About Medicare Advantage plans, frustrated doctors, and an old gal who has changed her mind

[Joinfortmill]

Full disclosure: I've always had a MA plan and I never had a single issue regarding coverage or denial of service or medications. I've gone through cataract surgery and two brain stents for for a brain aneurysm that costs thousands of dollars. Then in 2024 I ran into this:

I developed Geographic Atrophy, better known as 'Wet' Age Related Macular Degeneration (AMD), which is characterized by the growth of unnecessary , damaged, blood vessels that leak blood and fluid into the eye, causing central vision loss. The most common treatment is ongoing eye injections (yup, a shot into the eyeball) that temporarily stop the proliferation of these rogue blood vessels.

There are three or four different medications (most of these medications are anti-cancer drugs (It gets complicated) that are injected into the eye at a cost of $50 to $2000 per injection. The $50 shot works sometimes. The higher priced medications work all the time.

So, this is what my Retina Specialist (who is DISGUSTED) with MA plans told me today after I had my 4th shot in four months. Because one of the previous three shots was not the lowest cost drug, but a sample he used, it did not meet their 'requirement' that three shots of the lowest cost drug be used AND is shown not to be working before they will approve the higher priced drugs.

So, there you have it. The physician cannot provide the best, most appropriate medication for a disease that could well cost me my central vision. So, after ten years of coverage with an MA plan, I am going to enroll in original Medicare as soon as I meet a qualifying event.

I don't know what the moral of this story is. All I know is the decisions these health insurers are making are not based on sound medical advise, but on saving a few hundred dollars at the risk of human lives and the loss of payments directly from Medicare, because you can't get blood from a stone or dollars from a dead old gal.