Thanks for talking about this. I'm a Medicare recipient who decided to go with traditional Medicare and a Medigap policy. I chose that route because I had read Thom Hartmann's rant, which described in great detail how Medicare Advantage plans are a scam on elder Americans and a windfall for insurance companies. I still get annoyed when I see all the happy ads about Medicare Advantage plans, as if the corporations really care about people. That said, the Part D prescription coverage has been an on-going issue for me. I have one prescription medication that I've taken for almost 20 years (well before Medicare) and every year I have to change prescription plans because of changes to the formulary. Luckily, I have a Medicare broker who helps me find an appropriate plan. This year was particularly crazy, because the generic version of the drug wasn't on the formulary, but a name brand version was. It took a lot of back and forth with both my doctor and the pharmacist to get it figured out. I can't wait to see what happens next year.
My situation is almost identical. The single med I’ve taken for 25 years costs less at full price annually than my Part D premium. But if we don’t carry a Part D plan we are penalized if we need to add it later. WTAF? I spent ten years buying coverage on the healthcare Marketplace because my employer did not offer healthcare. Each year required a change of plan and doctor because of premium rate increases. Each year meant accepting a high out of pocket cost so I could afford a plan premium. Two broken bones in three years and goodbye savings— I vowed never to be in that position again. I chose a good Medigap plan to avoid becoming indigent due to out of pocket costs on unexpected health events like surgery for a broken bone but now play the same game with Part D. Advantage plans take advantage of subscribers in too many ways.
What a mess our system is! I hope as the political winds shift, there will be a big push for universal health care. As other countries have discovered, it works. No one should go bankrupt due to illness or injury. I also paid my own way for about 10 years before Medicare, but I was able to continue Cobra on the City of Portland employees plan. It was expensive, but worth it.
We had great insurance through my late husband’s employer, so I never worried about whether my job offered a plan. When he died I wasn’t able to get COBRA because I wasn’t the primary insured. And it would have been over $800/month on a job I loved but that paid slightly over federal minimum. ( which is another travesty!)
Three things I've never understood: statistics, income tax forms, and insurance. Might as well be Greek.
I realized the whole system (Medicare and Social Security) had become a racket when I turned 65. I could pay my full Medicare coverage until I began collecting Social Security at 66, or I could forego Medicare until I received SocSec and pay a prorated monthly fee the rest of my life.
The lady or the tiger. I pay toward my Medicare every month (just like I did with every paycheck my entire working life) because I couldn't afford to pay full freight for a year.
(Am I the only one who, every time I hear "Dr" Oz, thinks "Pay no attention to that man behind the curtain"?)
WTF? WTAF? I figure the government is perfectly satisfied if every retiree kicks the bucket. We're just a drain on "their" money.
I chose traditional Medicare, a Medigap policy and Part D drug plan when I turned 65 in 2018. Only the part D drug plan has given me stomach pains because I only take two prescriptions which total under $100 a year, but my Part D premiums have increased dramatically in the eight years since I went on Medicare. I will be searching for an alternative during open enrollment but under no circumstances will I ever go to a Medicare “Advantage” plan. It is nothing but a disadvantage because you are no longer in control of your healthcare decisions in the way that you are under traditional Medicare.
I too am on original Medicare and have a Part D medigap plan. Last year I was on a plan that was$180 a month. When I figured out that I was paying more for the plan then my prescriptions cost I went to find a new plan. I found Welcare and the insurance was under $10! I do have many prescriptions but it works really well for me so far. I wonder if my prescription costs or the premiums will increase?
To get a new plan you have to wait for enrollment period in October I believe. I thought about forgoing the plan altogether when my insurance was too expensive. Maybe you should skip the insurance and just pay out of pocket.
I will wait till the open enrollment period and see what’s available, thank you for the recommendation. I would not recommend that anyone go “bare” (that’s a lawyer’s term for being uninsured).
And specialty and other providers do not accept traditional Medicare and only serve patients with Medicare Advantage plans that they accept - potentially displacing patients to seek care elsewhere, often a futile search for folks with urgent medical needs. This isn’t only an insurance greed issue. Just thoughts from someone who spent 30+ years providing healthcare for folks in underserved communities.
Thank you, Shanley for trying to make sense of our crazy sleight of hand, smoke and mirrors Medicare benefits. The hidden pit falls are plentiful and every year we pay more and get less. I lost respect for Dr. Oz when he started pushing snake oil.
Medicare Advantage is such a scam, for the reasons mentioned above. Another is the various Medicare “advisors” who “help” you find the “right” plan… “advisors” who are just insurance agents earning a commission for every new “customer.” We found that out the hard way. When our rural area lost its only MA plan, we were able to jump off that scam train and into Original Medicare with Medigap and Plan D. Monthly premiums are higher, but we pay virtually NOTHING for care, and we can receive care anywhere in the country - no exclusive “provider network” BS to navigate.
MA looks great for relatively healthy 65-year-olds… but wait till you’re 75 and stuff starts falling apart and you need more specialists, meds, etc. In many states (not mine, thankfully), insurers are allowed to turn you down or charge a higher premium for pre-existing conditions if you want to jump off the MA train (because they won’t pay for what you need) and back to Original Medicare.
There are just so many things wrong about Medicare Advantage that we shouldn’t be surprised this regime is pushing it so hard. Their corporate benefactors are rubbing their hands with glee.
I spent a month in Glastonbury with a cousin who works for the NHS. Nearly everyone I spoke to brought up their horror at the cost of private health care we live with. (or not -if we can't afford it)
Couldn’t read this. Why have you chosen to force white text on black background??? (I use the Substack app on iPad - don’t know if it’s like this on other platforms.) Please reconsider your design choice.
Thanks for talking about this. I'm a Medicare recipient who decided to go with traditional Medicare and a Medigap policy. I chose that route because I had read Thom Hartmann's rant, which described in great detail how Medicare Advantage plans are a scam on elder Americans and a windfall for insurance companies. I still get annoyed when I see all the happy ads about Medicare Advantage plans, as if the corporations really care about people. That said, the Part D prescription coverage has been an on-going issue for me. I have one prescription medication that I've taken for almost 20 years (well before Medicare) and every year I have to change prescription plans because of changes to the formulary. Luckily, I have a Medicare broker who helps me find an appropriate plan. This year was particularly crazy, because the generic version of the drug wasn't on the formulary, but a name brand version was. It took a lot of back and forth with both my doctor and the pharmacist to get it figured out. I can't wait to see what happens next year.
My situation is almost identical. The single med I’ve taken for 25 years costs less at full price annually than my Part D premium. But if we don’t carry a Part D plan we are penalized if we need to add it later. WTAF? I spent ten years buying coverage on the healthcare Marketplace because my employer did not offer healthcare. Each year required a change of plan and doctor because of premium rate increases. Each year meant accepting a high out of pocket cost so I could afford a plan premium. Two broken bones in three years and goodbye savings— I vowed never to be in that position again. I chose a good Medigap plan to avoid becoming indigent due to out of pocket costs on unexpected health events like surgery for a broken bone but now play the same game with Part D. Advantage plans take advantage of subscribers in too many ways.
What a mess our system is! I hope as the political winds shift, there will be a big push for universal health care. As other countries have discovered, it works. No one should go bankrupt due to illness or injury. I also paid my own way for about 10 years before Medicare, but I was able to continue Cobra on the City of Portland employees plan. It was expensive, but worth it.
We had great insurance through my late husband’s employer, so I never worried about whether my job offered a plan. When he died I wasn’t able to get COBRA because I wasn’t the primary insured. And it would have been over $800/month on a job I loved but that paid slightly over federal minimum. ( which is another travesty!)
Three things I've never understood: statistics, income tax forms, and insurance. Might as well be Greek.
I realized the whole system (Medicare and Social Security) had become a racket when I turned 65. I could pay my full Medicare coverage until I began collecting Social Security at 66, or I could forego Medicare until I received SocSec and pay a prorated monthly fee the rest of my life.
The lady or the tiger. I pay toward my Medicare every month (just like I did with every paycheck my entire working life) because I couldn't afford to pay full freight for a year.
(Am I the only one who, every time I hear "Dr" Oz, thinks "Pay no attention to that man behind the curtain"?)
WTF? WTAF? I figure the government is perfectly satisfied if every retiree kicks the bucket. We're just a drain on "their" money.
I chose traditional Medicare, a Medigap policy and Part D drug plan when I turned 65 in 2018. Only the part D drug plan has given me stomach pains because I only take two prescriptions which total under $100 a year, but my Part D premiums have increased dramatically in the eight years since I went on Medicare. I will be searching for an alternative during open enrollment but under no circumstances will I ever go to a Medicare “Advantage” plan. It is nothing but a disadvantage because you are no longer in control of your healthcare decisions in the way that you are under traditional Medicare.
I too am on original Medicare and have a Part D medigap plan. Last year I was on a plan that was$180 a month. When I figured out that I was paying more for the plan then my prescriptions cost I went to find a new plan. I found Welcare and the insurance was under $10! I do have many prescriptions but it works really well for me so far. I wonder if my prescription costs or the premiums will increase?
To get a new plan you have to wait for enrollment period in October I believe. I thought about forgoing the plan altogether when my insurance was too expensive. Maybe you should skip the insurance and just pay out of pocket.
I will wait till the open enrollment period and see what’s available, thank you for the recommendation. I would not recommend that anyone go “bare” (that’s a lawyer’s term for being uninsured).
And specialty and other providers do not accept traditional Medicare and only serve patients with Medicare Advantage plans that they accept - potentially displacing patients to seek care elsewhere, often a futile search for folks with urgent medical needs. This isn’t only an insurance greed issue. Just thoughts from someone who spent 30+ years providing healthcare for folks in underserved communities.
Thank you, Shanley for trying to make sense of our crazy sleight of hand, smoke and mirrors Medicare benefits. The hidden pit falls are plentiful and every year we pay more and get less. I lost respect for Dr. Oz when he started pushing snake oil.
Medicare Advantage is such a scam, for the reasons mentioned above. Another is the various Medicare “advisors” who “help” you find the “right” plan… “advisors” who are just insurance agents earning a commission for every new “customer.” We found that out the hard way. When our rural area lost its only MA plan, we were able to jump off that scam train and into Original Medicare with Medigap and Plan D. Monthly premiums are higher, but we pay virtually NOTHING for care, and we can receive care anywhere in the country - no exclusive “provider network” BS to navigate.
MA looks great for relatively healthy 65-year-olds… but wait till you’re 75 and stuff starts falling apart and you need more specialists, meds, etc. In many states (not mine, thankfully), insurers are allowed to turn you down or charge a higher premium for pre-existing conditions if you want to jump off the MA train (because they won’t pay for what you need) and back to Original Medicare.
There are just so many things wrong about Medicare Advantage that we shouldn’t be surprised this regime is pushing it so hard. Their corporate benefactors are rubbing their hands with glee.
Shanley,
I am in the UK, so this was really informative, and totally alarming. How horrendous to have to get through this maze.
I spent a month in Glastonbury with a cousin who works for the NHS. Nearly everyone I spoke to brought up their horror at the cost of private health care we live with. (or not -if we can't afford it)
Couldn’t read this. Why have you chosen to force white text on black background??? (I use the Substack app on iPad - don’t know if it’s like this on other platforms.) Please reconsider your design choice.
it's hard to read for me, too
Thank you for letting me know! This actually wasn’t intentional, I’m going to go take a look at the settings and see what’s going on!