Disadvantage Plans Continue to Inundate Us
With the primary election over in California, I was hopeful junk mail would lessen. However, the mailbox is still clogged with advertisements targeting older adults to re-assign their original Medicare to an “Advantage” plan.
Most recently, I received a card in the mail offering $1100 yearly in groceries, luring me to sign up for their package. However, in this day of inflation and shrinkflation, this amount is not an enticing consideration.
I have labeled these plans “Disadvantage” based on my experience as a physician. They offer “free” hearing aids, glasses, dental work, transportation, in-home care, and now groceries, but these “advantages” rarely pan out.
Many seniors tell me how they love their Advantage Plan and the great care they receive. I remind them they have not been critically ill in the hospital, as this is where their Advantage Plan fails.
These for-profit disadvantage organizations are quick to discharge you from the hospital and push seniors into nursing homes (which they’ve re-labeled “Rehab Centers”); put you on end-of-life hospice care so they can legally wash their financial hands of your medical problems; second guess your doctor’s recommendations requiring “prior authorization” for procedures, referrals to specialists, and diagnostic testing like CT scans or MRIs; and create high out-of-pocket cost, especially for medicines.
If you travel, you might need authorization from the Advantage Plan for treatment, even if you are in a distant emergency room. With advancing medical care and newer technology such as immunotherapy and targeted cancer treatment, these might be denied because of their costs.
Most recently, they have attempted to find loopholes in state laws to take over medical decision-making, even over family members, allowing them to “pull the plug” on ill patients.
I know original Medicare with a Medigap supplement is more expensive. Still, in the long run, the cost of one’s life is much higher when one jumps through hoops in an unfamiliar medical arena.
The Medicare system is complex, and switching from an Advantage Plan to an original Medicare with a Medigap supplement is difficult. Realize for-profit disadvantage lobbyists influence legislators and don’t want to lose their profit. Why not make it difficult and confusing for the public to make a change?
Should you be contemplating this change, call an insurance broker or your insurance agent before seeking anyone offering a $1100 grocery card.
We continue to be inundated with ads and enticements from Medicare Advantage Plans filling our mailboxes because they want your money.
Unfortunately, they might ultimately take your life…all for profit.
Gene Dorio, M.D.
Hi Gene,
I totally agree that these “Advantage” plans are a scam. My sister fell into that trap. She had eye surgery (in Chicago) and was using her straight Medi -Medi plan. Following the surgery she was contacted by Humana Advantage, who told her about all of the wonderful extra benefits she would receive if she had an Advantage plan and that “nothing would change” with her coverage post-surgically. She specifically had them check and see if her eye Dr was on the Advantage plan, and they assured her that her doctor was absolutely covered. Well, these were complete lies. The Drs office notified her that they didn’t accept Humana Advantage and that she was now responsible for the cost of post-surgical exams and meds. Crooks!
Brian
Dr. Dorio:
I just wanted to let you know that it was a pleasant surprise to find one of your articles in the Rafu Shimpo newspaper to which I subscribe. Hopefully, future articles will be forthcoming as I find your articles very informative. Thank you.
Dr. Dorio, As a member of an Advantage Plan, I could not disagree more. I have a medical team (5)of specialist who monitor me , Most of my meds are zero; true, the dental plan is skimpy. My experience with having a ruptured bowel w/ ostomy cost was $93.00 of a $135, 000.00 hospital bill. ANd that was only the beginning of the maintenance costs for (3) chronic diseases. For me, the 20% co-pay with Regular Medicare would put me on Med-Cal and /or take my house. And the cost of a supplemental plan would be so great as to not leave enough money to live on..
Gene: Good advice. I note that the TV is also inundated with “Disadvantage” commercials. My favorite is the grumpy old lady who keeps saying “NO” but is eventually worn down to call for her “Disadvantage.” Thank you, Gene.
The advantage plans are not labeled correctly….They are really disadvantage plans as they are plans that do not give what is needed to stay healthy, Gregory Jenkins MD
Dr. Dorio, you are dead on (no pun intended). It was my unfortunate circumstances that had me in the hospital last 3 for 3 months with a systemic staph infection that affected both my (osteomyelitis ) and my hand (destruction of the flexor tendon in one of my fingers). Because I had original Medicare with a Part G supplement, the cost to me was ZERO! I hate to think what it might have been with other insurance. I went to having further treatment and follow up., also at zero cost. The “disadvantage” programs as you call them only exist to serve the insurance companies, not the patients. Thank you for insightful commentary. G. Subar, Pharm.D