Medicare Annual Open Enrollment: Beware of Bad Actors  

Medicare Annual Open Enrollment begins on October 15 and runs through December 7. You have many choices to make and you should take the time needed to make them, for both your physical and your financial health. A smart choice could save you money and steer you away from bad actors.

Five things to keep in mind:

• Many insurers offering Medicare Advantage have long histories of fraud, which can endanger enrollees’ health and well-being. They profit more if they cover less care.
• Choose a Medicare plan that covers care from high quality doctors and hospitals, including cancer centers of excellence.
• Referrals and prior authorizations pose barriers to care in Medicare Advantage.
• Out-of-pocket costs in Medicare Advantage pose barriers to care.
• If you opt for Medicare Advantage, you might lock yourself out of Traditional Medicare because federal law does not guarantee you the right to buy supplemental coverage.

Access to care: Health insurance is about your care needs today and unforeseeable needs down the road. Your Medicare plan should cover all medically necessary care if you’re diagnosed with cancer, heart disease or stroke, fall and break a bone, or are in a serious accident.

• Traditional Medicare covers all the care you need from most physicians and hospitals across the US, without a referral or the need for prior approval.
• Medicare Advantage plans often limit access to a small network of physicians. They may engage in widespread inappropriate delays and denials of care, overriding your physicians’ opinions about the care you need. You often need prior approval for care.

Cost:  Many older adults skip needed care because of high out-of-pocket costs.

• Traditional Medicare covers virtually all your out-of-pocket inpatient and outpatient costs, so long as you have supplemental coverage—Medicaid, retiree benefits, or Medigap, which you buy in the individual market for about $2,500 a year.
• Medicare Advantage plans charge deductibles and copays that average around $5,000 a year and can be as high as $7,550. Each one charges different amounts for in-network care and most do not cover out-of-network care.

Fraud: Some providers and Medicare Advantage plans have histories of engaging in fraud.

• Whether you’re in Traditional Medicare or Medicare Advantage, remember that not all health care providers are equal. Make sure you can trust your providers.
• Many health insurers offering Medicare Advantage plans have long histories of fraud against the government, including consumer protection-related violations. Before enrolling in a Medicare Advantage plan, protect yourself. Look up the insurance company on violationtracker.org. You can’t trust the Medicare star-ratings.

Incentives: Beware of physicians and insurers that profit from denying or delaying your care.

• Traditional Medicare pays for each service you receive, so physicians have no incentive either to withhold care you need or to keep you from seeing top specialists.
• Medicare Advantage plans are paid a flat upfront fee, so they have a financial incentive to keep you from getting costly care. The less care you get, the more they profit.