CVS and Elevance appear to believe that some of their Medicare Advantage plans are less profitable than others. To maximize profits, they have ended commissions to insurance agents for certain Medicare Advantage plans, reports Allison Bell for ThinkAdvisor. Bottom line, if you live in a state where insurer agents don’t have a financial incentives to steer you to those Medicare Advantage plans, you have even more reason not to trust an insurance agent to help you choose a Medicare Advantage plan. Get free unbiased advice from your state health insurance assistance program.
It seems that the less profitable Medicare Advantage plans are in California, Connecticut, New York and Texas. What does that mean for consumers? Most likely, insurance agents will not advise them to sign up for certain Medicare Advantage plans even though those plans could be better options for them. Of course, one never knows.
Right now, during the Medicare Open Enrollment Period, people are choosing between traditional Medicare and Medicare Advantage plans. If you can afford traditional Medicare’s upfront costs–the cost of Medicare supplemental coverage–or you have Medicaid or retiree coverage, enroll in traditional Medicare to ensure you will be covered for the care you need from the physicians and hospitals you trust, in a timely manner. If you cannot afford the cost of supplemental coverage and you need costly care, you will be taking a gamble choosing a Medicare Advantage plan.
Most people with Medicare can still choose a Medicare Advantage plan that does not charge a monthly premium. And most will also have coverage for some dental benefits. But, beware. With Medicare Advantage plans, you don’t pay upfront, but as soon as you get sick and need complex care, you often pay big time–they might not cover your care, they might not cover the cancer center of excellence you want to use, they might delay your care even though you need it urgently, and they might charge high out-of-pocket costs.
The dental benefit offered in Medicare Advantage is often very limited. It can be hard to find a dentist near you who will accept coverage. You will still likely have high out-of-pocket costs.
No matter what you do, if you are in a Medicare Advantage plan and not switching to traditional Medicare, look very carefully at changes to your current plan and other options. You won’t be able to see whether a Medicare Advantage plan has high rates of prior authorization or high denial and mortality rates, unfortunately. That’s what you really need to know.
Also, keep in mind that the five-star Medicare Advantage plans are usually better than the 1, 2, 3 and 4-star plans on some metrics, but they can still have high denial rates and high mortality rates. You just can’t know.
Some good news on the prescription drug front. Your Part D drug coverage, whether through a stand-alone plan if you have traditional Medicare or through a Medicare Advantage plan, will have a $2,000 out-of-pocket limit in 2025. Unfortunately, your premiums and deductibles might go up and the list of drugs covered could shrink. Take a hard look at your options on Medicare Compare, the government’s web site comparing your options.
Centene’s WellCare division seems to have decided that its Part D drug plans are not profitable enough any longer so it has stopped paying brokers commissions to steer people to those plans.
For free unbiased help making a Medicare choice, call your state health insurance assistance program or the Medicare Rights Center at 1-800-333-4114.
Here’s more from Just Care:
- 2024: What to know this Medicare Open Enrollment Period
- To increase Medicare Advantage profits, insurers slash benefits and pull out of some markets
- 2024: Too little known about Medicare Advantage
- Ignore Medicare Advantage ads; they misrepresent costs and benefits
- Medicare Advantage: Tune out the Joe Namath ads
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