If you think you can trust the nice man (or woman) who claims to “want to help you choose a Medicare plan,” think again. The Medicare Advantage insurers have stacked the deck against you. They can pay commissions to agents to steer you to the MA plans that make them the most money. Moreover, at least some of these Medicare Advantage plans, if not all of them, are likely to deny you costly and complex care when you need it.
Americans for Beneficiary Choice and the Council for Medicare Choice just prevailed in a lawsuit against a Biden administration rule intended to protect people with Medicare, if only a bit, from the bad acts of insurance agents, reports Susan Morse for HealthcareFinance News. A federal judge in Texas determined that the Centers for Medicare and Medicaid Services did not have the power to limit compensation to companies that help insurance agents. The limit was “arbitrary and capricious.”
The Biden administration had construed MA administrative payments as “compensation” and limited them to $100. This money, as I understand it, is on top of the sizable commissions they pay insurance agents to enroll new enrollees in their plans and renew those enrollees in their plans. They could pay agents as much as $611 commission in 2024.
The Biden administration rule was designed to block “anticompetitive” insurer practices. That said, it does not stop the insurers from paying nothing to agents who enroll people in Part D stand-alone plans, critical drug coverage for people in traditional Medicare. So, insurance agents have a powerful incentive to steer people to Medicare Advantage and away from traditional Medicare, the only Medicare choice that covers people’s care from most doctors and hospitals across the US.
To be clear, the idea that compensation to insurance brokers would ever be designed to help ensure people were enrolled in MA plans that met their needs is ludicrous. No one knows whether any of the MA plans will meet people’s needs, given that their provider networks can be extremely narrow and that many engage in inappropriate denials of care. Put differently, in a Medicare Advantage plan, you often don’t get the benefits you get in Traditional Medicare–insurers deny them–and no one can distinguish meaningfully among them.
In short, insurance agents continue to have financial incentives to steer people to a Medicare Advantage plan that maximizes their commissions. And, those plans may very well not meet people’s needs.
Here’s more from Just Care:
- Medicare Open Enrollment: Don’t trust insurance agents
- Medicare Advantage delivers unreliable coverage
- Medicare Advantage costs likely to increase significantly
- Medicare Advantage inappropriate denials of care abound
- Medicare Advantage: Denials increase 56 percent
