Today, more than half of older adults and people with disabilities with Medicare are enrolled in a Medicare HMO or other type of Medicare Advantage plan. These plans are run by big corporate health insurers with the goal of maximizing profits for their shareholders. Don’t be fooled: Medicare Advantage can be deadly. Steer clear if you can.
You may be enrolled in a Medicare Advantage plan rather than traditional Medicare, which the government administers directly. If you are a typical older adult, there’s a good chance AARP helped steer you to a Medicare Advantage plan administered by UnitedHealthcare. AARP reaps more than $1 billion in revenues from its partnership with UnitedHealth, and it does not appear to be ensuring that UnitedHealth provides its Medicare Advantage enrollees with the Medicare benefits to which they are entitled.
Indeed, what’s clear is that these Medicare HMOs and PPOs in Medicare Advantage operate with little transparency or accountability. The federal government doesn’t have the will, the skill or the resources to keep them in line. As a result, the insurers operating these health plans can delay and deny care with near impunity. And, according to many reports, including reports by the HHS Office of the Inspector General, they too often do.
Medicare Advantage plans are particularly concerning because most people have no choice but to enroll in one. It’s possible to enroll and pay no upfront costs. So, low-income people, Blacks and Hispanics enroll in Medicare Advantage at particularly high rates. Only wealthy people with Medicare tend to enroll in traditional Medicare, which covers care from most physicians and hospitals across the US without prior authorization. They can afford the upfront costs of supplemental coverage, which picks up coinsurance, and the Part D premium.
Without a level playing field between traditional Medicare and Medicare Advantage, including an out-of-pocket limit in traditional Medicare, there’s no meaningful competition between them. People tend to be locked into Medicare Advantage. If you are relatively healthy, there’s little to be concerned about. Unfortunately, once you get sick, you are likely to find that you can’t get the care you need. At that point, most people are locked out of Traditional Medicare. Not only is supplemental coverage expensive, insurers usually are not required to sell it to you, except when you first enroll in Medicare at 65.
Traditional Medicare should be a meaningful option for everyone with Medicare. For that to be the case, it needs an out-of-pocket limit. At the same time, Medicare Advantage plans need transparency and accountability. Insurers should not be able to play games with people’s health. Ask your Congressperson to step in to protect our nation’s vulnerable older adults. And, if you belong to AARP, ask AARP to demand transparency and accountability in Medicare Advantage.
Here’s more from Just Care:
- Your right to buy a Medigap policy when you enroll in traditional Medicare
- How to switch to Traditional Medicare from Medicare Advantage?
- When your doctors leave your Medicare HMO, will the government protect you?
- Medicare Advantage: Expect lots of care denials
- Insurers pay Medicare Advantage brokers to steer you away from Traditional Medicare
