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Ten ways Medicare Advantage plans differ from traditional Medicare

Written by Diane Archer

There is a lot of confusion surrounding Medicare Advantage plans–commercial health insurance for people with Medicare–and the ways Medicare Advantage plans differ from traditional Medicare. You may hear about their low upfront costs relative to traditional Medicare and their “extra” benefits. But, they do not provide you with the same access to care you get with traditional Medicare, and your out-of-pocket costs can be many thousands of dollars.

Medicare Advantage plans are supposed to deliver all the benefits of Medicare, but a slew of federal government audits reveal that they too often do not meet the needs of people with costly conditions. These audits show that many of them engage in inappropriate delays and denials of care and coverage, threaten the health and safety of their members, have highly inaccurate provider directories and overbill the federal government billions of dollars a year. They have all of the core failings of commercial insurance–for individuals, for taxpayers and for the public good.

  1. Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and have little incentive to include providers who deliver value in their networks. They do not compete with one another to deliver high value care and meet the needs of Americans who need costly care. If they attract people with costly conditions, they profit less. For this reason, sicker people are more likely to disenroll from them.
  2. Meaningless choice: Medicare Advantage plans do not disclose what they charge people out of pocket when they need costly care and which doctors and hospitals they will be able to use. They have never disclosed even average out-of-pocket costs to their members for costly care.
  3. Inequitable: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap that can be as high as $6,700 each year, for in-network care alone, undermine access and ration people’s care based on their ability to pay.
  4. Unreliable coverage: Medicare Advantage plans cannot offer reliable coverage or continuity of care as they are constantly changing the products and services they offer, the providers in their network, as well as their enrollees’ cost-sharing obligations. And, at times, they are pulling out of the market altogether. Moreover, according to the US HHS Office of the Inspector General, they engage in widespread inappropriate delays and denials of care and coverage.
  5. Unsustainable: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending. They simply shift increasing costs onto their members.
  6. Inefficient: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.
  7. Profit-driven: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put their shareholders first, with incentives to maximize profits and delay and deny medically necessary care.
  8. No innovation for the public good: Medicare Advantage plans have no incentive to innovate for the public good or disclose information about medical protocols, devices and other treatments that would benefit the public at large. What they learn about what’s working and not working in our health care system, they tend to keep to themselves.
  9. Unaccountable: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers. According to the Medicare Payment Advisory Commission, MedPAC, they have failed to disclose complete and accurate data regarding the health care services their members receive, though required by law for effective oversight.
  10. Unethical: Medicare Advantage plans engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectively and hold them accountable for inappropriate behavior, let alone illegal activities.

With Medicare for All, there would be no need for Medicare Advantage plans. Everyone would have an improved and expanded Medicare, with freedom to use the doctors and hospitals of their choice anywhere in the nation without worry about the cost.

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

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10 Comments

  • I had a dear friend who signed up for a Medicare Advantage plan. She asked her doctor three years running about a lump on her breast and he always said it was nothing. Then she was diagnosed with Stage 3 breast cancer, had chemo, radiation and a mastectomy but the cancer had metastasized. She died in February 2018.

      • “Medicare Advantage” IS NOT MEDICARE! *They call it Medicare Part C to fool you into thinking it is Medicare. It is NOT Medicare. It is a 100% private company for profit insurance plan designed to make money NOT to provide the best care. They work ok until you get really sick and then you get screwed. They play the game of making money by denying you care.

        *”they” = all Republicans and the corporate sellout Democrats who take money from insurance companies

    • I got an ad for Humana Medicare Advantage and I was curious so I called them. The rep asked why I was opposed to Medicare Advantage so I tried to tell him my friends story. He refused to listen and got very angry. When he got abusive I disconnected the call.

  • Like every form of insurance there are both good and bad MA-PD plans.

    Some MA-PD plans allow the use of out of network options.

    CMS provides a quality star system which allows one to weed out the low performing (one or two star) plans.

  • Wow, you REALLY hate these plans! I guess I must be incredibly lucky then. I’ve think I have excellent care, plus was able to continue using my same doctors and clinics, including eye and dental care. I get appointments as soon as I need them, quick referrals to any specialists. Their “ask a nurse questions” and help line is excellent and I’ve benefited from using them. That’s sad if these plans are as terrible as you say here, but I want to let you know, they are not all bad. I’m grateful I have mine.

    • Yes, you have been lucky! If you get really sick and need very expensive care, I hope that you will get the same good care, but there is really no incentive for a for-profit insurance company to provide it if they can get away with not providing it. Furthermore, there is no guarantee that your doctor or clinic will still be participating in your plan the next time you call for an appointment, but you will be stuck in your plan until the next open enrollment period. If you develop
      pre-existing conditions, will you be able to buy a Medigap or supplemental policy if you want to return to Traditional Medicare? Yes, you have been lucky—so far!

  • My wife and I have Medicare Advantage plans for a number of years. We are happy with the coverage and their approval process. Costs are reasonable. A great assistance in choosing the right plan in the “Medicare and You” publication what we receive every year from CMS.

    • Donald, Glad to hear you are satisfied for now. Private companies make a good show of seeming to care. But “Approval process” is the operational phrase here. Under traditional Medicare you don’t have the same pre-approval process. As others have said, you haven’t been costly enough to get burned. Advantage plans give fine care as long as you are basically well. Here’s one example Where patients begin to get disappointed..You slip and fall and break something and need sub-acute rehab. Don’t expect to stay in a rehab facility until you feel you are better. A company rep will look at the records and arbitrarily declare you better, declare you ready for out-patient rehab and by stopping the payments, make them send you home. Maybe give you a little medicare Part A therapy at home through a visiting nurse Service and call it done. But don’t expect to get The intensive at-home physical therapy which you can easily get under part B from traditional Medicaid ( no out-patient therapists will be on their narrow provider list.) so, IF your pre-approval approves of more therapy, you will find yourself dragging your disabled body OUT of your house to one of the out-patient rehab centers on your short provider list. Doctor’s treatment options are more limited, so because you are in this plan that has certain protocols, the doctor is forced to treat you that way rather than an approach that might be better for you. A doc thinks you should go to one specialist, but, too bad, not in network. So refers to someone in network and doesn’t tell you. You will never know what better care you might be missing. So many other differences you only find out when you get sick and then it is too late. You are locked in till January. You have to wait till open enrollment to switch out and then start new plan in January. There is virtually no way to really know the workings of a private company. Therefore, no meaningful way to compare plans even if all your doctors and medications are all on the plan now. That can change, your health can change, your drugs can change. But you can’t change.

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