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Tag: Open enrollment

  • 2025: Take advantage of the Medicare Advantage Open Enrollment Period

    2025: Take advantage of the Medicare Advantage Open Enrollment Period

    If you’re in a Medicare Advantage plan, you should seriously consider taking advantage of the Medicare Advantage open enrollment period between January 1 and March 31 that allows you to switch to Traditional Medicare (government-administered insurance coverage) or to a different Medicare Advantage plan. This right to switch out of your Medicare Advantage plan is a critical consumer protection.

    Many people do not realize that there are few guarantees with Medicare Advantage. Between the time you sign up for a plan and the beginning of the new year, both the drugs and providers the plan covers could have changed significantly. So be sure to check. Moreover, you never know what illness you might be diagnosed with and whether your Medicare Advantage plan will cover the treatments your physicians recommend or deny them. And, most of the time, you will be faced with what could be harmful delays as a result of prior authorization requirements.

    I’ve written at length about all the reasons not to enroll in a Medicare Advantage plan, especially if you have Medicaid or can afford the supplemental coverage that you need in Traditional Medicare to limit your out-of-pocket costs. Upfront costs in Medicare Advantage are lower than those in Traditional Medicare with supplemental coverage. But, if you get sick and need care–the reason you have health insurance–your out-of-pocket costs are likely to be a lot higher in Medicare Advantage than in Traditional Medicare.

    Moreover, in a Medicare Advantage plan, you are at risk of not getting the care you need if you are diagnosed with a costly condition. The Office of the Inspector General has twice reported widespread delays and denials of care and coverage in most Medicare Advantage plans. Also, access to care is much simpler in Traditional Medicare than in Medicare Advantage.

    In Traditional Medicare, your treating physicians decide the care you need without an insurance company second-guessing your doctor and profiting every time it denies you care. And, there are no prior authorization requirements, requiring you to wait before your care will be covered. Furthermore, you are covered for care from almost all providers anywhere in the US, whereas in Medicare Advantage, your insurer generally will only cover your care from a limited set of providers. And, in Traditional Medicare, with supplemental coverage, your costs are predictable and often very little.

    Medicare Advantage HMOs restrict your coverage to the doctors and hospitals in their networks. You can go out of network for some coverage only if you’re in a PPO. But, even in a PPO, coverage tends to be limited and unpredictable. Driving your costs up further and/or endangering your health, Medicare Advantage plans usually impose prior authorization requirements before they will cover costly care. And, they inappropriately deny care, particularly to people with costly conditions–people needing rehab care, people with cancer and people with other complex care needs.

    The Centers for Medicare and Medicaid Services, which oversees Medicare, should be protecting you from bad actor Medicare Advantage plans, but it cannot. It does not have the capability, the money, or the power to oversee the 4,000 Medicare Advantage plans, much less to hold them to account for their bad acts.

    You should also bear in mind that you can’t count on the providers in Medicare Advantage directories actually being willing to see you. Multiple reports reveal “ghost” networks in some Medicare Advantage plans. As well, I’ve reported many times in Just Care on hospitals terminating their Medicare Advantage contracts, leaving Medicare Advantage plan enrollees scrambling to find alternative care or forced to drive long distances for inpatient services.

    N.B. If you want to switch to Traditional Medicare, note that you will need supplemental coverage (Medigap) to protect you from high out-of-pocket costs. Traditional Medicare does not have an out-of-pocket  limit. If you don’t have Medicaid or coverage from a former employer, make sure you can buy it in the individual market. In most states, insurers selling Medicare supplemental coverage are not required to sell you a policy, with some exceptions, including when you first enroll in Medicare at age 65 or later.

    Here’s more from Just Care:

  • 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).

  • Take advantage of the Medicare Advantage Open Enrollment period

    Take advantage of the Medicare Advantage Open Enrollment period

    If you’re in a Medicare Advantage plan, you should seriously consider taking advantage of the Medicare Advantage open enrollment period between January 1 and March 31 that allows you to switch to Traditional Medicare or to a different Medicare Advantage plan. This opportunity for to switch out of your Medicare Advantage plan is an important consumer protection. Medicare Advantage plans could have changed their provider networks or drug coverage between the fall Medicare Advantage Open Enrollment Period and now.

    I’ve written at length about all the reasons to avoid enrolling in a Medicare Advantage plan, especially if you have Medicaid or can afford the supplemental coverage that you need in Traditional Medicare to limit your out-of-pocket costs. Upfront costs in Medicare Advantage are less than those in Traditional Medicare with supplemental coverage. But, if you get sick and need care–the reason you have health insurance–your out-of-pocket costs are likely to be a lot higher in Medicare Advantage than in Traditional Medicare.

    Moreover, access to care is much simpler in Traditional Medicare than in Medicare Advantage. In Traditional Medicare, your treating physicians decide the care you need without an insurance company second-guessing your doctor and profiting every time it denies you care. And, there are no prior authorization requirements, nor is there a restricted network. You are covered for care from the vast majority of physicians and hospitals in the US. With supplemental coverage, your costs are predictable and often very little.

    Medicare Advantage HMOs restrict your coverage to the doctors and hospitals in their networks. You can go out of network for some coverage only if you’re in a PPO. But, even in a PPO, coverage tends to be limited and unpredictable. Driving your costs up further and/or endangering your health, Medicare Advantage plans impose prior authorization requirements before they will cover your care. And, they inappropriately deny care, particularly to people with costly conditions–people needing rehab care, people with cancer and people with other complex care needs.

    The Centers for Medicare and Medicaid Services, which oversees Medicare, should be protecting you from bad actor Medicare Advantage plans, but it cannot. It does not have the capability, the money, or the power to oversee the more than 4,000 Medicare Advantage plans, much less to hold them to account for their bad acts.

    You should also bear in mind that you can’t count on the providers in Medicare Advantage directories actually being willing to see you. Multiple reports reveal “ghost” networks in some Medicare Advantage plans. As well, I’ve reported many times in Just Care on hospitals terminating their Medicare Advantage contracts, leaving Medicare Advantage plan enrollees scrambling to find alternative care or forced to drive long distances for inpatient services. Memorial Hermann in Houston, Texas is the most recent hospital system to do so, ending its Medicare Advantage contract with Humana.

    Here’s more from Just Care:

  • Cigna plans to sell its Medicare Advantage business

    Cigna plans to sell its Medicare Advantage business

    The Wall Street Journal reports that Cigna is planning to sell its Medicare Advantage book of business. For nearly $4 billion, why not? While Cigna is a big health insurer, it has the smallest Medicare Advantage footprint of the big insurers. The sale signals the inevitable future of Medicare Advantage–one or two mega insurers with the vast majority of the Medicare Advantage business and all the power to undermine access to care in order to maximize profits.

    Currently, Cigna operates in 29 states. A sale to Blue Cross Blue Shield would boost its power in the Medicare Advantage marketplace. Originally, Cigna had considered buying Humana’s Medicare Advantage book of business, but investors did not receive that plan favorably.

    Cigna is a relatively small Medicare Advantage player with only 599,000 Medicare Advantage enrollees as of September 2023.  UnitedHealth has more than twelve times as many enrollees, 7.6 million. Humana has nearly 10 times as many enrollees, 5.9 million.

    Cigna’s departure from the Medicare Advantage marketplace will be unsettling for its enrollees, but should not come as a surprise. Nothing about a Medicare Advantage plan is reliable. Medicare Advantage management, along with coverage and payment practices, can change all the time. Plans can grow larger through acquisitions or shrink in size.

    Medicare Advantage provider networks also are ever-changing and unreliable. Denial rates and prior authorization rules are not even knowable and according to the Office of the Inspector General, there are widespread and persistent inappropriate delays and denials of care and coverage in some Medicare Advantage plans.

    Hospitals and specialists are increasingly canceling their Medicare Advantage contracts, meaning unreliable access to care for tens of thousands of Medicare Advantage enrollees. But, these providers are canceling in part because of patient safety concerns, meaning risks to health and well-being in Medicare Advantage. The AMA’s doctors report serious concerns with MA prior authorization, to the detriment of patients.

    The Medicare Advantage Open Enrollment period began January 1 and continues through March 31. If you want to be sure you get the care you need when you need it, take advantage of it and switch to Traditional Medicare.

    Here’s more from Just Care:

  • Seven questions you should be asking this Medicare Open Enrollment period

    Seven questions you should be asking this Medicare Open Enrollment period

    During this Medicare Open Enrollment period, ask yourself these seven questions. And, 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.

    1. Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. 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 doctors 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.
    2. Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to 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. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. 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).
    3. Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? 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 or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their health care. 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.
    4. Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, 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.
    5. Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. 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.
    6. Q. If I join a Medicare Advantage plan, can I 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 high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.
    7. Q. If I have traditional Medicare and Medicaid, what should I do? 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).

    Here’s more from Just Care:

  • 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan

    2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan

    The Annual Medicare Open Enrollment period begins October 15 and ends December 7. If you have Medicare, you are likely to see endless ads and receive lots of mail from an assortment of insurers chomping at the bit to get you to sign up with one of their Medicare Advantage plans. That’s how they rake in the big bucks, tens of billions of dollars a year. Unfortunately, our government does a poor job of helping you to understand differences between traditional Medicare, which is administered by the Centers for Medicare and Medicaid Services (CMS), and Medicare Advantage plans, which are administered by corporate health insurers that contract with the government. And, you can’t trust the corporate health insurers or their sales agents to tell you what you need to know.
    There are five basic differences between Traditional Medicare and Medicare Advantage that you need to understand.
    1. Coverage:
    Traditional Medicare. With traditional Medicare, you are covered for the medicallyreasonable and necessary care your providers believe you need. An insurance company is not second-guessing your doctors.
    Medicare Advantage. Medicare Advantage plans are supposed to cover the same benefits as traditional Medicare, but they cover significantly fewer, as has been documented over and over again. They often engage in widespread inappropriate delays and denials of care and generally require you to get approval before they will pay for most costly services. That’s how they maximize profits. If you think you might get sick or need costly health care at some point, even if you don’t need it now, think twice before signing up with a Medicare Advantage plan. No one provides you with the information you need to know to distinguish the good Medicare Advantage actors from the bad ones. And, there appear to be a lot of bad ones.
    2. Health care providers:
    Traditional Medicare. With traditional Medicare, you can see almost all doctors and use virtually all hospitals anywhere in the United States. Almost all take Medicare and more than 90 percent “take assignment,” accept Medicare’s approved charge as payment in full. The most they can charge is 15 percent above that amount.
    Medicare Advantage. With Medicare Advantage, your care is generally only covered when you use “in-network” providers. They can be few and far between and are often only located in your community. If you travel or spend time away from your primary residence, a Medicare Advantage plan usually will not cover your care, except in emergencies, Also, you might find that the providers in their directories are not taking new patients or have left the network. So, if you are thinking of joining a Medicare Advantage plan or are in one now, talk to any of the doctors you know you want to continue seeing to confirm that you will still be able to have your care covered when you see them. Keep in mind that a lot of the Medicare Advantage plans have lower quality providers in their networks and might not have a cancer center of excellence as part of their network.
    3. Costs:
    Traditional Medicare. With traditional Medicare you must pay your Part B monthly premium. You are generally liable for a hospital deductible and 20 percent of the cost of your medical care, unless you have supplemental coverage, either Medigap, which you buy in the individual market, Medicaid, or retiree coverage from a former employer. If you have supplemental coverage, most if not all of your costs will be covered. Traditional Medicare does not have an out-of-pocket maximum.
    Medicare Advantage. With Medicare Advantage, you pay your Medicare Part B premium and you might have no additional premium, but your out-of-pocket costs can be sky high. You cannot buy supplemental coverage to pick up your out-of-pocket costs. Your costs turn on the Medicare Advantage plan you choose, the care you need, and what the Medicare Advantage plan charges you for your care. You generally will have to pay a copay when you are hospitalized or need medical services. Your out-of-pocket costs can be over $8,000 for in-network care alone if you need costly care. But, each Medicare Advantage plan has its own out-of-pocket maximum. If you go out-of-network for your care, you will be liable for the full cost of your care, unless you are in a PPO (preferred provider organization), in which case you generally will be liable for 40 percent of the cost.
    4. Drugs:
    Traditional Medicare. With traditional Medicare, you will need to buy Medicare Part D prescription drug coverage if you want drug coverage. That typically costs about $55.50 a month.
    Medicare Advantage. With Medicare Advantage, your drug coverage is usually included in your plan’s monthly premium.
    Whether you’re in traditional Medicare or a Medicare Advantage plan, be sure to look at differences in your drug costs among Medicare Part D drug plans. And, keep in mind that it is possible, even likely, that you might spend less getting some of the drugs you take from Costco or another mail-order pharmacy than paying the copay for them through your Part D plan. Part D plans can have higher copays than the total cost of the drug from a low-cost pharmacy.
    5. Quality:
    Traditional Medicare. If you want control over the quality of your health care providers, you probably want to be in Traditional Medicare, where you choose the providers you see.
    Medicare Advantage. In a Medicare Advantage plan, the plan restricts your access to providers. And, even when you see a provider you want to see, the Medicare Advantage plan might not let your physician or hospital provide the care that they think is best for you. For example, if your doctor thinks you need 50 days of inpatient rehab therapy, your Medicare Advantage plan still might decide you only need 10 and will only cover 10 days.

    Bottom line: With traditional Medicare, your doctors and hospitals have every incentive to provide you with all the care they think you need and traditional Medicare will cover it. Medicare Advantage plans receive a fixed amount from the government to cover your care regardless of how much they spend on your care. Consequently, they have an incentive to withhold needed care and to incentivize their physicians to limit the care they provide you. The less money a Medicare Advantage plan spends on your care, the more money the Medicare Advantage plan has for its shareholders. Since there’s no good data to distinguish the good Medicare Advantage actors from the bad ones, you are gambling with your health and well-being when you enroll in a Medicare Advantage plan. To learn more, read this blog post by Diane Archer and Theodore Marmor on the fundamental difference between traditional Medicare and private insurance.

    Here’s more from Just Care:

  • It’s Medicare Open Enrollment: To save money and avoid big risks, check out your options

    It’s Medicare Open Enrollment: To save money and avoid big risks, check out your options

    The Medicare Annual Open Enrollment Period is underway through December 7. You could save a lot of money and headache if you check out your options. Most people don’t tend to switch Medicare drug plans or Medicare Advantage plans and many don’t even look to see how their benefits are changing next year, according to the latest research. To avoid big risks and beware of bad actors, check out this post. Here are a few additional tips:

    If you have Medicare directly from the government and supplemental coverage that fills gaps, little is changing except your Medicare prescription drug plan options. Even if you have a Medicare prescription drug plan that’s meeting your needs, keep in mind that everything about it can change in 2023.

    If you have a Medicare Advantage plan from a health insurance company, check to see how your provider network, out-of-pocket costs and additional benefits are changing and compare your options. You might want to switch to a different Medicare Advantage plan to save money. Some might have lower out-of-pocket maximums, and some might offer you better prescription drug coverage than others. You also might want to switch to traditional Medicare.

    With traditional Medicare, you will need to pay for prescription drug coverage and supplemental coverage separately, but the total cost of that coverage could be far less than your out-of-pocket costs in a Medicare Advantage plan, and you will have coverage from most doctors and hospitals throughout the US.

    As important as it is to look at all your options each open enrollment season, one recent survey found that most people with Medicare don’t switch plans from one year to the next. In fact, 45 percent don’t look at their options during the Open Enrollment Period. Four in ten people in Medicare Advantage plans don’t know how their benefits will change in 2023.

    To be clear, there is a lot you can’t know about your future health care needs as well as differences among Medicare Advantage options, including your out-of-pocket costs if you are diagnosed with a serious health condition, the specialists your Medicare Advantage plan will cover and your plan’s denial rates. Traditional Medicare offers more predictable coverage and easier access to care from the physicians and hospitals you want to use.

    Here’s more from Just Care:

  • Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment begins on October 15 and runs through December 7. You have many choices to make and you should take the time needed to make them, for both your physical and your financial health. A smart choice could save you money and steer you away from bad actors.

    Five things to keep in mind:

    Access to care: Health insurance is about your care needs today and unforeseeable needs down the road. Your Medicare plan should cover all medically necessary care if you’re diagnosed with cancer, heart disease or stroke, fall and break a bone, or are in a serious accident.

    Cost:  Many older adults skip needed care because of high out-of-pocket costs.

    • Traditional Medicare covers virtually all your out-of-pocket inpatient and outpatient costs, so long as you have supplemental coverage—Medicaid, retiree benefits, or Medigap, which you buy in the individual market for about $2,500 a year.
    • Medicare Advantage plans charge deductibles and copays that average around $5,000 a year and can be as high as $7,550. Each one charges different amounts for in-network care and most do not cover out-of-network care.

    Fraud: Some providers and Medicare Advantage plans have histories of engaging in fraud.

    Incentives: Beware of physicians and insurers that profit from denying or delaying your care.

    • Traditional Medicare pays for each service you receive, so physicians have no incentive either to withhold care you need or to keep you from seeing top specialists.
    • Medicare Advantage plans are paid a flat upfront fee, so they have a financial incentive to keep you from getting costly care. The less care you get, the more they profit.
  • With Medicare private plans, your costs are unpredictable

    With Medicare private plans, your costs are unpredictable

    With Medicare private plans, be they Medicare Advantage plans or Medicare Part D prescription drug plans, your costs are unpredictable. The corporate health insurers offering these health plans are free to increase your costs at any time. It’s another reason that you cannot meaningfully compare your private Medicare health plan options during the Fall open enrollment period.

    Susan Jaffe reports for Kaiser Health News on a woman who picked a Humana drug plan through Medicare’s Plan Finder during the Fall open enrollment period specifically because of the copay for the drug she takes. By January, Humana had increased the copay nearly 400 percent!

    Not only can Medicare private plans increase drug copays at the beginning of the year, they can do so again and again and again throughout the course of the year. The copays they list for the start of the following year during the Fall open enrollment period theoretically could be part of a bait and switch.

    CMS must approve a Part D drug plan’s drug tiering. But, the Part D plans retain a lot of latitude about what to charge enrollees. Also, enrollees’ drug costs depend upon a range of factors, including the pharmacies they use.

    AARP analyzed drug prices in December 2021 and again in January 2022. It found that 75 of the 100 drugs that Medicare Part D spends the most on had had a price increase averaging 5.2 percent in that time. None had a price drop.

    Medicare does warn people that prices can change. But, it does not allow people to switch to a new Part D drug plan after January 1 if they have been misled into signing up for a drug plan that charges them more than represented on the Medicare Plan Finder. People must wait until the next Fall open enrollment period, when they can again be misled.

    Sometimes, drug manufacturers give discounts to insurers or their pharmacy benefit managers. But, it’s impossible to know how much of those discounts insurers pocket. There’s little information surrounding what they do with them. The discounts tend not to go toward lower drug prices. If anything, they go toward lower premiums.

    Not surprisingly, lots of people with Medicare can’t afford their drugs even with Part D coverage. The copays are too high. One recent analysis found that a copay increase of as little as $10.40 led many people to stop taking all their medicines and ultimately to thousands of needless deaths.

    Fixed and predictable prescription drug copays are increasingly not the norm. Instead, insurers are charging enrollees a percentage of a drug’s price. And, with prescription drug costs often sky high, the coinsurance can be a lot of money.

    Medicare offers some enrollees extra help paying for their drugs through the Extra Help program. But, only people who meet specific income and asset levels qualify.

    Here’s more from Just Care:

  • Medicare open enrollment: Don’t be misled by ads

    Medicare open enrollment: Don’t be misled by ads

    When it comes to Medicare, every corporate health insurer seems to have an offer you can’t refuse, often from one of your favorite heroes paid to push their products. Don’t be misled by the TV ads and other promotional hype; get impartial information from your State Health Insurance Assistance Program. And, if you are misled, please know that you now have special rights to disenroll.

    Millions of older adults and people with disabilities are receiving misleading information from insurance companies offering Medicare Advantage. These insurers are not telling you the whole story about the health plans they are offering. Medicare Advantage plans offer you coverage from a limited number physicians and hospitals–generally far fewer than it appears from their provider directories–and often with large out-of-pocket costs if you need costly care. And, you are likely to need prior approval for your care, as well as to face delays and denials of care.

    So many people are signing up for these health plans based on misleading information that the Centers for Medicare and Medicaid Services (CMS) has threatened to penalize Medicare Advantage plans if they or the insurance brokers selling their products mislead people, reports Susan Jaffe for California Healthline. Under federal law, they are not allowed to engage in deceptive marketing practices, but that has not stopped them. And, since marketing is always deceptive–highlighting benefits but not costs–what exactly constitutes deceptive marketing?

    CMS is seeing a lot of complaints. Does the punishment CMS is threatening fit the crimes the health plans are committing? The Medicare Advantage plans make so much money off of each enrollee that it can be highly profitable for them to try to sell people a free lunch. When asked, CMS could not name one instance in which it had fined or suspended enrollment in a Medicare Advantage plan for deceptive marketing.

    The good news is that CMS has added new protections for people who are misled into joining a Medicare Advantage plan. You have additional rights to disenroll beyond the first three months of the year. According to CMS, enrollees have a “special enrollment period” if you want to disenroll because of deceptive sales tactics, including “situations in which a beneficiary provides a verbal or written allegation that his or her enrollment in a MA or Part D plan was based upon misleading or incorrect information … [or] where a beneficiary states that he or she was enrolled into a plan without his or her knowledge.”

    Most important: Never give a stranger your Medicare or Social Security number. In some cases, insurance agents are calling people, asking for their Medicare number and enrolling them in a Medicare Advantage plan without telling them.

    If you want health insurance that will meet your needs if you take a bad fall or are diagnosed with a serious condition, traditional Medicare gives you the freedom to see the doctors you want to see and use the hospitals you want to use anywhere in the country, generally with no bureaucratic hassle. The tradeoff is that you will need supplemental coverage, either through Medicaid, a former employer or a Medigap plan in order to protect yourself from out-of-pocket costs that have no cap. But, the cost of Medigap can be as low as $1,500 a year, far lower than the out-of-pocket cap in Medicare Advantage, which averages around $5,000 a year and can be as high as $7,550 for in-network care alone.’

    Here’s more from Just Care: