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The Problem with Medicare 'Advantage' Plans

The Problem with Medicare 'Advantage' Plans

1.  There is no 'Advantage' to a Medicare Replacement plan.  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. 


        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.

        c.  The government makes out because they limit what you can receive in treatment, resulting in lower quality, poorer availability, and decreased accessibility.


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 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.


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.  BCBS for the supplemental with United Healthcare for 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 Stephen Klein, MD, FACA, FACPM

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