06/12/2026
These findings have recently reached the news… and honestly this isn’t anything new. Unfortunately.
It’s important to remember a few things. First, Medicare advantage is NOT meant for everyone. They do have a few more “hoops” to jump through and also are not as easy for providers and facilities to work with. Do I think that’s ok? Absolutely not. Currently the way things stand when someone enrolls in a Medicare Advantage plan, Medicare is no longer the decision maker the selected carrier is. Just like the under 65 system. However, when someone has traditional Medicare, Medicare determines the yays and nays. They usually do not require as many “hoops” if any and really typically make things pretty easy. That is changing. In some states it already has and in others it is coming. Medicare is going to require prior authorizations and referrals. Do I agree? Again no, but I do know it’s probably necessary. So while the type of care you are going to receive is important to note, the cost is also important this is the part most medical professionals don’t know when they start with “stick with traditional medicare” is that the best solution, probably, if they can afford it. Medicare itself cost $202.90 per month this year, that will continue to increase. Medicare only covers claims at 80% and it provides NO stop loss or drug coverage. So if you want something to cover that 20%, it’ll cost ya. An average Plan G cost is an additional $100ish, usually more, also if you aren’t aging in or losing coverage you have to go through medical underwriting. Which is pretty strict with most carriers so someone with claim history probably isn’t going to qualify. Not to mention these increase annually and can increase dramatically. We have seen some SERIOUS increases the last two years and I anticipate we will be shocked at what still comes.
All this to say, I’m not an advocate for Medicare Advantage plans. However, I’m an advocate for the lesser of two evils and I’ve watched too many seniors stick with Medicare Supplements when their premiums hit $300-$400 a monthly and they just can’t swing it.
So before you come for me on how insurance is a racket. It’s terrible. It’s greed. They are awful humans, how can you represent them. I get it. I don’t LOVE insurance companies. I know they have a job to do just like I do. Doctors do. Nurses, medical professionals, etc. My job is to EDUCATE MY CLIENTS on their choices, make sure they know how something works, make sure they understand the pros and cons and the good and the bad. Many of my clients will tell you I often over educate them because I want them to have a strong argument when someone tells them they need something else.
Insurance is confusing. It’s a BIG decision, especially when it comes to Medicare because choices can be made that sometimes cannot be undone. I hate to see Medicare Advantage companies not treating our seniors with compassion when it comes to the care they are recommended to have but I also know that market is over prescribed, over tested, and over hospital stayed too.
It’s a no win situation but please PLEASE Medical Professionals find an educated Medicare broker to work with before you through insurance advice. I don’t throw out medical advice, because I don’t have any, it’s not my profession. I know you run into billing nightmares and situations where you KNOW what is best for the patient and the insurance company fights you but it’s important to know the other side of what people can afford, what they can’t afford, what they can get and what they can’t.
And that’s my Ted talk for today. Happy Friday friends 🙃
Questions? Feel free to reach out anytime.
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