The only question that matters when it comes to health insurance is whether it will meet your health needs when you have a costly and complex condition. Based on mounds of evidence, Medicare Advantage plans do not meet people’s costly care needs. A new Government Accountability Office report finds that a high proportion of people flee Medicare Advantage at the end of life–they go to traditional Medicare to provide them with the care they need.
In theory, Medicare Advantage plans are not allowed to restrict care to people with costly care needs. In practice, because they are paid a flat fee upfront to deliver care to people with Medicare and profit more when they do not spend money on care, they have every incentive to make it difficult to get costly care. And, they have the tools to do so–they choose the doctors and hospitals in their network, they design the copays and deductibles, they determine medical necessity, they decide when to delay and deny care–with virtually no oversight.
The HHS Office of the Inspector General, the Centers for Medicare and Medicaid Services, the Government Accountability Office, and independent health researchers from around the country have all found massive problems with Medicare Advantage when it comes to providing care and coverage to people with serious health conditions. But, to date, neither Congress nor the administration has acted to protect vulnerable older and disabled Americans enrolled in Medicare Advantage.
This new GAO study looked at people in Medicare Advantage during their last year of life. Much like other studies of people in Medicare Advantage with costly conditions, they found that people disproportionately disenrolled from Medicare Advantage because they struggled to get the specialty care they needed. As a result, Medicare spent a lot more money than it otherwise would have providing care to them. In 2017, payments for these people in traditional Medicare were estimated to be $490 million more than the Medicare Advantage plans would have received.
The flaw in the design of Medicare Advantage plans could not be more obvious. When you combine for-profit corporations with the upfront payments they receive to cover people’s care and no link between these payments and the care they cover, these health insurers have every incentive to avoid covering care for people with costly conditions. And, so long as they have little interest in making it easy for people with costly conditions to get high-value care, they present a huge risk to people with Medicare.
Here’s more from Just Care:
- Well-kept secrets of Medicare Advantage plans
- Medicare Advantage: Will you get care from the doctors you want to see at a price you can afford?
- Ten ways Medicare Advantage plans differ from traditional Medicare
- People living in rural communities disenroll from Medicare Advantage at a high rate
- 2020: What you might not know about Medicare Advantage plans
