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Beware of Medicare Advantage Plans

May 23, 20233 min read

I want to put these companies on notice,” said Senator Richard Blumenthal (D-Conn.). “If you deny life-saving coverage to seniors, we are watching. We will expose you. We will demand better. We will pass legislation if necessary. But action will be forthcoming.”


If you are over 65, chances are you already have have been approached by Medicare Advantage Plans by every communication style possible. They have beautiful commercials and a lot of money to contact you over and over again. Please be very careful and suspect of these plans.

Medicare Advantage Plans can be advantageous when you're young, relatively healthy and have a lot of medication costs. But, as soon as you start having health problems, they can be a nightmare. And, it's not easy to transition back to get a supplemental Medicare plan once you leave the Advantage Plan.

Senator Blumenthal

Senators probing largest Medicare Advantage plans over how algorithms factor in care denials

With that said, here are 8 questions you should consider while deciding on an Advantage Plan or to stay with traditional Medicare.

1. Can you afford a Medicare Supplemental Insurance that includes a drug benefit?

 With the right Supplemental Plan, you can have the best coverage. I can't stress enough - DO THIS IF YOU CAN!

2. How old are you and are you mostly healthy?

For many older Americans, the drug coverage is the biggest consideration and Medicare's coverage is spotty and confusing. Often, this is what convinces people to sub-contract their Medicare out to an Advantage Plan. If you can't afford a Supplemental Plan, this may be the best choice for you. But, please consider the remaining points.....

3. Do you travel?

If you like to travel, take a close look at coverage outside of network. Advantage Plans are usually PPO or HMO and often have a network. If you travel, this could be a problem for you.

4. Do you think you'll need Skilled Nursing or Home Health in your future?

Yeah, ok, this one isn't easy! But, some diagnoses are more predictable than others. If you have an ailment that is likely to need "Medicare Covered" nursing home or at home care - you may want to be very careful about an Advantage Plan. Their actual business models are to cut coverage down to as little as possible. Medicare's mentality is to always try to get the patient back to their "prior level of function".

5. Can you afford Medicare Advantage co-pays?

This is another "what it" for in the future that can be hard to predict. All Medicare Advantage Plans have co-pays. The co-pay for inpatient services can be very pricey and there are no Supplemental Plans available for Advantage Plans. Check on the Plan's co-pays before signing the contract. Especially if you have a degenerative disease.

6. Is your home and homelife appropriate for healing if needed?

As I previously stated, Medicare Advantage Plans are very motivated to send you home. Often before you think you're ready. Do you live in a 2-story home? Is there a bathroom on the floor where you'd have to recuperate? Do you live alone? Can someone come stay with you if needed?

Medicare Advantage Plans almost always send you home sooner that traditional Medicare.

7. Do you have doctor(s) that you want involved in your care?

Some of us have very good relationships with our doctor(s). Although they usually cannot 'follow' you at the hospital or Skilled Nursing Facility, they stand a much better chance of being involved in your care with Traditional Medicare.

Medicare Advantage is healthcare by committee - or algorithm as the news article above states. You, and your doctors, have a lot more input into your Care Plan with traditional Medicare.

8. Do you know you're never required to join an Advantage Plan?

Many Medicaid / AHCCCS payers are pushing for members to also be on an Advantage Plan. They sometimes imply that you must join their plan. Typically, you do not. Your benefits are your choice. Don't let anyone bully you!

Another article

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

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