By JEFF GOLDSMITH

A Shift in Health Coverage: My Journey ​from Medicare Advantage to ⁤supplement Plans

This morning marked a notable change ⁤for me; after twelve years of being enrolled in a Medicare Advantage (MA) plan, I made the decision to switch to a Medicare Supplement‌ policy. My growing dissatisfaction reached its peak, prompting this transition.​ The MA plan‍ I had was ⁤a national network option that boasted no⁣ premium costs.

The Allure and Reality of Medicare Advantage Plans

I initially chose an MA plan due to its ideological appeal—specifically, the concept of incentivizing healthy behaviors. However, I soon⁤ realized that many of the promised benefits where ‌unattainable; my ​preferred health club and dentist were both out-of-network providers. When I faced cancer treatment in 2015, my experience with the plan ‌was less than ideal; they reimbursed only about one-third of ⁣what it cost for my care at the University of Chicago—a facility located over 600 miles away.

throughout my twelve-year tenure with this insurance provider, there were no outright denials for⁢ care. Yet, they incessantly pressured my primary care physician by requiring his approval on every treatment decision related to my cancer journey or any other medical needs—resulting‍ in hours spent on unnecessary paperwork. Additionally, I received an ​overwhelming number of ‍unsolicited offers for “wellness visits,” where nurses would come to assess ⁢me at home under ⁢dubious pretenses. Essentially, my ​interaction with ​this insurance company consisted mainly of receiving countless automated calls.

The Decline of ‍Network options and⁢ Trust Issues

I began noticing troubling signs regarding their ‍network’s viability; prestigious institutions like the University of Pennsylvania and Cedars Sinai did not accept their ‍coverage anymore. The final straw came ‍when Mayo Clinic announced it would also stop accepting patients from this​ insurer—Mayo being crucial as‌ a‍ backup provider should local services ‌fall short.

The Evolution and Future Outlook on Medicare Advantage Programs

From a broader policy ​outlook,‌ when MA plans were revamped in the early ​2000s, they seemed promising. if ⁤options like SCAN or Kaiser Permanente had ​been available within my area’s market framework, ​I might have remained enrolled due to their complete approach towards multi-specialty care tailored for older adults or those eligible ⁢for dual coverage—a sentiment⁤ echoed by fellow healthcare expert George ‍Halvorson.

However, it’s becoming increasingly clear that capitation models—or even newer ​iterations involving AI-driven management—are not panaceas for​ our healthcare challenges. It’s not merely about incentives; having‍ experienced life ⁢under an MA plan firsthand over twelve years has shown me that true value lies within access to quality care during critical ​times. Aside ⁢from some frozen meals sent post-surgery ⁤following my cancer‌ treatment—the carrier contributed little⁣ else positively during our time together. Ultimately, even if it was free-of-charge⁢ coverage through MA wasn’t worth it anymore.

Jeff Goldsmith is an experienced health​ futurist and⁤ President of Health Futures Inc.,‌ contributing regularly‍ to THCB through his insights ​shared on his personal substack.