By
Trudy Lieberman Rural Health News Service Nov 22, 2019
Along
with crunchy leaves and pumpkins, fall brings a slew of advertising for
insurance plans that fill the gaps in Medicare coverage.
Misleading
and confusing messages continue to reach beneficiaries and those nearing
Medicare age. To take myself as an example, I’ve received an invitation to a
Medicare Advantage plan informational meeting. I’ve gotten a solicitation from
my physician’s medical group offering a “zero-cost, no obligation way to review
coverage” online or over the phone. The “review” is likely to bring a sales
pitch for a plan.
A
mailer from another plan offered “a friendly, money-saving Medicare Advantage
Plan” that seemed to promise the moon: savings of up to $2,380 a year, maximum
dental coverage of $1,500, and a $750 hearing aid allowance, a drop in the
proverbial bucket considering the average cost of two hearing aids is about
$4,500. One seller seemed to think I was on both Medicare and Medicaid and
pitched a “special needs plan.” Since I wasn’t a candidate for such an
arrangement, was the insurer trying to get in the door to sell a regular
Medicare Advantage plan?
Too
many people fall for those kinds of pitches. Shopping to cover the gaps in
Medicare is a task no one should take lightly. The stakes are too high.
Medicare
is a fine program, but it was never meant to cover everything. It’s based on
the old Blue Cross model of insurance common in the 1960s where the company
paid 80 percent of the medical bill and the patient paid 20 percent. An
industry selling Medigap policies sprang up to cover the 20 percent, and
deceptive sales practices plagued the business for years.
Congress
ended that and standardized the coverage into 10 plans (11 today, including a
high-deductible plan) that give people a broad choice for covering what
Medicare does not pay. If people bought Plan F or Plan C as their supplemental
insurance, they were pretty much covered for most illnesses.
Beginning
next year, however, new Medicare beneficiaries — those who turn 65 on or after
Jan. 1, 2020 — won’t be allowed to buy Plan F or C. Congress wants more
beneficiaries in Medicare Advantage plans, so it eliminated the option to buy
the most comprehensive plans. Lawmakers wanted seniors to pay more for their
care.
They
can still buy Plan G, which offers the same protection as F except that it
doesn’t cover the Medicare Part B deductible, which is $183 next year. People
already on Medicare can still buy Plans F or C.
The
goal is to push more people into Medicare Advantage plans, a private
alternative that is a step toward privatizing the entire program. To move the
process along, the government has overpaid insurers to provide the care, which
enables them to offer inducements to join. Considering that about one-third of
Medicare beneficiaries have moved to Medicare Advantage plans, that strategy
seems to be successful.
But
does it come at a cost?
Serious
questions have arisen about the overpayments the government has made using
taxpayer dollars, overpayments that allow plans to offer gym memberships and
even Apple Watches, monitoring devices, to new enrollees as one plan is doing.
In September, six Democratic senators wrote to Medicare noting that taxpayers
have overpaid Medicare Advantage plans more than $30 billion over the last
three years and that Medicare has “taken little to no action to correct” the
overbilling and overpayments.
Even
more troubling, the letter also says that several other government agencies,
such as the Office of the Inspector General, have raised “serious concerns”
about Medicare Advantage plans that fail to meet the needs of older adults and
those with disabilities.
The
letter raises questions about the kind of care beneficiaries are actually
receiving and notes that Medicare’s own audits have found “widespread and
persistent Medicare Advantage performance problems related to denials of care
and payment” that “threaten the health and safety of their members.”
Those
are government watchdogs raising a red flag about problems getting care when
you’re really sick and need good insurance.
Medicare
Advantage plan advisers note that traditional Medicare does not put a limit on
the amount a beneficiary must pay out of pocket each year while Medicare
Advantage plans do — $6,700 for in-network providers and $10,000 for those out
of network. They usually don’t mention that a good Medigap policy will cover
those amounts, but the premiums may be higher than for a Medicare Advantage
plan heavily subsidized by the government.
The
trade-off becomes what it does with all insurance: pay now in the form of
higher premiums or pay later in the form of higher expenses if the worst
happens.
Insurers
seldom mention that tough trade-off when they host those informational meetings
for shoppers.
These
columns, which focus on rural health issues, are funded by a grant from The
Commonwealth Fund and distributed through the Nebraska Press Association
Foundation, the Colorado Press Association and the South Dakota Newspaper Association.
Email trudy.lieberman@gmail.com.
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