By now, most who are changing choices about healthcare insurance, have already done so. If you are still undecided here is a little more about the BIG choice for most……….Original Medicare or an Advantage Plan.

**Most Important Guiding Principle in every

OPEN ENROLLMENT PERIOD

if happy DO NOTHING!!**

Well, every year we come into the open enrollment period now until Dec 7th. IF YOU ARE CONTENT WITH YOUR CURRENT HEALTH INSURANCE COVERAGE…..SIMPLY BLOW OFF EVERYTHING THAT YOU HEAR TO DO DURING THIS OPEN ENROLLMENT PERIOD….BECAUSE YOU NEED TO DO NOTHING!!!!

By now you know that I may not be the best one to talk to about a Medicare Advantage Plan. For me since I have Original or Traditional Medicare, I am not overly impressed with these MA plans. Now hear this, if you one or plan on switching to one, trust me I will not be your judge. In fact, since we all have different circumstances, all I really want is everyone to be happy and comfortable with their healthcare choices as we age. So again: IF YOU HAVE OR ARE SWITCHING TO A MEDICARE ADVANTAGE PLAN, God Bless and I hope it is all that you want out of it.

Here’s the ‘but’. But, the only promotion you see or hear during this enrollment period is how wonderful and perfect these Medicare ‘alternative’ plans are. Millions upon Millions of $$$ are spent convincing you of this in order to get old codgers, like us, to switch to it. If you switch, and are happy, I repeat more power to you. But it stands to reason that you should hear a little about whether or not this overly hyped up Medicare alternative is right for you. So with that said, the following is simply some personal experience and a good article produced by Investopedia about the Pitfalls of MA Plans. If you are interested you have reader automomy, take a look. If not, as always, skip to the next section of the High Life.

I have to admit I am not one who often chases after the shiny object. I was raised in a rural conservative family that often said that you get what you pay for and don’t listen to the loudest barker. Well, in open enrollment season, our mail, radio, and TV ads are incessant with come ons to get benefits “that original Medicare doesn’t provide,” or “benefits that you deserve,” or better benefits because you live in the right zip code. Imagine how much better a deal it could be if these companies didn’t have to spend millions upon millions of dollars just to get you to bite. Well, they wear you down and many many people finally call and talk to someone who represents themselves as a Medicare specialist, which is often assumed to be a government employee. Well the truth of the matter is you are talking to a private insurance salesperson who will spend the next hour or so telling of all the amazing things you are missing out on and all you have to do to receive all this is to sign up. Once you bite you pull the trigger you are signing up for private company insurance approved by Medicare, but benefits are not paid out by the government program. See the article on this issue below.

Now allow me to share my personal experience. I was a caretaker for my aging parents and I also handled their books. They had traditional Medicare with a ‘Cadillac’ Medicare Supplement Plan and I got to tell you a number of things:

1. They never had a problem with a medical provider “accepting this” which does happen with MA and other plans. They were welcomed with ‘open arms’ everywhere. Most Humana, Aetna, Anthem type MA plans are accepted for the most part inside a preferred network. If you wish to “shop” for the best surgical team for example it may be outside your network with an MA plan so you are boxed out. Original Medicare is almost ALWAYS accepted by nearly every provider so with the MA plan when it comes to providers acceptance, buyer beware.

2. The providers were ALWAYS glad to hear of my folks setup because they knew they would get paid via the government schedule and wouldn’t have to fight with and wait for a ‘private’ insurance company (which all MA plans are) for what they felt they were owed.

3. And, I never paid $dollar 1 for any patient co-pay or non-covered item. Every service and procedure that they ever needed was always completely covered by this setup. MA plans promise this but get a procedure done out of network and see what happens.

4. Finally, as with preponderance of their plan being the traditional government financed program of original Medicare, one make take some degree of solice that their benefits are backed by the full faith and credit of the Unite States Federal Government.

From that experience, I analyzed all the offerings the best r us and after done I decided to mirror what they had. Since Barb and I have now had some rather significant procedures and hospital stays, our setup has performed as expected. $0 owed by us for any part of the service provided. AND never a question from any provider whatever network they are in as to whether our insurance would be accepted or not. Being welcomed by virtually ANY medical provider is no small thing since what everyone wants is the ability to go to the providers that has very good reputations. So we choose not listen to all the flowery words of the “Medicare Advantage” annual incessant promo’s about “extra benefits” and “all the benefits that I deserved” and proceed with the attitude that you get what you pay for, as with this strategy you do pay premiums but I view that as paying now or paying later since most all of MA plan savings, if any, are front loaded and as you age may not perform so well.

Now I am not SELLING our Original Medicare strategy to anyone, I am simply sharing what we do. So I repeat over and over again, whatever setup you have with ITDR, Tricare, DPMP or any other Medicare or Medicare Advantage plan for your health insurance, IF YOU ARE HAPPY WITH IT DO NOTHING during the enrollment period and you will be auto re-enrolled with what you have. So far all I have shared is our strategy just so you see my point of view. But now I would like to offer a word of advice, every year when the enrollment promotional bombardment starts with all the hyperbolic phrases, do not fret and worry during this annual “enrollment period” push. If you are seriously not happy with your current setup just methodically take the time to get some knowledge and advice about what may be better for you and then proceed to switch. But for the vast majority of us, since we are happy with our set up, let all the noise and barking and clanging of shiny spoons go and don’t worry or be distracted because all plans auto re-enroll for you. Like Bing Crosby annually appears for Christmas, Joe Namath, Jimmy Walker and William Shatner will likely be cultural icons for enrollment for eons. I personally let their pitch go in one ear and out the other. All hyped up over promised rhetoric just runs off like water off a duck’s back. Mark

++++

Bob Pike pike180@gmail.com

Mark-

Your comments on Medicare Advantage plans are misleading. Please take a look at this article provided by the Medicare.gov website -particularly this line-

" If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your medicare Advantage Plan, not Original Medicare." Here's the link to the article-

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work

I have been very pleased with the Anthem Blue Cross Blue Shield Medicare Advantage plan offered through the Insurance Trust for Delta Retirees. My plan has no deductibles, no co-pays, 10 % charges, and a maximum Out of Pocket of $1500/year - check it out. Bob Pike

Editor: Thanks Bob for input. I dare say that virtually ALL of your benefits come from the private insurer. Medicare approves and manages them but they are private insurers and they negotiate within their restricted networks what they will pay for services provided. I do want to let our group know that Medicare ‘traditional’ hardly every advertises on the TV but all those incessant ads that are telling to get “all the benefits you deserve” and you “may be eligible for more benefits” and “get benefits that add money to your social security check,” these all come from Medicare Advantage plans. Now to be clear, Medicare Advantage Plans are NOT traditional Medicare.

++++++

Well, every year we come into the open enrollment period. IF YOU ARE CONTENT WITH YOUR CURRENT HEALTH INSURANCE COVERAGE…..SIMPLY BLOW OFF EVERYTHING THAT YOU HEAR TO DO DURING THIS OPEN ENROLLMENT PERIOD….BECAUSE YOU NEED TO DO NOTHING!!!!

Below I will publish a little info that I am sure you already know and is common knowledge. But one thing I wish to make clear again is that Medicare Advantage Plans are the ones that advertise 99% on the TV and THEY ARE NOT MEDICARE RUN BY THE GVNT, BUT RATHER PRIVATE INSURANCE PLANS. Anyone who signs up for a Medicare Advantage Plan that promises “more benefits that you deserve….aka Joe Namath” is foregoing traditional Medicare.

Once you understand this fundamental thing than you will be 1000% more knowledgable about comparing what is being offered and what is right for you.

What do I personally have? I paid the bills for my parents as they aged and noticed they had traditional Medicare with a high end supplement plan. For all the procedures, surgeries, hospital stays etc. the patient amount to pay was almost always $0. This amounted to hundreds of thousands in medical costs that were completely and totally covered. Because of this experience, I chose to do a similar plan of traditional Medicare with a high end Supplement. With this plan I do pay premiums, and have an additional Dental plan with premiums. BUT, what I have seen from most Medicare Advantage plans is that while they promise included dental, and optical etc. These add on’s are not totally covered and neither will all dentist or opticians accept their insurance.

So when and if you wish to “shop around” be cautious and don’t always chase after they shinier package. What can sound awfully good on the surface may not be so shiny in the end.

You get plenty of Advertisements and solicitations so below is a straightforward letter from the agency itself simply giving the essentials about the beginning of the enrollment period. As I have inferred many times 99% of all promo material from any source is pushing ‘Medicare Advantage’ plans that to be fair are not Medicare but rather private insurance. So if you like what you have then enrollment period means nothing and you need to do nothing. Simple as that.

Mark,

Medicare Open Enrollment begins October 15 through Dec 7th! It's your chance to review your coverage and see if you can save money next year.

Do you like to plan ahead? Visit Medicare.gov to preview plans ahead of Open Enrollment. Remember, you can use star ratings to look at the quality of health & drug plans as you compare coverage options.

Preview Plans

If you need help comparing plans, here are a few tips:

Consider these 7 things when choosing coverage.
Call us at 1-800-MEDICARE during Open Enrollment.
Contact your local SHIP. To get the phone number for your state, visit shiphelp.org.

Note: If you or someone you know needs help paying for Medicare costs, you may be able to get help from your state. Learn more about Medicare Savings Programs and how to apply.

Sincerely,

The Medicare Team

+++++++++++++++++

Article from Investopedia about the pitfalls of Medicare Advantage (approved private company) Plans.

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

Pitfalls of Medicare Advantage Plans

LITA EPSTEIN

Updated November 03, 2021

Verified by

MARISA FIGAT

Fact checked by

MICHAEL ROSENSTON

We publish unbiased product reviews; our opinions are our own and are not influenced by payment we receive from our advertising partners. Learn more about how we review products and read our advertiser disclosure for how we make money.

A Medicare Advantage Plan, also called a Part C or an MA Plan, may sound enticing. It combines Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and usually Medicare Part D (prescription drug coverage) into one plan. These plans cover all Medicare services, and some offer extra coverage for vision, hearing, and dental. They are offered by private companies approved by Medicare.

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.

KEY TAKEAWAYS

A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription) and other benefits.
All Medicare Advantage providers must accept Medicare-eligible enrollees.
Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses.
Medicare Advantage customers can switch back to Original Medicare during an annual enrollment period.
Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers.

Coverage Choices for Medicare

If you're older than 65 (or turning 65 in the next three months) and not already getting benefits from Social Security, you have to sign up for Medicare Part A and Part B. It doesn't happen automatically. However, if you already get Social Security benefits, you'll get Medicare Part A and Part B automatically when you first become eligible (you don't need to sign up).

There are two main ways to get Medicare coverage:

1. Original Medicare

2. A Medicare Advantage Plan

Original Medicare

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). To help pay for things that aren't covered by Medicare, you can opt to buy supplemental insurance known as Medigap (or Medicare Supplement Insurance). These policies are offered by private insurers and cover things that Medicare doesn't, such as copayments, deductibles, and healthcare when you travel abroad.

Medigap policies vary, and the most comprehensive coverage is offered through Medigap Type F, which covers all copays and deductibles. But as of January 1, 2020, the two plans that cover deductibles—plans C and F—cannot be sold to new Medigap beneficiaries. Be aware that with Original Medicare and Medigap, you will still need Part D prescription drug coverage, and that if you don't buy it when you first become eligible for it—and are not covered by a drug plan through work or a spouse—you will be charged a lifetime penalty if you try to buy it later. ¹

Medicare Advantage Plans

A Medicare Advantage Plan is intended to be an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits, and sometimes Part D (prescriptions). Most plans cover benefits that Original Medicare doesn't offer, such as vision, hearing, and dental. You have to sign up for Medicare Part A and Part B before you can enroll in Medicare Advantage Plan.

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.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’

Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.”²

Consider Premiums—and Your Other Costs

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—$175 per day for the first 10 days
Ambulance—$300
Diabetes supplies—up to 20% copay
Diagnostic radiology—up to $125 copay
Lab services—up to $100 copay
Outpatient x-rays—up to $100 copay
Renal dialysis—up to 20% 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."³

Switching Back to Original Medicare

While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur until you can switch plans during the next open season for Medicare. At that time, you can switch to an Original Medicare plan with Medigap. If you do, keep in mind that Medigap may charge you a higher rate than if you had enrolled in a Medigap policy when you first qualified for Medicare.

Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.

More Disadvantages of Medicare Advantage Plans

Dr. Brent Schillinger, former president of the Pam Beach country Medical Society, has pointed out a host of potential problems he encountered with Medicare Advantage Plans as a physician. Here's how he describes them:

Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
Some private plans are not financially stable and may suddenly cease coverage. (This happened in Florida when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.)
One may have difficulty getting emergency or urgent care due to rationing.
The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
Members have to follow plan rules to get covered care.
There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
It can be difficult to get care away from home.
The extra benefits offered can turn out to be less than promised.
Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications. ³

The Bottom Line

Shop very carefully if you are thinking of using a Medicare Advantage plan. Be sure to read the fine print, and get a comprehensive list of all co-pays and deductibles before choosing one. Also, be sure to find out if all your doctors accept the plan and that all the medications you take (if it's a plan that also wraps in Part D prescription drug coverage) will be covered. If the plan doesn't cover your current physicians, be sure that its doctors are acceptable to you and are taking new patients covered by the plan.

Why is Medicare Advantage a bad choice?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, the plan only offers a limited network of doctors, which can interfere with a patient's choice. It's not very easy to change to another plan; if you decide to switch to Medigap, there are often lifetime penalties.

Why should I choose Medicare Advantage?

Medicare Advantage covers some of the gaps of original Medicare (Part A and Part B), and usually offers a $0 premium through a private company. It can be an affordable option for patients who are not currently sick or requiring intense medical care. If a patient's situation worsens later on, it might be difficult or expensive to switch plans.

Can I choose any doctor with Medicare Advantage?

Not necessarily. Medicare Advantage only works a limited network of healthcare providers, so double check to make sure your doctor visit is covered.

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