Do patients choose Medicare Advantage for convenience?

Having just retired on July 1st, my medical group’s commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.

I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has been nothing short of an eye-opener. I should have of course known better, embarking on any venture with a government agency. I signed up online for Medicare Part A, but Part B was more challenging since I didn’t want to start collecting Social Security at the same time and the computer program didn’t like this.

There is of course Medicare Part A, which covers hospital bills, and Medicare Part B that covers other medical and physician service. Then there is Part D that is the drug prescription plan.  Medicare HMO’s combine A, B and D for one set fee and are known as Medicare Part C, or Medicare Advantage. However, hospital, physician, and drug choices are severely limited when signing up for Part C, no matter what the insurance company’s marketing advertises. “Medigap” plans can be purchased to fill in the many holes which A and B do not cover, for another premium. This is also called Medicare Part F. Are you still with me?

Now there is also Medicare Parts E, G, H, I, J, K and L. But let’s skip those for now. By late spring of this year, my head was spinning. I threw in the towel and used an insurance expert to help me navigate this alphabetical morass. Within the past two months, hardly a day would pass without some document arriving form Medicare, Social Security, or United Healthcare, the private insurance company that I had chosen for my Part D and F plans. Thankfully, they have an almost 24/7 telephone help line. I was told in writing no less than three times that my Medicare Part B would be higher than normal due to my “high” previous year’s income. I was asked in writing to verify, in writing, why I hadn’t applied for Medicare Part D benefits from the start of the year.

My epiphany was that many of my former patients probably chose Medicare Part C or HMO plans, not just to save money, but also not to have to deal with this endless maze of paperwork and redundancy. This system is so cumbersome, arbitrary, and difficult to understand that only another government agency, the IRS, can make it look simple.

I have come to the conclusion that navigating all of these arms of the Medicare tendrils is almost a full time job. I have a much better appreciation for what my patients have had to endure all these years while I was simply trying to diagnose and treat their heart disease. It is no wonder our Medicare system is such a mess.

David Mokotoff is a cardiologist who blogs at Cardio Author Doc.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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  • doc99

    I selected a MCare Advantage Plan for both myself and my wife because for us, it just made sense. The one thing I don’t like about Medicare Advantage is their capricious narrowing of the provider networks. This needs to stop.

    • SarahJ89

      Everything about private insurance is capricious. That’s why I decided against MA. I simply don’t trust insurance companies to not pull the rug out from under me when profit is at stake.

      • NPPCP

        What rug? It’s already gone!!!

  • EmilyAnon

    Yes, one of the doctors I see posts an ever growing list of insurance plans he no longer accepts. The first thing I noticed was that his waiting room is less crowded now. Don’t know what I’ll do when/if I see my plan on that list.


    Make all Medicare plans the same and providers who accept it will accept all. There are a couple of plans I will never accept. I have too much self respect.

    • SarahJ89

      That’s what the Plan B/Medigap set up does. MA, like Part D, is a boondoggle that was designed to benefit the insurance industry. I wouldn’t touch either them with a barge pole.

  • MentalPatient

    It was easy here in Minnesota.

    My husband and I got a Blue Cross Blue Shield plan with zero copay zero deductible and 97% of doctors take it plus every major hospital including Mayo Clinic. I called the Senior Linkage line for help, and the lady was incredibly helpful and knew her stuff. I remember when HMO’s rationed care, so I didn’t even look at Medicare Advantage. The only advantage is free eyeglasses once in awhile, so far as I know.

    The Part D was a lot harder. I got the cruddy walmart plan because I take no prescriptions regularly, and my husband gave up and gets his pills at the VA because we couldn’t deal with the mail order pharmacies anymore and the VA’s system for that is much better (WOW! Something great about the VA, which is also helping him with low vision aids).

    • ninguem

      My father uses the VA as a giant pharmacy. He gets his medical care privately, goes to see a VA doc about once a year. That doc (nurse practitioner really) basically rubber-stamps the work the private doc did, which then makes him eligible for the VA meds.

      If your VA exposure is limited and defined like that, it can work acceptably.

      • MentalPatient

        yep, that’s what we’re doing, too. But actually, I liked my husband’s primary care doctor in the VA, who apparently had the time to go thru the preventive care stuff in a lot more detail than his primary care physician outside the VA is able to do.

  • ninguem

    I’m in one now, that’s causing me no end of headaches. I’m finding myself about the only primary care doc in town taking it, and I’m finding out for damn good reason.

    Every new patient that has this Medicare Advantage insurance, and I mean every single one, comes hobbling in the office in a wheelchair, a walker, a scooter, a quad cane, implanted spinal pumps and spinal cord stimulators, complex tertiary work with a whole team of consultants for multisystem problems.

    Then they sign up for this plan, and they lose every single consultant they have, plus their primary care doctor.

    They see me, they expect me to be up to speed on a massive medical record, including work by the consultants they didn’t think to mention, mad that I didn’t read their mind, mad that I don’t know the consultants who ARE in their plan, and mad that I don’t have referrals arranged instantly.

    When I do identify the proper consultants, the referral process is a complicated dance between documents that I have to complete, and the consultant has to complete. When the consultant invariably fails to complete the stuff they need to do at their end, the patient blames me.

    I’m about ready to drop the plan as a primary care provider.

    • DeceasedMD

      You were ready to drop them a month ago too. Sigh. it’s not so easy when I know there are so few resources for these pts.

      • ninguem

        Only because it’s quieted down. In other words, no more parade of walkers, canes, etc.

        No new patients either. The idea is supposed to be the easy-to-care-for “healthy” elderly would make up for the medical disasters.

        But they don’t show up. The concept of “taking the good with the bad” goes out the window with the nonphysician clinics claiming they can do “99%” or whatever factoid of physician work, and you’re left with the “one percent”. The Big Box places do much of the same. In fact, it was a Big Box takeover that resulted in my being the only primary care doc in town in-network.

        Big Box was smarter than me, I guess. That must be why the CEO makes a million-dollar-plus salary.

        Maybe it’s just inertia on my part, only because it’s slowed down.

        • DeceasedMD

          The big difference between you and the Big Box is you actually want to treat patients. Not assembly line work.
          NY Times had article about Big Box urgent care more than not, funded by Wall Street, and making an extraordinarily lucrative business with the easiest pts.

          • SarahJ89

            The last time I had occasion to visit the walk-in clinic run by my local hospital I got to listen to the PA describe his symptoms to me! He’d just moved a few months earlier from the mid-west and apparently hadn’t had time to make friends. I could barely get a word in about my own symptoms. I finally decided I had a virus and just needed to chill and wait. And not walk in to the walk in again.

          • NPPCP

            That is awful – physicians, NPs and PAs get lonely too I guess.

          • SarahJ89

            Yep. This guy seemed stunned that he’d actually gotten sick. He was obviously used to being very healthy.

            I was too busy holding my head to be of much support to him. If he’d taken the geographic cure for burn out it wasn’t working well.

          • DeceasedMD

            thats a sad statement.

          • querywoman

            Well, a private doc could do that too. Perhaps you should have walked out or demanded another doctor.

        • SarahJ89

          Are you able to say “No more new MA patients?” That would limit things over time.

        • NPPCP

          I get the same mix you do doc. I get all the apples and all the worms. I have more hobblers than I can shake a cane at. You and I are in the same “little box.” :)

          • NPPCP

            And for the record, I could easily do what you think “all of us do.” I have more “easy business” than I know what to do with. But I turn no one away as well. Just can’t do it. Have to set strict guidelines with some of them but as long as they are not belligerent they are welcome.

  • Becky

    Thank you for clarifying. Are there any Medicare supplement plans that includes things like catastrophic coverage? You Made a good point about Medicare not paying for patients “under observation”. If so, you will be left with a bill that is tens of thousands of dollars! I have made it very clear to my family to fight ” under observation” tooth and nail and say I can’t afford it. Hopefully if my mother is persistent enough, I will get the status changed to inpatient.

  • SarahJ89

    My husband just signed up for Plan B without taking his SS payments. It was pretty simple, but he did it in person at our local SS office.

    And I found signing up for Medigap very easy compared to dealing with other insurances. The components of the various plans are required by law. Each plan has the same name in all the insurance companies. There are charts on line explaining the details of each plan that make it exceedingly easy to find the plan that fits your needs. After that you’re able to shop by price, knowing the product, unlike Medicare Advantage plans, is blessedly identical from vendor to vendor. You know Medicare is driving the approval bus so you won’t be wasting any time or energy arguing and appealing decisions of your insurer.

    I took one look at Medicare Advantage and backed away. I have no desire to try and sift through the marketing of the impossible to compare plans offered by private insurers.

  • querywoman

    My first Medicare D plan came out and tried to sell me that keerap. I require full choice so I can have a dermatologist and an endocrinologist. They told me my doctors could sign up for the plan. I can’t make them.
    Under regular Medicare, I can always go to the county (horror), the public med school (horror II), or to some other major med center if every specialist drops out.
    People think they plans will be cheaper, and the guvment encourages it! I don’t believe they are cheaper.
    I have a bad case of atopic eczema. The county and pub medical school did nothing for me. My current derm has helped immensely. I could go back to the public medicos to get them to continue his treatment, but it really chaps my buns that they couldn’t come up with it in the first place!

  • querywoman

    I dealt with this with an older friend who recently did a two month stay in a nursing home for injury rehab. A business manager was telling her how her advantage plan paid for various days. I told her that traditional Medicare paid differently, but she’d probably come out paying about the same. He agreed.

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