My father-in-law picked his Medicare plan the way most people pick a Wi-Fi password. Fast, once, and never again.
So when more than 40 House Democrats filed a bill this week to cut payments to Medicare Advantage plans, he is who I thought about. The Journal’s opinion page fired back the same day, with economist John Goodman calling it “arguably the best healthcare program we have.”
Both sides are shouting past the only question that matters to an actual retiree. Does this plan cover your doctors, your drugs, and your worst year?
More than half of Medicare enrollees have already voted with their enrollment forms and gone private — 68% among low-income beneficiaries in 2023. A $0 premium with dental and vision thrown in is hard to argue with when the budget is tight.
The fine print
Here is what the op-ed page will not put in the headline.
Medicare Advantage networks are narrower than traditional Medicare’s. Prior authorization — the insurer approving care before you can get it — can stall treatment when you least want a delay.
And the least-understood trap is the switchback. Leave Medicare Advantage after year one, and in most states the Medigap supplement — the private policy that makes traditional Medicare affordable — can require medical underwriting. Underwriting means being priced by your health history.
Read that again slowly. The very conditions that made you want out can get you charged more, or turned down flat. That is the door closing behind you.
None of this makes Medicare Advantage wrong. It makes it a contract, and contracts reward the person who reads them.
Compare the worst year
On the insurance side of planning, this is the whole ballgame. You do not compare the shiny $0 premium against a good year. You compare the out-of-pocket maximum — the most a bad year can cost you — against your worst one.
A $0 premium with a $9,000 cap is not free. It is a deductible in a costume.
Insurance is the one product you buy for your worst day. So the worst day is the only honest place to compare from.
The checklist runs against your own life, not a slogan. Your doctors, by name. Your drug list and its formulary tier — the pricing shelf your medicine sits on. Whether you winter in Arizona. And how long the Medigap door stays open in your state.
Watch the calendar
Now the good news buried in all this: almost none of it is permanent if you watch the calendar.
Plans rewrite their networks and formularies every single year. Last year’s right answer can quietly become this year’s wrong one while you do absolutely nothing.
Open enrollment opens October 15. September’s notice-of-change letter is the forecast — reading it now is checking the roof before the rain, not after the ceiling drips.
A review runs about fifteen minutes. Bring your plan statement and your list of doctors, and we will run the one-page version with your own numbers in it. General principle, not a plan recommendation.