This Happens: Even Current Enrollees Miss Stuff

The other day, a Medicare beneficiary and I were talking.

He uses VA for everything. Has a MAPD (HMO) in addition, with a Giveback option, which rebates money back into his Social Security check. Clearly he has enrolled in Part B because he can’t enroll in MAPD without Part B in this instance. However, he has a complicated health history, and is being told that VA will cover it. All good.

Missed? Insurance is about assigning a price to coverage. In this case, he missed out the fact that his complications can lead to requiring other services or physicians. And in the absence of a crystal ball, an HMO will have restrictions that will not exist in a PPO. Further, there are PPOs (different carrier) that have the same/similar Giveback option. He has given away a free option (this is Jae’s Manifesto Rule #1: Don’t Give Away Free Options).

This Happens: the market moves, every detail in Medicare Advantage is subject to change, every year. And then, people believe that insurance is an option for today, under the idea that nothing will change. For a long list of reasons, that cannot possibly be the case. Father Time, competition, changing Medicare coverage rules, etc are just the most obvious.