AUTHOR: Lucretia Ryan on 7/6/2025 FIRST: Dan Smith on 7/6 | RECENT: David Lancaster on 8/17
Comments
I'm glad you've had positive experience with Kaiser Medicare Advantage. However the key things to keep in mind is that may not be everyone's experience. Kaiser as with any Medicare Advantage plan you need prior authorization for many procedures. In addition even though your plan may be a PPO you may only be able to see the doctors and hospitals in the Kaiser network. Even if your Kaiser plan says you can go out of network, that is only if the out of network provider is willing to take the out of network plan. Many top hospitals and specialist won't. For me, if I'm sick I want to be able to go to the top hospital, see the top specialist, without any prior authorization any where in the country to improve my healthcare outcome. If you're not too sick, Medicare advantage plans may work out fine. But I like to go with the higher odds of Original Medicare and a G Supplement.
I think it is risky. You're better off getting a High Deductable G plan and investing the difference. Also unless you live in New York, Mass, Maine or Conn you may not be able to find an insurance company that will sell you a supplement because of pre existing conditions, https://www.financialfreedomforwomen.org/healthcare/surprise-your-medicare-coverage-isnt-guaranteedheres-what-you-need-to-know
Thank you. Thanks for pointing out how the current administration is bringing prior authorization to Original Medicare. The federal government (CMS) will choose and pay companies a percentage of the healthcare that they deny using AI
https://www.financialfreedomforwomen.org/healthcare/a-major-medicare-protection-just-vanished
However it there is still no comparison to the thousands of procedures that require prior authorization in Medicare Advantage
I would be very careful about choosing a health plan that is not on the ACA marketplace. You could be charged with a huge bill because they don't follow the rules of the ACA. Here is an article I wrote. https://www.financialfreedomforwomen.org/healthcare/retiring-before-65-how-to-avoid-health-insurance-nightmares
Good article. Thank you for sharing. I'm all for reducing waste and unnecessary treatment but the CMS should hire doctors on a salary to determine if it is necessary not hire a for profit company that is only receives commission when they deny care. Denying care is exactly how the Medicare Advantage companies make money. https://www.financialfreedomforwomen.org/healthcare/did-prior-authorization-killnbsp-a-ceo
Any Medicare Advantage company will take you. These for profit companies are paid at least $1,000 a month by the federal government because you are giving up original medicare. If they can upcode you with additional diseases they get even more.
I hope I was clear. This is in no way an endorsement of Medicare Advantage which has hundreds of prior authorizations. I just wanted to alert people to what the current CMS is doing to our healthcare
Comments
I'm glad you've had positive experience with Kaiser Medicare Advantage. However the key things to keep in mind is that may not be everyone's experience. Kaiser as with any Medicare Advantage plan you need prior authorization for many procedures. In addition even though your plan may be a PPO you may only be able to see the doctors and hospitals in the Kaiser network. Even if your Kaiser plan says you can go out of network, that is only if the out of network provider is willing to take the out of network plan. Many top hospitals and specialist won't. For me, if I'm sick I want to be able to go to the top hospital, see the top specialist, without any prior authorization any where in the country to improve my healthcare outcome. If you're not too sick, Medicare advantage plans may work out fine. But I like to go with the higher odds of Original Medicare and a G Supplement.
Post: Don’t make the wrong Medicare decision
Link to comment from October 26, 2025
I think it is risky. You're better off getting a High Deductable G plan and investing the difference. Also unless you live in New York, Mass, Maine or Conn you may not be able to find an insurance company that will sell you a supplement because of pre existing conditions, https://www.financialfreedomforwomen.org/healthcare/surprise-your-medicare-coverage-isnt-guaranteedheres-what-you-need-to-know
Post: Don’t make the wrong Medicare decision
Link to comment from October 25, 2025
Thank you. Thanks for pointing out how the current administration is bringing prior authorization to Original Medicare. The federal government (CMS) will choose and pay companies a percentage of the healthcare that they deny using AI https://www.financialfreedomforwomen.org/healthcare/a-major-medicare-protection-just-vanished However it there is still no comparison to the thousands of procedures that require prior authorization in Medicare Advantage
Post: Don’t make the wrong Medicare decision
Link to comment from October 25, 2025
I would be very careful about choosing a health plan that is not on the ACA marketplace. You could be charged with a huge bill because they don't follow the rules of the ACA. Here is an article I wrote. https://www.financialfreedomforwomen.org/healthcare/retiring-before-65-how-to-avoid-health-insurance-nightmares
Post: Healthcare Insurance Alternatives to Covered California Marketplace
Link to comment from October 17, 2025
Good article. Thank you for sharing. I'm all for reducing waste and unnecessary treatment but the CMS should hire doctors on a salary to determine if it is necessary not hire a for profit company that is only receives commission when they deny care. Denying care is exactly how the Medicare Advantage companies make money. https://www.financialfreedomforwomen.org/healthcare/did-prior-authorization-killnbsp-a-ceo
Post: A major Medicare benefit just vanished
Link to comment from July 8, 2025
If you believe this I have a bridge for sale.
Post: A major Medicare benefit just vanished
Link to comment from July 7, 2025
Great article. Thank for posting
Post: A major Medicare benefit just vanished
Link to comment from July 7, 2025
Any Medicare Advantage company will take you. These for profit companies are paid at least $1,000 a month by the federal government because you are giving up original medicare. If they can upcode you with additional diseases they get even more.
Post: A major Medicare benefit just vanished
Link to comment from July 7, 2025
I hope I was clear. This is in no way an endorsement of Medicare Advantage which has hundreds of prior authorizations. I just wanted to alert people to what the current CMS is doing to our healthcare
Post: A major Medicare benefit just vanished
Link to comment from July 6, 2025
I’ve seen enough details to see the devil in it.
Post: A major Medicare benefit just vanished
Link to comment from July 6, 2025