Remember the line about the bridge in Brooklyn? “If you believe that, I have a bridge in Brooklyn to sell you.” Don’t fall for the con. It applies in spades to all the hype about Medicare Advantage. You might save a little money, but it could cost you your life. No joke.
The families of two Medicare Advantage enrollees are suing UnitedHealthcare, in a proposed class action suit, for wrongly cutting off their medically necessary care in a rehabilitation facility. The enrollees have died. The families allege that UnitedHealthcare used artificial intelligence to deny their relatives care, without appropriate attention to their relatives’ particular care needs, as required under Medicare rules. UnitedHealthcare denies any wrongdoing.
You always can save money by not having health insurance or not getting health care when you really need it. That’s effectively what’s happening to some people in Medicare Advantage plans. When Medicare Advantage enrollees get sick–when they really need health insurance to cover their health care–they could be out of luck, without the coverage to meet their needs. And, that goes for people in Medicare Advantage HMOs with restricted networks, as well as people in PPO’s, with more open networks.
The American Hospital Association just sent another letter to the Centers for Medicare and Medicaid Services, CMS, which is charged with overseeing the insurers offering Medicare Advantage, urging CMS to enforce rules intended to keep the Medicare Advantage plans from inappropriately denying care. The problem is that the rules have no teeth. So, corporate health insurers are flouting them, denying care to people whose care would be covered in Traditional Medicare.
An earlier letter from the American Hospital Association to CMS documented the serious harm some insurance companies are inflicting on Medicare Advantage plan enrollees needing critical hospital care.
CMS appears to believe that its ability to protect people from Medicare Advantage plan bad actors is circumscribed, even when the insurers offering Medicare Advantage are clearly violating their contractual obligations. Consequently, people enrolled in Medicare Advantage plans are taking a huge gamble. If they need costly care, it’s not clear they will get it.
There could be some insurers offering Medicare Advantage that are doing right by their enrollees. But, if there are, no one knows which ones. Do you really want to roll the dice with your health and well-being?
Right now, during the Medicare Open Enrollment period, you should seriously consider making a switch to Traditional Medicare. If you have Medicaid, you will have almost all your costs covered. Even if you don’t have Medicaid, if you don’t need a lot of health care, you will have few out-of-pocket expenses. If you want good protection from financial risk, you will need to buy supplemental coverage, which can be costly and hard to come by. But, in most states, Medigap plans K and L are low-cost. Even without Medigap coverage, your out-of- pocket costs are not likely to be any higher than your out-of-pocket costs in Medicare Advantage, which can be as high as $8,850 for in-network care alone. And, in Traditional Medicare, you can be sure that you will get the care you need when you need it.
The Biden Administration could protect people in Medicare Advantage immediately, as it figures out how to ensure that the Medicare Advantage insurers are accountable for their bad acts. The Administration could, through executive order, require CMS to put an out-of-pocket cap in Traditional Medicare. The cap should save Medicare money, as the government is so wildly overpaying the insurers offering Medicare Advantage plans, that giving people the ability to enroll in Traditional Medicare without having to buy supplemental coverage would guarantee them access to the care they need at a lower cost to the Medicare program.
Here’s more from Just Care:
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- 2023: Four things to know if your income is low and you have Medicare
- When will the Medicare Advantage scam end?
- Seven questions you should be asking this Medicare Open Enrollment period
- Don’t judge a Medicare Advantage plan by its stars
Leave a Reply