Photo: Rebecca F. Miller/Associated Press

Regarding Dr. Nathan Punwani’s letter “Medicare Advantage Shows the Path Forward” (Aug. 30): My wife and I are on Medicare and enrolled in a Medicare Advantage health-maintenance-organization plan. My wife has been suffering from a so-far-undiagnosed severe pain following hip surgery last year. We have tried two HMO plans. Both severely limit the nearby doctors you can see, and referrals can take over 30 days because they must go from Dr. A to your primary-care physician, then to the insurance company for approval before you can make an appointment, assuming the doctor is in network. Obtaining outside-network treatment is very difficult.

The number of physicians, including primary care and even at urgent-care centers, is quite limited with both of the HMOs that my wife has used. Since many places, including the Mayo Clinic, will not accept fee for service or self-pay, especially if you have an HMO, we have been limited further.

Unless you are fortunate enough to be on Kaiser or a similar program, there is no coordination between entities. Moreover, Medicare’s arbitrary enrollment rules eliminate the possibility of changing from an HMO to a preferred provider organization (PPO) until the open-enrollment period, and then it won’t take effect until Jan. 1.

Both former Gov. Bobby Jindal (“The Danger of Expanding Medicare,” op-ed, Aug. 26) and Dr. Punwani are concerned about cost, but we are concerned about getting proper and prompt treatment and certainly would not recommend expanding Medicare Advantage in its current form. Perhaps the good doctor should move to a nonurban area and try a Medicare HMO plan.

George Waters

Leesburg, Fla.