Here’s why so many doctors are frustrated with the current state of Medicare Advantage—and what patients need to understand before choosing a plan.

1. Administrative Burdens Delay Patient Care

Doctors overwhelmingly cite prior authorizations as one of the most frustrating elements of Medicare Advantage. These plans often require approval for a wide range of services, including basic lab tests, MRIs, outpatient surgeries, and even prescription medications.

To navigate this red tape, the average medical practice must employ at least two full-time staff members just to handle prior authorizations. This administrative burden increases overhead costs and takes time away from patient care. And with over 3,800 MA plans in the market, each with its own unique rules, even seasoned providers struggle to keep up.

In contrast, Original Medicare and supplemental Medigap policies rarely require prior authorizations, resulting in fewer delays and a smoother experience for both patients and providers.

2. Lower and Slower Reimbursements Hurt Practices

Medicare Advantage plans typically reimburse doctors at about 85% of what they’d receive under Original Medicare. Not only are payments lower, but they’re also slower. While Medicare pays claims within weeks and Medigap plans within days, MA plans often delay payments for weeks or even months, putting financial stress on smaller practices.

This reimbursement gap makes it harder for providers to sustain their practices, especially those serving a high volume of MA patients. Many report losing money on certain procedures or patients due to these reduced rates.

3. Limited Provider Networks Frustrate Patients and Providers

One of the most common complaints about Medicare Advantage is its restricted provider networks. Unlike Original Medicare, which is accepted by 99% of non-pediatric physicians and nearly all hospitals nationwide, MA plans use HMO and PPO networks that significantly limit provider choice.

Studies show that only 22% of MA plans give access to 70% of doctors in a metro area. Worse, 43% of plans limit access to just 50% of doctors. These limitations make it difficult for patients to keep their preferred providers and often force them to switch plans or pay out-of-pocket for care.

4. Denials of Necessary Care Are Far Too Common

Government audits have found that Medicare Advantage plans deny medically necessary care more often than Original Medicare. From delaying knee replacements and chemotherapy to refusing approval for PET scans and stents, the consequences of these denials can be severe.

Doctors argue that these decisions often come from insurance administrators rather than clinicians. This not only undermines their professional judgment but also puts patients at risk by delaying critical treatments.

5. Profit-Driven Policies Undermine Medical Judgment

MA plans use utilization management tools—such as step therapy, quantity limits, and algorithm-driven care decisions—to cut costs. Unfortunately, these systems often prioritize insurer savings over patient well-being.

For example, some MA plans prematurely discharge patients from skilled nursing facilities, regardless of medical advice. Others require patients to “fail first” on cheaper medications before authorizing the doctor’s recommended treatment. These policies not only frustrate doctors but also jeopardize outcomes.

6. Real-Life Consequences of Medicare Advantage Barriers

The data may be compelling, but the real-world stories are even more telling:

• A breast cancer patient experienced delayed treatment when her MA plan denied a PET scan, allowing her cancer to progress.
• A cardiac patient waited overnight in the ER for MA approval for a stent—a delay that risked his life.
• A patient with severe depression was left waiting three months to see an in-network psychiatrist.
• A hip surgery patient was discharged early from rehab due to plan limits, only to fall at home and suffer a hip fracture.

Each of these cases underscores how insurance interference can create dangerous and unnecessary hurdles.

7. What Doctors Are Saying Across Specialties

• Primary care doctors: Report heavy paperwork and difficulty getting even routine tests approved.
• Cardiologists: Face delays for stress tests, imaging, and post-operative medications.
• Oncologists: Experience frequent denials for advanced imaging and lifesaving chemotherapy.
• Orthopedic surgeons: Encounter delays for MRIs, surgeries, and rehabilitation.
• Mental health providers: Battle limited access to psychiatrists and prior authorizations for medications.
• Geriatric care specialists: Warn of tight limits on home health care and skilled nursing, even when patients clearly need more support.

Final Thoughts: What Patients Should Know

While Medicare Advantage plans may offer lower premiums and appealing extras like dental or vision, it’s important to weigh those perks against the real-world consequences. If your doctor is reluctant to accept your plan or you face frequent delays in care, those savings may come at a high cost.

Doctors aren’t just complaining for the sake of it. They’re raising alarms because these plans often interfere with their ability to care for patients effectively. If you’re considering Medicare Advantage, take the time to understand how your access to care—and your doctor’s ability to provide it—might be affected.

The post The Hidden Costs of Medical Care appeared first on ROI TV.

2. Understanding Medicare Parts and How Part D Fits In
Medicare is split into four parts:

• Part A: Covers hospital stays
• Part B: Covers outpatient care and certain administered medications
• Part C (Medicare Advantage): Bundles A and B, often includes Part D
• Part D: Covers self-administered prescription drugs

If you’re using Original Medicare (Parts A and B), you can add Part D as a standalone plan. If you have a Medicare Advantage plan, it may already include drug coverage.

3. How and When to Enroll
Enrollment is open to anyone who qualifies for Medicare Part A or B. Your initial enrollment period spans seven months: three before, the month of, and three after you turn 65. Miss it, and you may pay penalties. There are also special enrollment periods if you lose employer coverage or qualify due to life changes.

4. When Can You Switch Plans?
Standalone Part D plans can be switched annually during Open Enrollment (October 15 to December 7). Medicare Advantage plans with Part D can also be changed from January 1 to March 31. Many people switch due to changes in medications or plan formularies.

5. The Real Cost of “Free” Plans
Plans advertising $0 premiums may not actually be the cheapest. One case showed that a $97 monthly premium plan cost less annually than a $0 premium plan because it covered expensive medications better. Always consider your personal medication list and calculate total yearly costs.

6. Alternatives That Count
If you have creditable drug coverage through a union, employer, the VA, or Tricare, you may not need a Part D plan. But make sure your coverage is officially “creditable” to avoid penalties.

7. Avoid the Lifetime Penalty
Skip Part D when you’re first eligible without other creditable coverage, and you’ll face a permanent penalty: 35 cents per month for every month you go without coverage. A one-year delay could cost an extra $4.20/month for life.

8. How Part D Plans Are Structured
Each plan has its own:

• Formulary: List of covered drugs (usually 2,500 to 4,000)
• Tiers: Drug pricing levels from generics to specialty meds
• Deductibles: Up to $590 in 2025
• Out-of-pocket maximum: Capped at $2,000 annually
• Pharmacy networks: Preferred pharmacies offer better prices
• Coverage tools: Quantity limits, prior authorizations, and step therapy

9. Real-Life Example: Generic vs. Brand Name
One client taking four generics (Diltiazem, HCTZ, Lisinopril, Warfarin) found a $0 premium plan that cost only $40 annually. But when switching to a high-cost drug like Eloquis, the $97 premium plan became cheaper overall—saving nearly $500 a year.

10. Get Help Choosing the Right Plan
You don’t have to figure this out alone. Licensed Medicare agents can compare plans across carriers and help you make the best choice for your medications and budget. Their services are free to you. Many also help with enrolling in Social Security or Medicare Part B.

The post Choosing the Right Medicare Part D Plan: What You Need to Know appeared first on ROI TV.

To simplify this process, here are five essential questions you should ask before enrolling in a Medicare plan.

1. Do You Have a Tight Monthly Budget?

For many, healthcare costs are a major concern in retirement. Understanding your budget will help you decide which Medicare plan best aligns with your financial situation.

• Medicare Part B: The 2025 Part B premium is $185 per month for single filers earning $106,000 or less and married couples earning $212,000 or less. Higher-income individuals pay additional surcharges.
• Medicare Supplement Plans (Medigap): These plans have additional premiums but provide predictable costs.
  • Plan G: $150/month
  • Plan N: $120/month
  • Drug Plan (Part D): $25/month
  • Total estimated cost for Plan G: $360/month
  • Total estimated cost for Plan N: $330/month
• Medicare Advantage Plans: Many have low or $0 monthly premiums but require co-pays and out-of-pocket costs when services are used.

If predictability and budgeting are a priority, a Medigap plan might be better, whereas lower monthly costs favor Medicare Advantage.

2. How Much Financial Risk Can You Tolerate?

Understanding your comfort level with out-of-pocket medical expenses is essential when choosing a plan.

• Medicare Part B only: Unlimited out-of-pocket expenses, making it risky for those with frequent healthcare needs.
• Medigap Plans: Offer stable, predictable costs, with a Medicare Part B deductible of $257 in 2025.
• Medicare Advantage Plans: Have out-of-pocket maximums, but they vary:
  • HMO plans: $3,000 – $5,000 per year
  • PPO plans: $4,000 – $10,000 per year

If you prefer fixed costs over financial uncertainty, Medigap provides better protection. If you can manage higher out-of-pocket risk to save on premiums, Medicare Advantage may work for you.

3. Do You Want Permanent or Temporary Insurance?

Medicare plans differ in terms of contract duration and portability:

• Medigap (Medicare Supplement):
  Lifetime contract—your coverage cannot be canceled as long as you pay your premiums.
  Portable across the U.S., meaning you can receive care anywhere that accepts Medicare.
• Medicare Advantage (Part C):
  Annual contract—plans change yearly, and benefits are not guaranteed long-term.
  Service area restrictions—coverage is limited to specific geographic areas, and moving to another state may require enrolling in a new plan.

If you want long-term stability, Medigap is the better choice. If you’re comfortable reassessing your plan annually, Medicare Advantage may work.

4. Do You Want to Choose Your Own Doctors?

Doctor choice is a major factor in Medicare plan selection:

• Medigap (Medicare Supplement):
  Allows open access to any doctor or specialist who accepts Medicare—no referrals required.
• Medicare Advantage:
  HMO Plans require you to stay in-network and get referrals for specialists.
  PPO Plans allow out-of-network care but at higher costs.

If you want the freedom to choose your doctor, Medigap is the better option. If you’re okay with network restrictions in exchange for lower costs, Medicare Advantage works.

5. Who Do You Want Making Your Healthcare Decisions?

Medicare plans differ in pre-authorization requirements:

• Medigap:
  No pre-authorization needed—as long as Medicare covers the service, you can receive care without additional approvals.
• Medicare Advantage:
  Requires pre-authorization for costly services (surgeries, specialist visits, MRIs, etc.), potentially causing delays or denials.

If you prefer direct access to healthcare decisions, Medigap is the way to go. If you’re comfortable having an insurance company approve certain treatments, Medicare Advantage could be suitable.

Making the Right Medicare Choice for You

Choosing between Medicare plans depends on your budget, risk tolerance, long-term goals, doctor preferences, and control over healthcare decisions. Here’s a quick summary to guide you:

Final Tip: If you prioritize flexibility, stability, and broad access to doctors, Medigap is the better choice. If you prefer lower monthly costs and can manage network limitations, Medicare Advantage may work.

Do you need help selecting the best Medicare plan for 2025? Share your questions below, and let’s navigate your options together!

The post How to Choose the Best Medicare Plan: 5 Key Questions for Smart Decision-Making appeared first on ROI TV.

1. Medicare Open Enrollment Period: Key Dates and Decisions

The Medicare Open Enrollment Period runs annually from October 15 through December 7. During this time, you can make important changes to your Medicare coverage, such as switching between Original Medicare and Medicare Advantage or adjusting your prescription drug plan.

• Beware of High Pressure: Advertisers and sales agents often aggressively push consumers to switch plans during this time. Before making any decisions, it’s critical to understand if a new plan is truly better for your situation.

2. Traps to Avoid During Medicare Enrollment

Many Medicare beneficiaries fall into common traps during enrollment. Here are some pitfalls to avoid:

• Trap 1: Grass is Always Greener – Don’t assume a new plan is better just because of attractive benefits. Weigh the entire plan, including coverage, premiums, and out-of-pocket costs.
• Trap 2: Dishonest Agents – Watch out for agents who push you into making quick decisions without full disclosure. Always ask for detailed explanations and take your time.
• Trap 3: Something for Nothing – If a deal sounds too good to be true, it probably is. Many plans have hidden costs, so carefully read the fine print.
• Trap 4: Skipping Supplemental Plans – Even if you’re in good health now, you may need a supplemental plan (Medigap) for future medical needs.
• Trap 5: Misconception About Switching Later – Some plans have restrictions on when you can switch. Understand your options before committing.
• Trap 6: Copying Others’ Plans – What works for your neighbor may not be the best option for you. Each person’s healthcare needs are unique.
• Trap 7: Underestimating Complexity – Medicare can be confusing. Getting assistance from an experienced expert can make the process smoother.

3. The Importance of Evaluating All Options

When choosing a Medicare plan, it’s important to compare all options. This includes both Medigap (supplemental insurance) and Medicare Advantage plans.

• Medigap Plans: These are standardized by Medicare, meaning that the benefits for a particular plan (like Plan G or Plan N) are the same across all insurance companies. The key differences are in initial premiums and the rate stability over time.
• Medicare Advantage Plans: Evaluate whether an HMO or PPO plan best suits your needs. HMOs typically require you to stay in-network, while PPOs offer more flexibility with providers but may come at a higher cost.
• Evaluate Co-Pays and Max Out-of-Pocket: Consider both co-pay amounts and the maximum out-of-pocket costs when selecting a plan. These factors can significantly affect your healthcare expenses throughout the year.

Working with an experienced, full-service expert can provide valuable support during this evaluation process, ensuring you make an informed choice.

4. Expert Assistance in Enrollment: Why It Matters

Navigating Medicare can be daunting, but an experienced and honest agent can guide you through the enrollment process. Here’s why expert assistance is crucial:

• Credibility: Look for agents with positive online reviews and referrals from trusted sources. This ensures that they are reputable and have a track record of helping clients find the best Medicare plans.
• Time and Full-Service Support: A good agent will take the time to explain your options in detail and offer full-service support, not just during enrollment but also for ongoing needs.
• No Additional Cost: There is no extra cost for using an expert agent’s services. They are paid commissions by the insurance companies, so you can benefit from their knowledge without worrying about extra fees.

Conclusion

Avoiding the traps of Medicare enrollment requires education, careful evaluation of all options, and expert assistance. The 2025 Medicare open enrollment period is your opportunity to choose the right plan, but don’t let high-pressure sales tactics lead you into a bad decision. Instead, take the time to understand your needs, compare all your options, and rely on the guidance of a full-service expert. By doing so, you’ll avoid common pitfalls and secure the coverage that’s right for you.

Catch Medicare School every morning on ROI TV or for more information go to www.medicareschool.com

Intended for educational purposes only. Opinions expressed are not intended as investment advice or to predict future performance. Past performance does not guarantee future results. Neither the information presented, nor any opinion expressed constitutes a solicitation for the purchase or sale of any security. Consult your financial professional before making any investment decisions. Opinions expressed are subject to change without notice.

The post How to Avoid Medicare Enrollment Traps and Make Informed Decisions in 2025 appeared first on ROI TV.