By Ann Troy, M.D.
Pacific Sun (Marin County, Calif.), October 17, 2023
Seniors are being bombarded with ads encouraging them to switch from traditional Medicare to a āMedicare Advantage plan.ā
The ads point out that premiums for Medicare Advantage plans are less than what one has to pay for traditional Medicare plus a supplemental (or medigap) plan. In addition, they offer perks such as vision, hearing, and dental care and gym memberships. Wonderfulāas long as you donāt actually need medical care.
But what if youĀ doĀ need medical care? Then, you are faced with everything we hate about health insurance: narrow networks, high co-pays and deductibles, and denials of careāoften costing members tens of thousands of dollars.
Traditional Medicare is efficient and well-run with overhead of only 2%. Medicare Advantage plans are allowed to keep 15% of what Medicare pays them as profit. They are paid on a capitated basis based on the age and medical problems of their enrollees.
Medicare Advantage plans routinely āupcodeā the diagnoses of their patients to make them sound sicker than they really are in order to get more money from Medicare. It is estimated that these plans steal as much as $140 billion a year from Medicare, and they have faced many multi-million dollar fines for their dishonesty.
As someone who has had traditional Medicare for several years, I am happy to pay my monthly premiums for Medicare and supplemental (or Medigap) insurance for the peace of mind of knowing that this is all I will pay for medical care regardless of what I need and that I can go to almost any doctor, hospital or clinic in the country.
Physicians for a National Health Plan, a 25,000 member group, urges seniors to avoid Medicare Advantage plans (which they call MedicareĀ Disadvantage) and opt for traditional Medicare. I couldnāt agree more.