The Problem with Medicare 'Advantage' Plans: They are Awful!
1. There is no 'Advantage' to a Medicare Replacement plan. They are truly awful for most patients that enjoy the freedom to choose their provider, choose high quality over cheap and value the quality of the prescriptions that they receive.
The advertised Medicare "Advantage" is the commission that the insurance company and their sales agents pull from your benefits from Medicare. You convert from a standard insurance model directly to an HMO model. Traditional Medicare is the best insurance that you can get. When you fall for the 'you DESERVE more benefits, you can count on the fact that someone has their hand in your pocket.
Medicare covers a variety of services, pays for them and leaves you with a 20% 'Co-pay' of the negotiated fee schedule. You can elect to get insurance for this, as I do, to insure against catastrophic events. The pharmacy coverage is inexpensive, and is best shopped for your individual needs.
NOTE WELL: When an insurance company offers you benefits that traditional Medicare does not, it means that they are taking money out of the funds that you may need for real medical care. NOBODY gives you 'free grocery money,' 'free dental coverage,' 'free gym membership.' The fund have to come from somewhere and it is out of what they take from their coverage for physical therapy, pharmacy and physicians.
If you fall for this one, you may find yourself dealing with doctors and facilities that are somewhat below your expectations, to say, the least.
In short,
a. They offer 'new Medicare benefits,' such as cheap gym memberships, sun glasses, gym shorts, and what not.
b. These 'benefits' are cheap compensation for the thousands of dollars in moneys that they take off of the top from the government, for 'management.'
c. The government makes out because they limit what you can receive in treatment, resulting in lower quality, poorer availability, and decreased accessibility, decreased mobility.
In short, there is NO ADVANTAGE to the Medicare Advantage Plans!!!
2. They take several thousands of dollars right off of the top from a fixed amount that the government pays them to 'administer' the plan. This is a poetic way of saying that they are paid to deny you coverage that you would otherwise receive, and you get second or third class coverage.
3. Regular 'Red white and blue' Medicare is the best insurance that you can get. When they cut it down with the Advantage Plan, it is clearly to your 'Disadvantage.' You lose the ability to see who you want, where you want and you have to choose from their list of contracted doctors. The card may say IPO, but if you have to 'pick their doctors' it is clearly a Medicare HMO.
Recommendation:
4. I recommend to my patients that they use regular Medicare and shop for the appropriate pharmacy program to supplement Medicare. You do this by looking at your medications, the most expensive first, and then find which plan covers that medication cluster.
5. Then, you pick a different Supplemental plan. It can NEVER be the same one as your pharmacy plan, or they will roll you into their Medicare Advantage plan, without your consent or knowledge. If this were another industry, it would not be permitted.
6. As an example:
a. United Healthcare for supplemental with BCBS for Pharmacy
b. Mutual of Omaha for supplemental with Aetna for Pharmacy
c. Cigna for the supplemental, with UnitedHealthcare for the Pharmacy
There are many possibilities, most work well.
Above all, do not let the insurance sales people talk you into using the same company because it is 'convenient.' It is convenient in guaranteeing them a more juicy commission.
I am not an insurance agent, but this approach has served my patients well for the past 30 years. Further, This is exactly what I am doing for myself.
David S. Klein, MD, FACA, FACPM
copyright 2023 Stages of Life Medical Institute
