JustCare

Tag: Medicare Plan Finder

  • Many people find themselves locked into their Medicare Advantage plans

    Many people find themselves locked into their Medicare Advantage plans

    If you’ve just joined a Medicare Advantage plan this open enrollment period, you have until December 7, and than again between January 1 and February 14, to reconsider. Here’s what you need to know: Once you’re enrolled in a Medicare Advantage plan, you could find yourself locked in. Medpage Today reports that many people mistakenly think they can leave their Medicare Advantage plan.

    In all but four states, however, switching to traditional Medicare is effectively impossible for people with a health condition. Yes, no matter where you live, you can technically switch to traditional Medicare. But, traditional Medicare has no out-of-pocket cap; you need Medicare supplemental insurance to fill coverage gaps and protect yourself financially.

    Except in limited situations, you have no right to buy Medicare supplemental insurance. Without Medicare supplemental insurance, your out-of-pocket costs in traditional Medicare if you have a serious health condition could be tens of thousands, if not hundreds of thousands of dollars. With Medicare supplemental insurance, your costs are minimal.

    Medicare Advantage plans, in contrast, have an out-of-pocket cap. Still, people are often stuck with huge out-of-pocket costs; you could end up spending as much as $6,700 a year out of pocket for in-network care alone. Many people who join and need costly health care only learn how expensive a Medicare Advantage plan can be after they have joined. Moreover, they may discover that their health plan does not cover care from the doctors and hospitals they want to use. Or, they may find that their health plan unduly delays or inappropriately denies them access to the care their doctors say they need.

    Even if you find doctors in the Medicare Advantage plan that you like, those doctors can leave the plan at any time. Or, the plan might raise premiums and deductibles significantly. You can’t rely on the plan for your health and financial well-being.

    Understandably, the data show that people with costly conditions often want to switch to traditional Medicare. If they have Medicaid as well as Medicare, it’s an easy switch. Medicaid picks up the out-of-pocket costs in traditional Medicare. But, if they don’t, Medicare supplemental insurers who sell “Medigap” policies to fill gaps in traditional Medicare coverage are likely to refuse to sell them insurance or charge them exorbitant premiums.

    You do have limited rights to buy Medigap coverage. You are guaranteed Medigap coverage in the first six months of enrolling in Medicare. And, if you join a Medicare Advantage plan, you are also guaranteed Medigap coverage if you switch to traditional Medicare within a year and sign up no later than 63 days after your Medicare Advantage plan coverage ends.

    MedPage Today reports on one man enrolled in a Medicare Advantage plan, who, after surgery to repair a mitral valve and suffering a stroke, ended up with hundreds of dollars a month in copays for his medical services and drugs as well as $295 a day for his hospital stay. He was stunned. Neither the Medicare Advantage ads nor the insurance brokers tell people about these costs or about the difficulty of switching to traditional Medicare and buying Medicare supplemental insurance.

    The American Medical Association, which is working hard to oppose Democratic health care reform proposals, knows well the risks of Medicare Advantage plans. It passed a resolution in 2018 recognizing that “seniors are lured to these advantage plans by misinformation and confusing sales techniques.” The AMA also recognizes that these corporate health plans can delay access to care and can deliver poor service.

    Many people understandably can’t afford the cost of Medicare supplemental insurance and join a Medicare Advantage plan thinking they will save money. They might. But, you should know that you could spend a lot more in a Medicare Advantage plan if you become seriously ill and need costly care. People who get sick too often go bankrupt or forego needed care. The Medicare Plan Finder tool won’t tell you this.

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  • 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.

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