In an opinion piece for the Washington Post, Helaine Olen lays out the disadvantages of Medicare Advantage plans, corporate health plans offering benefits to people with Medicare. Olen warns that people with Medicare should take care before deciding to join a “Medicare Disadvantage” plan.
Medicare Advantage plans came into being because a majority in Congress believed they were a way for the government to save money on Medicare. They believed that insurers could do better than government at keeping costs down. Twenty years later, evidence abounds that private insurers do not improve care for people with Medicare at lower cost. Still, to the detriment of older Americans and the US Treasury, 2023 marks the year when more people will be enrolled in a Medicare Advantage plan than in traditional Medicare, government-administered Medicare.
Medicare Advantage plans are profit centers for private insurers and too often present obstacles to care for their enrollees. Though Olen does not say this directly, Medicare Advantage offers very different benefits from traditional Medicare, including coverage from a restricted network of doctors, hospitals and other providers, all-too-frequent inappropriate delays and denials of care, and out-of-pocket costs that can be as high as $8,300 a year for in-network care alone in 2023. Unlike traditional Medicare, people can’t buy supplemental coverage to pick up their out-of-pocket costs.
Representatives Pocan and Khanna recognize the enormous differences between traditional Medicare and Medicare Advantage. They have proposed legislation to reflect those differences. They want to prohibit insurers offering benefits to people with Medicare from using Medicare in their names.
Insurers have been and continue to make enormous profits off of Medicare and US taxpayers. Meanwhile, Congress is not doing anything about it because they claim their members are happy. [Editor’s note: Congress fails to recognize that most people with Medicare use little health care; policymakers should focus on the mountains of evidence that Medicare Advantage is often not meeting the needs of people with costly and complex conditions.]
People should also understand that if they don’t choose the right Medicare Advantage plan–something that is almost impossible to do–they could end up in a health plan that denies them critical care or delays needed care and leads them to die prematurely. Delays and denials are “widespread.”
But, people are attracted by what they see as extra benefits in Medicare Advantage, such as some dental or vision coverage or a gym membership. They don’t focus on the compromised access to high quality care they are at risk of getting. They usually don’t imagine themselves getting sick, even though that’s why they need insurance.
Olen concludes that Congress should strengthen Medicare for older adults and people with disabilities and make it less profitable for insurers. At the moment, that’s not happening. At the very least, the corporate health plans offering benefits to people with Medicare should have a name that describes them accurately: Medicare Disadvantage.
Here’s more from Just Care:
- CMS overpays Medicare Advantage plans and lets them keep the extra billions
- The high costs of Medicare Advantage and how to address them
- People in Medicare Advantage trade away access to care
- Medicare Advantage plans are an “Insatiable Cash Monster”
- 2023 Medicare and You Handbook continues to mislead on Medicare Advantage
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