Medicare Advantage enrollment is up, and people with low incomes and people of color are enrolling in Medicare Advantage at disproportionate rates. A new study published in JAMA by Avni Gupta, BDS, MPH, Diana Silver, PhD, David J. Meyers, PhD; et al. finds that lower income individuals are often drawn into Medicare Advantage because of ads promising vision and dental benefits. The authors consider whether this is a good reason for people to enroll in a particular plan or whether these people are more likely to end up in Medicare Advantage plans that threaten their access to care.
Many people of color and low income individuals rely on misleading marketing to make their choices, which is highly problematic.
The worst performing Medicare Advantage plans are largely responsible for tens of thousands of unnecessary deaths a year. But we don’t know which ones they are. The data is not available. People who enroll in a Medicare Advantage plan take a gamble that if they develop a serious condition they will get the care they need.
The American Hospital Association (AHA) has urged the government to step in to protect people in Medicare Advantage. The AHA explains the harm to patients from prior authorization rules that lead to delays and denials of critical care. So does the HHS Office of the Inspector General. The Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, does not have the resources to conduct adequate oversight and enforcement.
In this study, the data show that Black Americans were more likely to sign up for MA plans with dental or vision benefits than White Americans. People with incomes no more than twice the federal poverty level also were more likely than higher income individuals to enroll in Medicare Advantage plans with dental benefits.
It’s not clear from the study whether the MA plans with dental and vision benefits have better or worse health outcomes. As it is, they have on average 43 MA plans to choose from, all differing in ways that are impossible to assess, including with respect to premiums, deductibles and out-of-pocket caps, which are knowable, and with respect to typical out-of-pocket costs, denial and delay rates, and mortality rates, which are not knowable. What is clear is that people who enroll in a Medicare Advantage plan take a big gamble with their health and well-being that they will be able to get the care they need should they develop a complex and costly condition.
Vision and dental benefits in MA plans tend to come with high out-of-pocket costs and to be restricted. While data is limited, it appears that most people do not end up using these benefits, either their dental and vision needs are not covered or they can’t find a provider to see them or their costs are unaffordable.
What will happen to dental and vision benefits when the government addresses overpayments to MA plans? Based on prior research, changes to these benefits are likely to be minimal. One researcher found that with $1,000 less to spend, MA plans increased monthly premiums by $5. There is also a five percent risk that vision or hearing benefits would end.
What will happen to Medicare if the government does not address overpayments to MA plans? It is not unlikely that Traditional Medicare will wither on the vine and that insurers will take over all of Medicare. Because they cost so much and often delay and deny care inappropriately, more people with Medicare are likely to be unable to afford or get the care they need, endangering their health and well-being.
If you’re in a Medicare Advantage plan, take advantage of the Medicare Advantage Open Enrollment period, which runs through March 31. If you can, switch to Traditional Medicare if you want to ensure easy access to the care you need.
Here’s more from Just Care:
- Administration proposes new rule to address myriad problems with Medicare Advantage
- Take advantage of the Medicare Advantage Open Enrollment period
- OIG finds widespread inappropriate care denials in Medicare Advantage
- CMS can’t oversee AI denials in Medicare Advantage
- AHA warns Medicare oversight agency about dangers of Medicare Advantage
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