New Medicare Program: Full List of Services That Will Need Prior Approval

[thesquanderer]

77. Medicare Advantage can require pre-authorizations not required for Medicare/Medigap,

which also means more opportunity for coverage to be denied. That's another difference between MA and Medigap besides what you mentioned. (And the fact that Medicare is introducing that concept in a potential "camel's nose under the tent" scenario is what makes the headline of this topic worrying.)

But yes, as you were basically saying, the bigger (and more consistent) selection of providers is one of the Medicare/Medigap advantages, and trading that away for other things (like lower premium) is not necessarily unjustifiable, as long as you go in with your eyes open, as it sounds like you have. Though also...

I am very sick and tired of people who are all gung-ho about pushing those of us on Medicare Advantage onto far more expensive Medigap (aka Medicare Supplement) plans. A lot of us cannot afford that, understand? The premiums are way more. If you have chronic conditions and need certain doctors, by all means pick Medigap. A lot of us DON'T.

Medigap plans don't have to be especially expensive... mine is $60-ish a month... but the tradeoff is an annual deductible of about $3k. But similar to where you talked about "If you have chronic conditions and need certain doctors...", a high deductible Medigap is, in that respect, kind of similar to your MA scenario... it's something you're more likely to consider if you're in good health, no chronic conditions, no expectation of needing a lot of specialized care, etc. The tricky thing is, some day you probably will have more extensive health care needs, and you won't see it coming, so it's always a gamble. (Though you can also switch from a high deductible Medigap plan to a higher premium low deductible one.)

I don't begrudge people who select MA because it saves them money. Like pretty much everything else in America, the better options cost more, and if you're in a tight financial position, a lesser option is better than no option. You're willing to trade-off the better provider network and put up with a greater possibility of fights over coverage, etc., to get the cost savings. Everyone's situation is different, and you made the decision that was right for you. But one thing that bugs me about MA is that it is marketed as being a better plan for less money, when in reality, it is (unsurprisingly) a lesser plan for less money. (Lesser in choice of doctors, assurance of coverage, administrative hassle potential when it comes to coverage/billing, etc... similar to the compromises of an HMO, to repeat your analogy.)