Healthcare Veteran Dumps Medicare Advantage After 12 Years, Cites Lack of Value
A growing number of seniors are reevaluating their Medicare Advantage (MA) plans, and one prominent healthcare futurist has publicly joined their ranks. This morning, after twelve years, Jeff Goldsmith, President of Health Futures Inc, switched from a Medicare Advantage plan to a Medicare Supplement policy, a decision fueled by years of mounting frustration.
Goldsmith’s initial enrollment in MA was driven by an ideological preference for programs that incentivize healthy behaviors. However, he quickly discovered that the promised benefits were largely inaccessible. “None of the alleged MA perks were actually reachable-my health club was out of network as was my dentist,” he explained. This disconnect between promise and reality became a defining characteristic of his experience.
His experience with navigating a serious illness further highlighted the limitations of the MA system. In 2015, when diagnosed with cancer, Goldsmith chose to seek treatment 600 miles away at the University of Chicago. While his plan didn’t impede his choice of provider, it only covered approximately one-third of the actual cost of his care.
Despite never experiencing a denial of care, Goldsmith described a constant barrage of administrative burdens. He noted that his primary care physician was “pestered mercilessly” with requests to approve every care decision, creating “hours of needless ‘paperwork.'” He also recounted fending off sixteen unsolicited offers for “wellness visits,” which he suspected were attempts to inflate billing codes. His primary interaction with the carrier,he said,consisted of receiving “hundreds of robo-calls.”
A gradual erosion of the plan’s network signaled further decline. Prestigious institutions like the University of pennsylvania,Cedars Sinai,and the Hospital for Special Surgery stopped accepting the plan. However, the final catalyst for Goldsmith’s departure was the proclamation that the Mayo Clinic would no longer participate. “Mayo is my ‘safety net’ provider if my local Charlottesville folks are not able to meet my needs,” he stated, emphasizing the importance of access to top-tier medical facilities.
Goldsmith acknowledges that MA held promise when it was redesigned in the early 2000s. He concedes that plans like SCAN or Kaiser Permanente, if available in his market, might have retained his membership. He also recognizes the potential benefits of tightly integrated, protocol-driven care for individuals with complex health needs, a view he shares with healthcare leader George Halvorson.
Though,Goldsmith is increasingly skeptical of the broader premise that capitation – or its modern iteration,AI-driven micro-management – can fundamentally solve the challenges facing the healthcare system. “It isn’t about the incentives, folks.I ate the MA dog food for twelve years,” he wrote. “it’s about the care system you rely on when things get scary.” Ultimately, after twelve years, the only tangible benefit he received from the carrier was a delivery of frozen dinners following his cancer diagnosis.
Here’s a breakdown answering the “Why, Who, What, and How” questions:
Why: jeff Goldsmith switched from Medicare Advantage to a Medicare Supplement plan because he found the MA plan lacked value despite twelve years of enrollment. He experienced inaccessible benefits,high out-of-pocket costs during a serious illness,excessive administrative burdens,and a shrinking provider network.
Who: Jeff Goldsmith, President of Health Futures Inc.,a healthcare futurist,is the central figure. The story also involves Medicare Advantage plans generally, and mentions SCAN, Kaiser Permanente, George Halvorson, and the
