Don’t join a Medicare Advantage plan because you believe it will offer good primary care. According to a new report by the Commonwealth Fund, primary care could be good and it could be bad in Medicare Advantage, depending upon the plan you are enrolled in and the primary care physician you use. What’s for sure is that if you get sick and need costly care, you are taking a huge gamble with your health in Medicare Advantage.
For sure, some if not most insurers offering Medicare Advantage plans want you to see a primary care doctor. That’s how they can most easily add diagnoses codes to your medical records in order collect more money from the government for your care. But, it’s not clear whether seeing a primary care physician in Medicare Advantage will improve your health or not.
We know very little about whether a particular Medicare Advantage plan will ensure a primary care doctor coordinates your care in ways that keep you healthy. The government pays Medicare Advantage plans upfront regardless of whether they coordinate care. So, they could advise their primary care doctors to spend little time with you or pay these physicians more if they don’t refer you for specialty care or refer you to specialists who cost less and provide lower quality care.
The Commonwealth Fund examined whether primary care physicians treat Medicare Advantage patients in different ways from physicians who treat Traditional Medicare patients. They found that, overall, there were not many meaningful differences between the care primary care physicians provide patients in Traditional Medicare as compared with the care they provide patients in Medicare Advantage.
Unfortunately, “overall,” is not really helpful in this analysis. It’s like saying that “overall” restaurants in NYC are fine. The question for people with Medicare is which are the good Medicare Advantage plans and which ones should be avoided. This Commonwealth Fund survey does not provide that information.
In short, it seems not to be the case that insurers are making it easier for their primary care physicians in Medicare Advantage to manage and coordinate care than Traditional Medicare.
Here’s more from Just Care:
- Six reasons you need a primary care doctor in this age of specialization
- Four questions to ask yourself about your primary care doctor
- Five tips for talking to the people you love about their health
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Get the preventive care you need: Medicare pays for it
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