.Medicare Malady: A second opinion

Seniors are being bombarded with ads encouraging them to switch from traditional Medicare to a “Medicare Advantage plan.”

The ads point out that premiums for Medicare Advantage plans are less than what one has to pay for traditional Medicare plus a supplemental (or medigap) plan. In addition, they offer perks such as vision, hearing, and dental care and gym memberships. Wonderful—as long as you don’t actually need medical care.

But what if you do need medical care? Then, you are faced with everything we hate about health insurance: narrow networks, high co-pays and deductibles, and denials of care—often costing members tens of thousands of dollars.

Traditional Medicare is efficient and well-run with overhead of only 2%. Medicare Advantage plans are allowed to keep 15% of what Medicare pays them as profit. They are paid on a capitated basis based on the age and medical problems of their enrollees.

Medicare Advantage plans routinely “upcode” the diagnoses of their patients to make them sound sicker than they really are in order to get more money from Medicare. It is estimated that these plans steal as much as $140 billion a year from Medicare, and they have faced many multi-million dollar fines for their dishonesty.

As someone who has had traditional Medicare for several years, I am happy to pay my monthly premiums for Medicare and supplemental (or Medigap) insurance for the peace of mind of knowing that this is all I will pay for medical care regardless of what I need and that I can go to almost any doctor, hospital or clinic in the country.

Physicians for a National Health Plan, a 25,000 member group, urges seniors to avoid Medicare Advantage plans (which they call Medicare Disadvantage) and opt for traditional Medicare. I couldn’t agree more.

Ann Troy lives in San Anselmo.

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