Every year for the last several years, the Medicare Advantage plans ask members of Congress to sign onto a letter addressed to the head of the US Department of Health and Human Services that paints the Medicare Advantage plans in a rosy light. The letter is always riddled with misinformation. Even so, dozens of Republican and Democratic representatives sign on, in large part because many older adults and people with disabilities in their states are enrolled in a Medicare Advantage plan.
This year’s letter to Secretary Xavier Becerra has the following fundamental errors.
- Medicare Advantage plans do not meet the “holistic health needs” of people with Medicare, as the health plans would like people to believe. In fact, out-of-pocket costs combined with administrative obstacles and inappropriate medical necessity determinations keep large swaths of people enrolled in Medicare Advantage plans with costly and complex conditions from getting needed care. For example, the dental benefit that some plans offer lures people into joining, but the coverage is so minimal that people without coverage get dental care at the same frequency as people in Medicare Advantage plans with coverage. And, the typical Medicare Advantage out-of-pocket cap of around $5,500 is so high that many people enrolled are forced to skip care because they can’t afford their copays. The maximum annual out-of-pocket cap for in-network care alone is $7,550.
- There is no evidence that Medicare Advantage offers either “high-quality” or “affordable” coverage, even though the plans repeat these claims as often as they can. To the contrary, one NBER paper finds that some Medicare Advantage plans are killing people. Another NBER paper finds that an increase in copays of just $10 keeps many people in Medicare Advantage plans from filling their prescriptions, suggesting that Medicare Advantage does not offer affordable coverage. As for quality of care, MedPAC says it does not have the data to make a finding as to the quality of services offered. Researchers at Brown University and elsewhere find that quality of home care and nursing home quality is better in traditional Medicare than Medicare Advantage.
- Many people enrolled in Medicare Advantage have no choice–they did not “actively” choose it but rather were steered into it by their employers and unions. Or, they were forced into it because the Medicare supplemental coverage they need in traditional Medicare to protect themselves from financial risk was unaffordable or unavailable. Or, they were lured into it by misleading ads.
On top of all that misinformation, the letter relies on findings of ATI, a research company hired by the trade association for the Medicare Advantage plans, not independent research. And, ATI does not base its findings on actual claims data for its findings.
In fairness, many people cannot afford the upfront costs of traditional Medicare. If they want to protect themselves from financial risk, they need to buy supplemental coverage, unless they have Medicaid or retiree wrap-around benefits. Traditional Medicare does not have an out-of-pocket cap. They might not realize that their out-of-pocket costs in Medicare Advantage can be much higher than the cost of Medicare supplemental coverage, if they need costly services. Or, they gamble with their health, as a way to manage their expenses, hoping that they will not need costly care.
Here’s more from Just Care:
- Ten ways Medicare Advantage plans differ from traditional Medicare
- People living in rural communities disenroll from Medicare Advantage at a high rate
- Well-kept secrets of Medicare Advantage plans
- Medicare ratings of Medicare Advantage plans a farce
- Will the DOJ let UnitedHealth control more of the US health care system
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