It's that season again. All multiple advertisements for Medicare Advantage plans.
“Call now to see if you qualify.”
“If you have Medicare Part A and Part B, you will not automatically receive Part C benefits.”
Both advertisements are misleading. It's not about whether you qualify for an Advantage plan, it's about whether you're eligible to sell an Advantage plan in your zip code. An insurance company cannot sell a plan in an area unless there are contracted doctors or contracted hospitals in that area. And you have to make a call every year. Because it's a revolving door of doctors and hospitals retiring every year. Doctors hate advantages. Part C is the plan. why? This is because these plans require doctors to obtain prior approval before ordering tests or procedures, creating delays and obstacles to treatment delivery.
The advertisement suggests that Part C Advantage plans are an addition to Medicare Parts A and B. In fact, if you choose a Part C plan, which is a plan from a private insurance company, you will lose Medicare Parts A and B. I don't like the Part C plan. It will be very difficult to go back and you will also lose the option to purchase additional plans. The hooks they use to entice people to drop regular Medicare are “free” things like dental, hearing aids, and glasses. However, not all Advantage plans offer these, and you'll only pay a small amount. Free transportation to appointments and meals on wheels are available to all seniors in need. Most Plan C Advantage plans are HMOs or PPOs. This means you will only use doctors or hospitals within your network. The network may be small and limited, and doctors may be overbooked. You will also have to pay for any out-of-network travel or doctor's visits. Also, all plans have copays for services, and some have deductibles where you pay the first dollar.
So far, about 40 percent of Medicare beneficiaries have chosen Plan C Advantage plans from private insurers such as Humana, Aetna and Blue Cross. Both Trump's 47 Plan and Project 2025 plans include forcing all Medicare beneficiaries to enroll in private insurance plans and eliminating traditional Medicare.
I would like to share with you my experience, my husband's experience, and my experience as a physician who has worked with insurance companies and practiced medicine for 30 years. We both have regular Medicare Parts A and B, and we purchased a supplement for the portion not covered by Medicare and an additional 20 percent. We each had about $185 a month deducted from our Social Security checks for Medicare. I could understand that it would have been free if your income was very low. We each purchased supplements that can only be purchased when you first enroll in Medicare. I paid about $190 a month and my husband (who is 10 years older) $220 a month. Since we were traveling and wanted international coverage, we both chose the more expensive plan. My total cost is $375 per month. His total costs were $405 per month. He used his insurance a lot, including two strokes, heart surgery, prostate cancer, and high blood pressure, but I rarely used it. Neither of us ever paid an extra penny for care. There are no copays or deductions. I once had to see a doctor on a cruise ship and it cost about $3,500. I paid in cash but was fully refunded with supplements.
I encourage everyone to avoid collaborating again with private insurance companies, their restrictions, and ever-changing regulations. If you have or are enrolled in an Advantage plan and want to go back to regular Medicare, you may miss out on purchasing supplements and find that they are expensive or unavailable even if you want them. My advice is to use regular Medicare Part A and Part B, buy the best supplements you can (I have one from AARP-US Healthcare), and add Part D if you need a large amount of medication. It's the best. Lowest overall cost, widest choice of doctors and hospitals with no restrictions or prior approvals, and no changes. You don't have to do anything every year.
And think about it. Who is paying for the thousands of TV ads? That's what happens when you purchase an Advantage plan. Costs arise from limited care.
Lyle Hamilton is a resident of the village of Sanibel.
