It’s Medicare Open Enrollment season in the midst of a novel coronavirus pandemic. If you have Medicare, you should be checking out your options for 2021. And, if you’re planning to remain in a Medicare Advantage plan–a private insurance plan that contracts with the government to offer Medicare benefits–or considering enrolling in one, it’s especially important to look at the tradeoffs you will be making. Once you’re enrolled in a Medicare Advantage plan, it can be far more challenging and costly to get the care you need than in traditional Medicare.
For sure, it’s simpler to enroll in a Medicare Advantage plan than traditional Medicare, public insurance administered directly by the federal government. With Medicare Advantage, there is an out-of-pocket cap, and you can’t buy supplemental coverage to fill gaps. Also, as a general rule, your prescription drug coverage is included with your medical coverage, so you don’t have to buy a separate policy.
But, it’s harder to leave a Medicare Advantage plan than traditional Medicare. In most states, insurers that fill gaps in traditional Medicare, Medicare supplement insurers or “Medigap,” are not required to sell you this coverage except when you first enroll in Medicare or you move. (There are a few other exceptions.) And, many people who need costly health care services, such as home care, nursing home care, or specialty care, find they are far better off in traditional Medicare.
Also, with Medicare Advantage, in 2021, your out-of-pocket costs for in-network care can be as high as $7,550, which the Medicare Handbook fails to mention. On top of that, you have out-of-pocket costs for your prescription drug coverage. In addition, you are restricted in the doctors and hospitals you can use and often need permission from your Medicare Advantage plan–“pre-authorization”–in order to be covered for specialty tests.
A report from the Kaiser Family Foundation finds that more than three in four people enrolled in a Medicare Advantage plan have restricted access to doctors and hospitals. On average, plans offered them access to less than half the physicians in their area. Your access to care depends significantly on where you live and the plan you choose. Fewer than one in four people are enrolled in broad-network Medicare Advantage plans, offering access to at least 70 percent of physicians in the community.
Access to certain types of specialists can be especially restricted in a Medicare Advantage plan. Kaiser found that some plans offer very little choice of certain types of specialists. What’s worse is that it is virtually impossible to know in advance whether you will have access to the doctors you want to use. And, while you might be healthy when you join the Medicare Advantage plan, the whole reason to have health insurance is to protect you in the event that you develop a complex condition and need costly services.
Kaiser looked at 391 Medicare Advantage plans in 20 counties. Its findings assume that the Medicare Advantage provider directories were accurate and that the physicians listed were taking new patients. Other studies have found these provider directories to be wildly inaccurate, and often, providers are not taking new patients.
Here’s more from Just Care:
- Medicare ratings of Medicare Advantage plans a farce
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- The Medicare Advantage scam and beyond
- Coronavirus: Medicare Advantage plans doing little to ensure their members get needed care
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