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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