You might consider the choice between private Medicare Advantage and public traditional Medicare as a trade-off between Silver Sneakers and Memorial Sloan-Kettering Cancer Center. When you opt for a Medicare Advantage plan, you’re likely to get a Silver Sneakers membership and unlikely to be covered at Memorial Sloan-Kettering. When you opt for traditional Medicare, you’ll have coverage at Memorial Sloan-Kettering Cancer Center or any other center of excellence you choose but no Silver Sneakers membership.
Congress gives you what you might want to think is a fair choice, but in fact forces you to take a serious gamble that no one should have to take.
The Medicare Advantage option offering the Silver Sneakers membership will likely save you a bunch of money while you’re healthy. With traditional Medicare, you will be able to get the health care you want, but you will need to buy supplemental coverage to protect yourself from financial risk. Keep in mind that health insurance is about tomorrow, and tomorrow you might be diagnosed with cancer or stroke or heart disease or any of a number of conditions for which your Silver Sneakers membership will be of no use.
Of course, for the hundreds of billions of dollars the federal government spends on Medicare Advantage plans, it could do a far better job of ensuring you access to high-value providers. That’s what many big employers and unions do when they steer their retirees into Medicare Advantage plans.
Instead, the government pays the big bucks to Medicare Advantage plans, tells them the benefits they must cover, but otherwise gives them a lot of free rein over the terms of that coverage. No surprise that the OIG finds inappropriate and widespread delays and denials of care in Medicare Advantage. And, if you need costly and complex care, the government is of no help when your Medicare Advantage plan limits your access to the doctors and hospitals you want to use, charges you high out-of-pocket costs, and forces you to surmount huge administrative hurdles.
Medicare Advantage plans tend to make accommodations for big employers and unions acting on behalf of retirees. Union and large employer retirees usually can rely on their unions and employers to advocate on their behalf, to insist that the provider network be robust, to ensure people get access to needed care. Put differently, even though these unions and large employers are not paying the bill for Medicare Advantage, their retirees get special treatment that the government does not get for everyone else in Medicare Advantage. Huh??
OK. Not always. Sometimes the union or the large employer doesn’t care enough about its retirees, only about saving money on retiree health care costs, and retirees are left holding the bag when they get sick. That’s what happened to an SEIU member with cancer. SEIU moved her out of traditional Medicare and into Aetna Medicare Advantage involuntarily, mid-course of treatment at Memorial Sloan-Kettering, reports Russell Mokhiber in The Corporate Crime Reporter. And, because the Aetna plan did not include Sloan Kettering in its network, she was left to spend days fighting to continue the care she had begun.
Medicare was once one size fits all for everyone. Now, with Medicare Advantage, it’s all too easy to pick a Medicare Advantage plan that does not fit your needs, or in the case of the SEIU member, to be involuntarily moved into one. For Medicare Advantage, it’s all about insurer profits.
It’s time to unrig our health care system. We need Medicare for all, everyone getting care from the doctors they want to see at the hospitals they want to use, with no out-of-pocket costs, and without corporate insurers coming between patients and their doctors, creating obstacles to care to satisfy their shareholders’ hunger for profits.
Here’s more from Just Care:
- Well-kept secrets of Medicare Advantage plans
- Medicare Advantage gold mine puts traditional Medicare at grave risk
- Your projected Medicare benefits and costs in 2021
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- How to get free or low-cost dental care
