It’s that time of the year when seniors must choose a healthcare plan. It’s Medicare open-enrollment time, but beware of making Medicare mistakes.

Medicare Advantage plans will be filling the airwaves with their enticing advertisements to join their plans. Medicare Advantage plans are not the federal government; they are private insurance plans for seniors who are eligible for Medicare. Their advertising makes them appear to be government plans, but they are entirely managed by private companies. This may be a good thing, if they provide you with more coverage for less money, but beware of the limitations of these plans.

According to the Center for Medicare Advocacy, as of March 2023, 65,748,297 people were enrolled in Medicare, an increase of almost 100,000 since the last report of September, 2022. Of those, 33,948,778 were enrolled in Original Medicare and 31,799,519 were enrolled in Medicare Advantage or other health plans. That’s nearly half of all seniors enrolled in Medicare.

Why the popularity of Medicare Advantage plans? They generally give you more coverage for the money. They usually provide benefits greater than Original Medicare, such as dental, vision, and fitness coverage. They usually cost less, too. So why doesn’t every senior sign up for Medicare Advantage?

An article in The Wall Street Journal, by Anna Wilde Mathews tells us why. Lothaire Bluteau, 66 years old, an actor who lives in West Hollywood, Calif., last year enrolled in one of the private plans known as Medicare Advantage. After he was diagnosed with prostate cancer last May, he discovered the specialists he wanted to see weren’t in his UnitedHealthcare HMO’s limited network. He faced delays getting tests and treatment.

He got a bigger shock when he tried to get access to more doctors by switching to traditional Medicare, run by the federal government. Bluteau worried about the steep out-of-pocket costs, so he tried to get a fill-in policy known as a Medigap plan that would cover many of those expenses. Yet health insurers said no because of his cancer diagnosis. He didn’t realize he could be rejected. “I didn’t inform myself enough,” Bluteau said. “I was so stupid.”

Bluteau’s struggle to get a Medigap plan shows one of the risks seniors may miss when they are selecting coverage. Medicare beneficiaries generally don’t know that they have a right to get Medigap policies only at certain times, and if they don’t jump then, they might not be able to purchase them later. Medicare’s open-enrollment period kicked off Sunday and goes until Dec. 7. During that time, beneficiaries can pick new plans for next year. The options include traditional Medicare from the government, or the wide array of Medicare Advantage plans, which are private-insurance products that wrap in the same benefits.

Pitfalls to Avoid

If you are a senior going through open enrollment this fall, here are five pitfalls to avoid:

Medigap Trap

Patients with health issues may want to move to original Medicare, but they can’t buy Medigap or Medicare Supplement policies. Medigap, or Medicare supplement insurance, doesn’t have the same rules as most health insurance. For other types of coverage, insurers can’t reject you or charge you more based on your medical conditions. With Medigap, such guarantees are available only at certain times. Medigap is vital for many people who enroll in traditional Medicare. The original government program can leave beneficiaries with big out-of-pocket bills for their care, and there is no cap on how high that tab can go. Medigap policies help cover those costs.

The best time to get a Medigap plan is when you first join Medicare when you turn 65. Then you have a six-month window to buy your policy. After that you must find a protected window, such as if you opt out of Medicare Advantage during a limited initial “trial period.” State rules vary so check with your own state department of insurance.

Wrong Doctors

Another common trap that can ensnare people who sign up for Medicare Advantage plans: a lean menu of doctors and hospitals. The plans—particularly health maintenance organizations, or HMOs—can have limited networks that sometimes mean beneficiaries can’t go to the doctors or hospitals they want. When Bluteau chose his HMO plan on the advice of an insurance agent, he said, he didn’t realize it lacked doctors he would want to see. He was ultimately able to switch to a different UnitedHealthcare Medicare Advantage plan, a preferred provider organization or PPO, that included them.

You can find directories of in-network doctors on the insurers’ websites, but be careful. “They can be wildly inaccurate,” said Julie Carter, senior federal policy associate at the Medicare Rights Center, a nonprofit. “It’s a mess, and we don’t really have a great solution other than doing a lot of legwork.” Don’t just trust—be sure to verify. You should call the doctor offices and hospitals that matter to you, and consider looking up other providers you might need unexpectedly, such as nursing homes. You should call the insurer, and be specific about what plan you are researching and which doctors and hospitals you want.

(Author’s Note: There are three more pitfalls to avoid. We’ll cover those in my next blog.)

Recently I wrote about the growing demand for school choice in many states. (School Choice Demand Growing) New or expanded school choice programs were legislated in Indiana, Florida, Arizona, West Virginia, Iowa, and Arkansas to name just a few. This movement has grown in popularity as low-income families of all races come to recognize that school choice is the key to escaping poor-performing public schools, especially in large cities. And everyone knows that a good education is the key to escaping poverty.

Most of this school choice movement has happened in red states as Republicans support school choice, but most Democrats support teachers unions, who oppose school choice. But one red state has notably lagged behind this movement – the state of Texas. Since Texas is a red state, controlled by Republicans in the state house and the governor’s mansion, you might wonder what’s behind their opposition.

The Wall Street Journal editorial board tells us that Texas has no school choice program for its more than five million K-12 students. While Texas Governor Greg Abbott is a strong supporter of school choice, his Republican legislature is not. The reason is the rural nature of much of Texas. It seems that rural Republican legislators believe rural students won’t benefit from school choice because they have no options beyond their current district schools. They believe that rural district schools will be devastated if students use Education Savings Accounts (ESAs) and leave for alternative schools that don’t currently exist.

Stop and think about what I just said. They worry that students will use ESAs to leave for alternative schools that don’t exist. In other words, they have nothing to worry about! But if ESAs inspire new school options in the future, then rural students would benefit like those in cities and suburbs.

Governor Abbot has determined this is a fight worth having. He has called the state legislature into a 30-day special session starting this week and ESAs are a priority. “I am hopeful that we will be able to put together a package that will allow ESAs to get passed in the first special session,” he said on a recent visit to the Journal. If it doesn’t, “I can call another one right after it, which is what my game plan is to do. I can play this game longer than they can play this game.”By “they” he means Members of the Texas House, chiefly Republicans representing rural districts, who stonewalled efforts to pass ESAs this spring. The state Senate passed a bill to provide ESAs worth $8,000 each to most students, but the House never voted on it.

The problem is not money. Texas public school have some $5 billion in funding if the Legislature passes the ESAs, and a chunk of this money is to raise teacher pay. Lawmakers have options to attract votes in the special session, such as passing a bill with universal eligibility that starts with a limited dollar amount in the first year. Representative Jacey Jetton announced a bill that would provide universal ESAs but put low-income and special-needs students first in line.

Should House Members continue to balk, Gov. Abbott has another point of leverage: Primary elections next spring. Iowa Gov. Kim Reynolds set an example in 2022 by endorsing primary challengers to legislators who opposed school choice, and she defeated several. Iowa passed universal ESAs this year, and Gov. Abbott has suggested he might do the same.

“If we don’t win [in a special session] then I think it’s time to send this to the voters themselves to vote in the primaries,” the Governor told the Texas Public Policy Foundation, KENS5 reported.  “We will have everything teed up in a way where we will be giving voters in a primary a choice. They can choose someone who supports school choice or they can support someone who is against school choice.”

A 2022 GOP primary ballot question found 88% of voters support parents’ “right to select schools, whether public or private, for their children, and the funding should follow the student.” A University of Texas at Austin poll in August found that 52% of Texas registered voters support school vouchers, ESAs, or another school choice program, including 61% who live in rural areas.

School choice is growing in demand and it’s time everyone got on board. It will benefit everyone in the long run – except may be the teachers unions.

Everyone knows that doctors take an oath to “first do no harm.” Since Hippocrates declared this fundamental principle of healthcare in 400 B.C., doctors have routinely taken this oath when they complete medical school. While nurses and other non-physician healthcare workers don’t take this specific oath, it is deeply ingrained in the culture of medicine that the patients come first.

Fast forward today to Kaiser Permanente, the nation’s largest managed care integrated health system, where some 75,000 Kaiser workers walked off the job and stranded sick patients this week. It seems their new mantra is “first pay me more.”

Kaiser is the nation’s largest single-payer healthcare system whereby the same entity pays for and provides medical care. Progressives have been pushing hard to convert the whole nation into this single-payer model. Kaiser Permanente is often hailed by the left as a model of single-payer healthcare. Imagine the whole country having doctors walk off the job, stranding their sick patients and postponing urgently needed procedures. That’s what’s happening in Great Britain where the British National Health Service is also on strike.

The Wall Street Journal editorial board tells us Kaiser serves nearly 13 million patients nationwide, mostly on the West Coast. Patients with Kaiser insurance are treated by doctors and nurses employed by Kaiser. Its managed-care system has been hailed as less expensive than standard private insurance. Kaiser controls spending in part by restricting patient access to outside providers and typically requiring primary-care physicians to authorize specialty care. The flip side is that sick patients may have to wait longer for treatment.

This is socialized medicine by just another name. In every socialized medicine system in the world, expenses are controlled by restricting access to care and in some cases refusing to authorize needed treatment if it is considered too expensive.

Kaiser’s single-payer model has other adverse effects. Unions say it skimps on staff, resulting in lower-quality care. It’s not unusual for unions to complain about staffing levels since they want employers to hire more workers to boost their membership. But Kaiser’s model is intentionally lean. Patients “are telling you how long it took to get the appointment, and then you have to tell them how long it will be to get results,” an ultrasound technician who has worked at Kaiser for 27 years told CBS News. “There’s a breakdown in the quality of care.”

Kaiser’s strike is the largest by healthcare workers in U.S. history, and patients will suffer the most harm. “Non-urgent” operations and chemotherapy treatments this week were rescheduled, in some cases reportedly for months later. But because patients are locked into the system, the stakes are lower for both the union and company. Kaiser has offered to increase wages by between 12.5% and 16% over four years, but the unions are demanding a 24.5% raise. Medicare payment cuts and the end of the national pandemic emergency will likely crimp its revenue. Other hospitals and physicians can bill private insurance more to offset government payment reductions, but Kaiser can’t.

This is a real-life demonstration of the consequences when you allow healthcare workers to unionize and you put the same people in charge of determining what treatment is authorized who also pay the bills. The conflicting incentives of providing quality healthcare and saving money means the patients will be the ones to suffer.

Single-payer healthcare is socialized medicine, whether run by a private corporation like Kaiser Permanente or the federal government. Both situations lead to lower quality healthcare, rationing, and reduced access to care. But the real villains in this current situation are those healthcare workers who have forgotten their commitment to the care of their patients in order to serve their own selfish desires. Shame on them!