Insurers offering Medicare Advantage plans too often delay and deny care inappropriately. If you happen to live in a low-income community, you are more likely to be forced to join a Medicare Advantage plan that does not cover the care to which you are entitled under Medicare, according to a new analysis by Avni Gupta et al. published in JAMA. This analysis adds to the mountains of evidence that insurers are fostering health inequities among Black, Hispanic and other vulnerable Americans in Medicare Advantage.
To be clear, you should not assume that if you are a middle-class white American in a Medicare Advantage plan that you will get the care you need. Even Medicare Advantage plans with five-star ratings delay and deny care inappropriately. And, there is no way for you to know which ones do.
You are better off in traditional Medicare if you get sick and need costly and complex care. You can choose your physicians and you will get the care you need in a timely manner without bureaucratic hassle. But, you will need Medicare supplemental insurance or Medigap, to protect you from financial risk. With Medigap you will have few out-of-pocket costs, but it will cost you around $2,500 a year. While Medicare Advantage plans have an out-of-pocket cap, your out-of-pocket costs for in-network care alone can be as high as $8,850 this year, depending upon the Medicare Advantage plan you join. If you go out-of-network, your costs will be even higher.
But, if you live in a low-income community, you are more likely to have fewer choices of Medicare Advantage plans with five-star ratings. And, it is fair to assume that plans with one, two, three and four-star ratings should be avoided. If a plan is not able to earn a five-star rating, there’s likely something wrong with its performance.
Put differently, it is harder to enroll in a Medicare Advantage plan with a five-star rating if you live in a community with greater poverty and unemployment. As a result, you are likely to experience worse health outcomes. Specifically, you are more likely to receive poorer chronic care management and less likely to receive screenings and vaccinations. Customer service is more likely not to be good. And, if your Medicare Advantage plan inappropriately denies the care you need, it could be harder to challenge that denial.
Here’s more from Just Care:
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Well-kept secrets of Medicare Advantage plans
- OIG finds widespread inappropriate care denials in Medicare Advantage
- What we don’t know about Medicare Advantage
- Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?
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