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!

Will the GOP "solve" access to health care? No, unless you can redefine "access"!

An editorial in the New York Times on February 20, 2017 (“Ryancare: You can pay more for less!”) does a very good job of concisely demonstrating what the new Republican plan is likely to do to access to health care, the cost of health insurance, and what it covers. The key to House Speaker Paul Ryan’s plan for replacement of Obamacare involves “…flat tax credits unrelated to income, that could be applied to the purchase of insurance” (Paul Krugman, “Death and tax cuts”, NY Times February 24, 2016). As Krugman makes clear, the credits would be insufficient for low and middle income families to buy insurance, but would be a small benefit to high income households. The obvious result would be the loss of health insurance for millions of Americans who gained it through either the ACA exchanges and accompanying subsidies or through Medicaid expansion.

Giving tax credits or deductions is a long-standing Republican strategy that pretends to be equitable but in reality always benefits the financially better off. Ivanka Trump (the President’s daughter who is not, it should be observed, elected or even appointed to anything) has her pet project, tax deductions for childcare. Again, this sounds good, especially to the more well-off, two-income couples who would benefit (but don’t get your hopes up; the $500 billion tab makes it unlikely to pass even with the First Daughter’s support), but would be of less benefit to the poor. The one thing that is certain about Republican and Trump policy is that it will benefit the better-off; the problem with such deductions, from their point of view, is that it is costly and doesn’t benefit a narrow enough slice of the highest income individuals and corporations (sorry, Ivanka).

As summarized in MedPage’s Washington Watch Policy Papers on ACA Repeal: Many Question, Few Answers, no one, outside the Republicans pushing it, has any belief that the Ryan plan will provide coverage for most of the people who gained coverage from the components of the ACA, not to mention those who remained uninsured even with ACA in place, mostly poor people in states that did not expand Medicaid and undocumented people, as well as those who risked the penalties for violating the individual mandate rather than buy health insurance that they felt they could not afford. The first two groups are completely left out of any “replacement” plan (and of course undocumented people were never part of Obamacare). None of these plans will in any way benefit the middle and lower income people who voted for Trump in part because they wanted to get rid of Obamacare, which was costing them too much, and get the terrific, affordable health care coverage that the President promised them in the campaign. It is not going to happen, and people are beginning to understand that; CNBC reports that Obamacare is getting more popular in the first month of Trump’s presidency.

All that has been revealed so far about the content of a Republican “plan” indicates that it will cover fewer people than the ACA currently does. Some of this has to do with the mechanism of funding, with “tax credits” replacing direct subsidies for lower-income people. There is even a debate among Republican lawmakers about whether those tax credits should be “refundable” or not; if they are, then people will get the amount designated for the tax credit even if that amount is greater than the amount they would have owed in Federal income tax. Thus, it would be a subsidy, and thus many “conservative” (their word) Republicans oppose it. For a very large percentage of those who would be buying insurance and need help, the amount would likely be greater than the amount of Federal tax they owe. Of course, this depends upon how much the tax credit is determined to be; one thing, however, is that there is essentially no chance that it will be enough to actually purchase insurance.

Which brings up another big part of the way Republicans talk about health coverage. They use the term “access” rather than coverage, and have defined it in such a way that it is different from coverage; people, they say, will have the option of buying health coverage, not be forced to, the way that the ACA’s individual mandate did. This requires a conscious effort to ignore the crucial “ability to pay for it” as part of access, and makes the idea of “option” insincere. Something is not an option if you cannot afford it. Sen. Bernie Sanders said, in a good takedown of this use of “access”, that he had access to purchase a $10 million house; he just didn’t have the money to do it!

Insurance companies are a big part of the problem for ACA. The absence of a “public option”, not to mention a single-payer plan, meant that the law had to build in a way for insurance companies to be able to make money. To be able to profit, they have to either be able to charge a lot for coverage (or deny it altogether) for sick people, which was the pre-ACA status quo, or have a large pool of healthy low-cost people buying insurance. Thus, especially given ACA’s elimination of their ability to refuse insurance to people with pre-existing conditions, the individual mandate, requiring everyone to buy insurance, was needed. Despite the mandate, though, not enough healthy people bought insurance, and there was no rate cap, so it quickly has become unaffordable for many. Of course, we could have done what other developed countries do – have either a single-payer system where we have everyone automatically in the risk pool and everyone is actually covered, or have a highly regulated system, where benefit packages and rates are set by the government and insurance companies are non-profit, so compete on customer service. We actually have examples of both in the US. Medicare is a single payer plan (and while Medicare Part A, hospital, is paid for by the Medicare trust fund, Part B, doctor and outpatient bills, require individuals to pay, with high-income  people paying a supplement), as is the military health care system and the VA. Medicare supplement (Medigap) plans are regulated with regard to benefits; there are a number of plans lettered Type A to Type N (except there is no E, H, or I) with different benefit packages. The degree of comprehensiveness does not follow the alphabet (F is the best, K probably the worst) but at least they are standardized so all Type A, C, F, or K plans offer the same benefits regardless of which company you buy from, and so you can shop based on price.

I do not think that we are going to have such a simple situation as a highly-regulated marketplace, and certainly not single payer. We are likely going to back as far away from comprehensive coverage and affordable health care as the Republican Congress and President can get away with, which means as far as the American people will allow. Of course, the American people (other than the small number of, but incredibly powerful, wealthy ideological conservatives) do not want to lose their health coverage; they just want to pay less. Or not pay until they are sick. For them, and maybe for their families. For others, maybe not so much; some studies have found that as many as 2/3 of Americans support Medicare for All, while for Dr. Paul Gordon on his “Bike Listening Tour” across the US in 2016, one of his most upsetting findings (at least among the mostly white, rural, northern people he interviewed) was people’s lack of concern for others. Or at least “the other”, folks not like them.

It’s a real shame. We could have comprehensive quality care for everyone, at a more reasonable cost. Too bad the ideologues and the greedy are in control.