Medicare What's Buzzing

Many people find themselves locked into their Medicare Advantage plans

Written by Diane Archer

If you’ve just joined a Medicare Advantage plan this open enrollment period, you have until December 7, and than again between January 1 and February 14, to reconsider. Here’s what you need to know: Once you’re enrolled in a Medicare Advantage plan, you could find yourself locked in. Medpage Today reports that many people mistakenly think they can leave their Medicare Advantage plan.

In all but four states, however, switching to traditional Medicare is effectively impossible for people with a health condition. Yes, no matter where you live, you can technically switch to traditional Medicare. But, traditional Medicare has no out-of-pocket cap; you need Medicare supplemental insurance to fill coverage gaps and protect yourself financially.

Except in limited situations, you have no right to buy Medicare supplemental insurance. Without Medicare supplemental insurance, your out-of-pocket costs in traditional Medicare if you have a serious health condition could be tens of thousands, if not hundreds of thousands of dollars. With Medicare supplemental insurance, your costs are minimal.

Medicare Advantage plans, in contrast, have an out-of-pocket cap. Still, people are often stuck with huge out-of-pocket costs; you could end up spending as much as $6,700 a year out of pocket for in-network care alone. Many people who join and need costly health care only learn how expensive a Medicare Advantage plan can be after they have joined. Moreover, they may discover that their health plan does not cover care from the doctors and hospitals they want to use. Or, they may find that their health plan unduly delays or inappropriately denies them access to the care their doctors say they need.

Even if you find doctors in the Medicare Advantage plan that you like, those doctors can leave the plan at any time. Or, the plan might raise premiums and deductibles significantly. You can’t rely on the plan for your health and financial well-being.

Understandably, the data show that people with costly conditions often want to switch to traditional Medicare. If they have Medicaid as well as Medicare, it’s an easy switch. Medicaid picks up the out-of-pocket costs in traditional Medicare. But, if they don’t, Medicare supplemental insurers who sell “Medigap” policies to fill gaps in traditional Medicare coverage are likely to refuse to sell them insurance or charge them exorbitant premiums.

You do have limited rights to buy Medigap coverage. You are guaranteed Medigap coverage in the first six months of enrolling in Medicare. And, if you join a Medicare Advantage plan, you are also guaranteed Medigap coverage if you switch to traditional Medicare within a year and sign up no later than 63 days after your Medicare Advantage plan coverage ends.

MedPage Today reports on one man enrolled in a Medicare Advantage plan, who, after surgery to repair a mitral valve and suffering a stroke, ended up with hundreds of dollars a month in copays for his medical services and drugs as well as $295 a day for his hospital stay. He was stunned. Neither the Medicare Advantage ads nor the insurance brokers tell people about these costs or about the difficulty of switching to traditional Medicare and buying Medicare supplemental insurance.

The American Medical Association, which is working hard to oppose Democratic health care reform proposals, knows well the risks of Medicare Advantage plans. It passed a resolution in 2018 recognizing that “seniors are lured to these advantage plans by misinformation and confusing sales techniques.” The AMA also recognizes that these corporate health plans can delay access to care and can deliver poor service.

Many people understandably can’t afford the cost of Medicare supplemental insurance and join a Medicare Advantage plan thinking they will save money. They might. But, you should know that you could spend a lot more in a Medicare Advantage plan if you become seriously ill and need costly care. People who get sick too often go bankrupt or forego needed care. The Medicare Plan Finder tool won’t tell you this.

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2 Comments

  • Thanks for the many articles and information provided through Just Care. Today’s article about switching out of a Medicare Advantage Plan as well as the many others regarding Medicare have prompted me to write a response.

    There seems to be no good or right answer when it comes to Medicare, Medicare Advantage or Medicare Supplemental Plans. I am now 4 years into Medicare and have found it to be a most frustrating and over-rated benefit to seniors.

    At 65 I chose straight Medicare as my husband and I are are both healthy, and straight Medicare worked for us. At 66 I started to look around at our choices. I was concerned about possible high out of pocket expenses, so I chose an Advantage plan with an out-of-pocket cap, with no additional premium. I never considered a Supplemental (Medigap) plan due to the high additional monthly premiums and as I said both my husband and I are healthy.

    After reading this post, I am now more concerned about lack of good insurance coverage for us seniors. There are not a lot of affordable choices that provide good coverage. There should be alarms going off everywhere.

    I realize that as long as we remain healthy, this insurance system works. I also now realize, after reading this post, that due to unforeseen health issues, things could become extremely difficult financially. This should not happen to anyone, especially seniors.

    And one last comment… Prescription (Part D) coverage and penalties. I am now paying $4/mo Part D Penalty due to my lack of prescription coverage for that year of Medicare only. I do not use my insurance plan for my prescriptions. I use GoodRX as they are always more affordable than my insurance plan. I realize that this may not be the case for everyone, but a monthly penalty?

    I believe that our current Medicare system that includes Medicare, Advantage Plans and Supplemental should be reviewed, changed, simplified. “Medicare for All”? If it is like the Medicare that I am now a part of, I believe we could and should do better.

    • You are correct, Deanna. Medicare Advantage is low-cost, so long as you are healthy. If you need costly health services in the future, as most of us eventually do, the costs can be sky high, as much as $6,700 a year for in-network care, not including prescription drug costs. Traditional Medicare gives you more choice, but you need supplemental insurance, which is a few hundred dollars a month, to fill coverage gaps and protect yourself financially. Medicare for All improves on traditional Medicare, filling all the coverage gaps so you have no premiums, deductibles or coinsurance and adding vision, dental, hearing and long-term care services. It would be very simple to use.

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