Is Medicare Advantage Really an Advantage?

We answer this question a lot between October 15 and December 7. That’s Open Enrollment for Medicare and the time to switch Advantage plans or from Advantage to a Medicare Supplement plan.

What is Medicare Advantage?

Medicare Advantage (also called Medicare Part C) was signed into law in 1997 because many people in the country were in HMOs and wanted the same kind of one-stop shopping (Hospital, Doctor, RX) when they went to Medicare.

About 13% of people on Medicare have an Advantage plan. They work best in places where there is a strong HMO system like Kaiser Permanente in California.

How does Medicare Advantage work?

The way Advantage works is that the government pays the insurance company a lump sum every year  to provide you, their policy holder client, with all your care. Your care is managed by the insurance company.

The October 2021 AARP bulletin explains Medicare Advantage as typically having a closed panel of doctors within which your care will be coordinated.

• Not all doctors will accept Advantage because they are paid less than what Original Medicare and Medicare Supplements pay them.
• If you go outside that network, the plan won’t pay for it at all. If you’re a snow bird, your Advantage plan most likely will not cover you outside of the area where you originally enrolled.
• If you want to see a specialist, say, a cardiologist, you’ll need to be given a referral from your primary care doctor in the network. This may limit your choices if there is a need for a top-grade specialist or research hospital

How does Advantage differ from original Medicare with a Medicare Supplement?

• If you are enrolled in Original Medicare, you can go to any provider in the United State who has signed up to treat Medicare patients.
• You control general oversight of your health care.
• Because Original Medicare pays 80% of the bill, you need a Medicare Supplement to pay the remaining 20%.
• When you go to the doctor, you hand them your Medicare card and your Medicare Supplement card. Medicare will pay their part. Your Supplement will pay the balance.
• There is a new Blue Cross Medicare Supplement that includes Dental, Hearing and Vision benefits.

Why we don’t sell Medicare Advantage

We were credentialed to sell Medicare Advantage and did so until:

              A client hospitalized with a heart condition was assigned in-hospital cardiac rehab by his primary care physician. (He lived alone in a second -floor apartment).  But his Advantage plan would only pay for out-patient rehab. We had to help him get a case worker to contest the decision.

              A woman needed a special spine surgery. She had several opinions pointing to a procedure being done in Texas. Her Illinois Advantage plan would not cover her.  She had to wait until the Advantage plan would release her so she could go back to original Medicare and get a Medicare Supplement. The surgery went well.

              We had so many complaints from clients who travel out-of-state and couldn’t use their Medicare Advantage plan that we stopped recommending it at all.

Why we strongly recommend a Medicare Supplement.

A Medicare Supplement pays the 20% Medicare doesn’t pay. It pays for all Medicare benefits, anywhere in the country.

              In 2015 our own Jerry Pearlstein, who’d never been hospitalized before, suffered a perforated bowel. Over 18 months he had infusions, procedures, surgeries and therapies in 3 different hospitals. He chose who he wanted to care for him and where . Total bill: $400,000. Original Medicare covered 80%. The Supplement paid the remaining 20%.. He had 100% coverage.

Why you must call us to switch to Medicare Supplement.

There are timing issues involved in dropping an Advantage plan and switching to a Medicare Supplement. Call us now: 847-362-8888.

You can add a Medicare Supplement to original Medicare or change from one Supplement to another at any time. We help you through the whole process. 847-362-8888.