A conundrum for Medicare

All the things people don’t like about health insurance are present in Medicare Advantage plans – mainly limited networks of doctors and hospitals, deductibles and co-pays in many cases and pre-approval or pre-certification for health care services.

So why does MA enrollment keep climbing, now almost 50% of Medicare beneficiaries?
Are patients willing to trade limitations and controls for lower or no premiums?


  1. So why does MA enrollment keep climbing, now almost 50% of Medicare beneficiaries? Sometimes it is because the MA option is an “open access” plan – allowing the individual to seek care from any physician or provider who accepts Medicare.

    Are patients willing to trade limitations and controls for lower or no premiums? Absolutely. As Stephen Douglas confirms, this harkens back to the closed group HMOs (Kaiser) – which likely provide equivalent (or better) care for 95+% of all medical services. By removing any real or perceived cost impediment to everyday care needs, retirees (and their medical providers) are often enabled to achieve and maintain a healthy quality of life.

    Many forget that a significant percentage of Americans delay or deny themselves care due to perceived unaffordable point of purchase cost sharing. I would criticize such decision-making.

    As we used to say at our pre-retirement planning seminar, “without good health, nothing else much matters” (in terms of quality of life in retirement).

    Supposedly, 40% of Americans skipped care due to out-of-pocket costs. Not sure whether I believe that or not, but, if it is true, or even if it is only half the survey results, 20%, that means from 1 in 5 up to 2 in 5 Americans who needed medical care may have made poor decisions about prioritization.



  2. Or they are just dialing the number on the TV screen to reach those “helpful” representatives. MA ads are almost as bad as political ads.


  3. Medicare insurance brokers sometimes recommend MA without explaining disadvantages. One reason might be commission differences. A broker told me she is paid $700 for selling a MA policy and $200 for a Medigap policy.


  4. I would estimate that more low income retirees go for the advantage plans for cost reasons and have no qualms about being jerked around when medical care is needed.


  5. The Medicare Advantage plans must have at least $150/month ‘savings’ to the insurance companies. Are the MA plans more ‘efficient’ or do they have a lot of hidden costs?

    A Medigap Plan G premium is about $200/month and cover everything except the yearly deductible. So the ‘savings’ must be around $150 to $200 per month


      1. They reflect cost of care in an area to some extent. In addition, the age of enrollment is a factor. Because my employer dropped coverage when i was 77 I pay $255 a month for Plan G


  6. Couldn’t agree with you more Dick. My wife and I have traditional Medicare supplements and I wouldn’t go near a MA plan. To me, the trade-offs (lower or no monthly premium) aren’t worth it. Too many restrictions.


  7. I reckon the healthy senior cohort is migrating to Medicare Advantage plans to save on premiums, despite the preauthorization and network hassels.


    1. A no brainer for me. My wife and I have been with Kaiser HMO for 50 years, and quite satisfied. Now 10 years with Kaiser Medicare Advantage. No complaints.


      1. Does your Kaiser MA plan cover a specialist (consultation or treatment) at MD Anderson Cancer Center or Mayo Clinic? I considered a group MA plan, but in-network vs out-of-network wasn’t clear.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s