Be prepared. If you opt to enroll in Medicare Advantage, you will pay more– more out of pocket for care your health plan covers and more out of pocket for care your health plan denies. What too many people don’t realize is that insurers offering Medicare Advantage profit more each time they deny care, creating a powerful incentive for them to deny care inappropriately, reports Brandon Novick for the Center for Economic and Policy Research.
The government pays Medicare Advantage plans a flat amount of money for each enrollee, and more for people who are sicker. Anything the plans don’t spend on people’s care, they keep. Do you think the insurers prioritize your care or their finances? Be prepared for inappropriate denials, in addition to higher out-of-pocket costs.
And, don’t think the federal government is making sure the insurers do right by you. There are more than 5,000 of Medicare Advantage plans across the US. They are close to impossible to oversee, let alone hold accountable for their bad acts.
The Trump administration recently proposed a new rule requiring insurers offering Medicare Advantage plans to verify that providers in their network directories were actually in-network. The goal is to help ensure that Medicare Advantage plans do not mislead people about the providers in their networks. Too often providers in their directories are not in their networks. One report found that four in ten providers listed in directories were “ghosts,” not actually in-network.
Why do ghost networks exist at all? Profit. Insurers are more likely to attract enrollees to their Medicare Advantage plans if their networks appear robust. That’s $$$$$$ for them. But, insurers also lose money every time an enrollee gets care from an in-network provider. Fewer in-network providers also means $$$$$ for them.
Traditional Medicare, in sharp contrast, covers care from virtually all physicians in the nation, any willing provider. Your care is covered just about everywhere.
Exactly why should we be spending taxpayer dollars on insurers offering Medicare Advantage plans?
Here’s more from Just Care:
- 2027: Five things to think about when choosing between traditional Medicare and Medicare Advantage
- Medicare agency proposes reforms to address inadequate Medicare Advantage networks
- Insurer provider directories misleadingly include physicians who are out of network
- Well-kept secrets of Medicare Advantage plans
- More hospitals dropping Medicare Advantage plans, favoring traditional Medicare
