One thing I know from experience: Don’t trust the insurance agentIf an insurance agent who is helping you decide what Medicare choices to make. It is more than possible that the agent is directing you to the Medicare choices that are the most financially lucrative for the agent. The Commonwealth Fund reports on another issue: Agents generally will not tell you about all your Medicare choices. They might not even tell you about your choice of traditional Medicare. It’s a big problem.
If you’re deciding between traditional Medicare and Medicare Advantage, read this. If you’re deciding among Medicare Advantage plans you should know that it’s virtually impossible to know which plan to choose. So it’s not at all clear that the limited choice the agent offers is an issue. The issue is which plan will give you the care you need at the best price, when you need it. And, no one can tell you that.
As the Princeton health economist Uwe Reinhardt once said: To choose a plan, pick two diseases you might have next year, then find the doctors you would want to see to treat you for those conditions, then find the Medicare Advantage plan that covers those doctors. If you can find one, pick two new diseases and run through the exercise again.
You need health insurance that protects you from unpredictable, unforeseeable health events. Unlike Medicare Advantage, traditional Medicare offers you that protection. It allows you to know that you can see virtually any doctor and use any hospital and your care will be covered. Your insurance agent is not going to be able to tell you that you will be able to see the doctors you want to see for every condition you might develop in any Medicare Advantage plan.
If you’re making Medicare choices, you first need to think about your needs. Do you spend time in different areas of the country? Do you want to be able to see specialists or use certain hospitals? Do you have any health conditions? Do you take any prescription drugs and, if so, what will your copays be in different Medicare drug plans? Are you prepared to spend money on a Medicare supplemental insurance policy to fill gaps in traditional Medicare? Can you afford to pay out of pocket as much as $7,550 a year for in-network care alone if you enroll in a Medicare Advantage plan?
The best independent help you can get with these questions is through a State Health Insurance assistance Program or SHIP. SHIPs provide free counseling from impartial people. They do not make money from steering you in one direction or another.
The Commonwealth Fund recommends that CMS should make it easier for people to use “high-quality” agents and more money should go to SHIPs to provide people with independent guidance. Really? There’s no way to know whether your insurance agent is steering you towards a plan that will meet your needs.
Much of the available information about Medicare Advantage plans is unhelpful. What people need are good meaningful choices–wide choice of providers without high out-of-pocket costs and other hurdles to getting care. Rather, The Commonwealth Fund suggests some kind of rating of agents that people can access; it also buys into the notion that the Medicare star-ratings are worth paying attention to when even MedPAC–the Medicare Payment Advisory Commission–says they are misleading.
Here’s more from Just Care:
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