Cons

A comprehensive list. We may need more pages.

In the spirit of balance, here are some of the minor inconveniences that Medicare recipients occasionally encounter.

The coverage gap is a feature, not a bug.

The Part D "donut hole" — a zone where you temporarily pay significantly more for medications — was designed by lawmakers who understood that the best way to help seniors afford drugs is to make it more expensive for a while first. You'll get through it. Probably.

Prior authorization is a two-way street.

Just as Medicare uses prior auth to ensure you don't receive unnecessary care, it also ensures you don't receive necessary care on the first try. This builds character.

Your doctor is in-network. Your doctor's building isn't.

Network coverage is a rich tapestry. Your physician may be covered; the anesthesiologist she works with may not be. The hospital lab may be out-of-network even though it's inside an in-network hospital. Maps are available upon request and are deeply confusing.

Insurers have a fiduciary duty to their shareholders.

Medicare Advantage plans are run by private insurers who are, legally and philosophically, primarily accountable to their investors. Your health outcomes are a secondary consideration in the sense that they affect the primary one.

The appeals process is a journey of personal growth.

Denied claims can be appealed through a multi-stage process that includes internal review, external review, an administrative law judge, and, theoretically, federal court. Few passengers reach the final destination, but the trip is very educational.

Supplemental plans supplement the supplemental plans.

Basic Medicare leaves gaps, so you buy a Medigap plan. Your Medigap plan has its own gaps, so you add Part D. Part D has a gap, so you consider a Medicare Advantage plan. Medicare Advantage is its own ecosystem. At some point you will have more insurance than a mid-size municipality.

Explaining your coverage to anyone takes about forty minutes.

"What insurance do you have?" "Medicare." "Which kind?" And then you're late for your appointment.

The system is working exactly as designed. Whose design is a subject for a different website.