Medicare Annual Open Enrollment runs until December 7. If you’re enrolling in Medicare for the first time, you have a choice between traditional Medicare, which is government administered and a Medicare Advantage plan, which is administered through corporate health insurers. For easy access to the care you need with predictable costs, traditional Medicare is the clear choice; you will need supplemental insurance either through a former employer, Medicaid or the individual market to protect yourself financially. If you are in good health and don’t want to spend money for supplemental coverage to fill gaps in traditional Medicare, here’s what to consider to avoid enrolling in a bad Medicare Advantage plan.
Don’t believe what the MA plans tell you; think about what they don’t tell you
- Don’t trust the Medicare Coverage HelpLine, Joe Namath or other ads
- Don’t trust your insurance agent
- Clover Health/Seek Medicare is not an independent advisor
- Will your care be covered from the doctors and hospitals you want to use at a price you can afford?
You are often locked in to Medicare Advantage, even if you make the wrong MA choice
- One study found that the wrong MA choice “could kill you”
- Widespread and persistent inappropriate delays and denials of care in Medicare Advantage
- People with serious health conditions are more likely to want to disenroll
- People try to leave when they need lots of care, at end of life
- Lower quality nursing home care and home care than traditional Medicare
- People living in rural communities disenroll at a high rate
- Often not possible to switch to traditional Medicare, supplemental coverage not available
- When you need a lot of care, traditional Medicare will likely cost you significantly less and make it easy for you to get care.
Can you make a good Medicare Advantage choice?
- Not based on the star-ratings
- Not based on the many plan options or available information
- Doctors, hospitals in-network, coverage policies, can be inadequate/change at any time
- Care often not available at centers of excellence
- Talk to your doctors; make sure that your care will be covered if you need it outside your area
Can you afford your care in Medicare Advantage?
- Costs are a barrier to care; out-of-pocket cap as high as $7,550 in 2021
- Costs for a week’s hospital stay generally higher than traditional Medicare
- Costs can be much higher than traditional Medicare for people with serious health conditions
Oversight
- Plans are largely unaccountable for failing to comply with contractual obligations
- MA plans release incomplete and inaccurate encounter data, MedPac
- Overpayments to the tune of tens of billions of dollars according to OIG, unaccountable
- Humana overcharges government for MA plans
- HHS OIG report on Medicare Advantage overpayments
Cost to taxpayers
Fraud
- Justice Department sues Anthem MA for fraud
- Justice Department sues United Health MA for fraud
- MA “honor system” breeds fraud
How MA differs from traditional Medicare
- Ten ways
- Meaningless choice, restricted access to care
- Four things to consider when deciding between MA and traditional Medicare
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