During this Medicare open enrollment season, take a hard look at all your Medicare options. Only in traditional Medicare are you likely to be covered for the care you need from the health care providers you want to use anywhere in the country and without hassle. If you enroll in a Medicare Advantage plan, don’t rely on a broker–be they from Chapter, Consumer Reports, AARP or anywhere else–to make your choice. When it comes to whether the Medicare Advantage plan will cover the care you need when you develop a costly condition, they are simply rolling the dice for you.
Brokers can’t help you avoid the Medicare Advantage plans that will refuse to cover the care you need. Sad to say, but even the brokers connected to what you think are reputable companies–Chapter (a health insurance agency,) Consumer Reports and AARP–are all paid lots of money to steer you to a Medicare Advantage plan. They will tell you that your upfront costs are lower in Medicare Advantage than in traditional Medicare, which is true. But, what they won’t tell you is that they could be directing you to a Medicare Advantage plan with high denial rates and poor health outcomes.
Brokers connected with Chapter, Consumer Reports and AARP won’t tell you that, when you need costly care–and everyone does, eventually–your costs in Medicare Advantage could be significantly higher than in traditional Medicare. Even though Medicare Advantage plans are legally required to cover the same benefits as traditional Medicare, Medicare Advantage plans can and do often second-guess your treating physician and deny you coverage for the care you need. The more denials they issue, the more they profit.
The Office of the Inspector General at the Department of Health and Human Services has reported on the widespread and persistent inappropriate denials of care in Medicare Advantage. One extensive study found that if the government cancelled contracts with the worst performing Medicare Advantage plans, it would save tens of thousands of lives a year.
The brokers will likely steer you to a Medicare Advantage plan that includes your physicians in their network and has other bells and whistles that appear attractive. But, they likely will not explain that some have very high denial rates and some have provider networks that might look good but are misleading because the physicians listed have left the network or only see patients at one hard-to-reach location. Bottom line: You could end up not being able to get the care you need or paying out-of-pocket for the full cost.
For sure, upfront costs in traditional Medicare can be high if you don’t have Medicaid or retiree coverage to pick up the coinsurance payments. But, you can buy low-cost supplemental coverage and spend less in traditional Medicare than in Medicare Advantage if you are diagnosed with a complex condition. Unlike Medicare Advantage plans, which too often overrule your treating physicians and won’t pay for the care you need, traditional Medicare generally covers the care your treating physicians deem medically necessary.
The big question to ask yourself this open enrollment season is whether you want to gamble with your health in a Medicare Advantage plan. You might also ask your representatives in Congress how they can allow insurers to offer Medicare Advantage plans without turning over data to show denial rates and health outcomes. Just as you wouldn’t buy a used car without taking it out for a drive first, you should not be forced to gamble with your health in a Medicare Advantage plan.
Here’s more from Just Care:
- 2027: Five things to think about when choosing between traditional Medicare and Medicare Advantage
- Seven reasons private health insurance can’t be fixed
- Medicare Advantage needs an overhaul
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Medicare agency proposes reforms to address inadequate Medicare Advantage networks
