Our blog has reported on the problems that exist with Medicare Advantage Plans. Many of these plans offer to give you an enhanced benefit in exchange for using a private insurance carrier. Most people find out the benefits disappear when they try to use a specialist or have an out of state healthcare emergency.
Medicare Advantage, otherwise known as Medicare + C claims to offer lower costs. Often, after the low Medicare deductible has been reached, patients find out their provider choices are limited as well as their choice of covered medications as compared to traditional Medicare. Also, after the deductible is met, the copay for an office visit is only 20% which can be much less expensive than the $40 copays that are common under Medicare Advantage plans. Also, there are no unwelcome surprises as most healthcare providers and practically all hospitals and labs participate with Medicare plus you have out of network coverage that offers a limiting charge meaning a healthcare provider can only charge you a fixed amount out of network. This eliminates many of the private insurance problems. True, you may want to purchase a Medicare secondary called Medigap at an additional monthly cost but it is well worth it.
Recently, we have had a couple of patients who had unwelcome surprises with their Medicare Advantage Plans. One had a Horizon Blue Cross Plans which we normally participate with. She found out after coming in with severe pain that her plan had an extremely limited network and we are not a participant, something neither of us would ever have suspected. Another under United had a United Medicare Advantage plan which used the Oxford network, which we are no longer participating with since they stopped paying chiropractors for their evaluations and x rays when medically necessary. There was no way for either of us to know that the plan used that network since there was no indication on the card or anywhere else. This would never happen under traditional Medicare.
Had either of these patients had Medicare, while chiropractic care is limited to manipulation of the spine only (something that will likely change as the chiropractic modernization act gains congressional support), they would have had at least part of their costs covered.
A new concern is preexisting condition clauses that are being reported on by Medpage today that occur with Medigap plans. Joining Medicare directly when you are 65 years of age with a Medigap plan is simple. If you developed a problem after joining Medicare, Medigap plans are now seeing this as a preexisting condition and will charge you a higher premium due to preexisting health problems. This can be avoided by joining both Medicare and taking a Medigap plan once you reach 65 years of age on your initial sign up for the program. Medicare Advantage plans do not have this concern.
If this already sounds complicated, choosing Medicare as your primary with a Medigap plan once you become 65 is the best option with the best coverage period. In our experience, we have never had a senior unhappy with Medicare. True, you may not get a discount on certain things like a gym membership but the big costs of hospitalization and doctor visits will be covered without the caveats of Medicare Advantage which is why there are many unhappy seniors with Medicare Advantage plans.
Check out the article on Medpage below
Medicare Advantage Enrollees Discover Dirty Little Secret
Getting out is a lot harder than getting in
by Cheryl Clark, Contributing Writer, MedPage Today
December 03, 2019
Like many of the 22 million seniors now enrolled in Medicare Advantage (MA) plans, Tom Mills belatedly discovered its dirty little secret.
Also called Part C, these plans can cover a broad array of health services at low cost — that is, until one gets sick, at which point out-of-pocket costs can soar. But once in an MA plan, getting out can be even less affordable.
After Mills underwent a mitral valve repair and suffered a mild stroke with no lasting effects, the San Diego resident’s plan now charges him hundreds of dollars in monthly copays for drugs and other medical services. He had to pay $295 a night for his hospital stay.
But there was a much bigger shock. Mills, 71, learned that switching out of his MA plan will incur exorbitantly higher costs the next time he needs a serious medical intervention. If he moves to traditional Medicare and a prescription plan, he still needs a supplemental Medigap plan to pick up his 20% copays and deductibles.
Though the retired environmental geologist is training for his 57th half marathon, he now has a pre-existing condition. Medigap plans in all but four states can and do reject people like him or require prohibitively higher premiums. Diabetes, heart disease, or even a knee replacement can be criteria for exclusion.