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Mr. RightField has had an advantage program since he got on Medicare 10 years ago. It has not worked well for him for several reasons. He is restricted to a network and that does not give him good coverage when we travel. We travel 4-6 months of each year in our motorhome. Also, while procedures may be listed as 'covered' under the MA, in reality there are no providers in the network, so it would end up much more expensive than even stand-alone Medicare because of the higher cost for non-network providers. We also had situations where a network provider tried to sub-contract to a non-network provider (think anesthesiologist) and the non-network provider billed us for services. For that one, we threatened legal action and the provider backed down quickly.

Another annoying feature of the MA plan was that the insurance company was always trying to insert themselves between Mr. RightField and his doctors. The company always wanted to visit him in our home, to provide "extra care" and provide a "list of concerns" to be shared with the doctor on his next office visit. We would also get calls from the insurance company pharmacist to "go over" his list of medications and "coordinate" with his primary physician. We would get offers to get $25 gift cards to various restaurants or stores if he would just acquiesce to a in-home visit to have a nurse practitioner give him an addition exam ... and evaluate the safety of our home.

The requests for home visits got the same answer: The only entrance to our home is with an invitation or a warrant, and you have neither.

This year, Mr. RightField's MA has cancelled their program in our area. It is called a "Service Area Reduction," and opens up what is called a Special Election Period whereby Mr. RightField can get a guaranteed-issue supplement plan. We're going to go with Plan F (same as what I have). Yes, it is more expensive, and he has to get a prescription plan as well.

But, for us, the freedom to choose any provider, anywhere in the country, far outweighs any so-called extra benefit touted by a Medicare advantage program. Freedom isn't free.

No one is restricted to a network of doctors or clinics or hospitals if they have PPO Medicare Advantage coverage. They would if they have an HMO but seems like you have to make a change now anyway so it’s a moot point.

Doctors should be but are not always careful about sending patients to labs or outpatient clinics for tests etc. We’ve never been caught in the “non payment” scenario as the MA company requires prior authorization but I guess it could happen. The company we have our MA plans with state on the EOB that such and such a claim was “out of network” so the claim was denied and it is not our responsibility. Big fat zeros for that claim.

A big issue that hasn’t shown up here yet is the “outpatient” vs “inpatient” hospitalization for a Medicare patient. That can be a real can of worms. ALWAYS question if you or a loved one is being admitted as an “inpatient”. Most ER or hospital personnel will understand just why it’s important to ask and to get the answer.

There are cases where a person gets stuck with the entire hospital bill because they were admitted as an “outpatient” - took up bed space in a room for several days, diagnostic tests run up the wazoo and weren’t considered inpatients.

I’ve always asked when my husband has been admitted from the ER to the hospital since I learned about that. Makes for interesting and frustrating reading online...