In an effort to ease regulations on insurers offering Medicare Advantage plans, the Trump administration has made it easier for Medicare Advantage insurers to mislead enrollees through insurance agents and brokers. These middlemen do not have to advise enrollees about all their Medicare options or let them know that State Health Insurance Assistance Programs (SHIPS) provide free unbiased Medicare guidance. Bottom line: Do not rely on brokers or agents when choosing a Medicare option.
It has always been the case that brokers and agents could steer people with Medicare into Medicare Advantage without helping them understand the benefits of traditional Medicare. Traditional Medicare covers your care from most doctors and hospitals anywhere in the US. Unlike Medicare Advantage plans, traditional Medicare has few restrictions on access to care.
Brokers and agents have always had a large financial incentive to steer people into Medicare Advantage plans and away from traditional Medicare. What’s worse is that they are often paid more to steer people to the most profitable Medicare Advantage plans, which might not be in people’s best interest. The new rules make it all the easier for them to mislead enrollees.
For the record, there is no way for sales agents and brokers, or anyone else, to know which Medicare Advantage plan, if any, will meet their needs. The information is unavailable. Moreover, most plans use prior authorization requirements to withhold care. But, how different Medicare Advantage plans use prior authorization is unclear.
Consequently, enrolling in a Medicare Advantage plan is gambling with your health and, sometimes, your life. These plans too often inappropriately delay and deny care, particularly when people have costly and complex conditions. The insurers’ financial incentive is to withhold care because it can maximize their profits.
The Trump administration’s new rule also ends the requirement of Medicare Advantage plans to alert people to their unused “extra” Medicare Advantage plan benefits. These “extras” often are what lure people into particular Medicare Advantage plans, but many of them go unused. The Biden Administration had imposed a requirement on insurers to let people know what “extra” benefits were unused six months into the year.
Here’s more from Just Care:
- More reasons not to trust Medicare insurance agents
- Medicare Advantage insurers face few penalties for their bad acts
- Free local resources to help older adults
- Four things to know if your income is low and you have Medicare
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
