If, for example, you learn that you have a serious illness and there is a high-quality first class medical center a few hours drive from your home, where all the best equipment and all the smartest and most qualified specialists are located, just get in your car and drive there if you have genuine Medicare and a Medicare Supplement Plan - It's your decision and your right and you're covered!
If you have an "…Advantage" Plan however, good luck. You will have to apply for your insurance company's permission and they will most likely tell you, when they get around to it, that no, that medical center and those physicians and specialists are "not in our network" and will give you the names of some doctors locally, doctors who, if they were really highly qualified and experienced in that speciality would be working at that nearby high-quality first class out-of-town medical center and not officed in your hometown!
The real-life experiences I referred to above are based upon both personal experience and the experiences of close friends and relatives with real-life medical developments, not on campfire stories. And my background in the insurance industry.
For a few reasons why "Medicare Advantage" is a scam both to its policyholders and to the taxpayer, you might want to take a look at:
The Trouble with Medicare Advantage
http://www.healthbeatblog.org/2008/07/t ... e-wit.html
It's a real eye-opener and the situation is even worse today than in 2008 when the article was written. An excerpt:
Respectfully, NateEven though these plans are marketed as nationwide and have no networks – this is false. They limit access to care and choice because significant numbers of doctors and hospitals have refused to accept the card, especially out-of-state. For example, many West Virginia retirees who moved out of state could get no doctor to accept the private MA plan.
MA private fee-for-service plans may offer additional benefits, such as gym memberships (the only major additional benefit in West Virginia), or hearing aids and eyeglass coverage, but they modify their benefits to cut corners in more important areas, such as limiting hospital days or charging higher co-pays for nursing homes than Medicare. Indeed, officials in West Virginia actually told a state legislative committee in November that “we know that … retirees who use more medical care will be worse off under this plan”.
PFFS plans more frequently deny claims in order to hold down costs.
The appeals processes are more difficult under the private plans. Retirees are no longer enrolled in traditional Medicare and must go through the company rather than Medicare’s transparent appeals process. Further, beneficiaries are often bounced between CMS and the insurance company seeking redress.
The subsidy to the private plans causes government employers, many of whom have secure, self-insured medical plans, to switch control of their medical decisions to these private companies, break up their efficient risk pools, and allow private companies to profit off our retirees.
The plans are not stable. They can and do pull out of markets, disrupting health care services and causing much anxiety among beneficiaries.
“There is a lack of quality and accountability. These private replacements for Medicare are exempt from basic quality reporting requirements.
