PSA - If you enroll in Medicare Advantage, you could be stuck for life

[Ms. Toad]

92. It is a very, very limited private insurance.

The Medigap plans are dictated by law. Each lettered plan is required to provide the same stuff as all other plans with the same letter. You are covered everywhere in the country (and, for some plans, out of the country). The bill goes first to Medicare. They make all decisions as to coverage. Once Medicare determines the procedure is covered, the remainder of the bill is sent to Medigap, which covers it - no questions asked - at the rate dictated by law. So while it is private insurance, there is virtually no wiggle room for the insurance company to play games - aside from what they charge you for the premium. So pick the letter plan that covers what you need covered, and choose the insurance company that charges the lowest rate for that plan.

Medicare Advantage, on the other hand, is closer to the insurance people are used to (which is one reason people like it - it's the devil they know). Each provider can limit your care to a small pool of doctors. They can require pre-approval for certain procedures, they can limit your care geographically, etc. As a practical matter, they deny a lot of care that Medicare requires them to cover - and get away with it because people aren't used to challenging insurance decisions.

The other reason people like Medicare Advantage is that they have not yet hit the kind of chronic illness which means they will be paying the maximum out-of-pocket expenses each and every year. That is the point at which they typically want to switch and are unable to without paying significantly more.