Traditional Medicare…Disadvantaged?

(By Tricia Neuman for Kaiser Health News)

Sometimes it takes a call from a friend to take a fresh look at what’s going on in Medicare.  My friend Craig, a rugged Coloradan, turned 65 a few years ago and signed up for a Medicare Advantage plan.  At the time, this decision was easy.  He wanted to stay with the same insurer he had before he was eligible for Medicare.  He liked the convenience of having one plan (his Medicare Advantage HMO) instead of three (traditional Medicare, a supplemental Medigap policy, and a separate Medicare drug plan).  He also liked the fact that his monthly Medicare HMO premium was lower than what he would have paid, had he opted for traditional Medicare with separate Medigap and Part D policies.

So far so good until he had a serious mountain-biking accident, was rushed to the emergency room, and in the course of getting patched up, learned that he had tumors on his spine and would likely need surgery.  After seeking a second opinion, he concluded that the best and most experienced surgeon was one who was out of his plan’s network.  His HMO denied his appeal to be treated by the out-of-network surgeon.  Had he stayed in his HMO and opted for that surgeon anyway, he could have been on the hook for the full cost of his surgery – a financial non-starter. Read Article here……

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


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