Medicare Advantage Plans – Beware!

Medicare Advantage Plans – Beware!

Beware! This year’s Medicare Open Enrollment period runs from October 15 – December 7. I call it “MediScare” season because private Medicare Advantage insurers try to scare consumers into signing up for their plans. These Advantage plans often over-promise and under-deliver, putting patients at risk.

During Open Enrollment, current and future Medicare recipients are bombarded with television, radio and print advertising urging them to review their Medicare options. The insurance companies offering Medicare Advantage plans intentionally create anxiety among consumers by warning them that they may be missing out on benefits or paying too much. Don’t fall for their slick advertising!

I always counsel my clients to sign up for and stick with traditional Medicare (Parts A, B, Prescription drugs Part D and a Medigap supplement). Traditional Medicare remains the golden goose for senior healthcare coverage. And thanks to the Biden Administration’s Inflation Reduction Act, Medicare premiums will be reduced in 2023, insulin co-pays limited to $35 and other enhanced benefits.

Medicare Advantage Plans, offered by many big insurers, may promise you dental, vision, hearing, gym memberships and other benefits. Perhaps if you’re just turning 65 and healthy, their promises are attractive as a one-stop shop. You cannot at that crucial decision point foresee the ways you’ll be disadvantaged in the future. And it sure can sound convenient to have everything under one roof.

However, there are huge trade-offs between traditional Medicare and Medicare Advantage plans. Advantage plans are essentially managed health care. They restrict you to their provider networks, require referrals for specialists and create other hoops to jump through that traditional Medicare does not. The Medicare Rights Center on October 20, 2022 published an important issue brief examining the pros and cons of Medicare decision-making.

The biggest drawback of an Advantage plan, in my experience with clients, is when something goes wrong that shatters your health. Suddenly, the patient can’t see the specialist they would like to, cannot easily get second opinions outside the provider network and may confront other obstacles that would not exist in traditional Medicare.

In my patient advocacy practice, I’ve encountered terrible examples of benefits being denied to Medicare Advantage patients that had serious impacts on their health. The most recent example is patients in a skilled nursing facility (rehabilitation after a hospitalization) being discharged too soon and well before their Medicare-allowed benefits run out. The government pays Advantage insurers a set amount for each enrollee, so, not surprisingly, the insurer will try to save money by skimping on benefits such as skilled nursing care. This article clearly spells out this latest ruse to shorten rehabilitation benefits. It’s just one example.

Moreover, large Medicare Advantage insurers are currently facing lawsuits by the Department of Justice for over-billing, diagnosing non-existent illnesses to get paid more and other fraud crimes. See “The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions” in the New York Times, October 8, 2022.  Prosecutors in Manhattan on October 17 filed a civil suit against Cigna accusing the health insurer of overcharging the Medicare Advantage program by making it appear that patients were more ill than they actually were.

Another shocking new report by the Center for Medicare and Medicaid Services (CMS) reveals the extent of Medicare Advantage fraud being perpetuated by these plans. Guess who ultimately pays for that fraud? U.S. taxpayers while these plans enrich themselves and often limit or deny necessary medical benefits.

There are tools available and excellent independent websites to help you understand these trade-offs and to become an educated Medicare consumer. The Kaiser Family Foundation, an independent organization, recently released a study comparing  Medicare options. The government’s Medicare site is also well done and offers a variety of comparison tools.

It is possible but not easy to switch out of Advantage plans to traditional Medicare. The biggest hurdle is that you may not be able to buy a Medigap supplement plan and there are only certain times when you can do this.

As with any big decision, do your due diligence. Of course, Medicare Advantage may be a good option for some individuals and situations. I just want my readers to make informed choices based on credible information and facts, not on dubious advertising.

Posted in Elder Care, Government Agencies, Health Care Reform, Insurance, Medicare, Other health issues, Patient Advocacy, Patient Centered Care
Patient Navigator LLC does not diagnose, treat clients or recommend a treatment plan. We are not a substitute for the consultation and care of doctors and other health care providers. We provide you with research and information to use with your doctors. Always check with your health care team before making medical decisions.

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