An article by Wendell Potter on medicareresources.org discusses the advantages and disadvantages of Medicare Advantage plans versus traditional Medicare in providing adequate care to seniors. For some people, particularly those without serious illnesses, Medicare Advantage may be the best choice. This is because some Medicare Advantage plans offer benefits not provided by original Medicare, such as dental coverage, vision coverage, hearing aids, gym memberships and more.
However, elderly Americans with serious ailments might be better off sticking with Medicare. Similarly, people who are already enrolled in a Medicare Advantage plan and develop a serious ailment might want to drop the Medicare Advantage plan and return to traditional Medicare. Why? Medicare provides what the article refers to as “unfettered access” to treatments and physicians. That is, people on Medicare have greater access to doctors and facilities of their own choosing.
Another potential problem with Medicare Advantage plans is they empower Utilization Management nurses to make decisions about the type of care received by patients. These nurses work for the Medicare Advantage plan provider. They likely have no direct contact with the patient and do not fully understand his or her specific needs. Utilization Management nurses have the authority to deny coverage for treatments desired by patients and recommended by their attending physicians.
In the article, Potter quotes Judith Stein, Executive Director of the Center for Medicare Advocacy in Connecticut. Stein summarizes the issue this way:
“Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled. This is particularly true for our clients with long-term and chronic conditions, many of whom also have low incomes. They are often denied coverage for necessary skilled care, or it is terminated before it should be, while the same coverage would be available in traditional Medicare.”
Given the high cost of medical care and the shortcomings of Medicare Advantage plans, the best approach might be to choose traditional Medicare and supplement it with a Medigap plan. Visit https://www.medicareresources.org/blog/2015/11/19/why-mom-went-back-to-traditional-medicare/ to read the entire article.