Medicare re-enrollment: Time to consider being dissatisfied with a new plan!

It is Medicare re-enrollment season again. It began Oct 15 and runs through the end of the year. This is when, if you are dissatisfied with the Medicare plan that you are in, you can choose a new plan with which to be dissatisfied. I know this, if for no other reason, by the large number of pieces of junk mail telling me of the joy I will have if I enroll in this-or-that Medicare Advantage (MA) plan, not to mention the commercials blanketing television programs. I almost only watch live TV for sports, so I am seeing these on sports shows; I don’t know what it means that sports show ads target seniors. Maybe it’s just that ads on all shows target seniors; it is presumed that we are sitting around doing nothing but watching television so are an audience not only for Medicare Advantage but all kinds of “health” ads, ranging from those for incredibly expensive recombinant-DNA drugs (anything ending in “ab”, for starters) for uncommon conditions to the touting of ineffective (and possibly dangerous) nostrums. At least we don’t see as many ads for mobility scooters “at no cost to you” (albeit to the taxpayers) since some of the vendors went to prison. Unless they are soon to be pardoned, not an impossibility.

There is only one form of real Medicare, “Traditional Medicare” or TM. This is what you paid those Medicare taxes for that were recorded on all your paychecks, to fund the Medicare Trust Fund. Well, at least for Medicare Part A, which covers inpatient care and is what is covered by the Medicare Trust Fund. Medicare Part B, covering outpatient care (including outpatient procedures) is funded by general taxes plus monthly payments from recipients that are graduated by income (based upon the previous year’s tax form, so for the coming year, 2026, based on your last filed return which was for 2024). The base payment this year is $185/month, although subsidies may be available for low-income people. But while TM (unlike MA) does cover you for all Medicare-approved treatment, and it, not the hospital, sets the charge, it does not cover all of what it permits the hospital to charge you. For inpatient care, in particular, it will only pay 80% of whatever it has approved as what a hospital can charge. That is, if Medicare has approved a charge of $1000 for procedure X, it will only pay the hospital $800, and you are on the hook for the rest. So (if you can afford it) you should buy a Medicare Supplement (Medigap) policy to cover that. There are several types, but at least they are standardized benefit packages (labeled by letters A-N, except E, I, and J; these letters not to be confused with the Medicare Parts A, B, C, D). In addition, you are required to have a drug plan (Medicare Part D), which is an additional expense.

Besides being confusing, that is a lot of expense for TM: monthly payments for Part B, Part D, and your Medigap. On top of that it doesn’t cover all the things you may need or want, like vision correction (glasses; it does cover treatment of eye diseases and surgery), or hearing aids. That facilitates the marketing of Medicare Advantage (officially Medicare Part C), as intended: one easy monthly payment (which, depending upon the MA plan, may be completely covered by Medicare without out-of-pocket payments from you) covers it all – inpatient, outpatient, drugs, and glasses, hearing aids and even gym memberships! Why would you not want this?

I have written previously why you may not want MA (The WiSER program to erode your Medicare coverage: Not WISE for you! Sept 22, 2025, Medicare and Medicaid at 60: Need more -- and more threatened -- than at 50!, Aug 6 2025, and other older posts), which boils down to the fact that they are health insurance plans like the one you had, and can, and do, delay and deny coverage for individuals in order to save money (or, really, make more money!) They usually are HMOs or PPOs with a limited panel of doctors and hospitals for which they will pay. While the Medigap and Part D coverage you need with TM are also sold by the same insurance companies, these benefits are much more explicitly stated and required by law to be provided, although there are certainly efforts to get you to use cheaper drugs (usually not the “ab” drugs being advertised in the next commercial!) If you travel a lot, you may find that MA plans are often based in one geographical area. Also, many “destination” hospitals that people travel to in order to receive excellent care for conditions like cancer (eg., Mayo, MD Anderson) do not accept MA. To a large extent, having an MA plan is like having the insurance that non-Medicare recipients have, warts and all. There are reports (such as in Health Care Un-Covered) that, in addition to raising their rates and cutting benefits, MA plans will be “exiting certain markets” (the unprofitable, or really less-profitable-than-they-would-like markets), leaving residents in those areas without available coverage.

"Health Care Un-Covered", the substack founded by Wendell Potter, also reports on the new report from Physicians for a National Health Program (PNHP) “No Real Choice: How Medicare Advantage fails seniors of color”, that shows MA plans increase (rather than decrease, as they claim) racial inequity.

PNHP’s researchers found that communities of color are being steered into MA plans not because they’re better — but because they’re cheaper upfront. This dynamic, dubbed the “Gap Trap,” means that affordability is driving people into coverage that often denies care, delays treatment and locks them into narrow networks.

The old “cheaper up front but not once you get sick” gambit.

Plus, from the PNHP study:

·       Black, Hispanic and Asian/Asian-American beneficiaries are disproportionately concentrated in MA plans that score lowest on quality ratings, while white beneficiaries are more likely to live in counties served by higher-quality plans.

·       One study found that MA prior authorization requests were denied 23% of the time for Black seniors vs. 15% for their white counterparts.

·       Despite industry claims to the contrary, racial and ethnic health disparities in the United States are not being reduced by Medicare Advantage.

·       Studies show that Black enrollees are more likely than white enrollees to choose a 5-star MA plan when offered one. They’re just not offered them as often.

·       Racial minority enrollees in MA suffer from worse clinical outcomes and face barriers accessing best quality care because of restrictive networks and misaligned financial incentives. Black MA enrollees experience higher rates of hospital readmission compared to their white peers.

When is having insurance worse than not having insurance?

And, while we’re talking about the insurance that people not yet on Medicare and not eligible for Medicaid (ie., most Americans) have, it is (you may have noticed) getting more costly. At the present time the government is shut down over disagreement between Democrats and Republicans (including the administration) as to whether subsidies that made enrollment in health insurance through the Affordable Care Act (ACA) actually affordable should be extended. For those who are fortunate enough to have employer-funded health insurance and do not have to buy plans through the ACA exchanges (154 million people), KFF (formerly the Kaiser Family Foundation) reports that covering a family of four now costs almost $27,000 a year, after two straight years of more than 6% increases, and 26% over 5 years. That is a lot, especially if the family is paying a hefty portion of it (often 50% or more) out of pocket.

It's not a good situation for people not yet on Medicare, not for those on Medicaid, not for those receiving subsidies to buy policies through the ACA, and increasingly difficult for those on Medicare or Medicare Advantage. How about we covering 100% of everything through Traditional Medicare, enroll every American of all ages in it, and fund it by not having to pay insurance companies?

Don't miss laughing at, and more important being informed by, this John Oliver video!

The greatest quality deficit? Physically destroying the health care system, and, oh yeah, the people it is supposed to serve

I have previously quoted from the important JAMA paper by Schiff, Bindman, and Brennan “A Better Quality Alternative: Single Payer National Health System Reform” (JAMA Sept 14, 1994, 272(10):803-808) the observation that “denial of care” is the “gravest of quality deficits”. It is generally hard to argue with this; if people are denied care they are not going to get quality care. While it can be argued that there are some forms of care that is worse than no care, this is clearly not what the authors have in mind. They are talking about the fact that people are denied appropriate care because they do not have money or insurance. More than 30 years later this still rings true, in an America that has not yet seen a health insurance system that covers everyone, as every other well-to-do country has, and indeed is even more threatened by cuts in the coverage that we do have. As I write, the federal government is facing a shutdown, with the Democrats in Congress demanding continued funding for those who received coverage from the expansion of Medicaid under the Affordable Care Act (ACA, “Obamacare”) of 2010, while the administration and Congressional Republicans steadfastly refuse to consider this, arguing mainly the high cost. This demonstrates once again their complete inhumanity and heartlessness, in no small part because earlier this year they cut more than that from the taxes of billionaires.

There are many ways to deny care, and rolling back Medicaid expansion is one. Another is closing hospitals, and many, mainly rural, hospitals, have and will close as a result of these cuts. They can also make existing insurance harder to get and more expensive, as is regularly documented in Wendell Potter’s substack “Health Care Un-Covered” and many other venues. I will talk more about this in a future blog post. But another, really effective, way to decrease access is to destroy health care facilities. Much more efficient than starving hospitals for money by discriminatory, greed-focused funding is actively blowing them up, killing the providers, and eliminating the infrastructure for providing care for anyone, insured or not. This is commonly done during a process called “war”, in which a strategy often adopted goes beyond violating the Geneva Conventions by not caring for enemy combatants, but indeed targets the elimination of the civilian health care infrastructure. The Geneva Conventions provide for not attacking health care providers, for caring for the wounded based on need, not loyalty, and certainly respecting civilian health care (some references: Rule 25 on medical providers, International Committee on the Red Cross, World Medical Association, Wikipedia (Medical Neutrality), among many others). I learned about much of this decades ago from a surgeon who worked for the International Committee on the Red Cross (ICRC) and HAD supervised one of its hospitals in Chechnya during the war there. It was this hospital which military combatants invaded, murdering four nurses. At the time, it was horrifying. Since then, such actions have become so common a practice in the 21^st century that, in itself, it almost refutes the idea that human beings have become more civilized over time.

While there are many places where combatants have used attacks on the civilian population and their health care facilities as methods of imposing their will, the attacks by the government of Israel on the healthcare facilities in Gaza stand out in their extent, persistence in the face of world opinion, lack of any sign of conscience, and contribution to genocide. I am not expert in war, but I know that you are supposed to try to not kill civilian noncombatants, and that you are not supposed to destroy medical infrastructure; these are war crimes. In Gaza both are happening; people’s houses and cities are bombed, thousands have been killed, hundreds of thousands displaced, and the facilities where they might go for care – for problems that occur in peacetime, of course, but far more for those inflicted on them by the military attack on them – are destroyed. On purpose. Repeatedly. As part of an immoral and illegal strategy to “win”, by killing or injuring as many as possible.

Israel, unsurprisingly, and its US supporters in the American Jewish Committee, deny this. They say that what they are doing in Gaza is not genocide, and that what they are doing in killing the people of Gaza as well as destroying its hospitals and other health care facilities and healthcare workers are not war crimes. Of course, what is happening is happening, but they are picking apart word, like the application of a particular term (“genocide”, “war crime”). I am also no expert on the definition of genocide (like, what percent of a group do you have to be trying to kill for it to qualify), but those who are most expert say that what Israel is doing in Gaza is genocide. No responsible independent body has even tried to justify what they are doing. The argument cannot be that “because we are Israel, what we are doing is ok, although it would be intolerable if anyone else did it especially to us”. Nor can it be that “no matter what we do, no matter how horrific or destructive, because we are a Jewish state, any opposition to it is anti-Semitism.” Of course, this position is without logic.

There can be no justification for the Holocaust, for any reason, for anyone. But just as the atrocities being committed by Israel do not mean “Hitler was right”, the fact that the Holocaust happened – and that there is serious anti-Semitism in the world today – does not justify those atrocities being committed by Israel. In true fascist tradition, the government of Israel is not only committing these atrocities, destruction of healthcare infrastructure and healthcare workers, killing civilians including children en masse and starving them, it is blocking international aid from coming to the people of Gaza. These flotillas of boats bringing aid, contrary to what Israel says, are humanitarian and the people doing it are brave and noble. The government of Israel, and those Israelis and non-Israelis who support its actions, are … not. Interested in knowing what is happening in Gaza? There are many sources, but here is a recent article from the NY Times, longstanding Israel supporter on the destruction of Gaza. Or how about the video, if you need visual evidence.

There are terrible threats to the health of the American people, longstanding and persistent threats from greedy and evil for-profit insurers and pharmaceutical manufacturers and PBMs and health systems and private equity. These have been exacerbated by the Trump administration’s hostility to covering all people, such as the cutbacks in Medicaid expansion from the ACA, an issue on which the Democrats have finally shown some spine although the GOP commitment to not spending the money in order to maintain tax cuts for the wealthiest has led to a federal government shutdown. It is a very bad situation for many Americans, especially those with the greatest vulnerability.

But this is almost nothing compared to the attacks on health in many places, and particularly in Gaza. The purposeful destruction of cities where people live, mass murder of civilians, huge displacements of people, augmented by the destruction of the very facilities that might provide some treatment and succor, is without conceivable justification.

The authors of the paper cited at the beginning of this piece were, thus, not correct in saying that lack of access is the greatest quality deficit. That is true when there is a functioning health system and some people are excluded. Actively doing what is done in many wars, and what Israel is doing in Gaza, is a much worse assault on not just quality of healthcare but on health and life itself.