People with Medicare have no means of distinguishing among their different Medicare Advantage plan options, forcing them to gamble with their health and their lives when enrolling in Medicare Advantage. Each Medicare Advantage plan has its own proprietary set of prior authorization rules, different networks and different cost-sharing requirements that cannot be compared. But, AHIP, a health insurance trade association and some members of Congress are pushing a bill they’d like you to believe would deliver a “fair comparison” of costs between Medicare Advantage and Traditional Medicare.
There are significant cost differences among Medicare Advantage plans. Each has different out-of-pocket maximums, copays and deductibles. Assuming that all Medicare Advantage plans are alike when it comes to costs or quality, for that matter, is like assuming all doctors, restaurants and sneakers are alike. We don’t have any good information on cost differentials because the insurers hide that information, but they are likely big. We do know that the five percent of worst performing Medicare Advantage plans responsible for tens of thousands of needless deaths each year.
But, Congressman Aaron Bean, a Republican from Florida, and Kevin Hern, Republican from Oklahoma, introduced the “Apples to Apples Comparison Act.” They think it would be helpful for people to see how much people in Medicare Advantage spend on care, on average, as compared with people in traditional Medicare. In truth, the numbers would be meaningless.
Yes, people in Traditional Medicare have higher upfront costs than people in Medicare Advantage if they buy Medigap coverage. They buy this supplemental coverage for catastrophic protection because Traditional Medicare lacks an out-of-pocket cap. But, in part, as a result, people in Traditional Medicare are more likely to get the care they need than people in Medicare Advantage. Cost is usually not an obstacle for care for these people. Moreover, Traditional Medicare tends to cover all care your treating physician and you believe you need.
Any cost comparison between Medicare Advantage and Traditional Medicare would not factor in the cost of going without care for people in Medicare Advantage–how often do they go without care because copays are too high or their insurer inappropriately denies it? The Medicare Advantage insurers do not disclose this data.
AHIP goes out of its way to say “Unfortunately, today’s analyses rely on incomplete or inconsistent data, leading to comparisons that do not fully account for differences in eligibility, benefits or value to beneficiaries.” But, it’s the insurers who continue to fail to disclose complete and accurate data, much less timely data, even though they are required to do so under the law.
Here’s more from Just Care:
- Costs in Medicare Advantage present barrier to care
- MedPAC blasts Medicare Advantage
- MedPAC: Traditional Medicare consistently costs less than Medicare Advantage
- Medicare Advantage networks can be narrow and harmful
- Medicare Advantage plans fail to release data required for oversight
