Medicare versus Medicare Advantage

Do you know of any advertiser on TV (other than PSA’s) that seeks your use of their product because it is purely good for you?  No!  Medicare Advantage plans ‘Plan C’ have become a huge portion of the TV advertising arena and they now escape enrollment date boundaries that were in place only a few years ago (rules change).   

Just how profitable are you to the insurance industry to warrant so many advertising dollars to get your business?

Did you ever wonder where insurers are making their profits?  It’s not quite directly from your pockets!  They entice your business and dollars by giving you ‘freebies’ like an OTC pharmacy allowance, gym memberships, free dental and vision care, etc.  It all seems just ‘peachy keen.’  But, Medicare itself along with MA denials and delays of care are paying for your perks while making huge profits for the insurance industry!  Medicare or the US government should not be paying into the profitable margins of the insurance industry.  We should be the beneficiaries of those funds.  The denials and delays of care will cost you more than dollars. 

Looking at rural patients in particular, they disenroll (when they can) from their MA plans at a rate almost 10 times higher than they enroll in them.  Clearly, they are not getting benefits from their Advantage plans and many others, especially those with worsening health have similar experiences.

My own family experience with MA plans has been enlightening and helped us help others avoid the same pitfalls.  My partner, a healthy and young looking senior, encountered a United Healthcare rep signing folks up for United’s MA plan in the grocery store.  He was already a United customer through AARP and was happy with that.  (I doubt anyone on a motorized scooter with their oxygen in tow would have been approached.  They are not the best for MA plans financial bottom line.)  “But this is FREE!  I don’t have health problems, so I am not so worried about my insurance.”  My objections fell on deaf ears.  It wasn’t long before he had expected need for routine screening and soon some health issues came along.  A simple screening colonoscopy scheduled as before seemed to be going smoothly.  Then, the Friday before Easter with the procedure planned for the Monday following, I received a call afterhours that I missed.  In addition to their calling the wrong phone, trying to get back to the caller was not easy at that time.  We got the message that his procedure couldn’t be done as planned since his ‘insurance’ wouldn’t let him use the surgery center where it had been scheduled.  Rescheduling took 3 months and moved the colonoscopy to the hospital. Hospitals accept lower payment for the use of the facility so they are often used by MA plans to lower their financial exposure, while making the hospital’s margins even tighter.

We hear that Medicare will go bankrupt or is unsustainable usually by those who oppose Medicare For All or a single payer type healthcare system.  It has long been shown that our overall health improves about age 65 when we are able to take advantage of Medicare.

Medicare costs less than the MA plans to provide care that is at least as extensive and with the same or better outcomes as an MA plan.  With Medicare, you have choice of providers to a much greater extent than with Advantage plans.  Unfortunately, blame can be misplaced onto Medicare for healthcare system problems created by the insurers and their MA plans.  That works for the insurance industry because we then have negative thoughts when we hear people speak of Medicare For All (M4A) or Improved Medicare For All (IM4A.)  It is another subtle way to wrongly fault Medicare with problems in our private insurance and profit run healthcare system. 

Medicare Advantage is not the only ongoing threat to Medicare.  Since the late ‘90s, small steps have been allowed that in effect slowly privatize Medicare.  Trump era programs such as Direct Contracting Entities (DCEs) have also further privatized Medicare and now those have been virtually unchanged and renamed REACH in the Biden administration.²