Medicare Advantage or Medicare Disadvantage?

It's that time of year again — open enrollment for health insurance. For many of us, the sticker shock is real. We're weighing difficult choices: Do we pay more for better coverage we might not need, or gamble on a cheaper plan and hope nothing goes wrong?

Now, imagine making that choice when you're over 65. That's the reality for 68 million Americans on Medicare. But here's what makes their decision even trickier—and why it matters to all of us, even if we're decades away from Medicare:

During open enrollment, Medicare recipients choose between two very different options. The first is traditional Medicare — the original government program that's been around since 1965. It's straightforward: see any doctor who accepts Medicare in the United States, no questions asked, no prior approval needed. Of course, traditional Medicare isn’t perfect; recipients still have to pay some co-payment.

The second option is Medicare Advantage, the privatized alternative launched in 1997 under President Clinton. The promise? That private insurance companies like UnitedHealth, Humana, and CVS Health's Aetna would run Medicare more efficiently and save taxpayers money. The plans sound appealing — they bundle everything traditional Medicare offers, often throwing in extras like dental coverage, hearing aids, and prescription drugs.

Sounds like a good deal. So, what's the catch?

Medicare Advantage locks you into a specific network of doctors and hospitals. Want to see a specialist? Just like with any HMO, you'll likely need prior authorization — meaning your insurance company gets to decide whether your doctor's recommendation is "really necessary." It's a frustration both patients and physicians despise, designed primarily to reduce costs by creating barriers to care.

Here's where this becomes everyone's problem: Medicare Advantage hasn't delivered on its efficiency promise. Not even close. Last year alone, the federal government paid these private plans $84 billion more than it would have under traditional Medicare. That's your tax money — whether you're 25 or 75 — padding the profits of those three giant insurance corporations and others.

And what are we getting for that extra $84 billion? Research shows that Medicare Advantage hasn't produced higher-quality care, better patient satisfaction, or improved health outcomes. It's essentially a massive transfer of public money to private shareholders.

The good news? People are catching on. This enrollment period, predictions suggest fewer seniors will choose Medicare Advantage plans. They're tired of fighting for authorization to see specialists. They're frustrated by restrictions on which doctors they can see. They're realizing that some dental coverage isn't as important as getting a necessary heart procedure.

Medicare Advantage now covers more than half of Medicare recipients. But the evidence is clear: privatization hasn't made healthcare more efficient — it's just made it more expensive for taxpayers and more complicated for patients.

It’s another chance for me to remind you that health care shouldn’t be an opportunity for private companies to profit.

– Dr. Michael Wilkes with a Second Opinion