Dec 1, 2022·edited Dec 1, 2022

It is so frustrating not to be able to get to the root of what is being presented, namely WHY is it a "disadvantage" for us over-65s to get medicare advantage instead of medigap. I am currently not paying anything at all for my Tufts advantage program. I understand that it is less flexible in selecting doctors than a medigap program would be, but it's FREE (after I pay my $170/mo). Why is that not a better deal than medigap, which is not free? I really want to know! Thanks, C. Field (Massachusetts)

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I wish you had covered the following things, even for 2 minutes in your talk.

A comparison:

What’s it cost just for Medicare alone? I pay $170/month out of my social security.

What are the benefits and limitations of Medicare alone?

How much extra do you pay for Medicare advantage?

Is it the same for everyone?

How much is it for Medicare with Medigap?

what’s I wish you had covered even for 2 minutes in your talk.

I hate health insurance companies – we really need a single-payer system. But at the same time, I think you and Ralph need to disclose the difference with and without Advantage, what it costs, and more about Medigap policies.

Just as Ms. Heiter mentioned here in the comments, just changing over without knowing the risk, could be financially devastating if someone blows off the “advantage program” without thoroughly checking on exactly what is covered, and what isn’t. Should they need ER, or a hospital stay, it could easily wipe them out financially. With Blue Shield a couple years ago, for a 2 1/2 hospital stay I paid maybe $150. If I had Medicare only, I'm assuming that would have paid 80% and the balance would have been close to $5,000. I don't know what it would have been with Medigap, or even if that's different from what I have already.

Please set me straight if I’m wrong or misunderstood something, but that’s my concern.

Also, FYI, when I wrote Ralph about this before and asked about those kinds of details, he didn’t seem to know.

It's important to disclose these things I believe.

John Glascock

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Hi. I am a primary care physician with 50 years working and also a traditional Medicare participant.

Part C Medicare is also know as Medicare Advantage. It is basically private health insurance and the insurance companies are paid a yearly benefit from the government for every person they sign up to their plan. They refused to originally participate unless they were awarded this benefit. And it this money that the government wants to stop supplying and the Advantage programs all cry that the government is trying to take your Medicare away from you. That is just one issue.

Traditional Medicare has Part A which is mostly hospital coverage and does not cost you extra if you have paid adequate Medicare taxes over the years. Part B is outpatient mostly physician services coverage and costs a monthly fee that usually comes out of your social security payment. Ten years ago it was approximately $90 per month, now it is around $170 per month. This covers 80% of your outpatient costs. The other 20 % is either out of pocket, through Medicaid, or by purchase of a Medigap policy, which there are about a dozen give or take depending upon your state, and are listed by letters. These plans give the same service no matter what insurance company underwrites them. The plans can range from approximately $60 per month up to approximately $200 per month, depending on high or low deductibles and services offered. You can change these yearly if needed. Part D Medicare is prescriptions coverage and is the most tricky, because of the yearly changes in their formularies. These also are handled by private insurers contracted with the government. Some plans have deductibles and the prices range from approximately $50 per month to $200 per month.

Medicare Advantage may or may not have prescription coverage. The monthly premiums for Advantage plans are very low but this is a HMO program with restrictions on certain services and clinicians, and there are co- insurance payments. Services such as dental, hearing aids, eye glasses may be covered but there may be restrictions on amounts. The main issue with Medicare Advantage, if one follows the news, is the ever increasing costs to the government by these programs, with issues of over-coding to a more complex visit so reimbursements are higher. It is just a matter of time before the government says enough is enough and cuts backs massively on payments. And while a person may only note that their monthly premiums are low or nonexistent with Advantage, the crisis of costs continues on a much greater scale than traditional Medicare. As noted the overhead of Traditional Medicare is 2% and that of the Advantage programs are 15%.

There is something inherently wrong with insurers making huge profits off of the illness of our citizens, and greater profits by denying care in many cases. That is why I and many of my brethren physicians call for a simplified one payer Medicare for All system, a system that all other industrialized countries provide through taxes.

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Best books I ever read- and videos - Your Not Sick Your Thirsty Dr. Batmangliesh and Contagion Myth by Dr. Tom Cowan MD-

have not been back to a doctor or sick since reading these books!


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Too bad someone who doesn't know what is going on in Medicare would be giving such false information. As a Medicare Broker who educates beneficiaries in ALL the ways of getting their Medicare benefits, it does not matter to me what Medicare option a client gets, however it is my job to give them ALL the details and advice based on their individual situation and health. How dare someone who hasn't gone thru all the licensing and training that an actual licensed broker has give any type of advice as to what is best for the general public! He can join the ranks of Joe Namath and Jimmy JJ Walker. Shame on Nader for being part of the problem instead of the solution!!!

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Great show about the MA programs but you didn’t answer the 20% question.

If you have Medicare and cannot afford the 20% or supplemental then what??

Medicare should privide a low cost supplemental? Or go to co-pay model of $50 a visit, etc?

Overuse can be cured by online requesrs for tests using algorithms and AI and having strict penalties for cheaters.

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