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Major problems with Medicare Plan Finder

Written by Diane Archer

Not long ago, advocacy groups called out the Centers for Medicare and Medicaid Services (CMS) for misleading the public about Medicare Advantage plans–private insurance plans that offer Medicare benefits–and steering people into them without providing appropriate warnings. Now, the Government Accountability Office (GAO) has issued a report highlighting major problems with the Medicare Plan Finder web site, which is supposed to help people compare Medicare plans.

People should be able to know when they choose a Medicare plan what their out-of-pocket costs are likely to be and which doctors and hospitals they can use. But, the Medicare Plan Finder cannot provide them with this basic information. People with Medicare understandably struggle to get the information they need from the Medicare Plan Finder.

Estimates of out-of-pocket costs are incomplete on the Medicare Plan Finder, so people cannot make a meaningful comparison between traditional Medicare and Medicare Advantage. People need to know that their maximum out-of-pocket costs can be as high as $6,700 in a Medicare Advantage plan and far higher if they use out-of-network doctors and hospitals. But, the Medicare Plan Finder does not highlight these costs. It does not make it easy for people to see that if they want to spend time with a family member outside of their community and need care, they may have to pay for all their care out of pocket if they join a Medicare Advantage plan.

To find out whether the doctors and hospitals you want to use are in a Medicare Advantage plan, call them directly and ask. You can also visit the Medicare Advantage plan’s web site. Always call the plan to confirm. Medicare Advantage plan provider directories are wildly inaccurate. Provider information is not on the Medicare Plan Finder.

In traditional Medicare, people with supplemental coverage have minimal costs. If they do not have Medicaid or retiree benefits to provide this coverage, they need to buy this “Medigap” coverage. And, they need to know its cost and the specific benefits covered. That information is not available on the Medicare Plan Finder site.

Note, the Medicare Handbook is also misleading. Call your SHIP (State Health Insurance Assistance Program) for free help choosing a Medicare plan.

Medicare for All, an improved traditional Medicare, proposed by Senator Bernie Sanders and others, guarantees everyone coverage from virtually all doctors and hospitals, without premiums, deductibles and copays, or the need for supplemental coverage. It would save people money on their health care, without forcing them to give up the choice of doctors and hospitals they most value. As important, it would not force people to try to navigate a sea of rules and constantly changing health plans and guess whether there’s a health plan that may meet their needs. It also would not ration care based on ability to pay.

If you support Medicare for All, please let Congress know. Sign this petition.

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  • This is excellent advice. I have been a SHIP counselor for over 10 years now. However, I’d like to add one other piece of advice.

    You say ‘To find out which doctors and hospitals are in a Medicare Advantage plan, people need to visit the Medicare Advantage plan’s web site and call the plan to confirm its accuracy. Medicare Advantage plan provider directories are wildly inaccurate. Provider information is not on the Medicare Plan Finder.’

    I always advise anyone seeking a Medicare Advantage (MA) plan to talk with their providers. A doctor’s office or a therapy group has office staff that routinely file insurance claims. These folks will be more up-to-date as to whether the provider is part of the network or not. They also can tell you if the provider is planning to leave the network and give you advice as to what MA’s to avoid.

    • Yes! I should have said that as well. Always ask your doctor’s office which Medicare Advantage plans the doctor contracts with. Then, confirm that information with the Medicare Advantage plan. Thanks, Deena! Diane

    • I agree. This recommendation not only holds true for Medicare Advantage Plans but
      for all insurance plans. No one knows what plan(s) the provider is planning to drop in the near future. In addition, a multi-centered facility/provider may participate at one location and not another.

      Diane, always an excellent article written by you.

  • Remember SHINE, while funded by the Federal government is run by the State and sometimes politics gets in the way for decisions like “Long Term care” and “Reverse mortgages”, which when used, can reduce financial pressure on the States Medicaid programs.

  • The Drug Plan finder does not include in its list of potential pharmacies the plans’ preferred network mail-order pharmacies. It only pulls in standard network mail-order pharmacy costs. The preferred network mail-order pharmacies are often the cheapest cost.

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