Seniors enrolled in Medicare Advantage who are dissatisfied with their plan have until March 31 to switch.
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Seniors enrolled in Medicare Advantage who are dissatisfied with their plan have until March 31 to switch.
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In 2016, Richard Timmins attended a free informational seminar to learn more about Medicare coverage.
“I listened to an insurance agent and he was basically promoting Medicare Advantage very hard,” Timmins said. The representative explained the low cost and wide range of coverage the plan offers. The plan is largely funded by the government but administered by private insurance companies.
For Timmins, now 76, signing up made financial sense at the time. And his decision was great for a while.
Then, three years ago, I noticed a lesion on my right earlobe.
“I have a family history of melanoma, so I was paying attention to it and thinking about it,” Timmins says of the growth, which doctors later diagnosed as malignant melanoma. “It started getting bigger and started to hurt quite a bit.”
But Timmins found that by enrolling in a Premera Blue Cross Medicare Advantage plan, she might have a limited network of doctors and need pre-approval from her insurance company before receiving treatment. He says the experience made it more difficult for him to get health care, and he now wants to go back to traditional, government-run Medicare.
But he can't do that. And he's not alone.
“I have very little control over my actual medical care,” he said, adding that he now advises friends not to sign up for private plans. “I don’t think people understand what Medicare Advantage is.”
Enrollment in Medicare Advantage plans has increased significantly over the past few decades, with more than half of eligible people, primarily 65 and older, taking advantage of low premiums and benefits such as dental and vision insurance. I am. And as private insurance's share of the Medicare patient pie swells to 30.8 million people, there are growing concerns about insurers' aggressive sales tactics and misleading coverage claims.
Even registrants like Timmins, who signed up when they were healthy, can fall into the trap as they get older and their illness worsens.
“It’s one of those things that people might like on the front end because the premiums are low or no, and if they get some extra benefits like vision and dental,” Christine・Mr. Huberty says. She is the Chief Benefits Specialist Supervising Attorney for the Wisconsin Aging Resources Agency.
“But it's when you actually need to use it for these big problems that people realize, 'Oh, this is completely useless,'” Huberty said.
Medicare pays private insurance companies a fixed amount for each Medicare Advantage enrollee and often also pays bonuses that the insurance company can use to provide additional benefits. Huberty said these additional benefits act as an incentive to “get people into the plan,” but the plan “limits access to so many services and coverage for so many more.”
David Myers, assistant professor of health services, policy, and practice at Brown University School of Public Health, analyzed 10 years of Medicare Advantage enrollment and found that: Approximately 50% of beneficiaries Both in rural and urban areas, people quit their contracts by the end of five years. Most of these enrollees switched to another Medicare Advantage plan rather than traditional Medicare.
Sen. Elizabeth Warren (D-Mass.) spoke at a protest at the U.S. Capitol in July about care denials and delays in Medicare Advantage plans.
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Sen. Elizabeth Warren (D-Mass.) spoke at a protest at the U.S. Capitol in July about care denials and delays in Medicare Advantage plans.
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In the study, Myers and co-authors believe that while plan switching can be a positive sign of the free market, it can also indicate “immense dissatisfaction” with Medicare Advantage. There is.
“The problem is, once you enroll in Medicare Advantage, if you have some chronic conditions and want to leave Medicare Advantage, you may not be able to go back to traditional services, even if Medicare Advantage doesn’t meet your needs. That's Medicare,'' Myers said.
Traditional Medicare may be too expensive for beneficiaries switching from Medicare Advantage, he says. Traditional Medicare requires the enrollee to pay a monthly premium and, after reaching the deductible, pay his 20% of the cost for each service or item used outside the hospital, in most cases. And there is no limit to the amount that an enrollee would have to pay as part of her 20% coinsurance if she needed significant care, Myers said.
To limit out-of-pocket costs, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or private Medigap insurance. If you have a low income, Medicaid may provide additional coverage.
But Myers says there's a catch. Beneficiaries who initially enroll in traditional Medicare are guaranteed eligibility for Medigap insurance without setting prices based on their medical history, but Medigap insurers are offering benefits for those transitioning from Medicare Advantage plans. Compensation can be denied to beneficiaries or based on price. Medical underwriting.
Only four states – Connecticut, Maine, Massachusetts and New York – prohibit insurers from denying Medigap insurance to people with pre-existing conditions such as diabetes or heart disease.
Paul Ginsburg is a former member of the Medicare Payment Advisory Commission, also known as MedPAC. It is the legislative branch agency that advises Congress on the Medicare program. He said the inability of enrollees to easily switch between Medicare Advantage and traditional Medicare during the open enrollment period is “a major concern in our system, and that should not be the case.” Ta.
The federal government provides a specific enrollment period each year to switch plans. During Medicare's open enrollment period, which runs from Oct. 15 to Dec. 7, enrollees can switch from private plans to traditional government-administered Medicare.
Medicare Advantage enrollees can also switch plans or transition to traditional Medicare during another open enrollment period. From January 1st to March 31st.
“There are a lot of people who say, 'I want to go back, but I can't get Medigap anymore or I'll have to pay more,'” Ginsburg said. Professor of Health Policy at the University of Southern California.
Timmins is one of them. The retired veterinarian lives in the rural community of Whidbey Island, just north of Seattle. With its rugged and idyllic landscape, it is a popular destination for holiday homes, hiking, and art. However, there are some places that are a little far away.
Doctors are typically difficult to find in rural areas, but Timmins said the Premera Blue Cross program has made it more difficult to receive treatment for a variety of reasons, including difficulty finding and seeing a specialist. He said he thought that.
According to , nearly half of Medicare Advantage plan directories contained inaccurate information about available providers. Latest federal review. New or expanded Medicare Advantage plans begin in 2024 Need to prove compliance If the federal network's expectations are not met, the application may be rejected.
Premera Blue Cross spokeswoman Amanda Lunsford declined to comment on Timmins' case. She said the plan meets federal network adequacy requirements and travel time and distance standards to “ensure that members do not experience an undue burden when seeking medical care.” .
Traditional Medicare allows beneficiaries to go to the following health care providers: Almost all doctors and hospitals In the United States, in most cases, registrants do not require authorization to receive services.
Timmins, who recently completed immunotherapy, said she doesn't think she will be approved for Medigap insurance “because of her health issues.” Timmins says if they tried to go for it, it would probably be too expensive.
Timmins said he will continue with his Medicare Advantage plan for now.
“I'm getting older, too. There's going to be a lot more going on.”
Timmins says there's a chance the cancer will come back, and “I'm acutely aware of my mortality.”
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