Medicare Advantage - Don't do it

[amper42]

Everyone considering a Medicare Advantage Plan should watch this video.
While it's designed to be comedy, it's a realistic warning of what to expect.

Medicare Advantage costs US taxpayers way too much and tries to implement road blocks to coverage so corporations get rich. The incentive for profit and quality healthcare delivery at a reasonable price can't coexist. Once you get into an Advantage Plan and realize how bad the networks are along with pre-authorization requirements, it's hard to get out without paying penalties. Stay with regular Medicare if you want good coverage and wallet protection.

The Medicare Advantage commercials and sales people are not your friends.

 

[ivayvr]

The video is unavailable in my region, but there was a whole story about how bad it is on the Last Week Tonight With John Oliver a week or two ago.
It looks like the absolute master scam. You pay money to be abused!

 

[Pareto Pragmatic]

More expensive and worse outcomes, that's been known for a while. Well, known by people who study such things at least.

Here is an article on some details, which I picked out of MANY options because it has lots of linked sources.

https://medicareadvocacy.org/report-real-impact-of-medicare-advantage/

That should work for those who can't access the video or who prefer to read about issues.

 

[analogonly]

Agree completely. Just want to add that going back from Advantage to Traditional is much worse than a one-time penalty. It is applied annually for the rest of your life and is based on how long you were on Advantage and not paying premiums. The Advantage advertising in all forms aimed at the elderly is a national disgrace (not that it's the only one).

 

[JPA]

Agree completely. Just want to add that going back from Advantage to Traditional is much worse than a one-time penalty. It is applied annually for the rest of your life and is based on how long you were on Advantage and not paying premiums. The Advantage advertising in all forms aimed at the elderly is a national disgrace (not that it's the only one).

That's true only if the Advantage plan doesn't include Part D (drug coverage). Most Advantage plans do include Part D, so there is no penalty to switch back to traditional or traditional+supplement.

 

[Petrushka]

Everyone considering a Medicare Advantage Plan should watch this video.
While it's designed to be comedy, it's a realistic warning of what to expect.

Medicare Advantage costs US taxpayers way too much and tries to implement road blocks to coverage so corporations get rich. The incentive for profit and quality healthcare delivery at a reasonable price can't coexist. Once you get into an Advantage Plan and realize how bad the networks are along with pre-authorization requirements, it's hard to get out without paying penalties. Stay with regular Medicare if you want good coverage and wallet protection.

The Medicare Advantage commercials and sales people are not your friends.

There are a hundred variations on Medicare Advantage, including medical savings accounts.

 

[Soandso]

I've had Medicare Advantage since turned 65 and am glad enrolled in it. The thing to understand about Med.Advantage is that each plan is based on your personal area of domicile. In my upscale city (under 175,000 inhabitants) there is an excellent modern hospital and many good medical specialists. Therefore, my options as a "member" of my Med.Advantage affords me a significant circle of care despite me being limited to just providers of medical services which are at any one time participating in my (HMO) plan.

Which means: if you are not living in a part of the USA with extensive medical options that in addition may at the same time not be providing good care anyway then Med. Advantage may not be as ideal for you as it has been for me. For example right in town within a 2 mile radius: I've had no problems accessing assorted specialists (U$0.00 co-pay), promptly get scheduled for every highly specialized medical test (so far at token and/or U$0.00 pay), have received both surgeries (plural) in hospital and as surgical out patient (all so far with U$0.00 out of pocket), and all anti-biotics as well as assorted temporarily prescribed costly medications at no cost to me (my plan includes Medicare Part D "drug" coverage). My guess is that in 2026 my Medicare Advantage plan, as will many other plans, will have instituted more specialized medical testing co-pays (fortunately I've already been notified my 2026 specialist physicians' visits will still have U$0.00 co-pays).

NOTE:

Bear in mind that if you start enrolling in Medicare and join a Medicare Advantage plan then afterwards it is not straight forward switching over to a (Medicare) Supplement plan. Medicare Supplement plans are also based on your USA domicile and the relevant insurer can refuse to belatedly cover a prior Med.Advantage person (however your area's Supplement plan insurer can not refuse to accept you as a first time eligible Medicare member). [There are a few nuances to this limitation hitch in switching coverage but basically if you are planning on remaining domiciled around where you've been don't expect leeway.] Therefore, if your domicile area has limited medical services taking into account a local Med.Advantage plan will possibly limit your access to medical providers then it makes sense to forgo Med.Advantage and wait until you can get/afford a Medicare Supplement plan.

Then too if you plan to travel a lot outside the USA most Medicare Advantage plans will give you up to 6 months (calendar year) to do so with some "emergency" medical coverage. You'll pay and submit a request for reimbursement according to your Med.Advantage plan's scale. In contrast Medicare Supplement plans (I think ) give much shorter durations for being outside the USA with overseas "emergency" medical coverage (you pay up-front and request scaled reimbursement). Another detail to check is what the "lifetime" total US$ maximum "emergency" medical coverage is for travel outside the USA since I think Med.Supplement plans have that clause.

 

[analogonly]

1) some Advantage plans salespeople lie about including Part D converge.
2) if you switch back from Advantage to Traditional, you have a limited time to add a Part D plan before incurring the penalty.
3) Switching back to Traditional from Advantage may be difficult if not impossible to get a Supplemental plan. It can be much more expensive if available.

 

[Soandso]

1) some Advantage plans salespeople lie about including Part D converge.

Salespeople get a higher commission signing you up for an Advantage plan than placing you a Supplement plan; in 2025 that was about U$600 vs. U$300. That differential indicates the actual Advantage insurers financially average out making more money than the actual Supplement insurers profit margin yields.

 

[amper42]

Reasons to sign up for Medicare Advantage:
1. You like to worry about whether your doctor is in network or not
2. You enjoy having to get pre-authorization for procedures
3. You don't mind having treatment delayed or denied
4. You appreciate having unexpected hidden expenses
5. You like someone else trying to over ride your doctors treatment plan
6. You don't mind your healthcare treatment plan being less important than corporate profit

 

[JStewart]

My wife and I have had Medicare advantage ppo plans for a couple of years. Zero premium, reasonable annual out of pocket. Numerous medical procedures including surgeries. No need for approval to see a specialist. The insurance company has issued every authorization requested in a timely fashion.
When I compare this to the 24 to 25k we paid in household premiums before retiring it looks pretty good.

My pet peeve? Before the “affordable” care act our household premiums were 5 to 6k. A higher out of pocket than now, otherwise pretty much the same. A 400% increase in less than 7 years. Somehow I don’t recall that being mentioned when the law was enacted. In fact, I believe the opposite was promised.

 

[JustJones]

You're also going to start seeing more of this.

Mayo Clinic will leave most Medicare Advantage networks at UnitedHealthcare, Humana

Neither the clinic nor insurers explained the changes for 2026, which come as seniors are facing higher premiums and finding fewer choices.

www.startribune.com

 

[Short38]

Medicare for all please.

The advantage plans should not be allowed to use the word Medicare.

The medical reimbursement process is a sad mess. No centralized rigorous auditing in place. One grotesque scandal after another: scooters, durable medical equipment, pain clinics, Columbia HCA and so on.

Plans coming and going, agents in the middle, endless phone solicitations.

Loony.

 

[Soandso]

You're also going to start seeing more of this.

Link is for Mayo Clinic which has been a premier level clinic for decades. What's reported is that it was the insurer United Health Care's Med.Advantage which could not reach financial agreement in negotiations over the Clinic's final sum(s) received. They wouldn't pay above a certain limit which I assume USA inflation has distorted the value of.

Mayo Clinic accepts Med.Supplement plans, although in some situations the patient still may be responsible for some payment(s). Obviously a Med.Supplement plan might have been collecting several hundreds of U$ in monthly premiums (which go up as one ages) amounting to thousands of U$ before one gets Mayo Clinic medical services.

NOTE:
If after becoming a Medicare recipient at 65 one does not soon enroll in a monthly Med.Supplement plan and wait to then only join later a Med.Supplement plan's monthly premiums' starting point in U$ will be higher than someone the same age as you (at that point in time) who unlike you started that exact same Med.Supplement plan at age 65.

The monthly premiums of Med.Supplement plans that one is enrolled in are regularly increased. I don't know how frequently this will be since the 2026 enacted Medicare reshuffling (as of 2025 I thought about every 2 years until hit age 95 but was told premiums were adjusted quicker).

 

[Gibsonian]

Geezers paying for Joe Namath and others to make money fleecing themselves. Who’d of thunk?

 

[amirm]

I signed up for Medicare this year and specifically opted out of Advantage program for reasons mentioned. But I can see why people get it (like my brothers). My month payments currently with Plan N supplement is something like $500 a month! It is half of what it is currently with individual plan so I am not complaining. But coughing up $6,000 a year is not for everyone.

 

[Philbo King]

I recall an article about United Healthcare using an AI program to randomly deny 95% of claims, then (after waiting on hold 6 hours when calling the Social Security office) was able to drop UHC and go back to basic medicare. It was worth the wait. A week later I got part D (drug) coverage for free.

 

[Joe Smith]

We looked at it with our expert health broker, no question for us but to have Med Sup plan. The drug plans are pretty lousy but better than nothing. I get one prescription from Canada, it’s cheaper than in US with a drug plan and with the current tariff applied. Med Advantage plans are just more of a crapshoot than I would accept.

 

[amper42]

We looked at it with our expert health broker, no question for us but to have Med Sup plan. The drug plans are pretty lousy but better than nothing. I get one prescription from Canada, it’s cheaper than in US with a drug plan and with the current tariff applied. Med Advantage plans are just more of a crapshoot than I would accept.

In 2024 under Biden, USA passed a law which made max out of pocket for drugs $2000 a year while on Medicare drug plan. That's a big deal and very helpful. Next year, it goes up to 2100. The key to making this work is having a good drug plan that covers a wide variety of drugs. Then, with the $2000 limit in place, out of pocket for drugs is manageable. In the past, with no limit seniors with expensive medicine needs could get into trouble. Now it's manageable.

It doesn't take much for this $2000 limit to kick in. All sorts of shots these days can run $1,000 to $7,000 each and may be needed every month or two. Or moderately expensive inhalers and other medicines. If you have Medicare in place that covers the first 80% of care and a supplement to cover the rest, but you could still have high drug costs in the past - even with a decent plan. NOW, with the $2,000 max out-of-pocket drug cap law it makes drug prices much more manageable and your family can access the latest pharmaceutical treatments without unlimited cost. That's progress.

With regular Medicare you get to go to just about any doctor. It's hard to find one that doesn't take Medicare. No more looking at doctor networks or being concerned a provider you want to use isn't in network. It's a huge benefit. Especially, if you are looking for the best care. And with Medicare and a good supplement it costs nothing to get that care after the monthly premium. That still left possible drug fees but with the new $2000 limit that's no longer the issue it once was.

The key is don't get sucked into a Medicare Advantage Plan. It may sound like you save a few pennies while well but once you actually need healthcare it's not a comparable service. Straight Medicare with a supplement plan offers better coverage on every front. And peace of mind you don't get with a program targeted for corporate profit at the expense of your health.

Can you imagine if the billions spent on Medicare Advantage marketing and commissions paid to brokers to sell you Advantage plans was instead spent on healthcare? The USA healthcare insurance system is upside down. You can't expect corporate earning to grow every year while also providing world class healthcare. They can't serve two masters. The system is setup for failure. It's either working for profit or healing people. It's impossible to do both well. One of these goals will always suffer. Straight Medicare isn't built on that fatal design conflict. It doesn't take much analysis to see why it's a better healthcare delivery system.

 

[JustJones]

Link is for Mayo Clinic which has been a premier level clinic for decades. What's reported is that it was the insurer United Health Care's Med.Advantage which could not reach financial agreement in negotiations over the Clinic's final sum(s) received. They wouldn't pay above a certain limit which I assume USA inflation has distorted the value of.

Mayo Clinic accepts Med.Supplement plans, although in some situations the patient still may be responsible for some payment(s). Obviously a Med.Supplement plan might have been collecting several hundreds of U$ in monthly premiums (which go up as one ages) amounting to thousands of U$ before one gets Mayo Clinic medical services.

NOTE:
If after becoming a Medicare recipient at 65 one does not soon enroll in a monthly Med.Supplement plan and wait to then only join later a Med.Supplement plan's monthly premiums' starting point in U$ will be higher than someone the same age as you (at that point in time) who unlike you started that exact same Med.Supplement plan at age 65.

The monthly premiums of Med.Supplement plans that one is enrolled in are regularly increased. I don't know how frequently this will be since the 2026 enacted Medicare reshuffling (as of 2025 I thought about every 2 years until hit age 95 but was told premiums were adjusted quicker).

They wouldn't pay above a certain limit which I assume USA inflation has distorted the value of.

Not sure what you’re getting at here since they still take Medicare and Medigap plans which are subject to the same pressures. My take is the Mayo Clinic was tired of being stiffed by these Advantage plans.

NOTE:
If after becoming a Medicare recipient at 65 one does not soon enroll in a monthly Med.Supplement plan and wait to then only join later a Med.Supplement plan's monthly premiums' starting point in U$ will be higher than someone the same age as you (at that point in time) who unlike you started that exact same Med.Supplement plan at age 65.

This is not entirely true as there are exceptions. For instance you continue working past 65 and are covered by an employer plan you can join a supplement when you retire without penalty or higher premiums as my wife did.

To continue the same theme of what we'll be seeing more of in the years to come,

The teaching hospital and only level 1 trauma center where I live quit taking Aetna Medicare Advantage in July 2025 and will opt out of United Health and WellCare Advantage plans beginning Dec 31 2025.