The Medicare Advantage ripoff every American should know about

[Ms. Toad]

118. It isn't really an option, if you can guarantee your health.

MA plans can be swapped annually. You can also add them if you start out with none (but only during open enrollment - so if you get a catastrophic illness in January you'll be stuck with that 20% expenses for most of a year before you can get on a plan. So if you're going with MA, at least get a cheap/free one when it becomes available to make sure you have something to fill in the 20% (it is 80% coverage).

My spouse didn't sign up for a Medigap plan until she was 70 because she was covered on my plan. So she was entitled to guaranteed issue (they can't deny her) at the community rates (no physical to decide how much to charge her).

I don't recommend going with MA - for the first reason you mentioned. Generally, when people think about switching from MA plans to Medigap plans is when the expenses get too high on MA (because you have a chronic or expensive illness, and are hitting the out of pocket maximum each year). The problem is that you may fail the physical (and not be able to get a plan at all) - AND - even if yoyu can get a plan it will be much more expensive because they can base the charge on your current health (and even if you get better it will be high for the rest of your life).

It even gets a bit more complicated - because once you get into the Medigap plans you can't change to a different one without a physical (and potentially higher charges). So the choice really is whether at any point before you die you will need a Medigap plan - and if so, you need to choose the one you will ultimately need now.

MA plans have three distinct disadvantages: limited networks, potentially high out of pocket maximums, and lots of gatekeeping that delay or deny care.

If you ever have a rare condition, it helps to be able to go to the people who specialize in those diseases. I have a sarcoma (rare, aggressive cancer) - the best place is in Texas. It is an aggressive enough cancer that time is of the essence, and there's not a lot of data for some of the potentially valuable plans.

Limited networks: Most MA plans would not allow me to go to Texas, since I live in Ohio - and the network would be limited to Ohio. On my Medigap plan I can go anywhere in the US and have some coverage outside of the US. (And that's just the out-of-state restrictions. Even within the state, my network might not have covered the Cleveland Clinic, where I get my care.)

Potentially high out of pocket maximums: So far my sarcoma isn't very costly - but some people have millions of dollars of expenses each year. Even the best MA plans have an out-of-pocket max that you have to pay before the money drain stops for the year. And then it starts again the next year. Insurance plans are built on the premise that big expenses don't come along very often - so you can manage up to $8000 in a single year. But when your expenses are high enough that you hit $8000 every year it is not really sustainable. There are plans with lower caps - but other coverage may not be as good. And with a chronic illness it is an every year expense.

Gatekeeping: Medicare/Medigap cover expenses largely without question or pre-approvals. So when I needed an MRI before surgery I was able to get it immediately. On MA I would have had to have pre-approval adding a potentially deadly delay (even if it was approved). If it was denied, and I had to appeal to get it it would have been months (even more likely to be deadly).