Jan 31, 2021

Medicare Advantage Programs Continue To Gain Members

About 40% of Medicare recipients, 24 million out of 62 million, including this Blogger are choosing Medicare Advantage PPO's and HMO's, rather than having straight Medicare alone, or with a costly Medigap supplement.  This means that they are signing up for part C of Medicare, which allows for private medical insurance companies to provide their benefits.  So the notion of single payer government health care for many Medicare recipients is just not true for lots of people.  The only people on single payer are people who just have Medicare with no private medical insurance one way or another and that is a dwindling number because there are high deductibles and co pays that are often avoided with private medical insurance in place.  In other words, it would be dumb to be on straight Medicare, which by the way many doctors will not take.  

Specific to Medicare Advantage, when the recipient opts for the PPO or HMO options, the government pays the insurance company premium, which is about $10,000 or more per year per person.  The recipient may then choose a Zero premium plan or in some cases choose to pay a low monthly premium, usually $40 - $80 a month, which comes out of the Social Security payment.  Zero premium plans generally will have higher deductibles related to hospital care.  

Medicare Advantage PPO plans allow the recipient to go to any doctor or hospital in network without the need for a referral from a primary care doctor.  Medicare Advantage HMO Plans require a referral from a primary care doctor to go to a specialists and there are fewer options related to doctors or hospitals in the program so it is more restrictive.  However, in general there is less out of pocket expense than in a PPO plan.  So lower income recipients are better off choosing the Medicare Advantage HMO plans.

Medicare Advantage Plans have gained in popularity because they typically cover dental, eye care and hearing aides and other benefits, in addition to regular doctor visits and hospitalization.  Seniors like the comprehensive coverage they get from these plans.  And, since this involves private medical insurance, there is lots of competition so these companies keep adding benefits each year to keep their customers from going to another company.  If current trends continue as 10,000 Baby Boomers turn 65 each day for the next 15 - 20 years, it is likely that the vast majority will choose Medicare Advantage Plans.