JustCare

Category: Medicare

  • Few psychiatrists accept Medicare

    Few psychiatrists accept Medicare

    If you and your spouse are not working, you likely need to enroll in Medicare at 65. But, as with many health insurance policies, it is extremely difficult to find psychiatrists who will accept Medicare coverage, reports Eugene Rubin, M.D. for Psychiatry Today.

    A study by John Havlik et al., reported in JAMA Network, finds that just over 18,000 psychiatrists were willing to bill Medicare for their services, out of a total of more than 56,000 psychiatrists nationwide.  The number willing to bill Medicare decreased by nearly 4,000 over eight years between 2014 to 2022.  That’s a 16.8 percent decrease in the number of shrinks willing to bill Medicare. Overall, only about one in three psychiatrists take Medicare.

    The researchers could not study the number of psychiatrists who contract with Medicare Advantage plans. But, overall, fewer physicians agree to work with Medicare Advantage plans than traditional Medicare. And, Medicare Advantage plans do not tout their great mental health coverage. So, it’s more than likely that it’s even harder to see a shrink in Medicare Advantage than in traditional Medicare.

    Other research has shown that people with Medicare can wait up to six months to see a therapist. But, Medicare now covers mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, as well as psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers, increasing the pool of mental health providers available for people with Medicare.

    People with employer coverage and in state health insurance plans also struggle to get insurance coverage for visits to the shrink. Fewer than three in five shrinks accept any health insurance.

    To be clear, access to Medicare coverage for visits to the shrink differs depending on where you live. In Wyoming, for example, there are just 13.8 shrinks who take Medicare for every 100,000 people with Medicare, in Mississippi, 22.1 shrinks, and Montana, 27.4 shrinks. In Rhode Island, there are 174.7 shrinks for every 100,000 people with Medicare. In nine states, there are fewer than 40 shrinks for every 100,000 people with Medicare.

    While Medicare Part B covers mental health services for people enrolled in Medicare Advantage and traditional Medicare, the federal mental health parity laws do not apply to Medicare. They should!

    Here’s more from Just Care:

  • Some hospitals now provide at-home rehab services 

    Some hospitals now provide at-home rehab services 

    Felice J. Freyer reports for Kaiser Health News on how some hospitals now provide at-home rehab services for patients post surgery. At-home rehab can be helpful to patients who would otherwise have to wait in hospital until a rehab bed opens up for them.

    People with Medicare in Medicare Advantage plans often struggle to get rehabilitation services after a surgery or other procedure that leaves them in pain, unsteady and/or unable to care for themselves. The cost is high and insurers would prefer to deny the care and save money, even when lack of rehab services keeps patients from a speedy and full recovery.

    People in traditional Medicare are more likely to receive rehab services when needed post hospitalization. But, too often there are no rehab beds available. They are forced to sit in hospital until a bed opens up. And, sometimes the facility is located far from their homes and their loved ones.

    At-home rehab gets patients out of the hospital more quickly. Caregivers can more easily visit patients. And, patients are monitored remotely.

    The at-home rehab program is being tested in New York, Pennsylvania and Wisconsin. Some say it is working well. But, there are no rules surrounding how they should work, which patients qualify, or what services should be offered. And, Medicare does not cover these services as of now.

    In short, at-home rehab is only being offered by a few hospitals that are paid upfront to manage their patients’ care. In some cases, a state Medicaid program pays for the care.

    The trade association representing nursing homes and rehab facilities does not support this at-home rehab model. Skilled nursing facilities (SNFs) and rehab facilities are required to provide a range of services to their patients, which the at-home model does not require. Do these requirements necessarily improve patient care?

    Many SNFs and rehab facilities offer precious little to their patients, other than unhealthy meals, endless hours in bed, and a short period of physical and/or occupational therapy. One quarter of patients end up with bed sores, infections or other poor health outcomes. At home, patients could be up and about a lot more and trained on how to navigate their homes safely.

    One at-home rehab program reports no bedsores, infections or other adverse events for their patients. But, this program provides services only when there is also an in-home fulltime family caregiver to help. Consequently, many patients do not qualify for the at-home program.

    Another at-home rehab program enrolls patients living alone and provides them with a call button to speak with a live person when needed. It’s not clear how well this program works. Home alone, patients needing rehab could be at serious risk of falling or otherwise hurting themselves.

    Here’s more from Just Care:

  • 2025: Programs that lower your costs if you have Medicare

    2025: Programs that lower your costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of $7,000. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2025, but vary somewhat by state. You might qualify for these programs in your state even if your income or assets are higher than the federal amounts listed below. States sometimes exclude certain income and assets when determining your eligibility. You should apply through your state Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan. It should cover premiums, deductibles, coinsurance and copays for Medicare-covered services.
      • Income limit monthly depends upon where you live but is around
        • $1,325 for individuals
        • $1,783 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium, if you have Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,585 for individuals
        • $2.135 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium if you have Medicare Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,781 for individuals
        • $2,400 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, slightly more than half the people over 65 who qualify for the Qualified Medicare Beneficiary program (53%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (32%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for Medicaid or any of the above low-income programs or receive Supplemental Security Income benefits. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2025, you may qualify if you have up to $1,976 in monthly income ($2,664 for couples) and up to $17,600 in assets ($35,130 for a married couple). With Extra Help your drug costs are no more than $4.90 for each generic/$12.15 for each brand-name covered drug, if your monthly income is above $1,325. Your drug costs are no more than $1.60 for each generic/$4.80 for each brand-name covered drug, if your monthly income is below $1,325. If your total drugs costs–what you and your health plan pay) go above $2,000 this year, you’ll pay nothing more. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-fee scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • 2025: Take advantage of the Medicare Advantage Open Enrollment Period

    2025: Take advantage of the Medicare Advantage Open Enrollment Period

    If you’re in a Medicare Advantage plan, you should seriously consider taking advantage of the Medicare Advantage open enrollment period between January 1 and March 31 that allows you to switch to Traditional Medicare (government-administered insurance coverage) or to a different Medicare Advantage plan. This right to switch out of your Medicare Advantage plan is a critical consumer protection.

    Many people do not realize that there are few guarantees with Medicare Advantage. Between the time you sign up for a plan and the beginning of the new year, both the drugs and providers the plan covers could have changed significantly. So be sure to check. Moreover, you never know what illness you might be diagnosed with and whether your Medicare Advantage plan will cover the treatments your physicians recommend or deny them. And, most of the time, you will be faced with what could be harmful delays as a result of prior authorization requirements.

    I’ve written at length about all the reasons not to enroll in a Medicare Advantage plan, especially if you have Medicaid or can afford the supplemental coverage that you need in Traditional Medicare to limit your out-of-pocket costs. Upfront costs in Medicare Advantage are lower than those in Traditional Medicare with supplemental coverage. But, if you get sick and need care–the reason you have health insurance–your out-of-pocket costs are likely to be a lot higher in Medicare Advantage than in Traditional Medicare.

    Moreover, in a Medicare Advantage plan, you are at risk of not getting the care you need if you are diagnosed with a costly condition. The Office of the Inspector General has twice reported widespread delays and denials of care and coverage in most Medicare Advantage plans. Also, access to care is much simpler in Traditional Medicare than in Medicare Advantage.

    In Traditional Medicare, your treating physicians decide the care you need without an insurance company second-guessing your doctor and profiting every time it denies you care. And, there are no prior authorization requirements, requiring you to wait before your care will be covered. Furthermore, you are covered for care from almost all providers anywhere in the US, whereas in Medicare Advantage, your insurer generally will only cover your care from a limited set of providers. And, in Traditional Medicare, with supplemental coverage, your costs are predictable and often very little.

    Medicare Advantage HMOs restrict your coverage to the doctors and hospitals in their networks. You can go out of network for some coverage only if you’re in a PPO. But, even in a PPO, coverage tends to be limited and unpredictable. Driving your costs up further and/or endangering your health, Medicare Advantage plans usually impose prior authorization requirements before they will cover costly care. And, they inappropriately deny care, particularly to people with costly conditions–people needing rehab care, people with cancer and people with other complex care needs.

    The Centers for Medicare and Medicaid Services, which oversees Medicare, should be protecting you from bad actor Medicare Advantage plans, but it cannot. It does not have the capability, the money, or the power to oversee the 4,000 Medicare Advantage plans, much less to hold them to account for their bad acts.

    You should also bear in mind that you can’t count on the providers in Medicare Advantage directories actually being willing to see you. Multiple reports reveal “ghost” networks in some Medicare Advantage plans. As well, I’ve reported many times in Just Care on hospitals terminating their Medicare Advantage contracts, leaving Medicare Advantage plan enrollees scrambling to find alternative care or forced to drive long distances for inpatient services.

    N.B. If you want to switch to Traditional Medicare, note that you will need supplemental coverage (Medigap) to protect you from high out-of-pocket costs. Traditional Medicare does not have an out-of-pocket  limit. If you don’t have Medicaid or coverage from a former employer, make sure you can buy it in the individual market. In most states, insurers selling Medicare supplemental coverage are not required to sell you a policy, with some exceptions, including when you first enroll in Medicare at age 65 or later.

    Here’s more from Just Care:

  • Why see a geriatrician?

    Why see a geriatrician?

    Today, more than 55 million Americans are over 65. The US has an older population than it has ever had. Sadly, the physician population has not grown to meet the needs of older Americans reports Pamela Paul for The New York Times.

    How many board-certified geriatricians are there in the US? Just over 7,000. Only one for every 10,000 older adults. The number has shrunk more than 25 percent in the last 25 years.

    Older adults with multiple chronic conditions can fare much better with treatment from a geriatrician. Much like with children, taking care of older adults is different from taking care of working people. As we age, our brains and bodies change.

    While there are a range of doctors who treat older adults, many of them have never received appropriate training to do so. That training can be invaluable. We have less muscle mass, smaller kidneys and weaker immunological systems by the time we are 65.

    When it comes to geriatric care, physicians should be looking at both the prescription drugs and over-the-counter drugs you take, your cognition, your movement and what you most care about. Geriatricians must consider which of a patient’s medical needs are most important. Patients’ life desires should rank high, be it going on vacation or having better balance. Physicians need to keep in mind that patients might not be able to follow a treatment plan.

    Geriatricians work to help promote as good health as possible. For example, my dad’s geriatrician got my dad off of a few of the prescription drugs he was taking after testing their efficacy over a several month period and finding that they were not benefiting him. His geriatrician also kept a doctor who saw my dad in the emergency room from prescribing him a new and costly medication he did not need. And, that’s not all.

    My dad’s geriatrician arranged for a nurse to visit him every two weeks to check his blood because he was on a blood thinner. She prescribed physical therapy for him because he was shuffling his feet when he walked and she worried about his risk of falling. After talking to him and me about his social network, she thought it would be helpful if he had more social interactions. So, she arranged for the hospital social worker to see him and help him find a program that engaged him socially.

    Why aren’t more physicians becoming geriatricians? It’s a fulfilling profession. But, it’s not glamorous. It requires spending more time with patients. It’s challenging because patients are ultimately not going to improve a lot. It requires an extra year of training over primary care. And, the pay is relatively low, averaging about $258,000 a year.

    Here’s more from Just Care:

  • Turning 65? When to enroll in Medicare

    Turning 65? When to enroll in Medicare

    Turning 65 is fraught for all kinds of reasons, one of which is that you will need to consider whether you should enroll in Medicare. Here’s what I just explained to a friend.

    Should you enroll in Medicare at 65? If you’re not actively working or you do not have health insurance coverage through your job or your spouse’s current job, you will need to enroll in Medicare when you turn 65. And, if you have insurance through your job or through your spouse’s job but the employer has fewer than 20 employees, you also should enroll in Medicare at 65. If you do not, you will pay a penalty for each year you delay enrolling.

    You can enroll before your 65th birthday. You can and should enroll in the three months before your 65th birthday to ensure you are covered on the first day of your birthday month. Contact your Social Security office to enroll. You do not have to sign up for Social Security at that time. In fact, if you can afford to delay taking Social Security, you should, in order to earn larger benefits down the road.

    What choices do you need to make? You need to choose between traditional Medicare, which you should get automatically (but you should confirm) and a Medicare Advantage plan. Traditional Medicare gives you coverage for care from almost all doctors and hospitals across the US, without administrative barriers to care like prior authorization. You pay for supplemental coverage, sometimes called Medigap, to fill coverage gaps–about $2,500 a year for a comprehensive policy–but then you have few out-of-pocket costs; almost all your care is covered in full.

    Medicare Advantage restricts your access to care to its network of providers and has administrative barriers to care such as prior authorization requirements, which can cause undue delays. Medicare Advantage plans also have been found to engage in widespread and persistent inappropriate denials of care and coverage. But, Medicare Advantage plans have an out-of-pocket cap so they save you money if you do not need a lot of care.  If you do, you could spend as much as $9,350 out of pocket in 2025 for in-network care alone. You cannot buy supplemental coverage to cover these costs. If you opt for Medicare Advantage, you will need to choose your Medicare Advantage plan carefully. Do not trust an insurance agent or broker to help you because they generally work on commission. You can compare options online here. You can call your State Health Insurance Assistance Program for free guidance.

    N.B. If you opt for Medicare Advantage when you first enroll in Medicare, you could be locked in. You can always enroll in traditional Medicare, but you might not be able to buy supplemental coverage. It will depend upon where you live. Your federally guaranteed right to Medicare supplemental coverage, sometimes called Medigap, ends one year after you first enrolled in a Medicare Advantage plan, with some limited exceptions. Only four states–NY, CT, ME and MA–require Medicare supplemental insurers to sell you coverage after your initial enrollment period.

    How about prescription drug coverage? With traditional Medicare, you will need to enroll in a Medicare Part D prescription drug plan. You can compare your options online. With Medicare Advantage, prescription drug coverage is almost always included. If you go with a Medicare Advantage plan, to save money, you should choose a Medicare Advantage plan that covers the drugs that you use at the lowest cost. That said, the drugs these plans cover and your out-of-pocket costs can change at any time. Moreover, it can sometimes be cheaper to get your drugs through Costco or another pharmacy. 

    Here’s more from Just Care:

  • Insurer provider directories misleadingly include physicians who are out of network

    Insurer provider directories misleadingly include physicians who are out of network

    Max Blau reports for Pro Publica on how the big insurers provide their enrollees with misleading directories of in-network providers, but nothing is done to fix the problem. We are in the age of tech, when accurate directories should be quick and easy. Insurers should be held accountable if they cannot keep an accurate provider directory, but neither the states nor the federal government is willing to hold the insurers accountable.

    Blau explains that insurers are not penalized for inaccurate directories and that it takes old fashioned cold-calling to figure out how misleading a provider directory is. Misleading directories are helpful to insurers since they encourage people to enroll; and, yet, the insurers won’t cover care from the providers they list who are not in-network.

    For more than ten years, the federal government has reported large inaccuracies in Medicare Advantage provider directories. Do not assume they are anywhere near accurate and up to date. Providers in the network today can leave the network at any time, and many have been leaving Medicare Advantage plans over the last few years.

    New York State government staff called health care providers listed in insurance company directories to determine whether they were actually seeing patients. They wanted to know two key things about the supposedly in-network providers: Do you accept insurance? And are you seeing new patients?

    But, the New York State staffers found that lots of physicians who were listed in the provider directories no longer accepted the insurance or were not taking new patients. Some of the time, staff didn’t even get a call back. As it turned out, insurers’ enrollees could not get treatment from more than eight in ten mental health providers listed in directories whom staff reached out to.

    The New York State law provides for penalties on insurers who do not keep accurate provider directories. But, New York State rarely penalizes insurers and, when it does, the penalty is tiny. When it comes to provider directories, New York State insurer behavior is no different from insurer behavior in other states. Misleading directories are the norm in most states, including Arizona, California and Massachusetts.

    The US Senate Finance Committee staff undertook an investigation a year ago of Medicare Advantage provider directories, and Senate Finance staff also found extremely misleading provider directories. As in the states, the federal government rarely holds the Medicare Advantage insurers accountable.

    The consequences of inaccurate directories can be dire for patients who cannot find providers to treat their conditions. For the insurers, it’s more money in their pockets. If their enrollees can’t get care, the insurers keep more money and grow profits.

    Here’s more from Just Care:

  • Getting public assistance? Beware of Medicare Advantage flex cards

    Getting public assistance? Beware of Medicare Advantage flex cards

    Maya Goldman reports for Axios on the risks of Medicare Advantage flex cards for people getting public assistance. The extra money people think they’re getting through a flex card could mean the end of your government housing or food benefits. UnitedHealth, Humana, CVS offer these cards to entice people to join their MA plans without warning people that the cards could mean the end of their public assistance, even if they don’t use them.

    How is it possible people can lose precious benefits? Government agencies can count flex cards as income. So, when people apply for Supplemental Security Income or rental assistance, adding the value of the flex cards to their income could disqualify them.

    Why are Medicare Advantage plans offering flex cards when they could be harmful to enrollees? It’s hard to imagine insurers are concerned with the risks of giving flex cards to disabled and low-income enrollees. They likely see the flex cards simply as a good hook to boost enrollment and profits.

    Some of the flex cards are specifically targeted to use on items such as groceries and electric bills. Each Medicare Advantage plan offers something different. But, the value of these cards can be significant, with an average value of nearly $1,000.

    People with Medicare and Medicaid could be far better off in traditional Medicare, with coverage from most providers in the US and without the prior authorization obstacles to care people face in Medicare Advantage. But, an extra several hundred dollars a year from a Medicare Advantage plan to offset grocery or utility costs is hard to pass up.

    Ideally, the Biden administration could direct agencies not to consider the flex cards as income, as more than 30 Democratic members of Congress have requested. But, regulations and statutory mandates for different agencies could get in the way of that. Alternatively, CMS should permit insurers to use the money in the flex cards for a different benefit, such as over-the-counter drugs, which would not be considered income.

    The Department of Housing and Urban Development (HUD) excludes most Medicare Advantage benefits from a person’s income when they apply for help. But, HUD is required by statute to count certain utility and rent benefits as income.

    One other concern: People can be misled about the flex cards. They can come with a bunch of limitations that prevent people from using them as they expected. Of course, the insurers profit more if people don’t use their flex cards.

    The insurers, for their part, have done nothing to address the serious issues their flex cards present for some of their most vulnerable enrollees.

    Here’s more from Just Care:

  • To protect older adults and people with disabilities, Congress must add an out-of-pocket cap to Traditional Medicare

    To protect older adults and people with disabilities, Congress must add an out-of-pocket cap to Traditional Medicare

    To promote health equity, meaningful choice, competition between Traditional Medicare and Medicare Advantage plans, as well as to protect older adults and people with disabilities, Congress should limit people’s out-of-pocket expenses in Traditional Medicare by adding an out-of-pocket cap. Congress also should eliminate the enormous overpayments to Traditional Medicare in order to ensure the sustainability of the Medicare Trust Fund and bring down Part B premiums.

    Health equity:  People of color and people with limited means are usually forced to choose among Medicare Advantage plans without being able to know which will cover their care appropriately. They are at serious risk. They are often locked into Medicare Advantage plans with very narrow networks and excessive prior authorization requirements because Traditional Medicare does not have an out-of-pocket limit and they cannot afford supplemental coverage.

    Medicare Advantage insurers are able to decide which Medicare Advantage plans offer more or fewer prior authorization requirements and better provider networks; but, there’s no way for consumers to know. The Medicare Advantage star-rating system is a farce; five-star plans can be bad actors, with ghost networks and widespread inappropriate delays and denials of care. The Centers for Medicare and Medicaid Services (CMS) has no way to protect vulnerable Medicare Advantage enrollees. Without an out-of-pocket cap in Traditional Medicare, they generally do not have it as an option.

    Choice: An out-of-pocket cap in Traditional Medicare would give people a meaningful choice of Traditional Medicare. It would allow people to enroll in Traditional Medicare without financial risk. Low and middle-income people and people of color lack this choice today because they cannot get the supplemental coverage they need to protect themselves financially. Supplemental coverage is either unaffordable or unavailable. 

    Indeed, today, people living in communities that insurers do not see as profitable, typically lower-income communities, can be left without any MA plan options and no meaningful Traditional Medicare option.

    Competition: An out-of-pocket cap would help level the playing field between Traditional Medicare and Medicare Advantage, driving competition.

    Cost savings: In 2024, Medicare Advantage plans cost as much as 22 percent more per person than Traditional Medicare, eating into the Medicare Trust Fund and driving up Part B premiums. Traditional Medicare is far more cost-effective than Medicare Advantage. An out-of-pocket cap in Traditional Medicare would enable more people to enroll, reducing Medicare spending.  

    Coverage: An out-of-pocket cap would protect people in Medicare Advantage plans who are too often inappropriately denied the reasonable and necessary services to which they are entitled. It would enable them to switch to Traditional Medicare. Today, the government cannot protect them from bad actor Medicare Advantage plans. The most vulnerable Medicare subpopulations are hardest pressed to navigate the rules and narrow networks in Medicare Advantage and get the care they need. 

    Here’s more from Just Care:

  • If Congress doesn’t rein in insurers, they will have Medicare over a barrel

    If Congress doesn’t rein in insurers, they will have Medicare over a barrel

    Jakob Emerson reports for Becker’s about big changes coming to Medicare Advantage in 2025. Emerson suggests that for-profit corporate health insurers offering Medicare Advantage plans are struggling, even though the big insurers can circumvent regulations with near impunity and are making huge profits hand over fist. In fact, the big insurers are making huge profits and leveraging their enormous power and influence in Congress to deliver even bigger profits; if Congress doesn’t stop these insurers from corrupting Medicare, older adults and people with disabilities are likely to see their health care costs rise significantly.

    The big health insurers are spending millions of dollars lobbying Congress and misleading people about Medicare Advantage, which costs taxpayers 22 percent more per enrollee than Traditional Medicare and too often prevents people from getting the critical health care they need and that they get in Traditional Medicare.

    The health insurers will do anything they can to maximize profits, even if it means abandoning whole communities. Emerson reports some insurers are giving up enrollees in low-profit margin communities, leaving these people in the lurch. Moreover, some big hospital systems are dropping their Medicare Advantage contracts because the insurers are not paying them appropriately and denying their patients the care they need.

    If you can enroll in Traditional Medicare, you will avoid facing huge hurdles to get the care you need. But, you will need supplemental coverage. To reduce your costs for Medicare supplemental insurance–if you can even get it–buy coverage with fewer bells and whistles.

    If you can’t afford supplemental coverage or can’t find an insurer to sell it to you, call your Senator and Congressperson to complain. Everyone should have a choice of Traditional Medicare, not just rich healthy people. Demand that Congress add an out-of-pocket limit to Traditional Medicare since the government cannot protect you in Medicare Advantage.

    Here’s more from Just Care: