Many of our patients above the age of 65 have the challenge of sorting through Medicare insurance options through the Social Security Administration (SSA) that all Americans who have paid into the system (40 quarters to be exact) are eligible to receive when they reach retirement age.  For many people, Medicare is the only way they can afford medical care.  

Amos has been receiving a lot of unsolicited advice about Medicare in the last few months.  All of us will have this experience upon eligibility for Medicare or when there is an open enrollment.  Medicare is broken up into three main parts:  Part A covers things like inpatient hospitalizations; Part B pays for outpatient services and medical equipment; Part D is the medication/pharmacy benefit.  Sometimes adults eligible for Medicare opt for Medicare Advantage because they believe it will give them more support/resources when navigating the health care system.

Medicare Advantage is Medicare plan that a commercial insurance provider buys out from Medicare and provides services to patients; examples are the Kaiser Senior Advantage plan and Anthem Medicare Advantage plan.  Medicare Advantage is significantly more expensive than traditional Medicare. That might be acceptable if there were also significantly better outcomes for enrollees.  For many who have limited financial resources and may only have Social Security or SSDI (Federal Disability), using their small government check may be the only way to cover the cost of Medicare premiums.  The option of applying for Medicaid to receive QMB (the state pays the Medicare premiums) is only available to people who have extremely low income and assets.

The original intention of Medicare Advantage was that it would be better because eligible people would be able to afford to use their insurance for preventive treatments/screening. The hope was to avoid a health catastrophe that might lead to debility and death and significant out of pocket expenses.  The barriers to health equity are not just cost of insurance. There are many other social determinants of health such as health literacy, transportation, lived environments and many others.  What is needed to address the individual issues and individualized plan.   A recent study in JAMA suggests that Medicare Advantage is mostly working for the insurance company, not so much for the individual patients and families and certainly not for the Medicare Trust Fund. We have attached the article below.

Here is a link to the Federal Medicare website: Get started with Medicare | Medicare

And here is a link to the JAMA article regarding Medicare/Medigap insurance: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793106?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=wklyforyou&utm_term=060822