11/26/2025    Paul Kesselman, DPM

John Oliver Explains Medicare “Advantage” A Must See (Joe Boylan, DPM )

While this story is done with a humorous tone, it
is nevertheless a very sad commentary on the
entire state of the insurance industry and can be
extended to all health and other types of
insurance offerings. Holding dinners and luncheons
at restaurants, providing free food, alluring
patients with other bonuses such as "free dental"
and transportation to/from doctors offices are but
a few of the lures these plans use on the
unsuspecting .

Free dental? Really? Until they read the full
prospectus which those who do, will run from. They
barely provide cleaning and x-rays from a limited
number of dentists. Other than that, these
unsuspecting patients find out they will be paying
out of pocket for most dental work, just as they
would in traditional Medicare. The dentists who
do participate in these plans usually are not
their own dentists nor are the listings accurate.
And what about the other promises and incentives?
These were carved out incentives provided by our
elected officials, yet if any provider or health
care system offered them to our patients, we would
be charged with numerous violations of Anti
Incentive Acts.

As for several comments made by others regarding
this posting, not sure where you got the idea that
patients enrolling in Part C plans don't pay their
Medicare Part B premiums. For the most part that
is false. Most patients in Medicare Part C plans
pay their regular Part B premium just as they
would if they were enrolled in Traditional Fee for
Service Medicare And if they are subject to IRMA,
they pay that too!

It is only the small segments of the population,
the so-called "dual eligible" who are on Medicaid
plans as well and the QMB patients. who may not be
required to pay their Part B premium. What is true
is that patients enrolled in a Part C plan do not
require is a Part B Supplement (Medigap) or drug
Plan (Medicare Part D).

But let's analyze those: Supplement plans have a
cost of about 200-300/mo/person. If a person with
a Medicare Part C plan, has a $40 copay
each time they go to the dr,after 4or more visits
they have just about met the premium for the
supplement plan on Traditional Fee for Service and
could see any doctor they want rather than
restricting themselves to the chokehold the Plan
C's will have on them.

As for part D plans, they are relatively
inexpensive ($30/mo) and yes there is a
deductible, but there are far less restrictions.
Thus for the most part, most middle and upper
class patients can afford to stay on traditional
fee for service Medicare, but if they chose not
to, they are shooting themselves in the foot. They
are paying almost the same premiums with far more
restrictions. So what about those who cannot
afford to pay those premiums. Let's look at that
next.

Had these patients been allowed to stay in
Traditional Medicare and state Medicaid plans, it
would have been far more cost effective.
Take a look at the recent studies by MEDPAC, an
independent think tank which studies Medicare.
The most recent one has suggested that the gov't
would save more than $84B, yes you read that
correctly, $84B in 2025,if the whole gamut of
Medicare Advantage patients were enrolled in
traditional Medicare and took the private
"Advantage" contractors out of the system.

Think about that, elected officials. Where is that
$84B going and why are we throwing all that away,
when instead we could be providing a significant
amount of quality health care to all?
$84B a year could save many rural hospitals, allow
physicians to be physicians and not kowtow to what
has become institutionalized health care,where
getting to your doctor is like going through a
maze. That $84B could have also been used to keep
every patient (regardless of need) on Traditional
Fee for Service Medicare. That is a stunning
fact!!!

And before one suggests that Medicare for all is
the solution, there are problems with that as
well. But that is a matter for another day.

The entirety of the system is rotten to the core!

Paul Kesselman, DPM, Oceanside NY

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