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Do your homework people. Medicare Advantage plans are almost never a good deal. They don't pay all those semi-celebs to tout them and run thousands of hours of tv ads because they are a good deal.

Billing fraud notwithstanding.

Shocking. Who would’ve guessed this heavily marketed area would have issues.

I did the homework. My Kaiser Advantage plan is a substantially better deal than anything else I could do. And that's even before I apply the significant benefit of no paperwork, no billing tracking, no claim submissions, and so on.

That's the benefit to me personally. Whether it's a benefit to the US government is an entirely different question.

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I have less problems with my Medicare Advantage plan than I did with my company medical insurance before I retired. It is a good deal for my family the consumer. I presume it is a good deal for the insurance carrier as they keep making slight improvements in the plan for the same cost each year. And it is a good deal for the Government as it costs them no more money that what my medicare premiums are. So that is a 3 for 3 win. Now if you are a Republican you could argue that nobody but the rich should have health care and I wouldn't be surprised, but for the rest of us this thing works well.

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So you get downvoted for offering personal experience that counters baseless conjecture. Makes sense to me /s

And another offer of first-hand positive evidence to counter the hysterical. Wonder if you'll get downvoted too! Happy day.

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Can I ask what you are on about? Did you read the article? Medicare Advantage plans overcharged our government lots and lots of times, typically via rules those insurance companies had a hand in crafting.

The fact that one or two people write on reddit about having a good experience means almost nothing in comparison. These two people have no clue how much a comparable medicare plan would have cost or what that coverage would have been.

Medicare Advantage plans exist because they milk money from the patients and government and coerce providers to do more and more for free.

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Sure you can ask what I am about.

Yes, I read the article, and discussed it at length with my wife. We signed up for an Advantage Plan last week, so it resonated with us. We generally like NPR, but do find it to be a bit reactionary sometimes. This is a good example.

The fact that one or two people write on reddit their actual experience does indeed mean something. One or two posts out of 13, and the only ones that relate actual, first-hand knowledge.

Especially when compared to the unsupported, overly broad claims such as those in your post. "Medicare Advantage plans exist because they milk money from the patients" What does this mean? It is absurdly unsupportable bombastic claims of malintent.

I hope it works out for you.

Can I ask what it was about the advantage plan you found to be advantageous? I've seen examples where people effectively pay less per month for the plan, and then get sick, and THEN realize how much coverage they lost vs the traditional medicare plan.

Speaking of anecdotal evidence I could offer a couple of observations. When I turned 60 doctors stopped talking about how healthy I was for my age and started talking about all the many, many diseases that were lurking just around the corner plotting to rob me of my “golden years”. This coincided with an avalanche of mailers offering me “advantage plans” that would fill in all the massive gaps in my Medicare coverage. It’s marketing. When I retired the company had seminars to help retirees sort thru the options - bottom line was, “it’s a crapshoot.” It all plays to fear, uncertainty, and doubt. Most of my colleagues based their choices on anecdotal evidence.

It is a tough decision. One of the hardest I have ever had to make. Not only do you need to learn each competing system you have to predict the future....i.e., your need for expensive medical treatments. That is unfortunately unknowable. The way I approached it was to actually take all the classes I needed to become licensed to sell medicare advantage or medicare supplement plans plus classes on base medicare coverage. I don't know anybody of means that simply takes base medicare and trusts the Govt to take care of them although unfortunately those people exist. My analysis was that the best coverage was base Medicare and a complete medicare supplement plan that would cover all the overages medicare won't cover and all the holes it has underneath the maximums. However that supplement was going to cost my wife and I about $500/month extra or $6000/year. Every year we were alive. Yes, Medicare advantage has some holes.......ours is a $5300 annual CoPay. So long as we stay out of the hospital we can save that $6000/year and put that money away for the years when we unfortunately will need some overnight stays. I have a colleague, another insurance professional, that took the Advantage plan for himself, a normal retired healthy male, but took the supplement for his wife who had a history of substantial medical problems. I support his analysis and decisions.

Whatever decision you made.....advantage or supplement, hopefully it will actually work out for you the way you analysed the choices.

Color me shocked… absolute shock!

I am Jack's complete lack of surprise.

Used to be licensed in all Medicare related products... Quick (VERY generalized) rundown for those interested:

You may hear medicare referred to in "parts":

Part A: Inpatient Coverage

Part B: Outpatient Coverage

Part C: Medicare Advantage

Part D: Prescription Drug Coverage (PDP)

Part A+B is "Original Medicare".

You also have medicare Supplements or "gap" coverage.

There's three primary flavors that you can pick from the above options:

1. Original Medicare: Part A+B (+D)
2. Original Medicare + Supplement (+D)
3. Medicare Advantage (generally has built-in D)

Option 1) Original Medicare (+drug plan)

OG medicare is great because it has immense flexibility in who you can see. Most doctors accept it. Take a trip across the country? You can still likely find a covered doctor if you need one.

Strongly suggest you purchase a PDP for drug coverage. Even if you don't need a pdp, there's a PERMANENT penalty increase if you later end up needing to sign up for one... The longer you didn't have a pdp, the higher the penalty.

Biggest downside is a 20% coinsurance for outpatient services. This 20% coinsurance has NO ANNUAL LIMIT. E.g., you get cancer and have chemo treatments that come out to $100k (like my mom), you pay $20,000 of it.

Option 2) Original Medicare + Supplement (+drug plan)

Same as original medicare, but you get a supplement plan to help cover that pesky 20% coinsurance.

Supplements come in various plan coverage options dictated by the gov. Plan A, Plan B, Plan G, etc.

Plan G is the current "top tier" choice.

If you're risk averse and can afford it, I'd go with a plan G supplement + Original Medicare + a PDP any day.

(My opinion. Not legal advice.)

Two major downsides to Supplements:

1. Affordability. Monthly cost can be high. You're paying up front for amazing coverage, but the cost can be hundreds a month. You'll also likely want to purchase a pdp (sold separately), for drug coverage, which costs extra. You also get charged more if you have certain medical conditions.

2. Eligibility. Not everyone can get a supplement plan. You have to pass medical underwriting to qualify. Rules depends on the private carrier you're purchasing from. However, When you first begin your Medicare Part B, you have a 6 month window to sign up for a supplement and AUTOMATICALLY qualify and NOT be charged more for preexisting conditions. So, if you're diabetic and about to start medicare Part A and B, definitely make sure you consider purchasing a supplement... You might not get another chance.

Option 3) Medicare Advantage

Medicare Advantage (part C) replaces your original medicare (part A and B). So, you get your coverage through the advantage plan instead of the gov.

All Advantage plans are different. So the following is generalized.

Positives:

• Vast majority qualify for one.

• Most advantage plans don't cost anything extra.

• Most include pdp coverage (saving you money)

• They come with Max Out of Pocket (MOOP) that limits your annual expenses. I've seen quite a few where the max out of pocket is LESS than the annual premiums for the best supplement in the geographic area... e.g. why pay $3k a year for a supplement when your advantage plan caps your expenses at $2,500?

• Advantage plans may include dental/vision. (Original Medicare doesn't cover dental/vision.)

• May include other benefits: Meals on wheels, silver sneakers gym membership, etc.

Dis-advantages (no pun intended)

• Most are HMO style that require prior authorization for specialists. Can be very clunky to get the care you're wanting. Really depends on the carrier and how the particular plan is structured.

• Advantage plans are geographically based. Unlike supplements that you can go anywhere in the US with, don't expect an advantage plan to offer good coverage if you go on vacation to another state.

• Coverage can change year-to-year. Just because the advantage plan is good this year doesn't mean it will be next year. (You do have an "open enrollment" each year to change to a different one though).

Side note: Advantage plans are geographically based. They tend to completely suck in rural areas and are much better in dense, elderly populated zones (Florida).

Edit: Not legal advice. Also, it's been a few years, totally open to making corrections to the above.

When I was a practicing attorney, I assisted seniors with figuring out their health care options. I can confirm that Medicare Advantage is almost always a bad idea. It might seem like a better option at first, but they scam you in ways that aren't readily apparent during enrollment (frankly, every private insurer is trying to scam you).

• Prior authorization - most advantage plans require preauthorization before allowing you to receive care. This is a key point where they will try to screw you over even though your doctor may actually disagree with their determination.
• Networks - advantage plans have networks like a typical insurance plan. Traditional Medicare does not - most providers will accept Medicare. Very few have opted out. Good luck finding skilled nursing care that is covered and in-network on your advantage plan.
• Profit motive and administrative overhead - come on. They are trying to make a buck and are far less efficient than traditional medicare.

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im lucky im disabled and poor and have medicare advantage and medicade! no bills what so ever for anything! and $500 a year for handicap stuff and $1000 for over the counter drugs and even dog food and stuff for a support dog and $50 a month for healthy foods!

Medicare explained

“are you getting all of the benefits that you deserve?”

My mom has a rare PPO Medicare advantage plan. It's cheaper than the gap plan by far, but still pretty damn expensive at times. :( the networks make HMOs awful.

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> Traditional Medicare does not - most providers will accept Medicare. Very few have opted out.

A ton of providers have opted out of Medicare, what are you talking about? It’s a huge problem with regard to getting needed care by specialists in many areas of the country.

ETA: the MA plans still absolutely are evil, but going the traditional Medicare route also has shortcomings.

I work in an adjacent field, and this is a great summary, thank you!

Once upon a time, 2008, the FED worked on drug abuse and settled cases against Big Pharma. ProPublica was / has a respository of many of those investigations. Sadly, it seems that that and other investigations of fraud into Medicare have been dropped by the previous administration. sigh.

Interestingly, one hospital in OK dropped their Medicare Advantage Plan, as it was too onerous and the hospital was loosing money. https://www.beckerspayer.com/contracting/oklahoma-hospital-terminates-medicare-advantage-contracts-amid-financial-challenges.html

I was told to avoid Medicare Advantage plans because they could change on me or drop me altogether, and leave me with pre-existing conditions and without a supplemental plan. Whereas if I signed up for a regular supplemental on first eligibility, they cannot refuse me, even though I come with cancer pre-installed.

https://www.healthline.com/health/medicare/can-a-medicare-advantage-plan-drop-you

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Maybe things have changed in the last two years, but this was my understanding:

> One percent of all non-pediatric physicians have formally opted-out of the Medicare program in 2020, with the share varying by specialty, and highest for psychiatrists (7.2%).

https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/

Simple. Like time share condos, Medicare Advantage shills obviously spend most of their income on ad campaigns. That doesn't leave much for real benefits.

Off the top of my head:

• Medicare Advantage Plans have max OOPs
• Medicare advantage plans most often have Copays when seeing doctors and specialists instead of coinsurance
• Medicare advantage plans have much more robust prescription coverage plans than traditional Medicare.

Also, you can switch back and forth every year during open enrollment. Making blanket statements about how Medicare Advantage is bad is silly.

Just get traditional Medicare with a supplement. You don't say money. Majority of doctors office take traditional but not all take advantage Medicare. Avoid HMOs as well

I may be being pedantic, but after reading that article it looks like there should be a fourth category: providers who do no accept Medicare under any circumstances. I see two types of opt-in and one opt-out, but no "we don't accept it, period." And the weasel words "formally opted out". What about informally opting out by just not taking on Medicare patients at all?

Edit: this article says that 1/3 of all primary care doctors will not accept any new Medicare patients. https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/

Most states do not allow you to switch back to regular Medicare without underwriting (read: unless you are healthy). I have been through this mess with both my parents. Medicare Advantage plans look great until you actually need them to pay for your healthcare and then then you aren’t allowed to switch back to a regular Medicare plus supplement plan. It is a nightmare.

That being said most seniors can’t afford regular Medicare supplement plans anymore so the long game to completely privatize Medicare is just about to come to fruition.

That’s cuz Kaiser. Kaiser can very good

Just in case you might be interested, advise is a verb; advice is a noun. As in “I advise you to take my advice.” Taught English as a Foreign Language for many years. This is just one of the crazy English oddities the poor students had to cope with.
Not at all intending to be pedantic!

Medicare plus supplement will require medical underwriting. Regular Medicare won't. Medicare supplement is, as you say, much more expensive than Medicare Advantage plans.

Also, it's not a game to "completely privatize" Medicare. It's called a public option. The idea that having a choice is inherently bad is more of a political opinion than a fact.

Fixed. Thank you!

How else are they able to deliver "low or no cost" plans?

"We don't need your money, we can just bilk the taxpayers when you sign up."

New Moniker: Medicare Take Advantage Plan.

You’re lucky. My mother had an advantage plan and a lot of her care was out of pocket. I have a supplement through my old employer (our retiree group of purchasers is 5-6K people) and we get a good plan for a couple of hundred a month. Depending on your healthcare needs different strokes work best for different folks.

A couple of hundred a month is about $2500/year. Do you think you would have deductible or copay of that or more each and every year? We haven't. We have had the Medicare Advantage Plan for 12 years now and only had one year when we used any of our $5300 annual copay max. I think that was about $2000 for one of us. We do pay the $20/40 copay when we have a Drs appointment but that is less than 5 times/year. Everything else has been covered, "knock on wood." Clearly the Supplemental plan is better if you have frequent medical problems. But when we made the initial decision we had pretty normal medical circumstances so guessed that the MA plan would be long time less expensive for us. So far it has been. My mentor chose the full $400/mo for both of them Med Suppl plan. His wife ended up having significant medical issues so that worked for her. He has been pretty healthy.

That is the real problem with the decision when you are 65......You have to guess what the future holds for you in terms of medical costs. High future costs, means that Medicare and a Med Supp plan will be best. Low future costs means a MA plan will work for you best. Unfortunately folks without means and experience in medical decisions often just take Medicare alone and that has significant holes as well as maximums that are easily exceeded.