Medicare Advantage???

Well it is that time of year when it seems like every Tom, Dick and Harry is cramming my mailbox, my computer and my TV screen with their so-called Medicare ADVANTAGE! programs. It is that time of year when the for-profit ghouls trot out their snake oil with glossy mailings and over the hills stars who tell us how great their products are. 

Ever since these went on the market they have promised the sky while saying it will cost you nothing – hell, even less than nothing!

What’s that old saying? “If it sounds too good to be true, it probably is.” I have been wondering for a long time how for-profit insurance companies can make their big bucks yet offer even better coverage than Medicare. Seems like a pretty good trick.

Until this year I haven’t been so curious that I wanted to try to look into it. Mostly I let it pass since their advertising period was only supposed to be from October to December. But as with most things it looks like the Trump admin allowed these companies to go way outside those limits.

So how do they make big bucks while spending big bucks on advertising and commissions? Well I am not sure of I can answer that question, but I did find out that as expected, this is a form of a scam on the old folks.

From investopedia we get this article that answers a lot of questions:

“Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health. Here’s a look at some of the disadvantages of Medicare Advantage Plans.

In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

To see how a Medicare Advantage Plan cherry-picks its patients, carefully review the copays in the summary of benefits for every plan you are considering. To give you an example of the types of copays you may find, here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

  • Hospital stay—$100 per day for the first 4 days
  • Emergency Room – $120 copay
  • Diagnostic radiology—up to $100 copay
  • Lab Services—up to $50 copay
  • Outpatient x-rays—up to $50 copay
  • Outpatient surgery – up to $100 copay

As this non-exhaustive list of copays demonstrates, out-of-pocket costs will quickly build up over the year if you get sick. The Medicare Advantage Plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick. “The best candidate for Medicare Advantage is someone who’s healthy,” says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. “We see trouble when someone gets sick.”

This is only a small part of the list of problems with Medicare Advantage. I recommend you click on the link and read the full article. When some flesh is put on the bones that the sales brochures and ads give us, this turns into a really ugly monster. 

Medicare has problems. What we need is universal health care for all in America. The problems that Medicare has are decidedly NOT solved by Medicare Advantage.

Had I had Medicare Advantage this year I would be considerably poorer after my Nurse Practitioner found an almost undetectable heart problem. The fix was not cheap. Had I had Advantage I would have been stuck with some big co-pays. With Medicare and the supplement my only real cost was a way overpriced drug that did not have a generic. We need drug price negotiating power with Medicare badly.

Think really hard and dig really deep on what the true costs of Medicare Advantage is before signing on.

About Dave Bradley

retired in West Liberty
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1 Response to Medicare Advantage???

  1. John Ensinger says:

    Instead of copays, you were stuck with a monthly premium that you pay monthly, regardless if you seek healthcare services or not. Whereas with a Medicare Advantage plan, you only pay when you seek services, and you have a Maximum Out of Pocket, only 2-3% of which participants ever hit. Tell me; do you have dental, vision, hearing, transportation, meal delivery or fitness benefits with Medicare Supplement?


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