In September 2021 an X-ray for shoulder pain inadvertently found a mass in my right lung. The radiologist wrote in her report that it was highly likely cancer. Because I had never smoked and had no symptoms, I went through a lot of denial. What I did not know at the time was that ten to twenty percent of lung cancer sufferers are never smokers. A CT scan later confirmed the suspicion of cancer. My sister who had worked in top-rated MD Anderson Cancer Center in Houston for many years. told me to come to Houston for a diagnostic workup. When I called MD Anderson about whether the diagnostic workup could be done there, I was told that there were just two criteria for admission: a suspicion of cancer diagnosis and having insurance to pay for treatment. I sent the CT scan results and the back and front of my insurance card to them. I had no worries on either count. The CT scan interpretation clearly stated that there was a suspicion of cancer, and I thought I had excellent retiree insurance, much better than most. I had retired after 29 years as a State of Connecticut employee. Like most state employees, I had very good benefits, including a life pension and medical insurance. The insurance, negotiated between the state and a coalition of state employee unions, had recently been changed from traditional Medicare plus a medigap plan to a Medicare Advantage Preferred Provider Organizations (PPO) plan. We were assured that the Medicare Advantage PPO plan allowed us to see any of the 98 percent of providers nationwide who took traditional Medicare. I flew to Houston from Portland, Oregon, where I was retired, for ten days of exhaustive diagnostic workup procedures. The hospital accepted my insurance. The result was that I had stage IIIa lung cancer. It had regionally spread to a nearby lymph node but was still potentially curable. The treatment plan was three courses of chemotherapy, one every three weeks, to be followed by surgery to excise the mass and infected lymph node. They recommended that I get chemotherapy in Portland and return to Houston for the surgery, which made sense to me. They further provided me with an oncologist referral in Portland to facilitate the chemotherapy. That was common procedure for a facility that dealt with people flying in from all over the world for cancer diagnoses and treatment plans. In Portland, I immediately contacted the office of the referred oncologist at Providence Hospital to arrange for the chemotherapy courses for which urgency was of the essence since lung cancer spreads rapidly. When I gave the office my Aetna Medicare Advantage insurance card, I was immediately told they did not take it. I told them there must be some mistake. I had excellent insurance from the state of Connecticut that had never been denied before. There was no mistake, they told me emphatically. Since it was urgent that I get on with the chemotherapy treatment, I did not contest the denial. Instead, I quickly arranged to get the treatment at MD Anderson Cancer Center. That required me to fly back and forth three times at my expense and subject myself on planes and in airports to the danger of the then raging Covid pandemic when the chemotherapy medications compromised my immune system. The chemotherapy and surgical treatments were thought to be successful for two years. But my shoulder pain did return. I called the Providence Physiatry Department to make an appointment. Once again, I was told that my Aetna Medicare Advantage PPO plan was non grata. This time, as treatment was not so urgent as with cancer, I decided to contest the decision. I first called an Aetna help desk. The person who answered told me that Providence Hospital had made a mistake in denying coverage and she would call them to straighten it out. Ten minutes later she called me back to tell me the bad news. Even though Aetna would pay Providence as an out-of-network provider, Providence still refused to accept the insurance. I asked if they had a right to do so and she admitted that they did. It takes two to tango with Medicare Advantage plans. The plan must be willing to pay out-of-network providers, which Medicare Advantage PPO plans are, and the provider must be willing to accept the plan. In this case, Providence simply exercised a right to reject an MA plan it did not like. Providers may want to reject Medicare Advantage PPO plans because the issuer has a record of unusually high claim denials, is chronically late in payments, has overly complicated filing requirements, or some other reason. Last year the Oregon Health and Science University, the largest hospital in the state, sent a letter to its Aetna Medicare Advantage patients stating it likely would cease accepting their insurance because it could not agree to contract terms with the company. But later it rescinded the letter after agreeing to terms. What has been happening in Oregon is part of a national trend of hospitals and providers increasingly rejecting Medicare Advantage plans. Requests for interviews with Providence Hospital and OHSU to explain the problems they had with Aetna’s Medicare Advantage plan went unanswered. Traditional Medicare is much less likely to be denied because 98 percent of hospitals and providers nationwide accept it. Once a hospital or other provider accepts it for anyone, it must accept it for all. What is more, by law providers must accept all traditional Medicare supplemental Medigap plans no matter which insurance company issues them. It was clear to me that I and my fellow Connecticut state employee retirees would be better served by returning to the traditional Medicare plus Medigap plans we had. It is the same issue that New York City municipal employee retirees have so far successfully fought. There have also been similar retiree labor conflicts in Delaware, Vermont, New York, and Illinois as increasing numbers of state employees are being forced out of traditional Medicare and into privatized profit-driven Medicare Advantage plans. To be fair, states and other public employers that wish to medically insure their retirees are in a bind. Congress set up Medicare Advantage plans with capitation payments, that is, regular payments per member. Originally, there were equal payments per member. That, though, gave insurance companies an incentive to sign up as much as possible healthy persons and avoid sicker ones to minimize payment of claims. Congress addressed that gaming of the system by making higher capitation payments for members with serious preexisting conditions. That payment reform, though, set up another perverse corporate gaming of the system. Medicare Advantage insurance companies began pushing at home visits ostensibly to provide convenient checkups. Their real purpose was to “up code” the member by finding a preexisting condition to justify higher capitation fees. I remember when I retired and moved from Connecticut to Oregon, I would receive daily robo calls from United Healthcare, the then administrator of the state’s Medicare Advantage plan, at 5:00 am trying to get me to agree to a home visit. Their software program assumed I was still living in Connecticut where it was 8:00 am. It took multiple calls to my union, state administration, and United Healthcare to shut down the nuisance calls. Since I’d already hit the capitation fee jackpot by having had cancer, suspiciously, I stopped receiving phone calls offering at-home visits. The higher Medicare Advantage capitation fees for the insurance companies allow them to lower the costs of group retiree insurance contracts. Connecticut saved considerably by shifting to Medicare Advantage plans—at the expense, I would add, of member access to healthcare, especially those with chronic conditions and serious illnesses, such as cancer. It is undeniable that many retirees, especially younger and healthier ones, are quite satisfied with the Medicare Advantage plans. But how long will that last if they become sicker? This year the Guardian newspaper exposed internationally the case of former UConn Physics Department member Gary Bent who United Healthcare, the state’s then contracted Medicare Advantageprovider, denied authorization for skilled nursing care after brain cancer surgery, treatment that would have been routinely authorized by traditional Medicare. The case was further exposed by How Corporations Raided Medicare, a video on YouTube that has been watched by 193 thousand viewers so far. Problems with Aetna have accumulated further for state retirees. These include most prominently retirees to Florida finding that their insurance was not as accepted as it had been in Connecticut, similar to my experience in Oregon, and preauthorization problems such as that encountered by Gary Bent. There are other types of problems as well that would not have happened under traditional Medicare. A class action suit may be in the offing against the state and Aetna. In September, as knowledge of the problems with the switch to Medicare Advantage plans grew among state retirees, the Connecticut State Employees for Medicare Choice formed. It seeks to win retirees the right to choose between traditional Medicare and Medicare Advantage plans. Connecticut is one of only 13 states that do not allow its state employees that choice. James W. Russell taught sociology for 29 years at Eastern Connecticut State University.  He is the author, most recently, of The Labor Guide to Retirement Plans and was an appointed member of Connecticut’s Retirement Security Board.