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Ten ways Medicare Advantage plans differ from traditional Medicare

Written by Diane Archer

There is a lot of confusion surrounding Medicare Advantage plans, commercial health insurance for people with Medicare, and the ways Medicare Advantage plans differ from traditional Medicare. You are likely to hear about their low upfront costs relative to traditional Medicare and their “extra” benefits. But, what you hear may be very different from what you get.

While Medicare Advantage plans are far more heavily regulated than commercial insurance in the private sector, they still have all of the core failings of commercial insurance–for individuals, for taxpayers and for the public good.

  1. Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and generally have little incentive to include providers who deliver value in their networks. They generally do not compete with one another to deliver value and meet the needs of Americans who need costly care. For this reason, sicker people are more likely to disenroll from them.
  2. Meaningless choice: Medicare Advantage plans do not offer people information that would allow them to understand what they will pay out of pocket when they need costly care and which doctors and hospitals they will be able to use.
  3. Inequitable: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap of nearly $7,000 each year undermine access and ration people’s care based on their ability to pay.
  4. Unreliable coverage: Medicare Advantage plans cannot offer reliable coverage or continuity of care as they are constantly changing the products and services they offer, the providers in their network, as well as their enrollees’ cost-sharing obligations. And, at times, they are pulling out of the market altogether.
  5. Unsustainable: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending.
  6. Inefficient: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.
  7. Profit-driven: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put shareholders first, with incentives to maximize profits and delay and deny medically necessary care.
  8. No innovation for the public good: Medicare Advantage plans have no incentive to innovate for the public good or disclose information about medical protocols, devices and other treatments that would benefit the public at large. What they learn about what’s working and not working in our health care system, they tend to keep to themselves.
  9. Unaccountable: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers.
  10. Unethical: Medicare Advantage plans may engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectively and hold them accountable for inappropriate behavior, let alone illegal activities.

With Medicare for All, there would be no need for Medicare Advantage plans. Everyone would have an improved and expanded Medicare, with freedom to use the doctors and hospitals of their choice anywhere in the nation and without premiums, deductibles and copays. If you support Medicare for All, please let your members of Congress know. Sign this petition.

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4 Comments

  • I had a dear friend who signed up for a Medicare Advantage plan. She asked her doctor three years running about a lump on her breast and he always said it was nothing. Then she was diagnosed with Stage 3 breast cancer, had chemo, radiation and a mastectomy but the cancer had metastasized. She died in February 2018.

  • Like every form of insurance there are both good and bad MA-PD plans.

    Some MA-PD plans allow the use of out of network options.

    CMS provides a quality star system which allows one to weed out the low performing (one or two star) plans.

  • Wow, you REALLY hate these plans! I guess I must be incredibly lucky then. I’ve think I have excellent care, plus was able to continue using my same doctors and clinics, including eye and dental care. I get appointments as soon as I need them, quick referrals to any specialists. Their “ask a nurse questions” and help line is excellent and I’ve benefited from using them. That’s sad if these plans are as terrible as you say here, but I want to let you know, they are not all bad. I’m grateful I have mine.

    • Yes, you have been lucky! If you get really sick and need very expensive care, I hope that you will get the same good care, but there is really no incentive for a for-profit insurance company to provide it if they can get away with not providing it. Furthermore, there is no guarantee that your doctor or clinic will still be participating in your plan the next time you call for an appointment, but you will be stuck in your plan until the next open enrollment period. If you develop
      pre-existing conditions, will you be able to buy a Medigap or supplemental policy if you want to return to Traditional Medicare? Yes, you have been lucky—so far!

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