Are Medicare Advantage Plans leaving you at a disadvantage?

Medicare remains the gold standard for the care of our senior population in the USA.   Patients are happy about their experiences with Medicare. During the yearly sign up period, Medicare Advantage Plans are heavily marketing to earn your business and get you to switch out of traditional Medicare.   Should you consider this option?

A number of years ago, the insurance industry lobbied to offer a choice of private plans that can be a Medicare Replacement through a private insurer.

The Hype vs. The Truth; Medicare is much better; here’s why

Medicare Advantage plans are often heavily marketed to seniors as being a better alternative with advantages over traditional Medicare.  If you look carefully, they offer smaller networks, poorer options for out of state coverage, and as recently reported by the NY Times, will deny more claims than Medicare would. If you choose a Medicare Advantage plan, Medicare pays the private carrier who has higher operating expenses than Medicare does, while they also try to turn a profit with these plans. Medicare, unlike Medicare Advantage Plans also offers the option to go out of network and doctors have a maximum limiting charge which limits the amount over Medicare fees that they can charge you.

Medicare offers a low yearly deductible for doctor visits and a rational deductible for hospitalization.  It will also automatically spin-off claims to secondary insurers which is great for patients and their healthcare providers.

Is Medicare perfect?   No; there is room for improvement in areas such as the Prescription part of Medicare that does not allow the government to negotiate drug costs. This alone has been inflationary, contributing to the rise in drug costs as sales have risen for different drugs.  The program also needs to be able to recognize improper billing better than it does now, even though many of these cases do get investigated.

Medicare Advantage plans typically only cover what Medicare covers, but not all states have participation with these plans as they do with Medicare, which means that your New York plan may not have the same coverage when you are in Florida.

Many Medicare Advantage plans offer a seemingly low copay, often these co-pays are higher than your co-payment with Medicare once your yearly deductible has been reached. Unlike Medicare, they will negotiate drug prices although, Medigap policies will pay these expenses in full once Medicare processes the initial claims.

While Medicare will not offer you perks like a discounted gym membership or a free breakfast, the system is proven, scalable, and has the power to negotiate healthcare costs in a way Medicare Advantage plans cannot.

It is our office’s position that patients are much better off with standard Medicare with a supplement.  While Medicare does not yet offer chiropractic coverage for exams, x rays, and other therapeutic services, one Medicare Advantage plan that is offered in NJ does offer those services for NJ employees. The state believes that their version of Medicare Advantage saves the state money.

Recently, the NY Times investigated complaints about Medicare Advantage plans having a higher rate of non-payment to providers than Medicare does.  Check it out

Medicare Advantage Plans Found to Improperly Deny Many Claims

More and more beneficiaries are choosing Medicare Advantage because the plans offer potential advantages, including a doctor who can coordinate care.

By Robert Pear Oct. 13, 2018

WASHINGTON — Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to patients and physicians alike, federal investigators say in a new report.

The private plans, which now cover more than 20 million people — more than one-third of all Medicare beneficiaries — have an incentive to deny claims “in an attempt to increase their profits,” the report says.

The findings, by the inspector general at the Department of Health and Human Services, come as policies in Washington are creating new incentives for older Americans to enroll in Medicare Advantage plans. Some experts predict that the share of Medicare patients in the private plans could grow to one-half in a few years.

“Because Medicare Advantage covers so many beneficiaries, even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers,” said the report by the inspector general, Daniel R. Levinson.

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