Medicare Medicare What's Buzzing Your Coverage Options

CMS approves new enrollment hook for Medicare Advantage plans

Written by Diane Archer

While at first glance a Medicare Advantage plan may seem like a better deal than traditional Medicare, appearances can be deceiving. If you sign up for a Medicare Advantage plan, you severely limit your choice of doctors and hospitals. You also open yourself up to out-of-pocket costs for Medicare-covered services that can easily top $7,000 a calendar year, or $14,000 if you happen to need costly care over two calendar years, (e.g., in December and January). Susan Jaffe of Kaiser Health News reports that the Centers for Medicare and Medicaid Services (CMS)) has just given Medicare Advantage plans a new enrollment hook.

Beginning in 2019, Medicare Advantage plans will be able to attract more members by offering non-medical benefits, such as transportation services and home-delivered meals. Before you sign up, consider what your health care options will be through the Medicare Advantage plan if you fall and break a hip, get hit by a car, or are diagnosed with a serious illness. You cannot compare Medicare Advantage plans based on the value of the care they deliver to people with costly and complex conditions; virtually no information is available. They compete for healthy people and design their plans and marketing to deter people who need care from joining.

Without a doubt, non-medical benefits could be extremely valuable to everyone with Medicare. But, if CMS wants to test their value, it should offer the benefit to anyone with Medicare and have an outside independent agency assess whether and how they benefit people. As of now, unlike with traditional Medicare, it is impossible to get most data from Medicare Advantage plans that allow experts to assess and report their relative performance.

Moreover, given the fraud committed by some Medicare Advantage plans and the inability of the vast majority to compete effectively against traditional Medicare, CMS should be making them more accountable or terminating their contracts. Because their administrative costs are high–largely going to profits–MedPAC, the Medicare Payment Advisory Commission, has reported that, overall, Medicare Advantage plans cost taxpayers about four percent more than traditional Medicare.

Medicare Advantage plans should not be allowed to spend taxpayer money on benefits not available through traditional Medicare. In the vast majority of the country, these commercial plans cost taxpayers more. Any money they would otherwise allocate to non-medical benefits should go to reducing deductibles and cost-sharing to ensure access to care for their members with costly and complex conditions.

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2 Comments

  • Sounds to me like they are trying to get more people to choose advantage plans and not go with traditional Medicare.

    • Who are “they”? Republicans in Congress and the Dept of Health and Human Services, who pass the laws and write the regulations, and whose supporters and donors profit from privatizing Medicare!

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