The Hidden Dangers of Medicare Advantage Plans for Social Security Recipients

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46. There is no lifetime maximum on MA. And original Medicare does deny claims and you do get

stuck with paying the providers. It’s handled differently, though. For example, Medicare will deny behavioral health, injections, physical therapy, knee and joint injections, etc., based on exceeding a set number of encounters. There are rules on how often you can have a colonoscopy, mammogram, etc.

Like prior authorizations, the provider has a chance to appeal the denial with additional info. Similarly, physicians learn quickly to delay many expensive treatments until conservative care is tried first because Medicare will audit docs who provided too many services years after the service is rendered.

Another interesting fact, while original Medicare is not allowed to negatively drug prices (until recently on a small number of drugs), Advantage plans can and do negotiate drug prices. Admittedly, the negotiations impact will be greater if both original and MA are negotiating.

I believe those that can afford original Medicare, a supplement, drug plan, and go without limited dental, food cards, etc., have more flexibility. But lots — 30+ million beneficiaries — can’t afford original Medicare. They should have that choice until Medicare is completely overhauled. Don’t see that happen anytime soon.