JustCare

Category: Medicare

  • Administration expands Medicare special enrollment periods

    Administration expands Medicare special enrollment periods

    Most people enroll in Medicare in the three months before their 65th birthday month so that their coverage begins on the first day of their birthday month. But, some people miss this initial enrollment period and often pay a penalty for delaying their enrollment. A new Biden administration rule gives more people the right to enroll during a special enrollment period, eliminating penalties for late enrollment.

    As of January 1, 2023, more people who do not enroll in Medicare at 65 will be eligible for a special enrollment period, ending coverage delays and penalties for late enrollment. Without this change, these people would only be eligible to enroll in Medicare during the General Enrollment Period, between January and March of each year. They also would need to wait several months after enrolling for their Medicare coverage to begin. And, they would pay a 10 percent Part B premium penalty for each year they delayed enrollment in Medicare Part B.

    A special enrollment period (SEP) will be available to people who did not enroll in Medicare because of exceptional conditions. As of January 1, 2023, people affected by a disaster or government-declared emergency, people whose employer or health plan materially misrepresented information regarding timely enrollment, people who were in prison, and people whose Medicaid coverage ended after the COVID public health emergency ends will be eligible for a special enrollment period.

    In addition, some people who have had a kidney transplant and would lose Medicare coverage will have a new immunosuppressive drug benefit, giving them immunosuppressive drug coverage.

    If you need help enrolling in Medicare or have questions about your coverage, contact your State Health Insurance Assistance Program through www.shiphelp.org. 

    Here’s more from Just Care:

  • The high costs of Medicare Advantage and how to address them

    The high costs of Medicare Advantage and how to address them

    Taxpayers and people with Medicare are overpaying big time for Medicare Advantage, the corporate health plans that offer Medicare benefits. In a letter to the New York Times, Richard Kronick, a former government official, explains that the administration has the power to address Medicare Advantage’s high costs and reduce the heavy financial load Medicare is bearing. The Centers of Medicare and Medicaid Services (“CMS”) needs to adjust the way it pays Medicare Advantage plans.

    Right now, CMS pays MA plans a flat fee per enrollee and that fee is adjusted up, based on the diagnosis codes of each enrollee, thereby incentivizing the Medicare Advantage (MA) plans to identify as many diagnosis codes as possible for each enrollee.

    Kronick estimates that, if CMS does not fix its method for calculating payments to Medicare Advantage plans, overpayments to Medicare Advantage will be more than $600 billion in the next nine years. Some Medicare Advantage plans are engaging in fraud and inappropriately adding diagnosis codes to patient records. But, stopping their behavior, were it possible, won’t fix the overpayments. Because of the way the government pays them, all Medicare Advantage plans are adding as many appropriate diagnosis codes to patient records as possible–so that they will be paid more–even when for patients who might not need or receive any additional services.

    Kronick suggests that CMS payments to Medicare Advantage could be adjusted to be more in line with Traditional Medicare, instead of about four percent more. His fix would correct one piece of the problem with payments to Medicare Advantage plans. But, the big problem lies with the government paying Medicare Advantage plans a fixed amount per enrollee unrelated to the cost of covering their health care services. So long as Medicare Advantage plans profit more when they deny or withhold care, they are likely to deny or withhold care or send enrollees to low cost providers as much as they can.

    If the government wants to ensure Medicare Advantage plans well-serve the needs of people with costly conditions, it must pay them based on the cost of services they cover. On top of that, Medicare Advantage plans should receive a care management fee. To contain costs, the total payment amount should be capped.

    Here’s what you need to think about when it comes to costs in Medicare Advantage:

    Medicare Advantage (MA) often costs less than Traditional Medicare and supplemental coverage for people who use relatively few health care services. But, people in MA plans cannot buy supplemental coverage to pick up deductibles, copays and other out-of-pocket costs. These out-of-pocket costs can total as much as $7,550 a year for in-network care alone.

    Medicare Advantage costs more than Traditional Medicare for:

    • Taxpayers: The government has always paid more for MA than Traditional Medicare. MA is projected to cost $600 billion more over the next nine years.
    • Everyone with Medicare: People in Traditional Medicare as well as in MA pay higher Medicare Part B premiums because of MA’s higher costs.
    • People with complex care needs: People in MA often face financial barriers, including copays and deductibles, which can force them to forgo critical care. Out-of-pocket costs in Medicare Advantage could be as high as $7,550 a year, a lot more than Traditional Medicare with supplemental coverage. In Traditional Medicare, people with supplemental insurance have few if any out-of-pocket costs. Supplemental insurance typically costs around $2,500 a year.

    Medicare Advantage causes stress and anxiety for people with complex care needs that they do not face in traditional Medicare. They disenroll from MA at disproportionately high rates.

    Medicare Advantage offers less value than Traditional Medicare. The available data suggests that people in MA, overall, receive about the same quality care as people in Traditional Medicare. But, the cost of MA is significantly higher. Higher costs and similar quality mean lower value in MA. 

    Fixed payments to Medicare Advantage wastes taxpayer dollars. MA receives around $12,000 a year on average per enrollee, including the 50 percent of enrollees with few health care needs who cost Traditional Medicare an average of $875 a year, wasting taxpayer dollars.

    Medicare Advantage imposes additional untold costs. Many insurers offering MA have long histories of engaging in fraud against the government. Because they operate largely in secret, much of their behavior goes undetected, at unknown cost to people’s health and well-being.

    Medicare Advantage plans have never released reliable cost data. In a recent report, their consultants state that estimates of MA costs are  “inherently uncertain.”

    Here’s more from Just Care:

  • People in Medicare Advantage trade away access to care

    People in Medicare Advantage trade away access to care

    Both the Wall Street Journal and MedPage Today recently have run compelling stories on the tradeoffs of opting for Medicare Advantage. They focus on the fact that people in Medicare Advantage, health plans offering Medicare benefits run by corporate health insurers, lose access to care from the doctors, hospitals and other health care providers they might want to use. And, Medicare Advantage enrollees can end up paying a lot more out of pocket for their care than they would in Traditional Medicare with supplemental coverage, if they get sick.

    Medicare Advantage is not always low-cost or easy to use. One enrollee diagnosed with pancreatic cancer needed a PET scan to determine whether his cancer had spread and whether surgery was appropriate. But, the Cleveland Clinic told him that if he was in an MA plan, it would take at least three weeks for MA approval of the PET scan, during which time his cancer could be spreading. Fortunately, he was in Traditional Medicare and got the PET scan three days later.

    The MA ads and sales agents don’t begin to tell people the full story. In addition to restricted access to providers and undue and inappropriate delays in receiving care, MA plan denial rates can be quite high. So, even if your treating physician says you need care, your MA plan might overrule that physician’s decision. Then, your only choice is to pay out of pocket and/or appeal the denial.

    The Office of the Inspector General found that “among the prior authorization requests that MAOs [Medicare Advantage organizations] denied, 13% met Medicare coverage rules; in other words, these services likely would have been approved for these beneficiaries under” Traditional Medicare.

    Most of the time, denials are overturned on appeal, especially with a letter from your treating physician documenting your need for care. The process is easy and costs you nothing, but it takes time. During that time, people’s health can deteriorate.

    Insurance agents are paid more to enroll people in Medicare Advantage than in supplemental coverage that fills gaps in traditional Medicare. So, many of them steer people to Medicare Advantage and, often, to the Medicare Advantage plans that pay the biggest commissions. Sometimes, agents direct people to Medicare Advantage plans that don’t meet their needs–their doctors are not in-network, out-of-pocket costs are prohibitive, and administrative hurdles are too challenging.

    The federal government reports that complaints about Medicare Advantage have more than doubled between 2020 and 2021, from nearly 16,000 to nearly 40,000! And, most people do not bother complaining to the federal government. Hospitals have begun complaining in a big way, as well; in fact, the Mayo Clinic just announced that it won’t be contracting with Medicare Advantage plans any longer, in most parts of the country, telling its patients in Florida and Arizona to enroll in Traditional Medicare with supplemental coverage.

    So far, neither the administration nor Congress has begun to act to address the fundamental flaws with Medicare Advantage. Here are ten ways to improve it, few of which are under consideration at the moment.

    For its part, the Medicare Advantage trade association points to all the people enrolling in Medicare Advantage who are satisfied. It’s easy to be satisfied when you need few health care services, and the MA plan gives you free health memberships and discounts on eyeglasses to ensure you stick with it. The 5o percent of people with Medicare who use the fewest health care services cost Medicare well under $1,000 each. But, the government pays the MA plans more than 11 times that amount to cover their care. Talk about a waste of money.

    MedPage Today concludes its story with this: “Numerous beneficiaries told MedPage Today that they signed up for their MA plans when they were younger and healthier. Their premiums were zero or low. But after they needed care for newly diagnosed chronic conditions, they found themselves paying far more in co-pays and deductibles than a supplemental plan would have cost them. Now with pre-existing conditions they’re ineligible to sign up for a supplement. They’re stuck.” Of course, you never know when you will be diagnosed with costly chronic conditions.

    One physician explains that MA enrollees  are ” ‘trading money for access,’ that is low or no premiums for a limited network, and they may not be able to see the best specialist for their problem. I have to tell them, ‘Your plan does not offer that,’ he said.”

    Here’s more from Just Care:
  • Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment begins on October 15 and runs through December 7. You have many choices to make and you should take the time needed to make them, for both your physical and your financial health. A smart choice could save you money and steer you away from bad actors.

    Five things to keep in mind:

    Access to care: Health insurance is about your care needs today and unforeseeable needs down the road. Your Medicare plan should cover all medically necessary care if you’re diagnosed with cancer, heart disease or stroke, fall and break a bone, or are in a serious accident.

    Cost:  Many older adults skip needed care because of high out-of-pocket costs.

    • Traditional Medicare covers virtually all your out-of-pocket inpatient and outpatient costs, so long as you have supplemental coverage—Medicaid, retiree benefits, or Medigap, which you buy in the individual market for about $2,500 a year.
    • Medicare Advantage plans charge deductibles and copays that average around $5,000 a year and can be as high as $7,550. Each one charges different amounts for in-network care and most do not cover out-of-network care.

    Fraud: Some providers and Medicare Advantage plans have histories of engaging in fraud.

    Incentives: Beware of physicians and insurers that profit from denying or delaying your care.

    • Traditional Medicare pays for each service you receive, so physicians have no incentive either to withhold care you need or to keep you from seeing top specialists.
    • Medicare Advantage plans are paid a flat upfront fee, so they have a financial incentive to keep you from getting costly care. The less care you get, the more they profit.
  • Medicare Advantage plans are an “Insatiable Cash Monster”

    Medicare Advantage plans are an “Insatiable Cash Monster”

    In a no holds barred expose, Reed Abelson and Margot Sanger-Katz report for the New York Times on the fraudulent activities of the largest health insurers offering Medicare Advantage plans. “The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions” takes a deep dive into how Medicare Advantage plans add diagnosis codes to patients’ medical records in order to receive higher payments from the government and drive up profits. The overpayments the Medicare Advantage plans collect increase Medicare spending to the tune of tens of billions of dollars each year and do nothing to ensure that people in Medicare Advantage plans get the care they need.

    The story explains how Medicare Advantage insurers reward physicians with champagne, money and other goodies for adding diagnosis codes to patient records. Each diagnosis code means more money for the Medicare Advantage plans, which receive a fixed amount for each enrollee, adjusted up for enrollees with multiple diagnoses.

    Abelson and Sanger-Katz explain how “major health insurers exploited the [Medicare Advantage] program to inflate their profits by billions of dollars. Of the five large Medicare Advantage participants, UnitedHealth, Humana, Elevance (formerly Anthem) and Kaiser Permanente have been charged with fraud for adding inappropriate diagnosis codes to patient files. The Justice Department is currently investigating CVS Health for related conduct.

    Instead of saving money, Medicare Advantage costs taxpayers a lot more than traditional Medicare. One former government official projects that overpayments in 2020 alone totaled $25 billion and that overpayments will total $600 billion over the next nine years. Not surprisingly, the Kaiser Family Foundation reported that the companies offering Medicare Advantage plans generate twice as much gross profit from Medicare as from their commercial health insurance businesses.

    For reasons unknown, the Centers for Medicare and Medicaid Services (CMS) has done a poor job of keeping the Medicare Advantage plans from overbilling the government and an equally poor job of collecting overpayments that are identified. Instead of reducing Medicare Advantage rates to adjust for the overbilling, CMS has increased them substantially, up eight percent in 2023. And, when CMS audits plans and finds overpayments, it only goes after the plans for the small number of overpayments it finds through its audits.

    Where’s the value in Medicare Advantage? “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,” according to Dr. Donald Berwick, the head of CMS during the Obama administration. Contrary to what some might believe, traditional Medicare offers better value than Medicare Advantage, as good or better care, particularly for people with complex and costly conditions, at lower cost.

    Here’s more from Just Care:

  • Medicare Advantage: Beware of inappropriate nursing home stay denials

    Medicare Advantage: Beware of inappropriate nursing home stay denials

    Susan Jaffe writes for Kaiser Health News about the risk that your Medicare Advantage plan will inappropriately deny you the nursing home care you need. Because the government pays Medicare Advantage plans a flat upfront fee, they have a powerful financial incentive to keep you from getting the costly care you need. They profit more the less they spend on your care.

    No one is monitoring in real time when and how Medicare Advantage plans delay and deny nursing home care, or any other care for that matter. The government pays Medicare Advantage plans to cover the same amount of medically necessary care as traditional Medicare covers. And, though the Medicare nursing home benefit is limited, it should cover as much as 100 days in a nursing home for people who have been hospitalized as an inpatient for at least three days in the 30 days prior to nursing home admission and who need daily skilled nursing or therapy services.

    The Office of the Inspector General (OIG) reports that Medicare Advantage plans can and do stint on costly care, including nursing home care, even when your treating physician says it is medically necessary. And, the Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing Medicare, does not publicly identify the bad Medicare Advantage actors, let alone cancel contracts with those that engage in widespread inappropriate delays and denials of coverage, as some do.

    In her story, Jaffe reports on a 97-year old woman in a nursing home whose Medicare Advantage plan told her it was ending nursing home coverage after only an 11-day stay. Her medical team disagreed with the decision, saying that she was not in good enough health to return home. She had taken a bad fall. Experts report that it has become increasingly common for Medicare Advantage plans to overrule the treatment preferences of patients and their doctors and deny care, without even seeing the patient.

    The American Health Care Association has “significant concerns” about the behavior of Medicare Advantage plans. No question that people are better off in their homes when they are healthy and able to take care of themselves, as the Medicare Advantage plans argue. But, it’s unsafe to push vulnerable older adults out of a nursing home before they are in good enough shape to manage at home.

    If your Medicare Advantage plan denies you skilled nursing facility or rehab care that your medical team says you need, you have the right to appeal. With a letter from the medical team explaining why care is medically reasonable and necessary and why you meet the eligibility requirements for skilled nursing facility or rehab benefits, there is a very high likelihood the Medicare Advantage plan will reverse its decision. And, if it does not do so, you can appeal to a higher level authority, where you are likely to succeed on appeal.

    There is no cost to appealing a Medicare Advantage denial of coverage, and it’s easy. You will likely face bills from the nursing facility while your appeal is being decided. But, you can ignore the bills if you win your appeal, and you have a high likelihood of winning. The Medicare Advantage plan will have to pay. Unfortunately, your Medicare Advantage plan faces no penalty for inappropriate denials. So, it can continue to deny care inappropriately without any likely consequence.

    Here’s more from Just Care:

  • 2023: Medicare premiums and other costs

    2023: Medicare premiums and other costs

    The Medicare Open Enrollment period begins on October 15 and ends on December 7, so you will have several weeks to review your Medicare options for 2023. Particularly if you have Medicare Part D drug coverage or are enrolled in a Medicare Advantage private plan–a health plan offered by a corporate health insurance company–reviewing your options could save you a lot of money. Your Medicare Part B premium will be slightly lower in 2023, regardless of whether you are enrolled in traditional Medicare or a Medicare Advantage plan.

    In 2023, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $164.90, a monthly decrease of $5.20 from $170.10, for people with annual incomes of $97,000 or less in 2021. In addition, you will get a Social Security increase of around nine percent. The exact increase will be announced shortly.

    In 2023, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about seven percent of the Medicare population–pay a Medicare Part B premium of:
    • $230.80 a month, if their income is above $97,000 and no more than $123,000.
    • $329.70 a month, if their income is above $123,000 and no more than $153,000
    • $428.60 a month, if their income is above $153,000 and no more than $183,000
    • $527.50 a month, if their income is above $183,000 and less than $500,000
    • $560.50 a month, if their income is $500,000 or more

    For couples with combined incomes of $366,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $366,000 and less than $750,000 each pay a $527.50 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $560.50 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $26, a decrease of $7 from the 2022 annual deductible of $233.

    If your income is low, you may qualify for help paying your premium and sometimes also your deductibles and coinsurance through the Medicare Savings Programs: People with incomes up to 135 percent of the federal poverty level, ($1,549 in monthly income for an individual and $2,080 for a couple in 2022; these amounts may increase in 2023) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2023 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $259 a month; if you don’t have at least 30 quarters, the premium could be $471 a month.
    • The Medicare Part A inpatient hospital deductible is $1,600, in 2023 an increase of $44 from 2022, and  coinsurance for hospitalizations after day 60 is $400 a day in a benefit period; coinsurance for lifetime reserve days is $800 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $200.00, an increase of $5.50 from $194.50 in 2022.

    If you have Medicare and are 36 months post kidney transplant, you are no longer eligible for full Medicare coverage. But, beginning in 2023, you can elect to continue Part B coverage of immunosuppressive drugs if you pay a premium. In 2023, the immunosuppressive drug premium is $97.10.

    Medicare Part D premiums

    Premiums for Part D prescription drug coverage vary by income and by Part D plan. The premium is generally deducted from your Social Security check. People with annual incomes at or under $97,000 do not pay an additional income-adjusted premium amount.

    If your annual income is above $97,000, you will be charged between $12.20 and $76.40 a month extra. The extra amount is based on how much higher than $97,000 your income is, with a cap at $750,000.

    Insulin

    Beginning July 1, 2023, you will pay no more than $35 a month out of pocket for insulin. If you take insulin through a pump you get through Medicare, you will have no deductible.

    Here’s more from Just Care:

  • Health insurance industry continues to mislead on high costs of Medicare Advantage

    Health insurance industry continues to mislead on high costs of Medicare Advantage

    Whatever you say about Medicare Advantage–the Medicare health plans administered by private insurance companies–one thing is undeniably true: Medicare Advantage costs more than traditional Medicare and has cost more–all in, more than a hundred billion dollars more–since its inception. But, AHIP, the trade association representing health insurance corporations, is doing its damnedest to deny the high cost of Medicare Advantage, misleading the public on its costs.

    In a new report by Wakely, which AHIP commissioned to counter government claims about Medicare Advantage’s high costs, Wakely attempts to support AHIP. But, Wakely concludes its report with the following “limitations,” wholly undercutting its analysis and shifting responsibility for inaccuracies onto AHIP: “The assumptions and resulting estimates included in this report and produced by the model are inherently uncertain. Users of the results should be qualified to use it and understand the results and the inherent uncertainty. Actual results may vary, potentially materially, from our estimates. Wakely based this analysis primarily on CMS published data, which are subject to revision over time. It is the responsibility of AHIP to review the assumptions carefully and notify Wakely of any potential concerns.”

    Medicare Advantage costs more than traditional Medicare in three very different ways. Medicare Advantage costs more in dollars spent by the government, about four percent more per percent than traditional Medicare, according to the Medicare Payment Advisory Commission or MedPac. And, it is projected that Medicare Advantage will cost $600 billion more over the next nine years.

    Medicare Advantage costs more out of pocket than traditional Medicare with supplemental coverage for people with costly health care needs, in many cases. Annual out-of-pocket costs in Medicare Advantage can be as high as $7,550 for in-network care alone, while supplemental coverage costs about $2,500 a year. Moreover, in some instances, Medicare Advantage plans force people to go out of network if they want to use high quality specialists and top specialty hospitals; then, people must bear all those costs themselves.

    Medicare Advantage costs more than traditional Medicare in terms of health and well-being for people whom Medicare Advantage plans keep from getting the care they need. Sometimes, Medicare Advantage enrollees cannot afford their copays and forgo care. Sometimes, people’s Medicare Advantage plans second-guess their treating physicians and inappropriately deny them care. According to the American Hospital Association and many physicians, some people end up with disabling conditions waiting for needed care. Some die, needlessly.

    Medicare Advantage is also draining the Medicare Trust Fund needlessly. And, because Medicare Advantage costs the government more money, Medicare Advantage drives up Medicare Part B premiums for everyone with Medicare, including people in traditional Medicare.

    Yes, for people fortunate to need relatively little health care, Medicare Advantage costs less than traditional Medicare with supplemental coverage. Anyone who enrolls in Medicare Advantage saves money on the cost of the supplemental coverage they need to fill coverage gaps in traditional Medicare, since traditional Medicare does not have an out-of-pocket cap. But, given all the costs of enrolling in Medicare Advantage and the likelihood that people will need costly care at some point, joining a Medicare Advantage plan could mean playing Russian Roulette with your health.

    If Congress is not going to end the Medicare Advantage program altogether, which it should, the government must overhaul it. First and foremost, Medicare must stop paying Medicare Advantage plans a flat upfront fee regardless of the cost or quality of care Medicare Advantage plans cover. Until it does, you can expect that Medicare Advantage plans will take the government’s money and run with as much of it as possible.

    Here’s more from Just Care:

  • 2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    The 2023 Medicare and You Handbook is now available for your reading pleasure. Unfortunately, it continues to mislead and confuse in significant ways about Medicare Advantage. Though the Centers for Medicare and Medicaid Services (CMS) would like you to believe otherwise, Medicare health plans administered by corporate health insurers–euphemistically called Medicare Advantage–cover fewer costly services, often from lower quality providers, than traditional Medicare.

    Here’s what’s seriously misleading and what’s true in the Medicare Handbook:

    • The Handbook says: Medicare Advantage plans “may have lower out-of-pocket costs” than traditional Medicare. Here’s what’s true: You could spend as much as $7,550 out of pocket if you need costly care. However, so long as you are healthy or forgo needed care, you will likely spend less on your health care. The problem is that you need health insurance to protect you in the event you need costly care. It’s of far less importance if you’re healthy.
    • The Handbook says: Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers.” Here’s what’s true: You have the same Part A and B benefits in theory as people in traditional Medicare. In practice, Medicare Advantage plans have their own rules as to what services are medically necessary. They tend to be far more restrictive than Original Medicare, second-guessing treating physicians, whom they have hand-picked for their networks, as to what care is medically necessary. So, Medicare Advantage plans are likely to cover fewer services for shorter periods of time and, sometimes, from lower quality providers. And, the government is unable or unwilling to oversee them and hold them accountable when they do not do so. Only in theory are Medicare Advantage plans required to cover all medically necessary services that Original Medicare covers.
    • The Handbook says: Medicare Advantage plans “may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.”  Here’s what’s true: You may have extra “benefits” like vision, hearing and dental, but these benefits tend to be extremely limited in scope and tend to require you to pay large out-of-pocket costs.
    • The Handbook says: With Medicare Advantage plans, “you can’t buy and don’t need Medigap,” supplemental coverage that picks up costs that Medicare does not cover. Here’s what’s true: You can’t buy Medigap, but you likely would be better off with it if you need costly care. Without supplemental coverage, most people in Medicare Advantage, unlike people in traditional Medicare with supplemental coverage, are constantly having to choose between their health care and other basic needs. Or, they could be pushing themselves into medical debt.

    Here’s what the Medicare Handbook does not say:

    The government pays corporate health insurers a flat upfront payment to cover care for enrollees through Medicare Advantage, with little if any regard to the cost or quality of services each plan offers. These insurers have a compelling financial incentive to spend as little as possible on enrollees’ care and pocket as much of the money they receive as possible. While there is technically a limit on the amount they can pocket, they have ways to game that limit.

    Here’s more from Just Care:

  • Paying more for a Medicare Advantage plan is likely a waste

    Paying more for a Medicare Advantage plan is likely a waste

    If you are choosing a Medicare Advantage plan, keep in mind that you are taking a big gamble: You can’t know whether it will cover the care you need when you need it. The star-rating system is a farce. And, paying more is likely a waste. It’s not a proxy for better quality, according to a new study in JAMA Health Forum.

    The authors find that quality of care in Medicare Advantage does not differ in a meaningful way across premium levels. In fact, they find that there is tremendous variability in quality at each premium level. That said, the authors do report slightly higher quality of care and patient experience in higher-premium plans.

    The takeaway: If you can’t afford the supplemental coverage you need for traditional Medicare and you are choosing among Medicare Advantage plans, you should not choose the Medicare Advantage plan with the higher premium on the theory that it will provide you with better quality care.

    A second takeaway: The additional premium you choose to pay for a Medicare Advantage plan might not bear any relation to significant copays you might face should you need costly care. Those out-of-pocket costs are unknown. Because they can be high, many people end up skipping or delaying needed care in order to avoid paying these costs.

    The bottom line: With Medicare Advantage, what you think is more could very well be less. Higher premiums and “additional benefits” may end up delivering far less than you might think. The problem is that you likely won’t find out the financial and administrative barriers to care you face until it’s too late to disenroll.

    Here’s more from Just Care: