In the last few weeks, I’ve given a couple of talks focused on Medicare Advantage. I always highlight the biggest well-kept secrets of Medicare Advantage plans, summarized below. They should give anyone thinking of joining a Medicare Advantage plan pause.
Believe me, I realize that traditional Medicare is unaffordable for many people because it lacks an out-of-pocket cap. That’s an issue Congress needs to fix because traditional Medicare gives people the freedom to choose the care they want from the doctors and hospitals they want to use. Anyone who joins a Medicare Advantage plan loses that freedom and takes a big gamble.
Insurance is about tomorrow at least as much as today. Not needing much health care now is not a reason to choose a Medicare Advantage plan. When you do, accessing care in an MA plan can be stressful. Inappropriate delays and denials of care are routine, as are restricted and ever-changing networks.
Medicare Advantage can take a huge financial and emotional toll on you and your family. As long as you’re healthy, you’re fine. If you get sick, it’s impossible to know whether your Medicare Advantage plan will meet your needs. If you’re able to get the care you need when you develop a costly or complex condition, Medicare Advantage can be far more expensive than traditional Medicare. Annual out-of-pocket costs are now more than $7,550 for in-network care alone.
It’s inhumane and unconscionable for Congress to force vulnerable Americans to take such a large risk with their healthcare in Medicare Advantage. It’s equally wrong to keep people from switching out of Medicare Advantage to traditional Medicare because it lacks an out-of-pocket cap and getting affordable supplemental coverage is not guaranteed.
MA plans offer insurance that can disappear when you need it
- They can tempt you with inexpensive things like gym club memberships and low premiums
- They can tease you by not interfering with routine inexpensive items of healthcare
- They can arbitrarily deny you access to expensive healthcare your doctors recommend
- They can arbitrarily restrict and change their provider networks at any time
- They can arbitrarily change their coverage rules at any time
- They can change ownership, leadership and behaviors at any time
- They can leave your community at any time
MA plans take away your choices
- They often do not cover care from many of the providers in your community
- They often do not cover any care at Centers of Excellence
- They don’t reliably cover the care your doctors think you need
- They can endanger your health with widespread and inappropriate delays and denials of care
- They often do not offer high-value care for people with complex conditions; if they do, they don’t make it easy to get, and may not even let you know about its availability
- They impose out-of-pocket costs for most care and, for people who need expensive care, as much as $7,550 in out-of-pocket costs each year for in-network care alone
- They do not disclose their mortality rates, denial rates, and average out-of-pocket costs
MA plans are paid a fixed rate upfront; the less they spend on your healthcare, the more of your money they keep and the more profits they make
- Their business model prioritizes covering low-cost care over high-value care
- Their business priorities are to pay for less care and pay less for care
- To compete effectively and keep their premiums low, they design their plans to avoid enrolling people with complex conditions
- They lack an incentive to focus on people’s long-term needs or the needs of the community, as they must answer to Wall Street on a quarterly basis.
- They see money spent on your health as an avoidable expense, not as an investment in our mutual futures
- They are difficult and costly to oversee
- They are largely unaccountable for violating their contractual obligations or engaging in fraud
Here’s more from Just Care:
- What if the government paid Medicare Advantage plans differently?
- Medicare Advantage gold mine puts traditional Medicare at grave risk
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Senators ask Medicare agency why it is not holding Medicare Advantage plans accountable for violating their contractual obligations
- Will Congress allow Medicare drug price negotiation in 2021?
