Why I'm in Medicare Advantage

It’s Medicare Open Enrollment season until December 7. New enrollees can sign up for a plan, and those already in Medicare can switch plans if desired. 

There are two ways of enrolling in Medicare.

Original Medicare is the government-run program that pays 80 percent of covered services. Those who choose Original Medicare add a Medigap supplement to pay the other 20 percent, plus a plan to cover drugs. 

Medicare Advantage, which is offered by private insurance companies, bundles all coverage into one plan. Medicare Advantage plans are growing in popularity, claiming more than half of Medicare enrollees today, because they offer lower premiums (many $0) and more coverage than Original Medicare.

So why wouldn’t everyone choose Medicare Advantage? Two critics listed drawbacks in the October 29 Chicago Tribune. Here are the main ones, along with comments from a Medicare Advantage veteran — me. I’ve been in the Humana Gold Plus Medicare Advantage plan for nine years. 

• Medicare Advantage works well for younger, healthy people but gets costlier if your health declines. That’s because Medicare Advantage charges copays for treatments and hospitalizations that are paid for by Medigap plans.

I haven’t reached the point where the balance tips in favor of Original Medicare, if I ever will. Compared with the current average Medigap monthly premium of $164 for someone my age (according to MedicareSupplement.com), I have paid $0 in premiums during my nine years with Humana Gold Plus. If I had been hospitalized for a week at the plan’s 2023 rate of $150 a day, Humana Gold Plus would still have cost me less than the combined premiums for Medigap and a drug plan for not even six months. In addition, Medicare Advantage plans have an annual out-of-pocket limit, which Original Medicare does not.

Humana Gold Plus covered three pairs of hearing aids (the first two pairs were free and the third cost me $399), cataract surgery, an MRI and physical therapy for my arthritic knee, and chiropractic treatments for my back. This year it offered a $1,000 flex card to use for hearing, dental, and vision care on top of what is already covered. This year and next it will cover up to $5,000 in dental treatments.  

• Medicare Advantage plans restrict your choices to in-network providers who may have to get your treatment plans approved by plan administrators.

I can understand that people in rural areas might not want to be restricted to narrow networks, but I don’t think this is a big issue for people in metropolitan areas with large networks and excellent providers in many specialties. I chose the Rush network because it has a clinic near me, and I’d likely still go there if I had Original Medicare. If I were to have a serious illness, I’d have access to Rush’s nationally ranked physicians and medical center. With Medicare Advantage PPO plans, you also can go out of network by paying more.

I have never had a request for a treatment turned down. Recently I had another batch of chiropractic treatments approved. Medicare Advantage plans are legally obligated to offer the same services as Original Medicare, and many offer more, such as hearing, vision, dental, and fitness benefits. 

• It’s only when you first sign up for Medicare that Medigap companies cannot deny you coverage regardless of your health status. If you want to switch from Medicare Advantage to Original Medicare down the road, you may not be able to find a Medigap plan that will accept you, or your premium may be hiked.

It’s too late for me on that score, but if someday I want to switch to Original Medicare, I’ll deal with it then.

• Your providers may leave the network.

I would keep my providers and switch to another insurance plan. In Chicago, there are dozens.

I’m not trying to persuade everyone in Original Medicare to jump ship. There is no one right answer for everyone. Medicare choices should be based on one’s health and location. Agents may be helpful, but know that their advice might be biased by their commissions from Medicare Advantage, Medigap, and drug plans.