Medicare Without the Maze

Why it is Time to End Medicare Advantage and Fix the Real Program

By Mikel D. Daniels, DPM, MBA, President and Chief Medical Officer, WeTreatFeet Podiatry

If you talk to patients and clinicians actually living and working inside Medicare Advantage (MA), a pattern emerges that doesn’t show up in the glossy ads touting its promise. People are spending an enormous amount of time and energy trying to navigate a system that is supposed to make their lives easier. Clinicians are burning out on the administrative friction that comes with it. The promise was coordinated care, simpler choices, and better protection from costs. What we’ve built instead is a maze of plans, networks, and prior authorizations layered on top of Medicare. They often come with obscure coverage rules, delays for needed care and still manages to cost taxpayers more per person than straightforward traditional Medicare. These plans claim to cover everything traditional Medicare does, and they don’t. We have taken one of our most vulnerable populations (our seniors) and replaced the confusing maze of Medicare with an even harder puzzle: Medicare Advantage. 

From a beneficiary’s standpoint, the first problem is simply understanding what they are buying. Focus groups with Medicare enrollees show that people choose between Medicare Advantage and traditional Medicare based on 3 things they care about deeply.  These are:

1. Keeping their doctors
2. Feeling like their coverage is comprehensive 
3. Managing their costs

Many seniors think the extra benefits in MA (like dental, vision, hearing, gym memberships, etc.) are attractive “perks,”.  Surprisingly they are not usually the deciding factor. Seniors are trying to protect themselves from big medical bills and surprise gaps in coverage, not collect coupons. Once enrolled, most don’t switch plans often, not because everything works so smoothly, but because the learning curve is steep and the stakes feel high. When they do switch, cost, formulary changes for drugs, and unexpected restrictions are common triggers. The result tells us that the complexity is not just theoretical. It is showing up in people’s lives when they get sick and the fine print starts to matter.

Clinicians are seeing the same thing from the other side of the exam room. As MA enrollment has exploded, many practices report that their patient panels have tilted heavily toward these plans. This is largely because patients are drawn in by lower premiums, and some of those supplemental benefits. But once those patients are in the door, physicians and staff find themselves wrestling with a thicket of plan-specific rules. There are different referral networks, different prior authorization criteria, and constant uncertainty about whether a test, referral, or rehab stay will be approved. 

In focus groups, clinicians describe exactly what patients experience. The prior authorization requirements delay care, and drive wedges between patients and doctors. A confusing laundry list of drug coverage policies make it hard to get the right medication without a series of appeals. It’s not unusual for a clinician to accept “most or all” MA plans on paper, only to spend a meaningful share of their working week trying to get basic services authorized for their sickest or most needy patients.

When you layer that reality onto the financing, the picture gets harder to defend. Independent analyses have been clear that MA is costing the federal government more per enrollee than comparable people in traditional Medicare. This is even before you count the extra overhead and profits built into the MA business model. Those extra dollars show up as lower cost-sharing and supplemental benefits in MA, while traditional Medicare beneficiaries continue to face the standard 20 percent coinsurance for Part B (unless they can afford Medigap or qualify for Medicaid help). In other words, we are already spending above the cost of an 80 percent fee-for-service benefit to subsidize richer MA coverage for some seniors, while others remain exposed to significant out-of-pocket risk simply because they made a different coverage choice, or perhaps never fully understood the trade-offs in the first place.

Many of the MA plans also have a surprise for patients, copays. Medicare patients understand (for the most part) that Medicare covers 80% of the bill, and the 20% is either their responsibility, or covered by a secondary insurance. Most understand the yearly deductible for Medicare ($283 for part B and $1736 for part A in 2026) before Medicare pays their 80%. MA plans sell themselves often as zero deductible plans. Sounds great until they realize there is a $50 copay due for each doctor’s visit. Many seniors have several appointments a month, and that adds up quickly.

There is a simpler alternative that would serve patients and clinicians better. If we ended MA and redirected the money now going into MA overpayments and rebates, we could use those dollars to make traditional Medicare cover 100 percent of approved Part A and B charges (this is my perspective, don’t know anyone else advocating for this).  For beneficiaries, that could mean elimination of the 20 percent coinsurance for hospital and physician services. There would be no need to juggle Medigap policies or guess which MA plan will be least restrictive next year. It eliminates the annual scramble during open enrollment to parse ever-changing networks and formularies. For clinicians, it would mean practicing under one clear, national set of Medicare rules instead of a patchwork of plan-by-plan requirements. The result is freeing up time and staff that are currently consumed by chasing prior authorizations and plan-specific billing minutiae. Importantly, because MA now costs more per person than traditional Medicare for the same core benefit, most serious estimates indicate that moving everyone back to fee-for-service at current payment rates (while using those overpayments MA gets to eliminate cost-sharing) would likely reduce net federal spending rather than increase it.

Patients and clinicians don’t experience the Medicare program as a budget line. It is experienced as a series of doors that either open or close when they need care. Right now, Medicare Advantage adds extra locks to those doors, while drawing down public dollars. Imagine if Medicare could guarantee every senior first-dollar coverage for all hospital and physician care. If we want a Medicare program that is genuinely patient-centered and clinically workable, we should stop overpaying private plans to stand between patients and their benefits. We should fold those resources back into traditional Medicare, give every beneficiary simple, comprehensive Part A and B coverage without coinsurance, and let clinicians spend more of their time on medicine and less on navigating the maze.

Some people may call this either a “single payor system” or a “public option”, and the hype might be true. However, we are kidding ourselves if we think this isn’t already in place. How many private payors use Medicare guidelines in establishing policy? Medicare alone is 14% of total federal spending (about 1 trillion dollars). This is more than National Defense (13%), Education (3%), and Transportation (2%). Whether we admit it or not, the government runs healthcare. It explains the efficiency and complexity of pricing in our healthcare system, as this is run by the same people who bring us the performance of agencies such as the IRS (3.4%) and the US Post Office (0.06%).

Dr. Mikel Daniels is a board-certified podiatrist and healthcare executive with more than 2 decades of experience in foot and ankle surgery, wound care, and medical economics. As President and Chief Medical Officer of WeTreatFeet Podiatry, he has grown the practice from 1 office into a regional network of surgical centers, and retail health services across Maryland, Pennsylvania, and Washington, D.C.

Dr. Daniels earned his Doctor of Podiatric Medicine from Temple University and an MBA in Healthcare Administration, combining clinical expertise with business strategy to deliver efficient, patient-centered care. His work focuses on complex reconstructive procedures, diabetic limb salvage, sports injuries, and minimally invasive techniques designed to accelerate recovery.

A Fellow of the American College of Foot and Ankle Surgeons and the American Professional Wound Care Association, Dr. Daniels also consults for biomedical technology firms and serves as a principal investigator in clinical research. His insights have appeared in Forbes, Parade Magazine, and CNN, and through his writing and mentorship, he continues to advance innovation. For more information about Dr. Daniels visit https://www.ThePodiatryVoice.com.