My Own Story Why I am Wary of Medicare Advantage

 I'm 57. I will be 58 in April. I am getting thisclose to retiring, or at least contemplating it. One thing I was looking forward to was continuing to have a great health plan when I turned 65. But this Medicare (Dis)Advantage that might be awaiting be is making me nervous.

I have two concerns how Medicare (Dis)Advantage can affect me if and when it comes into effect.

The photo on the right is my right shoulder. Actually, my new right shoulder. 

In 1987 I fell hard on it and tore the labrum. Bad. My shoulder was unstable for years. Arthritis set in. Pain. It was bad. I didn't have insurance when I hurt it and I suffered the consequences. In 2002 I had it scoped out but all it did was put off the inevitable.

In 2019 the pain was the worse it had ever been. I was popping Aleve like M&M's. I went to a shoulder surgeon. He said I needed a new shoulder but want to give physical therapy I try. I had bone on bone. How the hell was PT going to help?

I went to a second doctor. He said PT was a waste of time, but agreed I needed a new shoulder. However, I just didn't feel right with him.

I went to a third doctor, Dr Young Kwon at NYU (Yes, a shameless plug, but he is the best shoulder surgeon!). He saved me. He made me feel whole. 

Here's my issue. Artificial shoulders last from 10-15 years. I'm lucky, I'm a lefty. The artificial joint is in my non dominant arm, but you never know. Dr Kwon even told me that I was a bit too young for shoulder replacement.

What happens when I am between 65 and 70, on Medicare (Dis)Advantage and need another shoulder? I will need to get pre-approval? Will I be considered too old to get a replacement? I might be told since it is my right shoulder and that being left handed, a new joint is not a priority. Heck, will I be allowed to see Dr Kwon again? 

My dad had his hip replaced at Special Surgery at the age of 74 in 2005. My step mom was retired from DOE and everything copacetic. No fuss, no muss. 

Will Medicare (Dis)Advantage let me visit three doctors? I doubt it. 

My other concern is I am Type 2 diabetic. My numbers are great. My A1C is very close to where it should be. My weight is the best since high school. I go to the gym three times a week. I eat better than I have, but of course I can do better. But I am on several medications. I'm not on insulin and don't plan on it. I see the eye doctor every year. I don't want anything chopped off or to go blind.

But what happens if  insulin is needed? Will I be sufficiently covered? Will my medications be covered? Even if I am covered what out of pocket charges will I face? I see my endocrinologist every three months. Will I be able to continue this? Like Dr Kwon, my diabetes doctor is one of the top in her field. Under Medicare (Dis)Advantage will I still be able to see my doctors or still be able to choose from the best physicians? Or will I be left to choose between Dr Nick and Dr Hartman?

I don't like what I have read or heard of Medicare (Dis)Advantage. Someone, somewhere is getting rich over this being forced upon us and it's not someone at Emblem/Blue Cross or Joe Namath. 

I have a fantasy of moving to Corning NY, for a year after I retire. How many providers will I find there? One? None? Or maybe Hudson NY. There might be three providers in Hudson.

I don't need nor want a Fitbit. I don't need or want rides to and fro. I don't want meals sent to me. There is one thing I want with my health insurance when I am 65. 

I want certainty. And I want myself and my health professional to make the decisions what is best .