Traditional Medicare (TM) or Medicare Advantage (MA)
 

Medicare Advantage (MA) was designed with the intention of saving the government money compared to Traditional Medicare (TM).

However, that has not happened. MA costs significantly more per patient with estimates of $83 billion in excess spending in 2024 alone.

If the savings aren’t being realized, I would expect that MA would cut benefits such as vision, dental, health club membership, OTC benefits, etc.

For those with MA, at what point would you drop it because there is no advantage.

For those with TM, what additional benefits would you need to switch to MA?

I will never leave traditional Medicare. I like being able to choose my own doctors, without concern about in or out of network. I like not having to get permission for procedures my doc recommends. I like not needing a referral to see a specialist if I feel something needs attention.

Easy answer, a nation wide network accepted anyplace TM is accepted, nothing can be denied that is accepted under TM, no referrals necessary, and about a $250 annual deductible with everything covered 100% after that. Those are the four key things already available with TM (and a good Medigap Plan) that made signing up for it a complete no brainer for our needs.

It sounds like you want to abolish advantage plans altogether.

To me, the biggest difference between an advantage plan and traditional Medicare is that advantage plans are managed by a private company with a profit incentive. If they deny claims or prevent you from using a doctor or other provider who charges too much or performs unnecessary procedures, they can increase their profit. By contrast, traditional Medicare claims are managed by Federal employees who have no profit incentive. I don't trust the Government's accounting costs for these programs, but it seems that advantage plans should cost less than traditional Medicare. But for the patient, it appears as though traditional Medicare would be a better choice.

TM does not cover out of country needs. TM consistently reduces what they cover, especially for quality rehabilitation - which is a high need in elderly populations. TM does not meet criteria to retain certain retiree federal health care benefits, but MA does. MA have some plans which reduce TM premium costs. MA - PPO plans let you see docs in other areas of the country (TM does but the clinic may cap their new pts, unlikely for MA to be capped). Many reasons to go with MA depending on your specific health needs.

TM vs MA
 

Good points made above. Here are some other thoughts:
TM subscribers often get a supplemental which will increase in price with age. Supplementals don't include Part D - which must be purchased separately. The better the supplemental and Part D, the higher the price. Both supplemental and Part D providers are private for profit companies. TM doc's and facilities don't have a common integrated health info network, so each time you change either, get ready to provide your health history all over again.
Apart from the above issues, TM would seem to provide the most health flexibility independent of cost.
MA (aka Part C) comes in many forms including HMO, in network only, out of network optional and PPO. All include Part D. I currently have HMO and am satisfied with it with two exceptions - speed of service for anything other than ordinary care and the potential for disagreeing with a doc and having little recourse. The integrated health info system is very good - no time wasted in providing health history or dealing with billing.
I'm glad we have choices. And I would be interested in hearing from anyone who is very pleased with their health care choices - and what those choices are.

This is a timely and important discussion, especially since I just hit the big 6-5 this month and dove headfirst into the Medicare jungle (no machete required, but a good cardiologist helps). One of my closest friends—who also happens to be my cardiologist—was a lifesaver in helping me figure out which coverage made the most sense.

He told me he no longer accepts certain Medicare Advantage plans because, in his words, “they’re more interested in saving pennies than saving patients.” He’s had to fight tooth and nail just to get approval for basic tests. Based on his advice, I also met with a Senior Health Advisor—because when it comes to Medicare, Google just doesn’t cut it.

After chatting with both the advisor and my cardiologist (and surviving the paperwork avalanche), I decided traditional Medicare, a supplemental (Medigap) plan, and a separate drug plan was the way to go. It’s not the cheapest combo, but it felt like the safest bet for my health and sanity.

In my humble opinion, if you’re on a very tight budget, I totally get the appeal of an Advantage plan, those zero-dollar premiums can look mighty tempting. But if you’ve got a little financial breathing room, traditional Medicare with a supplemental and drug plan might just be the Cadillac of coverage. And hey, at our age, we’ve earned a smooth ride.

No, that’s not necessarily true. MA plans don’t suit my wife and my needs, but that doesn’t mean they don’t work for others. I was simply answering the OP’s question regarding what it would take to get us to switch from Traditional Medicare, with a supplemental plan, to MA.

That being said, I would be in favor of abolishing them if the powers that be can’t get their act together and revise MA plans so the cost to the Medicare Fund is the same or less than traditional Medicare. By costing Medicare 22% more per subscriber than Traditional Medicare, MA plans are bleeding the rapidly dwindling Medicare Fund dry even faster, which is not a good thing for anyone involved. Plus, their excessive costs are causing everyone’s Part B premiums to increase more rapidly.

I would add that I get the appeal of MA plans for healthy subscribers, since they are much less expensive (to them, not the government) and come with benefits that Traditional Medicare subscribers don’t get. But I also worry for those people as they get older and develop potentially very expensive medical conditions. At that point, they will have a pre-existing condition and very well might not be able to switch to Traditional Medicare with a supplemental plan, since they won’t pass medical underwriting.

Recently went through all that as well, and came up with the exact same conclusion.

Before I went on Medicare a few years ago, I thought that Medicare was free. People were always saying that the answer to the health problems in this country was “Medicare for All.” So after paying into Medicare for about 55 years, I expected that I would not have to worry about ever paying for medical coverage again.
To my surprise, I found out that even though I had retired and was not making much money, I still had to pay for Medicare.

I was also surprised to learn that the amount you pay for Medicare depends on how much money you make. The more you make the more you pay.

Married Filing Jointly:
$212,000 or less: Standard premium ($185 in 2025)
Above $212,000 to $266,000: $74.00 surcharge
Above $266,000 to $334,000: $185.00 surcharge
Above $334,000 to $400,000: $295.90 surcharge
Above $400,000 to $750,000: $406.90 surcharge
Above $750,000: $443.90 surcharge

I have learned a lot about Medicare since I retired.

Take part D out of the equation. There are zero cost options by Well Care.

You forgot to mention what your monthly premiums are for the TM plan and the Medigap plan? Costs vs benefits are one of the most relevant equations.

My original comment here was not accurate therefore is no longer needed. Cheers....

I think Part A is free and the monthly premium is for Part B (TM) or Part C (MA).

I’m paying $185 for part B, $189 for the absolute best Blue Cross Blue Shield Medigap plan available (which includes a year 1,2,3 discount of 15, 10, and 5% respectively, and also includes an annual vision and hearing exam and $150/year for corrective eyeglasses or contacts), and $12 for a WellCare part D prescription plan that covers both of my scripts for no cost via mail order. That’s a grand total of $386 for outstanding insurance with about a $250 annual deductible/max out of pocket plan. How sweet is that after having to pay over a grand per month through Obamacare for a high deductible and max out of pocket plan with a limited network and having to get a referral for everything. Although I hate getting older, becoming eligible for Medicare has helped mute the pain : ) I am well aware I could have saved a couple hundred bucks per month with a MA plan, but the piece of mind of a national network with no referrals, and more importantly, knowing if I ever need major medical care I’m totally covered after a $250 annual deductible, is priceless. Also, knowing both a hip and another knee replacement are in my future, that $200 per month MA savings would more than disappear very quickly.

How does that work? If you feel something needs attention you just go?

For example,

You have a pain your chest and you just go to a cardiologist for an exam?

You have a headache and you just go to a neurologist?

You want a colonoscopy so you just go to a gastroenterologist?

You have history of skin cancer so you go to a dermatologist every three months for a check up?

You twist your knee so you just show up for an MRI because you may have a torn ACL?

The key is, you get to take charge and be part of managing your own health care. You are no longer totally captive to the system and the constraints of your primary care doctor. You can talk with friends and family for references, coupled with your own research, and make an appointment with the doctor you feel is the best for your health issue at hand. As long as the doctor accepts traditional Medicare, which is just about everyone, you’re good to go. Plus, you never have to worry about them being out of network. You can’t just order your own MRI if you injure your knee, but you can determine who is the best orthopedic doctor specializing in knees and make an appointment to see him/her, and if they feel it’s necessary they can order it.

I can sort of see the MRI. But if you go to a specialist and they don’t think the MRI is necessary but you do, are you out of luck?

How about the other appointments? Can you make them without any problem?

For example, years ago I severely sprained my ankle. Sometimes my ankle still bothers me. I don’t know if that is caused by the original injury or just old age. I would like to see a specialist but with MA, my doctor won’t refer me for a specialist.

I have a lot more aches and pains than when I was younger. It would be nice to see a specialist every time one acts up.

It would be great to be my own primary care physician so that I could take charge of my health care.

A supplemental plan along with TM covers all of the above concerns. Advantage plans are geared towards profit in spite of the sales hype…patient care does suffer. No way do you want someone weighing the cost of your care over what’s best for you.

Never was an advantage.

:ho:

In addition to that, if you should get some rare tumor or disease..places like Mayo do not take advantage plans.

I have traditional Medicare and would NEVER switch to Medicare Advantage. I can go anywhere in the US, all lab fees are covered, no deductible, no referrals, no charges whatsoever. Yes, I have a supplement, but that monthly payment enables me to sleep at night and not have to worry about charges occurring if I get sick, car accident, cancer, surgery. That to me is worth every single penny.

We're on UHC Advantage and are happy with it. They have a large nationwide network and we use the wellness benefits, as well as the dental and vision. Choice is a good thing.

We did our research and even talked with people on our plan. SHINE also said it was a good option for us.
Medicare is not a one size fits all. It's about what works best for you.

My MA provides all the above.

Tm & ma
 

Happy Traveler - thanks for sharing your specifics. Very helpful.
One question - have your supplemental premiums increased over time?
And I'll look into Well Care - and Part D $$.

Yes, you can make an appointment with any specialist that accepts traditional Medicare. You can’t order your own imaging or other diagnostic tests, that’s up to the specialist. If you’re unhappy with the treatment from a specialist, you can make your own appointment with a different one for a second opinion.

I just wanted to "second" your statement. I have exactly the same position. I'm not lured by "free this and free that" with MA plans. It's not free if you give up something (autonomy to make decisions about when / where of care when needed).

You normally cannot drop Advantage plans. You can always change from traditional Medicare to an Advantage plan but not vice versa. Advantage plans are great until you need an expensive treatment and then the insurance companies will delay the treatment using prior authorization delays or denials. With traditional Medicare there is no prior authorization and you get your treatment right away.

Don't ever leave traditional Medicare. Your life may depend upon it.

If you have chest pain and want to be examined by a cardiologist you just call the office and make an appointment. No referrals needed.

Traditional Medicare has no out of pocket limit. If something catastrophic happens, your costs keep going up. We know a couple in NC where the husband was in the hospital for the last 7 months of his life. The wife had over $100k in bills when he died. My MA plan has a $3500 out of pocket max in NC. Nationwide coverage, have never been denied service. In fact, going in for a cervical fusion next week. All states are far from the same when it comes to MA plans. Medicare supplement plans are astronomical in price if you are under 65. I started Medicare at age 50 due to disability. Many factors to consider.

Just a moment...

key statement:

She added that the company has also already repriced its ACA plans to account for the higher costs.

analysts have forecasted / predicted the increases will be greater than 20% my comments to regain the profitability growth needed for corporate bonus plans. . and to keep their jobs with the stock market price trend. .

But remember, the out of pocket costs if you get approved has a limit with most MA plans, and medicare does not, so be sure to include a medigap plan for the out of pocket costs which can soar with a prolonged stay in the hospital. .

Holy smokes. I assume that Medicare supplements might have an out of pocket limit.

I thought that the ACA required all health insurance plans to have unlimited coverage upper limits. That is, there can be no lifetime cap on coverage. A plan can have an annual catastrophic limit, but no lifetime coverage limit.

Yes, within the Medicare guidelines.
Yes for cardiologist.
Yes for neurologist.
I think the colonoscopy guideline is every 5 years.
I think the skin check guideline is once per year.
For lab work you need an order from a doctor. Go to the appropriate doc first.

As I understand it, if you don't have a supplement plan, you are responsible for 20 percent of all health care costs under Medicare Part B, with no limit, and about $1,500(?) copay per hospital stay under Medicare Part A. If you have a supplement, the supplement will pay the 20 percent Part B cost and the Part A hospital copays.

For me, Medicare Advantage works beyond satisfaction. I'm facing a life-threatening illness. I've seen more medical specialists in the past year than in my previous 74 years combined. The medication alone costs $16,000/month; I haven't paid a dime. Without exception, the specialists I've seen are highly qualified. After exhaustive analysis, I would have selected the specialists assigned to me. I feel blessed to have MA coverage.

People who think this believe that the "gatekeeper" system--where you see your primary care doctor who refers you to a specialist within the system--is filled with incompetent specialists who couldn't otherwise attract patients. I live in a large metropolitan area. I get exposed to the cream of the crop. If, for some reason, an assigned specialist doesn't click, I simply ask for another referral. Has happened to me once, and it was no big deal.

I have Medicare Advantage through Aetna. Aetna hasn't denied a single test or procedure since I've been under its coverage for 13 months.

I think you meant this comment for someone else. I didn't describe any of my specifics.