The ads tout Medicare Advantage as the perfect choice for you. Is that right? For some, it may work just fine. For others it’s not ideal and could end up costing you more, or require you to fight for the care you need. So during this time of open enrollment until December 7, 2019, it’s a smart idea to figure out if Medicare Advantage, often called Part C, is right for you.

First of all, Medicare Advantage is an alternative to traditional Medicare where you might get a Part F supplemental Medigap program to cover what Medicare doesn’t. Part F has been popular with Baby Boomers because it covers that 20 percent of the costs that Medicare doesn’t. You can also choose your own doctors and hospitals.

If you have it, you won’t lose it. But as of 2020, anyone who hasn’t already signed up for Part F will not be able to get it. Why?  Because Congress passed a law in 2015 cutting it to reduce the federal deficit. Why weren’t we screaming? And what about the Trump tax break for the rich that will raise the deficit to $984 billion this year? 

Okay. Back to Medicare Advantage

Medicare Advantage is run by private companies and functions pretty much like an HMO, or PPO. You have to use the doctors and hospitals in their networks. With traditional Medicare you can choose your own doctor or hospital.

The Trump Administration and the Centers for Medicare and Medicaid Services (CMS) are pushing Medicare Advantage plans for 2020. They rightly point out that you have more choices and premiums have declined. About a third of Medicare beneficiaries enrolled in Medicare Advantage in 2019, and these plans do work well for many people. Some offer coverage for basic dental checkups and some cover an annual vision exam. Others offer wellness programs. 

Medicare Advantage plans are great if you are healthy.

Downside

• • If you get sick you could end up with higher out-pocket-expenses for short hospital stays or something you need, like oxygen.
  • You may be asked to pay a higher premium for drug costs. 
  • It’s possible your insurer will try to deny services you need.

There is a financial incentive for them to do so. Medicare Advantage plans receive a set fee for every member and if medical expenses exceed these payments, they’ll lose money.

Also

If you travel and get sick or have a medical emergency, the plan may not cover your care beyond an emergency room visit.

And

If you enroll in a Medicare Advantage plan and don’t like it, you have to wait a year to get out of it.

Medicare Advantage plans have apparently overcharged the government $30 billion over the last three years. And in September, Ohio Senator Sherrod Brown and others, including Senator Bernie Sanders and Senator Amy Klobuchar, wrote to the Centers for Medicare and Medicaid administrator demanding better oversight.

Brown and advocates for Medicare have also criticized CMS for promoting Medicare Advantage plans. He asked, “Why did CMS engage in this inappropriate ’tilting of the scales’ through repeated emails to individuals highlighting the benefits of MA over traditional Medicare?”

The question remains unanswered. But it’s a good one and it’s a red flag to those of us thinking about choosing a Medicare Advantage plan.

The Center For Medicare Rights has a simple breakdown of the differences between Medigap plans and Medicare Advantage. You can find that here.

The Center for Medicare Advocacy is another excellent go to place for information.