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I WENT TO SEE MY primary care physician about a medical problem. I actually felt pretty good and wasn’t in any pain. I was fairly confident there wasn’t anything seriously wrong with me, so—when the doctor greeted me and asked how I was doing—I said, “I’m doing well.”
When he responded, “No, you’re not,” I knew this wasn’t going to go well.
I gave him my explanation of what might be causing my physical condition. After listening intently, he said, “I’m not buying it. I don’t believe what you’re telling me. That’s not what’s causing your problem. We need to run some tests on you.” He also suggested I see a specialist. Between the two of them, they ran me through a month-long battery of tests, one after another.
I tried to remain positive by telling myself there’s nothing seriously wrong with me, because I take good care of myself. But after a while, the unknown began to wear me down and my mind went to places I didn’t want to go.
I started going over my finances to make sure everything’s in order. I thought, “I’m glad my wife and I consolidated our financial accounts. It’ll make it easier for her to manage if something unexpected happens to me.” I thought of things around the house that needed to be addressed. I fixed the annoying garage door that seems to have a mind of its own. Another thought that kept banging around inside my head: Maybe I should have claimed Social Security at an earlier age.
I kept my medical adventure to myself, telling only my wife and a close friend who’s fighting his own health care battles. My reason: I just wasn’t ready to share it with anyone else.
As I went through this medical ordeal, I was glad I’d chosen federally run Medicare instead of opting for Medicare Advantage, the private insurance alternative. Because I have traditional Medicare, I didn’t have to wait to get approval for any of the tests and for my appointment with the specialist. Also, I wonder if Medicare Advantage would have approved all the tests that my doctors recommended. Even if a Medicare Advantage plan had approved them, how long would it have taken and how much would the co-payments have been? These are the types of things you don’t think about until something happens to you.
Medicare Advantage is okay if you’re fairly healthy. But if you have something seriously wrong, you’re relying on a private insurer with a network of doctors to provide you with timely, adequate and affordable health care. With traditional Medicare, you have more control over health care decisions. For instance, I could have easily gotten a second opinion or changed doctors if I were dissatisfied. That alone greatly eased my mind while going through this ordeal.
At this point, my medical problem seems to have gone away and, so far, they haven’t found anything wrong with me. I can see the light at the end of the tunnel.
My specialist, however, wanted to run one more test on me to make sure something hadn’t gone undetected. Before he starts the exam, he explains that I’m going to feel some discomfort. To help me feel more at ease, he and his assistant talk to me while they perform the procedure.
The assistant is a young man going to the University of California, Irvine. He begins the conversation by asking me if I have any vacation plans and what I do for fun. He tells me he’s applying for medical school and has been writing a lot of essays. I tell him I do some writing myself.
This catches my doctor’s attention, who finally speaks up. “What do you write about?” he asks.
“I write about personal finance,” I say. There’s dead silence for about a minute. There are no follow-up questions. I get the feeling that my doctor and his assistant are disappointed. They were probably hoping I wrote about something more exciting. Then again, maybe they think that, at this moment, there are more important things to discuss than money.
Dennis Friedman retired from Boeing Satellite Systems after a 30-year career in manufacturing. Born in Ohio, Dennis is a California transplant with a bachelor’s degree in history and an MBA. A self-described “humble investor,” he likes reading historical novels and about personal finance. Check out his earlier articles and follow him on Twitter @DMFrie.
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I think that the decision about Medicare Advantage depends on the plan and where you live. My Medicare Advantage plan includes 100% of the local hospitals and 99% of local physicians. I don’t need a referral for a specialist. The premium is currently zero other than the standard Medicare B premium (which is deducted from my Social Security) and drug coverage similar to Medicare E is included. They have higher-priced options but they mostly just decrease copays. Since there is a yearly maximum on out-of-pocket expenses, I don’t so the need for something else.
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Dennis- love your articles! Will pray for your health.
Dennis, best wishes for your health outcomes.
Glad you made it through that unsettling time and are OK healthwise. And I agree with you about the advantages of traditional Medicare—after decades of dealing with traditional insurers, it’s been a breath of fresh air for me.
I agree, but unfortunately the fact Medicare does virtually no pre- service or medical necessity review and little retrospective review of claims could be its downfall cost wise.
There is a high degree of fraud and several audits indicated paying for unnecessary or ineligible care. Toe nail cutting is a big fraud item, although not high unit cost.
I’ve been retired for 20 years, the last half on Medicare. Prior to reaching 65, I managed the health and financial affairs of my parents and my in-laws. My parents were in Medicare Advantage and my in-laws on traditional Medicare. I see the differences more in terms of financial impact. Traditional Medicare plus a supplement is more expensive in terms of what is paid in premiums while Medicare Advantage has lower premiums but more usage based costs. For many, including my parents, the additional premium cost of the supplement is not affordable and Medicare Advantage is the only practical alternative to choose. For my parents, obtaining medical services meant a lot more work than for my in-laws. Every specialist visit had to be preceded by a primary care visit. Primary care providers and specialists in their Medicare Advantage network were very busy and scheduling was sometimes difficult. In the end, I think my parents received adequate care.
In our own situation, because we escape the wet PNW Winters each year by going to AZ, Medicare Advantage wasn’t the best choice for us. To my knowledge, there is no MA plan that will let you obtain services easily in two different states. Fortunately, we can afford the premiums.
First I hope you are well.
I think your criticism of Medicare Advantage plans is unfair.
It’s accurate alright, but not the total picture. I too have basic Medicare for exactly the same reasons you stated. I want total freedom when seeking care. I managed health plans for many years and know how it all works.
Most employer and private plans operate the same a MA plans and for the same reasons, not to add to profits but to keep costs under control. Keep in mind that 60-70% of workers are in self-insured plans where there is no insurance company profit issues.
Nearly 40% of those age 65 have selected MA plans and the number grows each year. They do so because of their total cost, some simply cannot afford Medicare plus Medigap and Part D. In exchange for the limitations, there is added value for many, more for the sick than the well. Most important you need to verify that your desired providers are in the MA network, not unlike PPO plans and HMOs.
My choice as yours probably carries a high price tag each month when you consider Part B, Part D and Medigap. The average retiree will pay about $400 a month, $800 for a couple.
I often ask in doctors offices which plan they deal with is the least hassle, the answer has always been Medicare. That is because there is virtually no pre-certification or authorization and very little retrospective review. Medicare just pays what is submitted and fixes the reimbursement rate.
On the other hand, the GAO and others have repeatedly criticized Medicare for its lack of scrutiny before paying claims. Not only does that add to costs, but many will argue it leads to poorer health care. Unnecessary, duplicative and sometimes risky care can be harmful. Even physicians acknowledge that up to 25% of health care is unnecessary.
If Medicare is expanded or even if it becomes a universal plan, it cannot continue to operate as is. Total freedom seeking and receiving health care is just not compatible with affordability.
The interesting thing about some of those Medicare comments is that under regular insurance there is a lot of wasteful medicine as well, mostly incurred to meet insurance company cost saving requirements, ironically enough. Procedures that doctors are pretty sure won’t work are mandated before the procedures that doctors believe will work will be approved for payment, for example. I’m not sure that Medicare isn’t actually superior to a private insurance industry. Their overhead is about 1/3 lower, but that savings is because they get support from other gov’t agencies, so i’d say when it comes to basic Overhead, it’s a wash. The difference really appears to be in “fraud prevention” costs.
I am curious about medical fraud because private companies often spend 10-15% of revenues on – pick one – “fraud prevention” or “denial of care” (anecdotally it seems to be some sort of blend) – while Medicare spends very little.
Anyways, about 7 or 8 years ago I tracked down fraud data for private industry vs medicare. To my surprise, the numbers I had were about the same amount of fraud per customer (i.e. $ fraud experienced / # of people covered under policies). I’m sure that there are other ways to measure this kind of activity that are more informed, and I may have had marginal data or unknowingly linked unrelated information, but i’d be interested in learning if anyone else has tried to dig out this kind of data…
Dennis: Glad things worked out OK for you on your most recent health scare. I’m a firm believer in keeping things as simple as possible. You made the right choice in sticking with traditional MEDICARE. The “Kabuke Dance” process of getting specialist pre-approvals is a time-consuming nightmare. In a closing note, I always enjoy reading your insightful articles and your emphasis on declaring (financial) victory, pushing away from the table; and, enjoying life. The very best to you and Miriam.
You’re absolutely right about sticking with traditional Medicare, and people who state otherwise have no health issues. Frankly, Medicare Advantage plans ought to be called disadvantage plans as not only do you limit your medical providers, your out of pocket expenses with a larger bill cost will end up costing more than if you are on traditional Medicare. The older you get the more likely you’ll have involved claims, and this is not even a discussion…stick with traditional Medicare.
I’m sorry you had to go through this uncertainty, but I find not much of value in your article. Basically you are presenting your vague perceptions of the differences between traditional Medicare and MA, but providing no evidence or even personal experience to justify your assertions that in this case traditional coverage is advantageous.
I would also have like to have seen specifics and references to support Mr. Friedman’s comparison of traditional Medicare with MA. For example, it might have been useful to note that the Center for Medicare Advocacy criticized the Centers for Medicare & Medicaid Services for weakening the standards for MA networks last year.
https://medicareadvocacy.org/final-rule-for-medicare-parts-c-and-d-includes-weakened-standards-for-medicare-advantage-networks/
Thanks for the insight Dennis. Hope all a well.
Thank you Mr. Friedman. I wish you the best of health.