Considering Medicare Advantage

If you are considering Medicare Advantage for your Medicare coverage, here are some things to think about:

  • Most Medicare Advantage plans are HMOs (Health Maintenance Organizations) and have networks of doctors, hospitals, and other providers. If you go to a provider who is not in the network, the plan will not pay your bill.
  • How big is the plan’s network?
  • How are your prescriptions covered?  Some plans call generics brand drugs, meaning those drugs will have a higher co-pay.

The Kaiser Family Foundation website ( has a new article on Medicare Advantage titled:

As Seniors Get Sicker, They’re More Likely To Drop Medicare Advantage Plans

The article refers to a Government Accountability Office (GAO) report.

A GAO report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to “preferred doctors and hospitals” or other medical care, as the leading reasons for leaving.

“People who are sicker are much more likely to leave (Medicare Advantage plans) than people who are healthier,” James Cosgrove, director of the GAO’s health care analysis, said in explaining the research.

The article is pretty negative on Medicare Advantage – and I take issue with some of the statements.

One man said his opthalmologist did not take his Medicare Advantage plan.  My response to that is: Why would he sign up for a Medicare Advantage plan without checking to be sure all of his doctors were in the plan’s network? His insurance agent should have done that for him.

When considering Medicare Advantage, it’s all about network, network, network.

When I talk to clients who are considering Medicare Advantage, I make sure to emphasize that they must stay in the network and get referrals to see specialists.

I tell my clients that Medicare Advantage is a “pay as you go” system. You don’t have a monthly premium (most Arizona plans), but you pay a co-pay when you see a doctor. You pay a co-pay for diagnostic tests. You pay a big co-pay if you end up in the hospital.

I tell my clients that Original Medicare with a Medicare Supplement is a “pay in advance” system. You pay the Medigap premium every month and then, when you see doctors, or end up in the hospital, you have no co-pays (Plan F) or limited co-pays (Plans G, C, N).

When I talk to people who are turning 65, we compare Medicare Advantage to Medicare plus a Medicare supplement. People who are healthy are drawn to the “pay as you go” Medicare Advantage program. I always warn them them their health can change and they might not like their Advantage plan so much if they become seriously ill.  What happens then? That requires another blog post to explain a person’s options.

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