Bob Herman writes for Axios on the surge in Medicare Advantage enrollment these last several years, notwithstanding its high costs and questionable quality of care, particularly for people with complex and costly conditions. It’s driving up Medicare premiums and eroding the Medicare Trust Fund. Yet, it’s likely to take over Medicare if not reined in.
Right now, more than four in ten people with Medicare are enrolled in Medicare Advantage. Why? In no small part because traditional Medicare has no out-of-pocket cap. So, in order to protect yourself financially in traditional Medicare, you need Medicare supplemental coverage. And, that can easily cost $2,500 a year. As a result, employers, unions and people with lower incomes opt for Medicare Advantage, believing they can save money. Most people do not understand the risks, both in terms of access to care and out-of-pocket costs.
People in Medicare Advantage who develop costly conditions can spend as much as $7,500 a year on their in-network care, depending upon their plan’s out-of-pocket cap. They also might not be able to see the doctors they want to see. So, they take a big gamble, especially because it can be difficult to switch back to traditional Medicare. Many people in Medicare Advantage are effectively locked in because they cannot buy supplemental coverage to pick up and limit their out-of-pocket costs in traditional Medicare.
Medicare Advantage plans lure people in with their out-of-pocket caps and what they claim to be vision, hearing and dental benefits. But, in many cases the out-of-pocket costs are so high that people can’t afford to get the care they need. For vision, hearing and dental services the data show that is often the case. Out-of-pocket costs often are many hundreds of dollars.
Medicare Advantage plans are supposed to coordinate care, but many of them simply restrict access to doctors and hospitals and provide little or no care coordination. Medicare Advantage plans have changing provider networks which undermines continuity of care for their members.
Moreover, even if you need emergency care while you are away from home, your coverage is limited. Medicare Advantage plans must cover your care in the emergency room. But, you should assume that any non-emergency care you receive might not be covered, even if you are too weak to transfer home to receive in-network care.
Medicare Advantage plans have never saved the government money. In fact, their per member costs keep going up. According to the Medicare Payment Advisory Commission, Medicare has never seen “net aggregate savings” from the Medicare Advantage program. Rather, Medicare Advantage is driving up Part B premiums and eating into the Medicare Trust Fund. Congress needs to change the way plans are paid, and quickly!
Here’s more from Just Care:
- High proportion of people flee Medicare Advantage at end of life
- Costs in Medicare Advantage present barrier to care
- People living in rural communities disenroll from Medicare Advantage at a high rate
- The Medicare Advantage scam and beyond
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
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