Why I Would Never Choose Medicare Advantage

In this video, I'll share why I would never choose Medicare Advantage. If you're considering your Medicare options, this is a must-watch!
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In this video I discuss why I personally would never choose to have a Medicare advantage HMO plan. You can make your own decisions.

00:00 Intro
00:25 Keith Armbrecht
02:01 Managed Care
03:34 Please Subscribe
03:53 Cost Difference
07:25 Pre Authorizations
08:35 Referrals
09:30 Networks
10:35 Travel
14:34 Leave a Comment

Reasons I would never choose a Medicare Advantage HMO plan:

Reason #1 - Limited network of doctors and hospitals. A Medicare Advantage HMO plan will have a network of doctors and hospitals you are required to use to receive care. Generally the lower the premium the smaller the network. Many times you will find a lower quality of doctors and hospitals in the network.

Reason #2 - Pre Authorization. For most specialty items you will need to ask for permission before service is rendered. You can find many horror stories where care was denied for something a doctor had recommended.

Reason #3 Out of Pocket expense. MAPD can be very expensive when you use it.
Reason #4 - Doctors and hospitals leave plans on a regular basis. You may need care and find out that your doctor is no longer in the plan.

Reason #5 - Very limited coverage when traveling. Most HMO plans only cover emergencies when outside of network. If you have an extended care you will have to travel back in network.

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[carolpool]

I am an RN who worked for an HMO at one time that offered Medicare Advantage Plans. I was trained to deny claims as a prior approval/utilization review nurse. I only lasted 3 months there because I could not in good conscious continue to deny services to clients who in good faith signed up for the plan only to have something really bad happen and find they could have the procedure they needed or the stay in rehab that would help them recover. I remember one 80 year old Spanish speaking only, tracheostomy patient that need home health to come an teach the wife to do the trach suctioning. The HMO would only pay for 1 home health visit and NO disposable supplies. I was supposed to tell the family to reuse the sterile trach suction catheters by soaking them in 3 parts water and 1 part Clorox. That was the end for me, I could not lend my name to that kind of 3rd world care in this country where poor people suffer disproportionally in cases like this.

[voxveritas]

My wife and I signed up for Medicare plus the G supplement plus Medicare D. At First it was fine, but after 3- 4 years it was costing us 700 dollars a MONTH. We kept it when we were traveling. It did pay claims, but we did have to pay some stuff. It just became too expensive to keep. So, we changed to the Advantage type after moving to a higher population area. Referrals are not a problem most of the time. Now our max out-of-pocket is 700 dollars a YEAR. My drug copays were 25 bucks for the YEAR, no deductible. True, we have to stay within the provider groups, but we have quite a few to pick from. Original Medicare is great, if you're rich or can go to wherever you have the money to afford to seek out expensive care. Not so much if you live in a backward state or a medical wasteland. Either way you go, you're screwed. Insurance companies, PBMs, hospitals, medical groups, drug companies, crooks who cheat Medicare at every turn are what we Americans are stuck with at this point. The ruling rich overlords will never change it. Congress and the courts have been bought, and YOU AND I have been stuck with the bill.

[dianayates]

You’re right on point. I’ve worked in healthcare business for 20yrs. When asked, I tell people to hold onto their traditional Medicare. Don’t buy into the selling points. When my parents became Medicare eligible, I advised them the same way. Stay with traditional.

[SomebodysGrandmother]

I really like my Advantage plan!
Haven't had any problems, never denied coverage never any monthly output, always had complete coverage.

[JellyBean-jrxb]

I’m on an advantage plan now for 8 years. I’m very grateful for my plan.

[joyfurden]

I’ve had a Medicare advantage plan for about ten years, and never had a problem even though I had a stroke, rheumatoid arthritis, and pneumonia.
I take nine Rx a month and this past month, February, I paid out 37.00. thanks for your input I’ve had the same doctors for many years.

[sadieme]

I have a Medicare advantage plan and I wouldn’t ever think of leaving unless there was some dramatic change. This coverage has gotten me through two bouts of cancer, and they have never caused me any grief or delays. Also, I had rotator cuff surgery recently, and I was shocked at how little I had to come out of my own pocket, really, really shocked!

[georgesouthwick]

Unfortunately, many of us can’t afford anything else. We have had a Medicare Advantage plan for the last 10 years and it has delivered excellent care for us. It all depends on which plan you choose. Do some research and compare the different companies for their customer satisfaction ratings, and get input from friends who have these plans.

[BrewMoe]

I spent the last half of my career working in the billing office for a medical specialist group. I dealt with everything from private insurance, worker's compensation, medicare, medicaid, etc. By a large margin, the problems I encountered with payment denials came from Medicare Advantage plans. And most of those happened because people did not understand the rules of their plans. Thanks for the informative video.

[daveforeman]

I worked both for a HMO and medical biller in my working life. Yes, traditional Medicare AND a supplement are the way to go. HMOs ALWAYS had lots of customer service calls regarding problems- especially when a person was traveling and had a medical emergency and could not use a network provider. I remember one time the HMO denied paying ambulance service saying it was not "medically necessary". The person died IN the ambulance. That was nuts- the family got the bill after denial. They were livid.

[ronmorales]

For regular folk the Medi-gap premium can get really high as you get older. Best option is to research and educate yourself the difference between Medi-Gap vs Medicare Advantage. The entry rate for Medi-gap may be great but increases rapidly. The competition in the Medicare advantage is really providing great benefit but remember to alway look at the Medical Group you choose. The Medical Group make all the difference in the quality of your care.

[MedicareonVideo]

Don't forget to download my free Medicare book !
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[bgregg]

My mother just passed at 96 1/2 & regular Medicare paid for literally all of her end-of-life care. I was amazed that we never got any medical bills. They even covered the helicopter transport to a larger hospital after a heart attack.

[ninamc]

I totally agree! I was a RN case manager for 5 years & frequently after a hospitalization the Medicare Advantage plans would not pay for skilled nursing facilities or long term care facilities. Everyone would talk about the great “dental & vision benefits”, but if you’re 85 & break your hip & can’t go to skilled nursing, you’re hosed.

[BryanMcCann-ksjh]

Inflation and Recessions are part of the economic cycle, all you can do is make sure you're prepared and plan accordingly. I graduated into a recession (2009). My 1st job after college was aerial acrobat on cruise ships. Today I'm a VP at a global company, own 3 rental properties, invest in stocks and biz, built my own business, and have my net worth increase by $500k in the last 4 years.

[rogerdsmith]

This advice is good for those that can afford the Medicare option. Couple of years ago I was climbing up out of homelessness. And I should the age where I had to either go on Medicare or Medicare advantage. I had no choice but to pick the best possible Medicare advantage plan that I could. Still don’t have sufficient money for month-to-month living expenses. But I’m not on the street anymore. Every situation is different and specific. Is he saying something good? Yes. Is it the best advice for everyone? Not by a long shot.

[frankl]

I tend to agree with most of your points. However it is truly scary that many people on Medicare and paying for a supplement are completely unaware that their care is still being "managed" by providers who are in ACO/Shared Savings/Direct Contracting arrangements. So, the beneficiary is getting the worst of both worlds. They are paying for a supplement but unknowingly have providers "managing" their care behind the scenes to line their own pockets.

[primordialmeow]

Retired RN here. Absolutely NO to Medical Advantage. I love my traditional Medicare with a strong supplement.

[dsa]

I have a PPO advantage plan and I have never been denied anything, and I've had many MRIs and expensive cardiac tests. Pre-approval for one test was done within 24 hours. However, my mother was on a supplemental plan and they denied her a life-saving surgery after already approving it. They didn't deny it until she was in the hospital, being prepped for surgery. She had no choice but to have the surgery and ended up paying THOUSANDS out of pocket. We had to sue that company to recoup her losses. Plus, supplemental plans cost so much in FL that as someone with low income, I could never afford them. You can push these plans all you want, but they are just as bad as any advantage plan. All insurance companies are crooked.

[magdalopez]

My husband and I were paying over $700 a month for premiums alone with Medicare and a Supplement plan, so we changed to Medicare advantage plan Preferred Care with UHC and here in Miami it works fairly well. We never had any issues to go to specialists. Even though my husband takes a lot of medications, at the end of the year we end up saving money.