Medicare Your Coverage Options

2019 Medicare Handbook is misleading

Written by Diane Archer

The Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has released the 2019 Medicare Handbook, which continues to be misleading in its comparison of traditional Medicare with Medicare Advantage plans, commercial health plans that contract with CMS to deliver Medicare benefits.

The Handbook suggests it is impartially comparing traditional Medicare with Medicare Advantage plans. But, rather than highlighting or even mentioning the thousands of dollars in out-of-pocket costs people who need care may face in a Medicare Advantage plan or the bureaucratic hassles, and inappropriate delays and denials of care, the Handbook overlooks them entirely.

Instead, on the first comparison page, page 5, CMS highlights Medicare Advantage features that only some may benefit from, without explaining that they are not universal. And, it fails to highlight features of traditional Medicare not available through a Medicare Advantage plan, such as virtually unrestricted access to hospitals and most doctors, the choice people most value, until the second comparison page.

Deeper into its comparison of traditional Medicare and Medicare Advantage, CMS states that people in traditional Medicare will have 20 percent out-of-pocket costs for Part B-covered services. Only later down the page does it explain that Medicare supplemental insurance “Medigap” or Medicaid or retiree coverage picks up those costs. For Medicare Advantage plans, it simply says: “Out-of-pocket costs vary—some plans have low or no out-of-pocket costs,” even though Medicare Advantage plans all impose out-of-pocket costs. Moreover, these costs can be as high as almost $7,000 for in-network care alone, which the Handbook appears never to mention.

Without question, people who sign up for a Medicare Advantage plan who do not have retiree coverage or Medicaid to fill gaps in traditional Medicare save on the upfront costs they would need to pay for supplemental coverage to fill gaps in traditional Medicare. And many people are willing to take the gamble that they will not face high deductibles, copays and other out of pocket costs in a Medicare Advantage plan, and will get the care they need, in order to save money on supplemental coverage.

Medicare for all, which guarantees everyone coverage from virtually all doctors and hospitals, without premiums, deductibles and copays, or the need for supplemental coverage, would save people money on their health care, without forcing them to give up the choice of doctors and hospitals they most value.

Note: The Medicare website is also misleading. And, don’t trust the five-star ratings of Medicare Advantage plans.

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2 Comments

  • Bottom line – Medicare Advantage is only a savings if you are not sick. I had two friends who were on Medicare Advantage plans die this year. The first asked her Medicare Advantage doctor three years running about a lump on her breast. The fourth year she was diagnosed with Stage 3 breast cancer but it had already metastasized to her brain. The second had suspicious prostrate cancer markers for several years but his doctor wasn’t worried. His cancer had already metastasized when he moved and changed doctors. Plus, don’t believe their roster of doctors. Medicare Advantage tends to list doctors without actually signing them up.

  • Nothing surprises me about the current Administration. Republicans have been fighting for years to destroy and dismantle Medicare, Medicaid and Social Security in addition to any Safety Net which protects elderly, disabled and low income individuals.
    Everyone must be their own advocate for their healthcare. Otherwise people will end up subscribing to high cost, no coverage uninsurance plans which exist primarily to line the pockets of Corporate Officers and their shareholders.
    I’ve kept my private insurance to supplement Medicare. Even though the cost is about $200 per month it’s well worth it.
    I don’t fall into the ‘donut hole’. When I go into catastrophic coverage I don’t have to make any co-pays or co-insurance payments. Best yet, because I have private insurance I can qualify for rebates and other discounts which are illegal under any Government-sponsored health insurance.

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