an advantage plan may be for you, but if you want to choose who you see you need medicare.

[radical noodle]

32. I've found that to be true as well

I have wondered why some doctors refuse patients with an advantage plan.

[yellowdogintexas]

46. The doctors are not part of the Preferred Provider network for that Advantage plan

God forbid you need medical care outside your network. The payment scale for the OON services is ridiculous.

[Hekate]

27. Wotthehell, people

[MySideOfTown]

30. I opted for Medigap at 65 and switched to Advantage at 70. Why?

Primarily because I was paying 125/month part B plus another 125/month Gap. I was and still am pretty healthy so don't have a lot of copays. Now the premiums for part B and Gap are 150 plus 150/month. $3600/year. So that's a lot of money for me. Advantage pays my part B plus covers dental, hearing and eye care which original Medicare or Gap does not. My copays last year were $500. Saved $3100 with advantage. Doing what's best for me. If you can afford to pay $3100 a year to "save" original Medicare, be my guest. I can't.

ETA: And my late wife was diagnosed with stage 4 lung cancer on her 65th birthday. We opted for Gap. Her chemo treatments were atrocious. Medicare didn't cover the $17,000 shot per month. So it was 30 days till Gap kicked in and we delayed the first chemo till it kicked in. I don't know if that caused her to die nine months later, but there it is. We sure as hell didn't have $17.000 at the time. But after that Gap picked up the entire cost of her treatment over Medicare until it was over. SSA gave me $250 to bury her.

And $17,000 for a shot? Fuck you Sinemawont and Manchicant for opposing pharma negotiation.

[Demsrule86]

62. That is it...I had the same experience. I saved a ton a money with Advantage.

[Cryptoad]

34. Dont have enought income ,,,,,,

to go back to straight Medicare,,,,,,,, and I still have to make monthly decisions on whether to eat or healthcare........

[yonder]

50. Thanks to the OP for this thread. Kicked as far as I can.

There are many good comments/opinions which will be helpful to us for our own upcoming decision.

[LymphocyteLover]

55. I do believe that was the goal for that plan in the first place

Wasn't this a GWBush policy?

[Tom Rinaldo]

56. I chosee Medicare along with an AARP Supplemental Plan ("United Health Care")

In my case my income is low enough that I qualify for some limited state assistance through New York's Medicaid program, although my income is too high to outright qualify for Medicaid. That means that my monthly Medicare premium is paid for by Medicaid, and so is my prescription drug plan. On top of that, my prescriptions are capped at a low rate, with generic drugs virtually free and other drugs fully subsidized beyond a moderate fee. I am left paying for the Supplemental Plan itself, which is roughly #175 per month. No Dental or Vision care. It has a deductible and co-pays, but I chose a relatively comprehensive (a little bit more expensive) plan that severely limits my out of pocket expenses (up to $20 for a doctor's visit, up to $50 for an emergency room visit etc.) once an annual cap of I think $250 is met.

I am not a disciplined enough person to have done fully exhaustive research before having made that choice. Maybe there is some loophole out there that can leave me footing a major bill in some particular situation, but I honestly don't think so, as long as any treatments are authorized by Medicare. I assume that even in my situation, under normal circumstances, that I could save money annually with a Medicare Advantage plan instead, but I don't want my health care decisions to fall under the control of a private insurer. I don't want to potentially run afoul of out of network costs, and I want the freedom to pick who I can seek care from, in the event some complex illness befalls me. Now, as I understand it, I can theoretically approach any specialist in the country.

I am in actually in the middle of dealing with some coronary issues that were just diagnosed that require medical intervention, so I may find out in real time whether I made the right choice. This much is clear to me however, if Medicare Advantage has any financial advantages for patients over original Medicare, it is only because the private insurance lobby has manipulated Congress into providing them with enough of our tax dollars to make them competitive with traditional Medicare. I get angry every time I see one of their ads now on TV hyping all of the great additional benefits Medicare Advantage provides, without even mentioning that by accepting such a plan you are consigning yourself to care within that specific company's network of providers, in stark contrast to traditional Medicare.

[Autumn]

57. Be sure and thank the politicians who represent their constituents who matter the most. Lobbyists.

[area51]

100. +1

We need Enhanced Medicare for All.

[GoneOffShore]

59. Call them what they are - Medicare DisAdvantage plans.

Every insurance professional I spoke to before I started Medicare Part B told me to stay well away from them. And that was 8 years ago.

They look attractive, but in the end, they weaken the Medicare program, they can drop you like a hot potato, and as others have pointed out, they can, and often do, collapse.

Full disclosure: I am now out of the Medicare system completely, aside from Part A, as I am covered under the French healthcare system.

[Demsrule86]

74. That was eight years ago when Medi-gap policies still had decent coverage...they don't

now. I looked into it. If you have one of those plans keep it because you won't get it again ever as they are discontinued.

[GoneOffShore]

86. As I said, it's moot for me now. Unless I get thrown out of France.

Even up until 4 years ago, every insurance professional I spoke to told me to stay away from Dis-Advantage plans.

Then we moved to France. Cancelled PartB, cancelled PartD and my PartF plan because the drug plan and the supplemental won't do a thing for me here.

[myohmy2]

64. I have...

...Original Medicare only and I'm no expert...

...my experience with looking a ppo's is that they're too costly just for a little more freedom, choice and coverage...

...with 'free' hmo's you seem to give up your 'freedom' to choose...and their 'dental' is mostly just cleaning, their 'vision' is cheap crap glasses and their 'hearing aid' coverage is garbage...

...what we need to do is improve and expand Medicare coverage...the private sector is making money here and they never do things for 'free' or without making money...so, how are they doing that?...by chumping us on choice and quality?...by making us go to doctors and services we would rather not go to?...by making us pay more?

...the way I look at it is Original Medicare will get my foot in the medical establishment's door and cover most of my major medical problems and expense...I expect and demand best of treatment and care for their Medicare participation...

...after I'm back home we can talk about how I might (or might not) pay for any monetary difference I might owe...if you explain to them and beg/ask for financial relief many places will give it to you...(I don't know what you call it, but many medical establishments have community serving obligations)

...if all else fails and what I owe is big, there's always bankruptcy...

...this is the price we pay for a capitalist medical system...

[Demsrule86]

67. My sis in law had regular Medicare. Before she got her hip done...we had to come up with the

out of pocket costs...I believe it was $4000. So don't tell me about how Medicare will make sure you get treatment...simply not true in states like Ohio...maybe super liberal states. If so lucky you. I can't afford regular Medicare for both hubs and myself...we are not yet on it. But I have taken care of Medicare for years for my sister-in-law. Medigap policies suck these days. Unless you had one of the good plans that are no longer available and are grandfathered in, most folks won't be able to afford it. We don't even know for sure what Medicare B will cost this year.

[voteearlyvoteoften]

68. Regular Medicare with medigap is my choice.

If you can afford it. Up to 200 month in addition to @130 for parts A&B. Never get a bill. Can go anywhere I want.
(Must also get Part D prescription coverage only @20 a month in my area) They push the Advantage plans so hard that makes me suspicious. I don’t want to be told where to go and have to get referrals. Plus idk if Adnantage covers you out of area so if you are a snowbird or move around regular Medicare is probably your best bet.
I’m no expert this is just my experience.

[Demsrule86]

76. Also, Medigap policies are sold by insurance companies and are not subsidized by the government...

so insurance companies make plenty of money. They are not part of the original Medicare. And while if you go out of your area regular Medicare will work anywhere here but the 20% in most cases is not covered by Medigap...at least the ones I saw. The Advantage plans had some coverage.

[Karma13612]

95. Wow

I couldn’t eat if I had to come up with another $200 per month for a medigap plan.

We have Aetna Medicare Advantage and no extra premium beyond the basic MCR premium. And you mention you still need to pay an additional premium for prescription drug coverage?

[drexelkathy]

75. I think it is pretty crappy

to cast the blame at the feet of the participants which tend to largely be senior citizens for "killing" medicare.

Medicare itself kind of sucks. There is a lot of gaps, etc. and seniors are paying hefty pricetags out of pocket.

Don't blame participants...often who can't comprehend all the choices, prices, different additional plans, etc. It is complicated ON PURPOSE.

Blame the people writing the rules and FIX IT.

[Karma13612]

94. Thank you

Also, a big issue is the cost.

Hubby and I are not made of money. We cannot afford another premium on top of what MCR automatically takes out via our Social Security benefit. I have started researching these gap plans and they are costly.

My Advantage plan is zero extra dollars and works fine for me. Yes, if I go out of network it will cost me, but I have not been paying anything for regular check ups, labs and even some imaging.

The entire MCR scheme must be lowered to include anyone 50 years old and older. Get reasonably priced premiums from everyone and it will lower the cost overall. And it should mean we can do away with this in-and-out-of-network nonsense. All healthcare providers everywhere cover care for anyone with MCR card. Period.

Further, employ all the staff used at the advantage plan insurance companies to help administer the plan. All regulated by MCR. In another 10 years or sooner if financially viable, lower the qualifying age to 40 years old. And so on.

[Zorro]

88. I really don't get the hostility to Medicare Advantage plans

My Medicare Advantage HMO plan is $0 out of pocket monthly with minimal copays to our PCPs and specialists, and most of our prescriptions are $0. Our HMO medical facilities are world-class state-of-the-art and our doctors are great.

Payments would run about $5k/$6k per year for me and my wife with Medigap Plan G + Medicare Part D.

Doesn't really make financial sense to switch to a Medigap plan or to original Medicare Parts A and B; our Medicare Advantage plan already includes the Parts A and B coverage plus all the other extras.

[GoneOffShore]

97. Here's a link to SBM some thoughts as to why these plans could be renamed Medicare Disadvantage

https://sciencebasedmedicine.org/those-joe-namath-medicare-commercials/

[Zorro]

98. Not seeing any meaningful criticism of Medicare Advantage programs in the article

From the article: "Medicare Advantage plans have out-of-pocket (OOP) limits; original Medicare doesn’t." Seems to me that's a good thing for Medicare Advantage plans; they cover expenses once your out-of-pocket limit has been met, but you'll keep on paying if you have just Medicare A+B (As you may know, Medicare A+B doesn't cover all medical costs.)

Also: "If you travel to another state to visit family, Medicare Advantage doesn’t go with you. You will have to pay out of pocket." True, but misleading. Medicare Advantage plans do cover emergency treatments, and who goes to see an out-of-state doctor for routine matters? It's already a challenge to get an appointment with one's regular doctor, so I don't think it's plausible to just drop in and see an out-of-state doc for non-emergency situations.

So I don't think there's much anything in the article that condemns Medicare Advantage plans. Maybe it's because of my SoCal location, but I do get the kind of coverage that Namath promotes in the Medicare Advantage plans, and my co-pays are nominal for excellent medical care. Perhaps it's an anomaly compared to other (maybe more rural) areas where plans aren't as generous.

[GoneOffShore]

99. Your point is taken. Medicare Disadvantage plans do vary by state.

I do think that because of the private aspect that they weaken the entire program though.

Time to get the private sector out of the picture, have Medicare cover it all. Drugs, dental, hearing aids, optical. Leave Part A alone, and then expand the Part B coverage to cover all costs. Plus make the out of pocket limit $100.