I was a licensed clinical social worker for 44 years at a large midwestern VA Hospital. My last assignment before retirement was as the social worker for the Geriatric Outpatient Clinic. Actually a good training assignment for the rest of your life if you are over 65. I learned alot of interesting information as I helped veterans 80 years old and over to deal with the many challenges that come up in life with aging.

Now that I am retired it seems as if every other phone call I got in the last month (I get it in stereo since I still have a land line in addition to my cell phone) is some caller who wants to counsel me about my options for Medicare. And then on TV I get Joe Namath or Danny Glover trying to do the same.

I have Medicare B and I was able to keep my High Option Blue Cross at retirement as my secondary so honestly I have great health insurance. But I am barraged with “counselors” who want to help me to “get all my Medicare benefits , “ which means they want to sell me a Medicare Advantage or Medicare C plan./ It all sounds so inviting because some people can get a rebating back of their Medicare B premiums even get a premium waiver on the the Medicare Advantage or Medicare C premiums. And now some plans include tier one and two dental coverage (essentially exams, fillings and dentures but no mention of cleanings and extractions), prescription eye glasses and exam, rides to appointments, health club memberships, some form of home delivered meals, free hearing aids, prescription drug coverage and some sort of home health care.

On the surface all of this looks really good, but seriously does anybody give away something for nothing? What you sacrifice with these Medicare Advantage plans is 1) Choice and 2) Skilled Home Nursing Care and Home PT, OT, and Speech Therapy 3)There is no mention of home oxygen or home medical equipment. The Medicare Advantage Program was created by President George Bush to pull Medicare beneficiaries away from traditional Medicare B which gives beneficiaries complete choice of health care providers, provides for home based Skilled nursing care and PT/OT/Speech. home oxygen and home durable medical equipment When we are healthy we don’t think about the importance of being able to choose the BEST doctor for any health issue nor do with think about the possible need for home IV infusion, home wound care, home medication injections, our possible need for home medical equipment, home rehab care, it can be a rude shock to find that you cannot choose the best doctor for your condition, cannot get home skilled nursing or rehab, home DME, or home wound care in many of the Medicare Advantage Options. When I was a Geriatric Social Worker at the VA I was so glad that the VA provided home care and home equipment for patients who were enrolled in Medicare Advantage and were denied these benefits by their Medicare Advantage Provider. And the other rude shock is that once you enroll in Medicare Advantage you can never return to traditional Medicare B coverage. If you find you don’t like your Medicare Advantage Plan, your only choice will be to change to another Medicare Advantage Plan and then only during the annual Nov/Dec Open Season

It is sort of late for me to be writing this article since Open Season ends Dec 7, but I really do feel bound to give a contremps to all of the high pressure advertising and phone soliciting that goes on not only during Open Season but also throughout the year. Yes, for some people the Medicare Advantage Plans may allow them to maximize their health care given their financial constraints but this decision needs to be made with a full knowledge of the pros and cons of Medicare Advantage Plans. Remember, Medicare Advantage was created to decrease the costs of the Medicare Program and to move towards privatizing Medicare and Social Security Programs. For every additional benefit that a beneficiary derives, there has to be some sort of restriction on traditional Medicare B benefits to pay for it. Caveat Emptor.

Retired Licensed Clinical Social Worker with practice specialties in Geriatrics, Mental Health, Substance Abuse and Gender Therapy

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