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Tag: Medicare Advantage

  • Insurer provider directories misleadingly include physicians who are out of network

    Insurer provider directories misleadingly include physicians who are out of network

    Max Blau reports for Pro Publica on how the big insurers provide their enrollees with misleading directories of in-network providers, but nothing is done to fix the problem. We are in the age of tech, when accurate directories should be quick and easy. Insurers should be held accountable if they cannot keep an accurate provider directory, but neither the states nor the federal government is willing to hold the insurers accountable.

    Blau explains that insurers are not penalized for inaccurate directories and that it takes old fashioned cold-calling to figure out how misleading a provider directory is. Misleading directories are helpful to insurers since they encourage people to enroll; and, yet, the insurers won’t cover care from the providers they list who are not in-network.

    For more than ten years, the federal government has reported large inaccuracies in Medicare Advantage provider directories. Do not assume they are anywhere near accurate and up to date. Providers in the network today can leave the network at any time, and many have been leaving Medicare Advantage plans over the last few years.

    New York State government staff called health care providers listed in insurance company directories to determine whether they were actually seeing patients. They wanted to know two key things about the supposedly in-network providers: Do you accept insurance? And are you seeing new patients?

    But, the New York State staffers found that lots of physicians who were listed in the provider directories no longer accepted the insurance or were not taking new patients. Some of the time, staff didn’t even get a call back. As it turned out, insurers’ enrollees could not get treatment from more than eight in ten mental health providers listed in directories whom staff reached out to.

    The New York State law provides for penalties on insurers who do not keep accurate provider directories. But, New York State rarely penalizes insurers and, when it does, the penalty is tiny. When it comes to provider directories, New York State insurer behavior is no different from insurer behavior in other states. Misleading directories are the norm in most states, including Arizona, California and Massachusetts.

    The US Senate Finance Committee staff undertook an investigation a year ago of Medicare Advantage provider directories, and Senate Finance staff also found extremely misleading provider directories. As in the states, the federal government rarely holds the Medicare Advantage insurers accountable.

    The consequences of inaccurate directories can be dire for patients who cannot find providers to treat their conditions. For the insurers, it’s more money in their pockets. If their enrollees can’t get care, the insurers keep more money and grow profits.

    Here’s more from Just Care:

  • Medicare Advantage networks can be narrow and harmful

    Medicare Advantage networks can be narrow and harmful

    If you’re in a Medicare Advantage plan or thinking of joining one, you should worry about two things: Whether you will get the Medicare benefits you are entitled to when you need costly care and whether you’ll be able to use the doctors and hospitals you want to use. Cheryl Clark reports for MedPage Today on a recent Medicare Payment Advisory Commission (MedPAC) meeting in which commissioners criticized the Medicare Advantage networks as ever-changing and often too narrow and harmful to enrollees.

    You can’t trust Medicare Advantage (MA) provider directories to list in-network providers accurately. A lot of the time, the listed physicians and hospitals are not, in fact, in network. They’ve left the network. Or, they leave the network midyear. It can hurt enrollees, who lose continuity of care and must scramble to find new providers.

    When you buy health insurance, you should be thinking not simply about now but about what could happen to you in the future. Literally anything. A car accident, a fall on ice, a cancer diagnosis, a stroke. You might be away from home. Will your care be covered the way you want it to be in a Medicare Advantage plan? What will you pay out of pocket?

    Here are some of problems you can face in any Medicare Advantage plan when it comes to getting a provider to deliver care. These problems don’t exist in traditional Medicare, the government-administered program that covers your care from almost any physician or hospital in the US:

    1. The Medicare Advantage plan can leave the Medicare program at the end of any year. And, many have done so in the last couple of years.
    2. Physicians and hospitals can leave the Medicare Advantage network. Your care is not covered if you keep seeing these providers. You can pay out of your own pocket to see them or you need to find new providers.
    3. In-network physicians might not be willing to see you. They might have too many patients already.
    4. Cancer centers of excellence and specialists you need to see might not be in-network.

    The Medicare Advantage network directories are very often out of date and inaccurate. Moreover, government oversight to ensure the adequacy of Medicare Advantage plan networks leaves a lot to be desired. Plans know that they can offer inadequate networks without accountability. The government has never penalized a Medicare Advantage plan for offering an inadequate network.

    There’s little good about Medicare Advantage networks in practice, though in theory they should help ensure you are getting good coordinated care. Unfortunately, the insurance companies offering Medicare Advantage make more money keeping you from getting good costly care. So, except for some of the nonprofit Medicare Advantage plans, Medicare Advantage insurers’ incentive is to delay and deny you care from good quality physicians and hospitals when you need them.

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  • Insurers end agent commissions for certain Medicare Advantage plans

    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.

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  • What happens to Medicare if Trump wins?

    What happens to Medicare if Trump wins?

    Older adults and people with disabilities have no warning to avoid enrolling in Medicare Advantage plans–plans run by corporate health insurers–that likely will deny them care. And, they have no good protections. If Donald Trump becomes President again, everyone could be forced into a Medicare Advantage plan, reports Jessica Glenza for The Guardian.

    Today, traditional Medicare, the government-administered alternative to Medicare Advantage, has become a luxury for the wealthy. People enroll in Medicare Advantage because the upfront costs are lower. And, they are then locked in. They can’t switch to traditional Medicare because it lacks an out-of-pocket cap, and they can’t afford supplemental insurance to protect themselves against catastrophic costs.

    Problems abound in Medicare Advantage for people who get sick and need costly care. Millions of people in Medicare Advantage struggle to figure out how they are going to stay with their treating physicians because their Medicare Advantage plan is leaving their area or their physicians are leaving their Medicare Advantage plan networks. Or, they wonder how they will travel tens of miles to get the care they need because their local hospital is no longer in-network. Or, they struggle to deal with Medicare Advantage denials of care their treating physicians says they need.

    Joe Namath and William Shatner might tell you how much they like Medicare Advantage, but dollars to donuts, they are in traditional Medicare. Traditional Medicare is a luxury for the wealthy because it actually covers the care you need from the physicians and hospitals you want to use.

    Trump and his supporters in Congress want to privatize Medicare and end traditional Medicare. They want you to believe that you will have all the choices you need in Medicare Advantage. The fact is that you will have a bunch of meaningless choices because you won’t be guaranteed the choice of a Medicare Advantage plan that will meet your needs if you are in an accident or are diagnosed with cancer or heart disease. Only traditional Medicare guarantees you coverage for all your needs.

    The ten big insurers offering Medicare Advantage have been charged with fraud many times. In 2022, eight of them were defending themselves in court.

    While Medicare Advantage plans might not meet your needs, they meet the needs of the biggest health insurers, who are able to profit wildly. Nearly half of United Healthcare’s total revenue came from Medicare Advantage. But, Medicare Advantage enrollees represent only 15 percent of all its enrollees, according to Accountable.US.

    Trump and his supporters in Congress appear to prefer a Medicare program in which health insurers have the financial incentive to stint on care and profit wildly at taxpayer expense, to a more cost-effective world in which people can get the care they need and the government is in charge.

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  • New OIG report finds taxpayers pay billions extra for Medicare Advantage insurers’ in-home visits

    New OIG report finds taxpayers pay billions extra for Medicare Advantage insurers’ in-home visits

    For years, government agencies and independent experts have reported that Medicare Advantage insurers game the Medicare payment system to generate billions of dollars in extra revenue from the government. A new report from the Office of the Inspector General focuses on how insurers use home visits as a way to add diagnoses to enrollee medical records and increase their Medicare reimbursements.

    The government pays Medicare Advantage insurers a flat upfront amount for each enrollee. The amount is based on what the government spends in traditional Medicare. But, the government increases that amount for “sicker” patients–patients with more diagnosis codes.

    So, insurers do what they can to increase the amount they get from the government; they “upcode” or add diagnosis codes to enrollee records. They engage nurses to visit enrollees at home and identify more diagnoses for these enrollees. The home visits could be value-added if the insurers provided care tailored to these diagnoses. But, the OIG reports that Medicare Advantage insurers generally simply bill the government more for these enrollees. They do not conduct follow-up visits or deliver other services related to the added diagnoses.

    On average, the insurers generate an extra $1,869 from each home visit. In fiscal year 2023, these visits translated into $3.73 billion for UnitedHealth alone. Not surprisingly, UnitedHealth contends that the home visits add value to the care they provide.

    What additional diagnoses did the nurses who conducted home visits tend to find? They found vascular disease, depression, morbid obesity, chronic obstructive pulmonary disease and rheumatoid arthritis most frequently. They also found enrollees with complications resulting from their diabetes.

    Now what? The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, has never been successful at recouping the overpayments. But, it has ended payment to insurers for certain diagnosis codes that are commonly added during in-home visits and do not result in further treatment. It’s a start, but CMS clearly needs to do a lot more.

    Here’s more from Just Care:

  • Senate investigation shows high Medicare Advantage denial rates for costly care

    Senate investigation shows high Medicare Advantage denial rates for costly care

    One thing’s for sure. If there’s a way for the UnitedHealth, Humana and CVS/Aetna to profit off of Medicare Advantage, they will find it. We know that they overcharge the government more than $2,300 a year per enrollee. A new Senate Permanent Committee on Investigations report finds that Medicare Advantage insurers also profit from denying rehab services, nursing services and other costly services at ever-increasing rates.

    The Senate Permanent Subcommittee on Investigations’ report warns that insurers “are using prior authorization to protect billions in profits while forcing vulnerable patients into impossible choices.”  Older adults and people with disabilities are getting hurt. What exactly are the insurers doing to manage their enrollees’ care?

    According to Senator Richard Blumenthal, who chairs the Subcommittee: “Insurance companies say that prior authorization is meant to prevent unnecessary medical services. But the Permanent Subcommittee on Investigations has obtained new data and internal documents from the largest Medicare Advantage insurers that discredit these contentions. In fact, despite alarm and criticism in recent years about abuses and excesses, insurers have continued to deny care to vulnerable seniors—simply to make more money. Our Subcommittee even found evidence of insurers expanding this practice in recent years.”

    How do the insurers get away with all these denials? The report does not explain how the insurers get away with all these denials. But, the answer is simple. They often deploy a proprietary “secret sauce” to determine whether they should cover costly care. Their sauce can take a very narrow view of what is medically necessary care. Consequently, amputees can be denied rehab services. Newly diagnosed leukemia patients can be forced to wait long periods before their urgently needed care is approved.

    Is there evidence that insurers are not using prior authorization to improve care? All we hear is that they use prior authorization to keep people from getting care and to increase their profits. The Senate report does not get into other findings that some prior authorization denials for costly services are overturned on appeal more than 75 percent of the time. But, most people don’t appeal their coverage denials. The vast majority end up going without needed care. No one is looking out for them.

    The Centers for Medicare and Medicaid Services does not begin to have the resources to oversee nearly 4,000 different Medicare Advantage plans. It also lacks the power to hold insurers to account for their bad acts in meaningful ways.

    How to fix prior authorization? More rules won’t fix prior authorization in Medicare Advantage. Congress needs to take prior authorization out of the hands of the profit-driven insurers and put it into the hands of an outside independent entity that applies medically sound prior authorization rules in a standardized way across all Medicare Advantage plans.

    Here’s more from Just Care:

  • Getting public assistance? Beware of Medicare Advantage flex cards

    Getting public assistance? Beware of Medicare Advantage flex cards

    Maya Goldman reports for Axios on the risks of Medicare Advantage flex cards for people getting public assistance. The extra money people think they’re getting through a flex card could mean the end of your government housing or food benefits. UnitedHealth, Humana, CVS offer these cards to entice people to join their MA plans without warning people that the cards could mean the end of their public assistance, even if they don’t use them.

    How is it possible people can lose precious benefits? Government agencies can count flex cards as income. So, when people apply for Supplemental Security Income or rental assistance, adding the value of the flex cards to their income could disqualify them.

    Why are Medicare Advantage plans offering flex cards when they could be harmful to enrollees? It’s hard to imagine insurers are concerned with the risks of giving flex cards to disabled and low-income enrollees. They likely see the flex cards simply as a good hook to boost enrollment and profits.

    Some of the flex cards are specifically targeted to use on items such as groceries and electric bills. Each Medicare Advantage plan offers something different. But, the value of these cards can be significant, with an average value of nearly $1,000.

    People with Medicare and Medicaid could be far better off in traditional Medicare, with coverage from most providers in the US and without the prior authorization obstacles to care people face in Medicare Advantage. But, an extra several hundred dollars a year from a Medicare Advantage plan to offset grocery or utility costs is hard to pass up.

    Ideally, the Biden administration could direct agencies not to consider the flex cards as income, as more than 30 Democratic members of Congress have requested. But, regulations and statutory mandates for different agencies could get in the way of that. Alternatively, CMS should permit insurers to use the money in the flex cards for a different benefit, such as over-the-counter drugs, which would not be considered income.

    The Department of Housing and Urban Development (HUD) excludes most Medicare Advantage benefits from a person’s income when they apply for help. But, HUD is required by statute to count certain utility and rent benefits as income.

    One other concern: People can be misled about the flex cards. They can come with a bunch of limitations that prevent people from using them as they expected. Of course, the insurers profit more if people don’t use their flex cards.

    The insurers, for their part, have done nothing to address the serious issues their flex cards present for some of their most vulnerable enrollees.

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  • 2024: What to know this Medicare Open Enrollment Period

    2024: What to know this Medicare Open Enrollment Period

    During this Medicare Open Enrollment Period, here’s the most important thing you need to know: You gamble with your health if you are in the Medicare Advantage program. Your upfront costs are lower in Medicare Advantage than if you enroll in Traditional Medicare and need to buy Medicare supplemental coverage. But, you could pay a much bigger price in Medicare Advantage when you need costly care. Please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP (State Health Insurance assistance Program) for free, unbiased advice on any of your Medicare questions.

    If you can afford it, choose Traditional Medicare over a Medicare Advantage plan. Enroll in Traditional Medicare to ensure you have good and speedy coverage when you need it. Most older adults will develop a serious condition at some point. In Traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all specialists and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in Traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in Traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.

    Get advice from your SHIP about your Medicare options and not from an insurance agent. Unfortunately, most insurance agents are paid to give you biased advice and steer you away from Traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).

    Assume you will get worse care in Medicare Advantage than Traditional Medicare. In Traditional Medicare you get all medically necessary care your doctor recommends without having to go through any hoops. Every Medicare Advantage plan is different, some good and some to avoid at all costs. But, there’s no good information to tell you which plans to avoid. Overall, in Medicare Advantage you are very likely to get less home care, less rehab care, less nursing care, less hospital care if you need it than in Traditional Medicare. Medicare Advantage plans must technically cover the same benefits as Traditional Medicare, but they tend to cover many fewer services, taking the view that care your doctors say you need is not medically necessary. They often overrule your treating physician or delay treatment when you most need care. Moreover, there’s mounting evidence that you will see lower quality physicians and might not get access to specialty hospitals in Medicare Advantage. Bottom line: You cannot know whether your MA plan will refuse to cover the care you need or delay needed care.

    Don’t rely on friends or the government’s star-rating system to pick a good Medicare Advantage plan. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their health care in a Medicare Advantage plan. Everything can change at any time. Unlike Traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the US and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the health care providers listed in their network. Providers leave Medicare Advantage networks all the time. Moreover, you can’t count on getting ready access to the care your doctors say you need. If you are choosing among Medicare Advantage plans, choose a five-star plan. But keep in mind that the government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.

    Don’t count on seeing the physicians listed in the Medicare Advantage network, much less the physicians you need to see if you develop a complex condition. Unfortunately, provider networks in Medicare Advantage plans are limited and can change at any time. This year, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care. Also, MA network directories are usually inaccurate.

    Know that the government can’t ensure that Medicare Advantage plans deliver the same benefits as Traditional Medicare. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.

    If you’re dissatisfied with a Medicare Advantage plan, you can’t disenroll and switch to Traditional Medicare. You can switch to Traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from financial risk. If you can, it might be very expensive. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage or be forced to forgo needed care.

    If you have Medicare and Medicaid, you should seriously consider Traditional Medicare. If you have both Medicare and Medicaid, Traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in Traditional Medicare than in a Medicare Advantage plan if you need costly health care services or have a complex condition.

    For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).

  • 2025: Fewer Medicare Advantage plans get five stars

    2025: Fewer Medicare Advantage plans get five stars

    To encourage insurers to perform well and help people choose a Medicare Advantage plan, The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, rates the performance of insurers offering Medicare Advantage plans through a five-star rating system. Based on this year’s star-ratings, Medicare Advantage plan performance is worsening. Susan Morse reports for HealthCare Finance that CMS gave five star ratings for just seven insurer Medicare Advantage contracts (1.79 percent of contracts), down from 38 in 2024.

    The government’s star-rating system should help people appreciate the quality of different MA plans but it is largely a farce because it misleads people into believing that they can choose a high-quality plan. In truth, CMS does not have the data to distinguish among MA plans effectively. Its ratings are based on insufficient data that lumps together lots of different MA plans offered by an insurer under one government contract, even though the MA plans can have different networks and different rules and processes for covering care.

    As it is, MA plans with five stars can have high rates of inappropriate delays and denials of care, particularly for people needing hospital, skilled nursing and rehab services, inadequate networks, and high mortality rates. The star-rating system won’t help people pick plans that meet their current and future needs.

    CMS is working to improve its star-rating system. But, it doesn’t yet have enough complete, accurate and timely date from the Medicare Advantage insurers to deliver effective ratings. The insurers offering the plans don’t release the data that CMS would need or don’t release reliable data. As a result, at best, the star-rating system tells people which plans to avoid. Don’t consider enrolling in a plan that has three or fewer stars. 

    Here are the MA plans that got five stars: Alignment Health Plan; HealthSun Health Plans by Elevance Health; Highmark Blue Cross Blue Shield; Leon Health; MCS Advantage Classicare; Network Health Medicare Advantage Plans; and Optimum HealthCare by Elevance.

    UnitedHealthcare, which covers the largest number of Medicare Advantage enrollees, lost its five star ratings this year and has sued the government. So has Humana, which in 2025 only has 25 percent of its enrollees in four or five-star plans, down from 94 percent in 2024.

    CMS gave the Medicare Part D prescription drug plans even lower ratings, with only 40 percent of them receiving four or five stars. People should know that Part D insurers often charge higher copays for drugs on their formularies than the full cost of the drug through Costco or Mark Cuban, and they often don’t cover the drugs that your doctor prescribes.

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  • Insurers pay Medicare Advantage brokers to steer you away from Traditional Medicare

    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: