JustCare

Tag: Medicare Handbook

  • 2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    The 2023 Medicare and You Handbook is now available for your reading pleasure. Unfortunately, it continues to mislead and confuse in significant ways about Medicare Advantage. Though the Centers for Medicare and Medicaid Services (CMS) would like you to believe otherwise, Medicare health plans administered by corporate health insurers–euphemistically called Medicare Advantage–cover fewer costly services, often from lower quality providers, than traditional Medicare.

    Here’s what’s seriously misleading and what’s true in the Medicare Handbook:

    • The Handbook says: Medicare Advantage plans “may have lower out-of-pocket costs” than traditional Medicare. Here’s what’s true: You could spend as much as $7,550 out of pocket if you need costly care. However, so long as you are healthy or forgo needed care, you will likely spend less on your health care. The problem is that you need health insurance to protect you in the event you need costly care. It’s of far less importance if you’re healthy.
    • The Handbook says: Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers.” Here’s what’s true: You have the same Part A and B benefits in theory as people in traditional Medicare. In practice, Medicare Advantage plans have their own rules as to what services are medically necessary. They tend to be far more restrictive than Original Medicare, second-guessing treating physicians, whom they have hand-picked for their networks, as to what care is medically necessary. So, Medicare Advantage plans are likely to cover fewer services for shorter periods of time and, sometimes, from lower quality providers. And, the government is unable or unwilling to oversee them and hold them accountable when they do not do so. Only in theory are Medicare Advantage plans required to cover all medically necessary services that Original Medicare covers.
    • The Handbook says: Medicare Advantage plans “may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.”  Here’s what’s true: You may have extra “benefits” like vision, hearing and dental, but these benefits tend to be extremely limited in scope and tend to require you to pay large out-of-pocket costs.
    • The Handbook says: With Medicare Advantage plans, “you can’t buy and don’t need Medigap,” supplemental coverage that picks up costs that Medicare does not cover. Here’s what’s true: You can’t buy Medigap, but you likely would be better off with it if you need costly care. Without supplemental coverage, most people in Medicare Advantage, unlike people in traditional Medicare with supplemental coverage, are constantly having to choose between their health care and other basic needs. Or, they could be pushing themselves into medical debt.

    Here’s what the Medicare Handbook does not say:

    The government pays corporate health insurers a flat upfront payment to cover care for enrollees through Medicare Advantage, with little if any regard to the cost or quality of services each plan offers. These insurers have a compelling financial incentive to spend as little as possible on enrollees’ care and pocket as much of the money they receive as possible. While there is technically a limit on the amount they can pocket, they have ways to game that limit.

    Here’s more from Just Care:

  • Major problems with Medicare Plan Finder

    Major problems with Medicare Plan Finder

    Not long ago, advocacy groups called out the Centers for Medicare and Medicaid Services (CMS) for misleading the public about Medicare Advantage plans–private insurance plans that offer Medicare benefits–and steering people into them without providing appropriate warnings. Now, the Government Accountability Office (GAO) has issued a report highlighting major problems with the Medicare Plan Finder web site, which is supposed to help people compare Medicare plans.

    People should be able to know when they choose a Medicare plan what their out-of-pocket costs are likely to be and which doctors and hospitals they can use. But, the Medicare Plan Finder cannot provide them with this basic information. People with Medicare understandably struggle to get the information they need from the Medicare Plan Finder.

    Estimates of out-of-pocket costs are incomplete on the Medicare Plan Finder, so people cannot make a meaningful comparison between traditional Medicare and Medicare Advantage. People need to know that their maximum out-of-pocket costs can be as high as $6,700 in a Medicare Advantage plan and far higher if they use out-of-network doctors and hospitals. But, the Medicare Plan Finder does not highlight these costs. It does not make it easy for people to see that if they want to spend time with a family member outside of their community and need care, they may have to pay for all their care out of pocket if they join a Medicare Advantage plan.

    To find out whether the doctors and hospitals you want to use are in a Medicare Advantage plan, call them directly and ask. You can also visit the Medicare Advantage plan’s web site. Always call the plan to confirm. Medicare Advantage plan provider directories are wildly inaccurate. Provider information is not on the Medicare Plan Finder.

    In traditional Medicare, people with supplemental coverage have minimal costs. If they do not have Medicaid or retiree benefits to provide this coverage, they need to buy this “Medigap” coverage. And, they need to know its cost and the specific benefits covered. That information is not available on the Medicare Plan Finder site.

    Note, the Medicare Handbook is also misleading. Call your SHIP (State Health Insurance Assistance Program) for free help choosing a Medicare plan.

    Medicare for All, an improved traditional Medicare, proposed by Senator Bernie Sanders and others, guarantees everyone coverage from virtually all doctors and hospitals, without premiums, deductibles and copays, or the need for supplemental coverage. It would save people money on their health care, without forcing them to give up the choice of doctors and hospitals they most value. As important, it would not force people to try to navigate a sea of rules and constantly changing health plans and guess whether there’s a health plan that may meet their needs. It also would not ration care based on ability to pay.

    If you support Medicare for All, please let Congress know. Sign this petition.

    Here’s more from Just Care:

  • Medicare Handbook misleading

    Medicare Handbook misleading

    Axios reports that the Trump Administration’s 2019 Medicare Handbook contains misleading information about Medicare Advantage plans, commercial health plans that contract with the Centers for Medicare and Medicaid Services to offer Medicare benefits. Among other things, the Medicare Handbook wrongly suggests that the out-of-pocket costs in Medicare Advantage plans are low. In truth, the Handbook has been misleading for some time and, in 2019, it will be more misleading.

    Consumer advocates are speaking out against the US Department of Health and Human Services’ misleading information in the 2019 Medicare Handbook, claiming it is “distorting and mischaracterizing the facts in serious ways.”

    Axios found some troubling changes from this year’s Handbook in the 2019 version. For example, one serious issue with Medicare Advantage plans is that if you need costly care, it is virtually impossible to know whether you will be able to see doctors who can meet your needs or what you will pay out of pocket. You can end up with thousands of dollars in bills. In traditional Medicare, so long as you have supplemental insurance, you have no out-of-pocket costs. But, the Medicare Handbook suggests otherwise.

    The Handbook also suggests that you can test a Medicare Advantage plan. The reality is far more complicated. So long as you are relatively healthy, there is not much to test. It is only if you need complex care that you can test a plan, and if it does not meet your needs, it may be too late to switch out and get the care you need in traditional Medicare or another Medicare Advantage plan.

    People with Medicare are best served, as are we all, having health insurance coverage that saves us from the stress of worrying about bills. Only traditional Medicare with supplemental coverage offers people that peace of mind. Unfortunately, upfront costs are high and too often unaffordable for the supplemental coverage that many people need to buy when they enroll in traditional Medicare.

    The Medicare Handbook suffers and has always suffered from the same issues as the Medicare Plan Finder website, which was just called out for being misleading. The Handbook fails to highlight the potentially high out-of-pocket costs in a Medicare Advantage plan as well as the risk of not being able to see the doctors and hospitals you want and need. It fails to explain that there really is no good way to choose among Medicare Advantage plans, since it appears that not a one of them either offers high value care to people with costly and complex conditions or, if there are ones that do, promotes their high value care.

    The changes to the 2019 Medicare Handbook only make a largely unhelpful document even less helpful. The 2019 Handbook will be sent out to everyone with Medicare in September.

    Here’s more from Just Care: