Tag: Insurance agent

Insurers end agent commissions for certain Medicare Advantage plans
CVS and Elevance appear to believe that some of their Medicare Advantage plans are less profitable than others. To maximize profits, they have ended commissions to insurance agents for certain Medicare Advantage plans, reports Allison Bell for ThinkAdvisor. Bottom line, if you live in a state where insurer agents don’t have a financial incentives to steer you to those Medicare Advantage plans, you have even more reason not to trust an insurance agent to help you choose a Medicare Advantage plan. Get free unbiased advice from your state health insurance assistance program.

It seems that the less profitable Medicare Advantage plans are in California, Connecticut, New York and Texas. What does that mean for consumers? Most likely, insurance agents will not advise them to sign up for certain Medicare Advantage plans even though those plans could be better options for them. Of course, one never knows.

Right now, during the Medicare Open Enrollment Period, people are choosing between traditional Medicare and Medicare Advantage plans. If you can afford traditional Medicare’s upfront costs–the cost of Medicare supplemental coverage–or you have Medicaid or retiree coverage, enroll in traditional Medicare to ensure you will be covered for the care you need from the physicians and hospitals you trust, in a timely manner. If you cannot afford the cost of supplemental coverage and you need costly care, you will be taking a gamble choosing a Medicare Advantage plan.

Most people with Medicare can still choose a Medicare Advantage plan that does not charge a monthly premium. And most will also have coverage for some dental benefits. But, beware. With Medicare Advantage plans, you don’t pay upfront, but as soon as you get sick and need complex care, you often pay big time–they might not cover your care, they might not cover the cancer center of excellence you want to use, they might delay your care even though you need it urgently, and they might charge high out-of-pocket costs.

The dental benefit offered in Medicare Advantage is often very limited. It can be hard to find a dentist near you who will accept coverage. You will still likely have high out-of-pocket costs.

No matter what you do, if you are in a Medicare Advantage plan and not switching to traditional Medicare, look very carefully at changes to your current plan and other options. You won’t be able to see whether a Medicare Advantage plan has high rates of prior authorization or high denial and mortality rates, unfortunately. That’s what you really need to know.

Also, keep in mind that the five-star Medicare Advantage plans are usually better than the 1, 2, 3 and 4-star plans on some metrics, but they can still have high denial rates and high mortality rates. You just can’t know.

Some good news on the prescription drug front. Your Part D drug coverage, whether through a stand-alone plan if you have traditional Medicare or through a Medicare Advantage plan, will have a $2,000 out-of-pocket limit in 2025. Unfortunately, your premiums and deductibles might go up and the list of drugs covered could shrink. Take a hard look at your options on Medicare Compare, the government’s web site comparing your options.

Centene’s WellCare division seems to have decided that its Part D drug plans are not profitable enough any longer so it has stopped paying brokers commissions to steer people to those plans.

For free unbiased help making a Medicare choice, call your state health insurance assistance program or the Medicare Rights Center at 1-800-333-4114.

Here’s more from Just Care:
November 4, 2024
Insurers pay Medicare Advantage brokers to steer you away from Traditional Medicare
Medicare Advantage insurers incentivize brokers to mislead people about their Medicare choices. A number of Medicare Payment Advisory Commission (MedPAC) Commissioners want to stop Medicare Advantage insurers from paying brokers more to steer people into their Medicare Advantage plans than to steer people into Traditional Medicare, Joyce Frieden writes for MedPage Today.

Medicare insurance brokers have no financial incentive to help people understand why Traditional Medicare might better meet their needs, providing easy access to care from doctors and hospitals across the US. They are not paid to do so. MedPAC Commissioner Lynn Barr called out the reality that these insurers are capitalists and said we need to “stop pretending they’re going to do things out of the goodness of their heart.”

In a series of 24 focus groups, MedPAC staff learned that few people use independent informed sources to make their Medicare choices. Many rely on insurance brokers, who are biased, or friends and family, who might not understand the tradeoffs between Medicare Advantage and Traditional Medicare. Few contact their State Health Insurance Assistance Program (SHIP), which provides free unbiased advice.

Brokers are often not paid to enroll people in standalone Part D drug plans that people with Traditional Medicare use. But, they earn over $600 to enroll a person in a Medicare Advantage plan and $300 if the person stays in the plan. Insurers pay brokers only a fraction of that amount to enroll people in a Medicare supplemental insurance plan (“Medigap”), and in cases where the person has a disability, they sometimes pay no commission at all.

The MedPAC Commissioners recognize that people need much more help choosing between Traditional Medicare and a Medicare Advantage plan. They also expressed concern that Medicare Advantage provider directories tend to include a lot of misinformation, making it impossible to know which physicians are in the insurers’ network.

Also keep in mind: You have no good way to distinguish the good Medicare Advantage plans from the bad ones. Medicare’s five-star rating system should steer you away from plans with fewer than five stars. But, even the five-star plans could have high rates of inappropriate delays and denials of care, high mortality rates, and large administrative and financial obstacles to care. The government doesn’t factor delays and denials into the star ratings. You are forced to gamble with your health.

Here’s more from Just Care:
October 14, 2024
Congress must stop the Medigap madness
On one hand, “Medigap,” health insurance coverage that supplements traditional Medicare, is an incredible product. It usually picks up all but a little of people’s out-of-pocket Medicare costs. On the other hand, people must choose among a sea options they are hard-pressed to understand. And, they must pay a lot of money for Medigap, in order not to worry about their out-of-pocket health care costs. Congress needs to stop the Medigap madness.

Jake Johnson reports in Common Dreams about Sen. Elizabeth Warren‘s recent report on how insurance companies encourage insurance agents through money and prizes to upsell people Medigap plans. Even though Medigap is regulated by the federal government, both state and federal governments allow the insurers offering Medigap to run away with the store, scamming “millions of seniors …, offering agents lavish vacations to steer unknowing beneficiaries into more expensive plans,” according to Senator Warren.

The insurance companies offering Medigap profited handsomely off the $16 billion in premiums they collected last year alone. Older adults are “getting fleeced.” Warren wants federal and state regulators to step in.

People in traditional Medicare, who don’t have Medicaid or retiree coverage to fill gaps in coverage, need an affordable Medigap plan. They tend to assume that traditional Medicare with Medigap is less affordable than Medicare Advantage, corporate health insurance coverage. But, should you need costly health care services, traditional Medicare plus Medigap can be far more affordable than Medicare Advantage. Medicare Advantage plans typically come with $5,000 in out-of-pocket costs for in-network care alone. Sometimes these costs are higher; Medicare Advantage plans can set our-of-pocket costs for in-network care as high as $8,300 this year.

Unfortunately, people can’t trust their insurance agents to help them understand the benefits of traditional Medicare over Medicare Advantage. These agents often steer them to Medicare Advantage plans, where they make the biggest commissions. And, when people opt for traditional Medicare, they can’t trust their insurance agents to steer them to the Medigap plan that best meets their needs.

What you can do: Contact your State Health Insurance Assistance Program (SHIP) for free unbiased assistance choosing a Medigap plan.

Warren wants the Centers for Medicare and Medicaid Services, which oversees Medicare, to step in. But, it’s hard to see how additional regulations would help much to protect people from predatory sales agents. The only truly non-predatory solution would be for the government to sell people a government-issued Medigap policy or, better still, cap or eliminate out-of-pocket costs in Medicare.

If Congress were to add an out-of-pocket cap to traditional Medicare, it would reduce people’s need for Medigap coverage altogether. That’s what’s needed. And, it would save Medicare money.

The Congressional Budget Office recently found that a high out-of-pocket cap–$8,500–would reduce Medicare spending. It would also give people the choice of traditional Medicare without having to buy Medigap supplemental coverage.

Here’s more from Just Care:
March 6, 2023
People in Medicare Advantage trade away access to care
Both the Wall Street Journal and MedPage Today recently have run compelling stories on the tradeoffs of opting for Medicare Advantage. They focus on the fact that people in Medicare Advantage, health plans offering Medicare benefits run by corporate health insurers, lose access to care from the doctors, hospitals and other health care providers they might want to use. And, Medicare Advantage enrollees can end up paying a lot more out of pocket for their care than they would in Traditional Medicare with supplemental coverage, if they get sick.

Medicare Advantage is not always low-cost or easy to use. One enrollee diagnosed with pancreatic cancer needed a PET scan to determine whether his cancer had spread and whether surgery was appropriate. But, the Cleveland Clinic told him that if he was in an MA plan, it would take at least three weeks for MA approval of the PET scan, during which time his cancer could be spreading. Fortunately, he was in Traditional Medicare and got the PET scan three days later.

The MA ads and sales agents don’t begin to tell people the full story. In addition to restricted access to providers and undue and inappropriate delays in receiving care, MA plan denial rates can be quite high. So, even if your treating physician says you need care, your MA plan might overrule that physician’s decision. Then, your only choice is to pay out of pocket and/or appeal the denial.

The Office of the Inspector General found that “among the prior authorization requests that MAOs [Medicare Advantage organizations] denied, 13% met Medicare coverage rules; in other words, these services likely would have been approved for these beneficiaries under” Traditional Medicare.

Most of the time, denials are overturned on appeal, especially with a letter from your treating physician documenting your need for care. The process is easy and costs you nothing, but it takes time. During that time, people’s health can deteriorate.

Insurance agents are paid more to enroll people in Medicare Advantage than in supplemental coverage that fills gaps in traditional Medicare. So, many of them steer people to Medicare Advantage and, often, to the Medicare Advantage plans that pay the biggest commissions. Sometimes, agents direct people to Medicare Advantage plans that don’t meet their needs–their doctors are not in-network, out-of-pocket costs are prohibitive, and administrative hurdles are too challenging.

The federal government reports that complaints about Medicare Advantage have more than doubled between 2020 and 2021, from nearly 16,000 to nearly 40,000! And, most people do not bother complaining to the federal government. Hospitals have begun complaining in a big way, as well; in fact, the Mayo Clinic just announced that it won’t be contracting with Medicare Advantage plans any longer, in most parts of the country, telling its patients in Florida and Arizona to enroll in Traditional Medicare with supplemental coverage.

So far, neither the administration nor Congress has begun to act to address the fundamental flaws with Medicare Advantage. Here are ten ways to improve it, few of which are under consideration at the moment.

For its part, the Medicare Advantage trade association points to all the people enrolling in Medicare Advantage who are satisfied. It’s easy to be satisfied when you need few health care services, and the MA plan gives you free health memberships and discounts on eyeglasses to ensure you stick with it. The 5o percent of people with Medicare who use the fewest health care services cost Medicare well under $1,000 each. But, the government pays the MA plans more than 11 times that amount to cover their care. Talk about a waste of money.

MedPage Today concludes its story with this: “Numerous beneficiaries told MedPage Today that they signed up for their MA plans when they were younger and healthier. Their premiums were zero or low. But after they needed care for newly diagnosed chronic conditions, they found themselves paying far more in co-pays and deductibles than a supplemental plan would have cost them. Now with pre-existing conditions they’re ineligible to sign up for a supplement. They’re stuck.” Of course, you never know when you will be diagnosed with costly chronic conditions.

One physician explains that MA enrollees are ” ‘trading money for access,’ that is low or no premiums for a limited network, and they may not be able to see the best specialist for their problem. I have to tell them, ‘Your plan does not offer that,’ he said.”

Here’s more from Just Care:
October 25, 2022
Medicare Open Enrollment: Don’t trust insurance agents
It’s Medicare Open Enrollment season from October 15 through December 7, and you should be reviewing your Medicare plan options to make sure you continue to get the coverage you want at the price you want. A new Commonwealth Fund paper explains why it is risky to trust the advice of Medicare insurance agents. It’s far better to talk to your State Health Insurance Assistance Program or SHIP before you make any final decisions.

Everyone with Medicare, whether enrolled in traditional Medicare or Medicare Advantage, will see their Medicare Part B premium increase in 2022. But, if you’re enrolled in traditional Medicare, you should see no other changes in your coverage or costs for medical or hospital care. If you’re enrolled in a Medicare Advantage plan, your in-network providers as well as your out-of-pocket costs could change dramatically. Your Medicare insurance agent or broker might be able to tell you about changes, but don’t rely exclusively on the agent’s advice.

Like all insurance agents, Medicare insurance agents have financial interests that are likely not aligned with your needs. For example, they might want to steer you to a Medicare Advantage plan rather than traditional Medicare, even if it’s in your best interest to enroll in traditional Medicare. They generally are paid a higher commission for enrolling people with Medicare in a Medicare Advantage plan than traditional Medicare with a supplement. They are paid nothing if you are in traditional Medicare and receive a lower amount if you enroll in supplemental coverage, “Medigap,” than if you enroll in a Medicare Advantage plan.

Moreover, insurers pay insurance agents different rates, depending upon the Medicare Advantage plan you enroll in. There’s little doubt that some will steer you to the Medicare Advantage plan that pays them the highest fee.

The federal government should not be allowing commission differences between traditional Medicare and Medicare Advantage, nor among Medicare Advantage plans. It leads to outcomes that can threaten the well-being of people with Medicare. It also hurts the traditional Medicare program.

Right now, the Centers for Medicare and Medicaid Services (CMS) sets a maximum amount for Medicare Advantage and Medicare Part D commissions. Agents receive commissions when they initially enroll people in Medicare Advantage and, then, when people renew. CMS does not set a maximum commission for the sale of supplemental insurance, but that commission is generally significantly lower by a couple of hundred dollars than MA commissions.

For these reasons, insurance agents cannot be trusted to give unbiased Medicare advice.

How to get unbiased Medicare advice? Every state has a SHIP, a state health insurance counseling and assistance program, which provides free, unbiased Medicare advice. SHIP counselors do not get paid more based on the advice they provide. You can find the contact information for your local SHIP at shiphelp.org or by calling 877-839-2675.

That said, if you do not have retiree coverage or Medicaid to fill gaps in traditional Medicare and can afford the cost of supplemental coverage–which can easily be $1,500 or more a year–traditional Medicare will give you far better choice of physicians and hospitals than Medicare Advantage and far easier access to care. Medicare Advantage plans impose financial and administrative barriers to care.

Unfortunately, it’s not possible to know which Medicare Advantage plans have high denial rates and delays, which have high copays, and which will cover your care from quality providers. So, choosing a Medicare Advantage plan can be a big gamble. It’s why people in Medicare Advantage plans who develop complex conditions tend to switch to traditional Medicare when they can, at disproportionately high rates. But, there’s a problem: They are often locked in. After you first enroll in Medicare, Medicare supplemental insurers do not have to sell you coverage, except in limited circumstances.

Here’s more from Just Care:
October 18, 2021