Are Medicare Advantage Plans Bad? This Fresh, New Book Tells All.

When MedicareWire.com founder, David Bynon, retired from the U.S. Navy in 2007, he put himself on a new mission to make Medicare easier for people to understand. Frustrated by the health insurance industry's practice of abusing seniors by forcing them to give up their personal contact details to get information about Medicare, and then selling it to telemarketers, Bynon vowed to make Medicare more transparent and accessible for America’s growing population of seniors.

On his warpath to transparency, Bynon released his first book, "Why Medicare Advantage Plans are Bad", in a new Amazon.com series called "Survive Medicare". The book underscores both the advantages and disadvantages of the U.S. Medicare program's private health insurance option. The book is available in paperback and for download to Kindle book readers.

I picked up an editorial copy of the book from Amazon.com to review. What I learned opened my eyes.

Medicare Advantage is an option to traditional Medicare, which has two parts. Medicare Part A is how beneficiaries get their hospital insurance coverage. Funded by Medicare taxes collected during the years a beneficiary works, Part A only covers about 80 percent of all Medicare-approved costs. The remaining 20 percent is paid through additional insurance, called Medigap, or directly out of the beneficiary's pocket.

Medical insurance coverage is what Medicare Part B provides. It pays for about 80 percent of doctor visits, lab tests, diagnostics, durable medical equipment, and medical supplies. And it will pay for medications used in an inpatient setting, but it won't cover a patient's regular prescriptions. For that, there's another part called Medicare Part D.

One of the benefits of a Medicare Advantage plan, says the book's author, is that it combines all of the beneficiary's benefits into a single plan that may cover additional benefits that are not included in Original Medicare. Readers also learn about the similarity of Medicare Advantage plans and the group health plans offered by many employers.

"Why Medicare Advantage Plans are Bad" digs into a highly controversial claim that what insurance carriers claim is a benefit is actually a double-edged sword. While it is true that most Advantage plans offer extra benefits, like prescriptions, and routine dental and vision, to name just a few, many people with chronic health conditions—diabetics for example—may end up paying a lot more for their coverage than they would if they stayed in Original Medicare.

The book also goes into great detail explaining who Medicare Advantage plans benefit and who they don't. The author explains that the most significant difference in the core health insurance coverage is when people pay. The book will help you understand how most of your costs are paid in advance, through monthly premiums, with Original Medicare and a Medigap plan. Bynon explains how this makes healthcare in retirement easier to budget and manage. Conversely, with a Medicare Advantage plan, most costs are paid when members use healthcare services. This makes budgeting more difficult.

If you love the details, "Why Medicare Advantage Plans are Bad" explains how Medicare Advantage plans are required to cover all of the same benefits as Medicare Part A and Part B, but the government allows them to cover the benefits differently. Specifically, plans are allowed to make their members get prior approval before getting treatment. This doesn't happen with Original Medicare. Also, plans can charge members copayments that are more or less than Original Medicare's flat-rate 20 percent coinsurance.

According to a recent Kaiser Famly Foundation report, nearly half of all Medicare Advantage plan members would pay more for a short hospital inpatient stay than people with Original Medicare and no additional coverage. This happens because plans are allowed to set their own copayment rates for inpatient care.

In Original Medicare, you pay a Part A deductible when they are admitted to a hospital as an inpatient. In 2021, the Part A deductible is $1,452 per benefit period. However, when a Medicare Advantage plan charges its members a copayment of $295 for the first five days, which is on the low end of the scale, the Medicare beneficiary ends up paying more.

The author claims that "The low monthly premiums tease many people into Medicare Advantage plans," and cites several examples. The book also helps readers understand that Medica