Why are medicare advantage plans being pushed so hard?

Advantage plans are advertised a lot because of the way they are funded. The premiums for these plans are low or non-existent because Medicare pays the insurer every time someone signs up. It is beneficial for insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare. Medicare Advantage can get expensive if you're sick because of uncovered copays.

In addition, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to switch to another plan. If you decide to switch to a Medigap policy, there are often lifetime penalties. Part of the growth is due to strong investment by health insurance companies in geographical expansion and commercialization.

Industry reports high consumer satisfaction rates with Advantage, highlighting additional services offered by many plans, such as health clubs, dental care, vision and hearing. Medicare website offers “suggestions too broad to enroll in MA when more nuance is required” (Medicare Rights Center). Stein, a retired editorial cartoonist for the now-defunct Rocky Mountain News, contacted his Advantage plan to confirm that all the doctors he wanted to see were in his network and said yes. Michael Rainey, commentator for The Fiscal Times, explains that private insurers are responsible for managing their plans to guarantee profits.

Keep in mind that with traditional Medicare and Medigap, you'll also need Part D prescription drug coverage. If you decide that the Medicare Advantage plan isn't for you, you have the right, under federal law, to purchase any Medigap plan if you switch to Original Medicare within 12 months of the date you first joined a Medicare Advantage plan. Defenders of Advantage programs target studies that conclude they are outperforming original Medicare in areas such as preventive care, hospital readmission rates, nursing home admissions and mortality rates. Medicare was a decent initial sketch of a health care system when it was established in the 1960s, but it had a lot of bad design elements and left a lot out.

Medicare email campaigns have also been criticized by advocacy groups for drawing more attention to MA plans. Philip Moeller, PBS contributor, explains: “Even when I knew that a specific plan offered new non-medical benefits, they were often not included in the Plan Finder or were not clearly explained (PBS). At that time, you can switch to traditional Medicare with a Medigap, but Medigap may charge you a higher fee than if you had initially enrolled in a Medigap policy when you first qualified for Medicare. Medicare Advantage may be right for you, but make sure you know and understand all of your options before you fall into heavy advertising campaigns.

And there are some difficulties that many Medicare Advantage members don't discover (the limitations of their Medicare Advantage plans) until they get sick. And one video touted “additional new benefits,” a reference to a new range of non-medical supplemental benefits that are beginning to be implemented in the Advantage program and are not yet widely available. Department of Education, which is required under statutes governing Medicare to 'promote active and informed selection' among Medicare plan coverage options, said. However, there is no built-in limit to out-of-pocket costs in original Medicare; the only way to get it is to get supplemental coverage.

You'll find that many plans unexpectedly don't cover certain expenses when you get sick, resulting in unforeseen out-of-pocket expenses for you, and what they pay can vary depending on your general health condition. .

Elise Woehl
Elise Woehl

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