Yves here. We have repeatedly warned that Medicare Advantage has become a second-tier of a two-tier Medicare system. The post below is a very good overview of the program itself and the extensive practice of highly aggressie and even fraudulent marketing of these skimpy plans. Please circulate it to anyone you know who might be a target of these misleading promotions.
Admittedly, since many of these plans lure prospective customers in by offering “zero premiums,” they are sadly a rational choice for the poor or relatively poor elderly, those so budget stressed that they need the amounts that would go towards Traditaoinal Medicare and perhaps also Medigap coverage to pay essential expenses. But for those who have any budget room, opting for Medicare Advantage is a false economy. One of the ways that private insurers keep their outlays for care down is by having narrow networks, while Traditional Medicare patients can see any doctor that accepts Medicare. The article (consistent with many other media coverage) points out that Medicare Advantage sales reps regularly lie about whether a prospect’s current doctor is included in the plan. Another Medicare Advantage patient-harming practice is extensive pre-authoriation requirements, while they are limited in Traditional Medicare.
This article also describes how dementia patients have been conned into signing up for Medicare Advantage plans.
The fact that Medicare Advantage plans spend so much on advertising, including blanketing old person TV with commercials with well-known spokescritters like William Shatner and Joe Namath, numerous and often misleading mailers (including mimicing government missives), and aggressive calling, says these plans are highly profitable and that has to be at the expense of patient care.
By F. Dougles Stephenson. Originally published at Informed Consent
Award winning journalist,Trudy Lieberman, a former president of the Association of Health Care Journalists, alerts us that it is now “open-enrollment season – the yearly grand bazaar when insurers and agents for them hawk Medicare Advantage plans – which just opened for coverage starting January 1, 2026. Lieberman cautions that If the past is any indication, sellers working for insurance companies, some with household names, others not, will snare new recruits into Medicare Advantage plans, possibly omitting in their sales pitches that they will be locked into an MA plan and could face great difficulty returning to traditional Medicare and buying a supplement policy if things go wrong – as they often do. Insurers will once again flood seniors with “free” Medicare Advantage goodies and offers. Lieberman concludes that “consumer protections, like those enacted by Congress to address Medigap marketing practices years ago, are urgently needed.”
What Is Medicare Advantage?
Medicare Advantage is a private profit program offering private health insurance industry plans as options to replace public traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending, and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Managed Care/Utilization management techniques are used, such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage “healthy behaviors”. In reality, “Medicare Dis-Advantage” is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.
How Do Medicare Advantage Plans Differ From Traditional Medicare?
• MA plans are owned and operated by for-profit, private insurance corporations and Wall Street investors.
• Unlike traditional Medicare, Medicare Advantage plans often refuse to pay for treatments and medications physicians prescribe.
• Unlike traditional Medicare, many physicians, other healthcare professionals and hospitals will be off-limits to patients because Medicare Advantage companies create their own proprietary and often skimpy, managed care type “networks” of healthcare providers.
• If patients go out of network, they could then be on the hook for thousands of dollars out of their own pocket.
• Patients do not have free choice of their professionals and health care institutions. Medicare Advantage does not allow choices within the entire health care system.
• They likely will have to pay extra—often a lot extra—for some of those extra benefits.
Burgeoning Profits In Private Health Insurance Industry
Health advocate Wendall Potter found that the seven biggest publicly traded health insurance companies collectively made $71.3 billion in profits, up more than half a billion dollars from 2023. Huge strides in privatizing both Medicare and Medicaid have been made. More than 90% of health-plan revenues at three of the health industry companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular. Enrollment in government-funded programs increased by 261% in 10 years.
What has changed dramatically over the decade is that the big insurers are now getting far more of their revenues from Medicare, Medicaid and from taxpayers as they have moved aggressively into government programs. This is especially true of Humana, Centene, and Molina, which now get, respectively, 85%, 88%, and 94% of their health-plan revenues from government programs.
For-profit private health insurance now controls more than 70% of the Medicare Advantage market.
In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion.
Beneficiaries Inundated With Aggressive, Misleading and Often Intentionally Deceptive Sales and Advertising Practices of Medicare Advantage Plans:
With so much money to be made in Medicare Advantage (MA), it’s not surprising that The Centers for Medicare and Medicaid Services (CMS) revealed that the number of Medicare beneficiary complaints about private sector marketing for Medicare Advantage (MA) plans more than doubled from 2020 to 2021. Senator Ron Wyden’s Senate Finance Committee Majority Staff launched an inquiry in August 2022, collected information on marketing complaints from 14 states and found evidence that beneficiaries are being inundated with aggressive marketing tactics as well as false and misleading information.Investigation shows a toxic pattern of false, misleading advertisements and fraudulent sales practices that go well beyond isolated incidents. Reports from state insurance departments and SHIPs confirm that vulnerable seniors are being flooded by plans utilizing subsidiaries, third-party organizations, and “bait-and-switch” tactics that evade existing Medicare rules on plan marketing and communications to beneficiaries. Unscrupulous actors appear to be taking advantage of the loosening of marketing regulations, which has ratcheted up confusion and pressure on beneficiaries as well as
Profiles of Deception
Each one of these profiles represents documented instances of aggressive or deceptive MA and Part D marketing practices that was found to be widespread, not isolated events:
• Seniors shopping at their local grocery store are approached by insurance agents and asked to switch their Medicare coverage or MA plan.
• Insurance agents selling new MA plans tell seniors that their doctors are covered by the new plans. Seniors who switch plans find out months later that their doctor is actually out-of-network, and they have to pay out-of-pocket to visit their doctor.
• Seniors receive mailers that look like official business from a Federal agency, yet the mailer is a marketing prompt from an MA plan or its agent or broker.
• An insurance agent calls seniors 20 times a day, attempting to convince them to switch their Medicare coverage.
• Widespread television advertisements with celebrities, (e.g. Wm. Shatner, Danny Glover and others) claim that seniors are missing out on benefits, including higher Social Security payments, in order to prompt seniors to call MA plan agent or broker hotlines.
Examples from“Deceptive Marketing Practices Flourish in Medicare Advantage”
A Report by the Majority Staff of the U.S. Senate Committee on Finance, Chairman Ron Wyden, D-OR. pdf
1). Fake “IRS Mailers” and “Official Mailers”: Mailers are designed to look like official notices coming from the Internal Revenue Service (IRS) or the Medicare Program. These mailers are both misleading and serve an important role in lead generation that allow TPMOs to get around many of the marketing prohibitions currently in law, per Section 103 of the Medicare Improvement for Patient and Providers Act (MIPPA) of 2008 that prohibits MA and Part D plans from conducting certain marketing activities, including cold calling. These mailers allow salesmen to skirt the rules because after the beneficiary initiates contact in response to an advertisement these prohibitions are no longer in place per CMS rules. Mailers framed as urgent that look like official notices from the IRS or other government entities serve the explicitly misleading purpose of prompting beneficiaries to “initiate contact,” so that MA marketing prohibitions can be circumvented. This loophole allows bad actors to inundate older Americans with unsolicited calls and other aggressive marketing.
2). Misleading Information about Provider Networks: False or misleading claims around in-network and out-of-network providers were reported and are of high concern because they have serious impacts on beneficiary health. In response to the March 2022 Advance Notice released by CMS, the National Organization for Rheumatology Management (NORM) submitted a letter describing the provision of incorrect information about MA plan provider networks. In its letter to CMS, NORM reported that “When researching MA plan options, beneficiaries are often told by MA plan enrollment representatives that there will be no disruption in their treatment, and they can continue seeing their current care providers. Some beneficiaries will contact their rheumatology practice for confirmation. The practice administrator can share whether the treating rheumatologist is “in-network,” whether the prescribed medications are on the plan’s formulary and/or subject to prior authorization or step therapy, or whether the patient would need to be “switched” to another option, as well as what their expected out-of-pocket costs would be, if they proceed with MA plan enrollment. Far too often, beneficiaries learn the information shared by the MA plan representative was incorrect.” The letter goes on to say, “practice administrators learn of a patient’s change in coverage at the time the patient requests an appointment (and the practice does not participate in the plan) or visits the pharmacy to request a refill (and learns they either need prior authorization or the medication is now cost-prohibitive). At that time, the damage has been done, as the patient is “stuck” with the new MA plan until the next open enrollment period…. In these situations, the patient’s care is severely disrupted solely as a result of misleading marketing tactics used by the plan to increase enrollment.”
3). The Missouri Department of Insurance detailed similar beneficiary stories in a letter stating:“A 94-year-old woman with dementia was sold a MA plan. The consumer lives in a rural area, and the hospital and providers she utilizes are not in-network with the plan chosen for her by the insurance salesperson. The plan did not allow for continuity of care for the consumer and forced her to obtain care (with the help of staff) miles away from her residence.”
4). Television/Internet:: Another example of misleading marketing is the Medicare Coverage Helpline television advertisement campaign, which first aired in 2018 and features former football star Broadway Joe Namath. In the ad, Mr. Namath says, “get what you deserve,” and “the benefit that adds money back to your Social Security check.” After numerous lawsuits, the ad was recently updated to comply with current CMS regulations. However, it still fails to mention basic information about the MA program, including that not all providers are in-network and was only recently updated to mention that benefits vary by zip code.
See YouTube video: Medicare Advantage: Last Week Tonight with John Oliver (HBO)
5). Television advertisements can be particularly effective at targeting Medicare beneficiaries. For example, the Missouri Department of Commerce and Insurance reported instances of consumers “reaching out to insurance agencies after seeing a television advertisement. For example, an elderly consumer in a long-term care facility and without the capacity to make her own decisions, called the number advertised on television. During the call she was switched from one plan to another.”
6). Oregon reported a case where a dual eligible Medicare beneficiary and Social Security Income recipient was enrolled in a plan without prescription drug coverage. The beneficiary reported that they “did not remember making any changes to his coverage; however, remembered seeing a TV advertisement and called about it. He said the plan representative mentioned getting $135 more in his Social Security check ([the beneficiary] wasn’t sure what that meant but it sounded good). [The beneficiary] already had the State of Oregon paying his Part B premium. [The beneficiary] was told he would have a gym membership and dental coverage (which he already has dental through his Medicaid benefit). The key issue is that he was not told by the MA-only plan phone agent that the plan does not cover Rx and does not include Part D.”
You Deal With a Private Health Insurance Company. the Wyden Committee Suggests
1). Use Extreme Caution If Calling A TV Help .The Federal Medicare program does not advertise MA plans or benefits on television. These so-called helplines will connect you with an agent or broker. That agent or broker does not have to tell you about all of your options in the Medicare program, and does not have to ensure that your plan will meet your needs.
2).If You Think You Have Been Enrolled In a New Plan That Doesn’t Work For You, Call 1-800-Medicare for Help. Seniors and people living with disabilities can also get no-cost counseling from the local State Health Insurance Assistance Program (SHIP) or Senior Medicare Patrol (SMP) office. In some situations, you may be eligible for a special enrollment period to switch back into your original plan. During the first three months of the year, you can also change your enrollment.
3).Be Careful What You Click Third-Party Marketing Organizations are using sneaky tactics to get your information and then sell your information to agents or brokers who can call you. When in doubt, don’t provide your information on unfamiliar websites or unfamiliar people. The Medicare Call Center (1-800-MEDICARE) and your local State Health Insurance Assistance Program (SHIP) office can help you understand your Medicare choices and enroll in a plan that will meet your needs.
Conclusion
Do everything you can to stay with (or return) to traditional Medicare and buy a supplemental Medigap policy. Beware of trusting those who may have ulterior motives, particularly when they present seemingly generous health insurance policy offers. Everyone should always remember that not all offers of help or generosity are genuine and that one should critically and thoroughly assess the intentions and specifics behind such programs and policies. This is particularly relevant in situations where aggressive sales agents of health insurance companies may present themselves as allies while harboring hidden marketing and sales agendas for Medicare Advantage.
Physicians for a National Health Program (PNHP) sum things up nicely:
Medicare Advantage represents the worst of private insurance coming to take over the best system of health care that America has to offer. Insurers in MA prey on some of the most vulnerable among us, luring them in with false promises of superior coverage and low costs only to make every effort possible to prevent them from accessing necessary health care, all while siphoning billions of dollars from taxpayers. The more MA is allowed to expand, the more harm will come to patients, physicians, hospitals, mental health care professsionals and the health care system writ large. More patients will die waiting for care to be approved, more doctors will face tremendous burdens trying to prevent this outcome, and more hospitals in areas of critical need will close as MA plans refuse to pay for their services.
The money that goes to profit-driven insurers in MA should instead be used to improve Traditional Medicare, including by adding dental, vision, and hearing coverage as well as establishing an out-of-pocket spending cap. Traditional Medicare follows the original spirit of the program, one that was created to serve all Americans without the perverse incentives that come from a profit motive. This is the model we should be following in our health system, instead of devoting more dollars to the failed experiments of managed care. We must eliminate out-of-control profit seeking in Medicare and beyond, both by reining in the abuses of insurers via executive action and legislation, and by greatly expanding our public health insurance programs. It’s time to take Medicare back for the people.
(For full PNHP report: Physicians for a National Health Program, “Taking Advantage: How Corporate Health Insurers Harm America’s Seniors,” May 23, 2024.
Please Support the M4A Act-2025:
a). The Medicare for All Act of 2025, now filed in Congress, would provide health coverage to every U.S. resident—including comprehensive medical, dental, vision, mental health, and reproductive care—with no out-of-pocket costs, copays, or deductibles.
b). By eliminating waste and corporate profiteering in health care, the bill would save hundreds of billions annually that could be invested in actual health care, resulting in better, more equitable health outcomes.
c). By covering everyone without the copays, deductibles, and insurance networks that deter care and drive medical debt, M4A would achieve universal and comprehensive coverage, while assuring real choice of physician, mental health / health professional and hospital.
d). By eliminating profiteering and wasteful insurance bureaucracy (plus the administrative costs that bureaucracy inflicts on healthcare providers), it would — according to the Congressional Budget Office — free up $400 billion annually in funds that could pay for the cost of such coverage expansions and improvements.
e). Medicare-for-All could also effect a much needed shift in the ownership of care away from increasingly dominant private corporations to public ownership by Americans and their communities.
Thank you for this. I’ve had to explain (as best I could) to a number of friends that the first con is the open enrollment thingy they think they are getting from the government itself. They might already have Medicare but are confused into thinking they need to do something again. Some perks are difficult for some to resist, like trips to a doctor or a debit card of some sort that offers monthly money (but replete with limits). Shameful.
The land of the scam. Free to choose between being scammed or being a scammer.
I’m just 13 months away from the holy grail, and expect about 30,000 pounds of mail, enticing me to this or that Medicare-adjacent gig.
I am constantly bombarded with junk calls from obvious sweat shop call centers trying to get me to sign up for Medicare advantage plans.
I am 7 years too young to sign up … a point I have made a few times; in case I get an actual human and not an AI-generated voiceover. Not that it matters – nobody ever removes me from the database. Now I just hang up as soon as I hear the word “Medicare”.
Congratulations, you qualify for AARP! No need to sign up. They’ll find you and barrage your mailbox. Some report that onslaught beginning as early as age 50.
What a, uh, joy. /:
They don’t seem to find me here in Italy….
Another caveat is that once you get into MA, you sometimes can’t get out. I did not sign up for traditional Medicare with a Medigap supplement plan, only because I could not afford the premiums for supplements – which used to be about $150/month extra but now run $200-500/month, beyond the amount taken out of one’s Social Security benefits to cover Medicare. I knew the supplement plans were better, but didn’t have the money.
Then I was diagnosed with a “high risk” condition,(heart failure caused not by usual causes, but by arrhythmia not fully controlled – because I had lost my employer-based insurance right after I was diagnosed w aFib) which I was told meant I couldn’t switch to a supplement plan, because the insurers wouldn’t underwrite me. All this happening to me in the context of my having been a supporter of PNHP and candidates for single payer for many years – for some years before I qualified for Medicare. Now the best I can do is choose a PPO plan instead of the horrible HMOs, which are where most of the abuse is occurring. BTW, Bill Clinton was a big supporter of HMOs. One of the many reasons I loathed that Great Deregulator.
There are certain situations when you can re-enroll in Original Medicare and Medigap no questions asked, called Guaranteed Issue Rights. If your existing MA plan drops you, sends you a letter saying you will no longer be covered with that plan (usually offering another “similar” plans you can sign up for) this dropping of you gives you the right to get OM and Medigap. The letter says so. Another option, a nuclear one perhaps, but facing huge medical issues maybe worth considering, is moving to a new address outside the country or MA plan area. That opens a Guaranteed Issue right too.
Thank you so much for that info.
The National Active & Retired Federal Employees Association (NARFE) is sponsoring a Federal Employees 2026 Health Fair tomorrow at a local library. It is ‘open season’ for Feds and ex-Feds to modify or change their health plans if the wish. Reps of AETNA, GEHA, UHC etc. insurance companies will be there. GEHA is my medigap provider, and it has been so-far, so-good with them, but I have questions for them so I will attend.
NARFE appears to be legit with not a peep about MA on their website. However, cash incentives being what they are I expect that reptiles will be lurking. I’ll drive the mile with low expectations.
I have a MA PPO plan that “gives back” $90/month of my Part B premium so my monthly benefit increased by $90. Prescription drug cost last year was zero. My total out of pocket was $117 for a dental crown. What’s not to like?
Hope this doesn’t happen to you, but as people get older, we tend to get sicker. If you do, there’s a pretty good guarantee you’ll find out what’s not to like about MA.
A good friend of mine spent a lot of her career working with “golden agers.” Now that she and I both qualify, she has explained to me that the challenge of aging seems to be one of falling off a cliff (health-wise), then plateauing, then falling off another cliff and reaching another plateau, and so on.
Crap insurance does not help anyone survive that process comfortably, and American health insurance is crap.
A friend and I were speaking recently, we are both 76-77. We were reminiscing about the golden years we used to hear about ages ago and that we must have taken a wrong turn somewhere, ’cause somehow we missed them. She has cancer, the treatment she received two years ago nearly did her in, but she is somewhat better today. I’m just muddling through.
I’m 75 now. My wife has the same plan and she does have CHF but even with all her meds (Xarelto, etc.) her out of pocket is still less than the $90 part B reduction. She was hospitalized for a week a couple of years ago and the part A covered everything with a $1700 co-pay. The hospital even gave us a 10% discount on the co-pay if we paid it on or before discharge. We’re covered in both of the states we live in and don’t have to get pre-authorizations.
Had an unfortunate cycling accident (hit by a car) in California where I had to spend time in the hospital and then under go specialist visits and more than 35 PT sessions. If I had MA, there would be restrictions / prior authorizations on doctors, hospital networks and treatments since I live in PA. All insurance is great if you are healthy and hardly ever use it. Don’t get a serious accident, illness or disease because you won’t be cheerleading for Joe Namath. Besides, MA is a scam since it has little if no oversight by when it falsely “upcodes” patient conditions to get higher reimbursements from Medicare. Billions of dollars of overpayments have been documented that we as tax payers are subsidizing. Besides, in central PA, HC empire UPMC just shut down its wonderful MA program in 10 or so rural counties. They are left hanging….
Clip from “Sicko”. How HMOs got their start.
https://www.youtube.com/watch?v=PA3kETvUXJg
Great movie!!!
Some tangential personal experience from literally last week.
Parents, both retirees, got bumped to a new health insurance “marketplace” by a prior employer, and so had to redo the entire insurance portfolio (i.e. I had to redo it for them). The new marketplace has both Medicare Advantage and MediGAP plans, thankfully on separate tabs. Thankfully also, my parents have a natural aversion to non-government health insurance (from back in the old country), and so insisted on MediGAP from the get-go.
I immediately noticed a split in insurance companies between the two tabs. Most of the big “brand names” – United Health, Aetna, whatever – were selling Medicare Advantage. MediGAP only had Cigna and Humana, though several plans for each. Though this may be area-dependent (NY Metro). Also, about three times the number of plans offered in the Medicare Advantage tab vs. the MediGAP tab (>20 versus seven or eight).
Narrow it down to two MediGAP plans very similar in coverage, but with different premiums and deductibles. Rounding off, one is $110 monthly premium and a $2500 deductible, the other is a $450 premium and a…$500 deductible? Something like that. So in one case you pay ~$3800 all in, in the other it’s ~$5900 all in, per person, though it’s the higher premium plan that has a bigger “star” rating and a “recommend!” label next to it. Fine. So we select the lower-premium plan, for obvious reasons of basic arithmetic. Now we have to have the voluntary-mandatory phone call with the marketplace rep.
First, the rep tries to steer us into the higher premium plan. We politely say no, let’s do the low-premium high-deductible one. Her exact words: “well if you’re going with the high deductible plan, you might as well just do Medicare Advantage”. Why? Who knows. I did not press. Nor did I try to explain the basic arithmetic. But the line itself intrigued me.
Anyway, we got the plans we wanted, and, thankfully, because at the start of the call we unequivocally stated that we want MediGAP and only MediGAP there was almost no push into the Medicare Advantage side of the pool. Based on a pre-call “mini-script” that we prepared together, as in, here is what we want, and here are the logistical questions (e.g. payment methods) that we have. But I can’t imagine what the process would have been like if they a) had to figure the marketplace website out on their own (they have trouble finding stuff on Amazon sometimes, never mind this thing), and b) had to have a go with the rep on their own, especially without the “mini-script”. I am about 95% confident they would have figured it out anyway, albeit in three times the time and with three times the drama.
And it’s still not done, by the way – we’d put in the applications, but now the insurance companies (plural – dental and prescriptions are each a separate plan by yet another company) have to approve them. Can hardly wait. But the main comment from my parents about the entire process was – how in god’s name are statistically average senior citizens (without Master’s degress in exact sciences) supposed to navigate this process? [Rely on a friendly sales rep, and you guessed what happens then…]
Helpful comment on a very helpful article. Thank N C and you, both!
Your parents are right. I used to live in Yellow Springs, Ohio, and they had a nurse and a social worker at the Senior Center whose sole purpose every Medicare plan enrollment period was to counsel seniors on which plan to pick and how to pick their Part D drugs plan. Unfortunately, the rest of Ohio doesn’t seem to have this, so now I have to go to a private broker who – theoretically – is impartial and signed up with several plans, so he/she doesn’t exclusively steer one to a particular plan, although they may lean certain directions. My deceased mother used to talk to her local pharmacist, who had learned all the lingo & steered her correctly for Part D, as well as a personal friend who shared the name of her MediGap plan, in which my mother enrolled first my dad and herself, and later herself. That plan’s local representative was the one who informed me I couldn’t switch because of my pre-existing “high risk” condition.
A relative lives in New York City and says that for her, AARP/United Health Care is the best MediGap plan, so there at least in the city is a third choice available.
I can’t help but notice most commenters here aren’t mentioning the reason why so many people sign up for MA HMOs is not that they are dumb or gullible, but because they can’t afford MediGap plans. It – like so very much in American life – is a class-based thing.
•Elder Abuse
•Fraud
•Theft by Deception…
All OK if you line the right pockets: the conspirators, co-conspirators, and accomplices all need to be imprisoned– from the brokers and agents, actuaries and executives, elected and unelected officials alike (they get kickbacks too, using their local, state, or federal offices as means of self-enrichment).
[Edit: Health and Human Services officials often get kickbacks from agents and brokers for client referrals]
This is a life-and-death issue for millions of Americans.
Here’s an example of the weasel-wording of one sales pitch. (my emphasis added)
“Medicare’s Annual Election Period runs October 15 through December 7—and it’s your chance to switch to a Medicare Advantage prescription drug (MAPD) plan. Switching could save you $667.20* in your drug copays and plan premium costs. Plus, you’ll get more benefits than with a prescription drug plan alone.
A prescription drug plan may help you save on medications. But what if your plan could also cover you at the eye doctor, the dentist and the pharmacy? Our MAPD plans may do just that.”
my comments:
could save you $667.20…. or could not. Could is a conditional word.
what if your plan could also cover x, y, and z? … what if …. could. I don’t see the words ‘will’ or ‘does’. Again, very conditional.
may do just that. …. or may not do just that. / ;) Buyer, beware.
https://healthcareuncovered.substack.com/p/unitedhealth-ceo-says-company-is
UnitedHealth CEO Says Company is Cutting Thousand of Doctors Out of Network to Boost Profits
“Value-based care” in UnitedHealth’s Optum division apparently means fewer doctors for fatter margins.
I avoided Advantage, went with traditional + supplement and it’s been great. I have an agent who handles the supplement and he discourages people from going with Advantage though he says it pays him better.
I think it’s important to promulgate this knowledge, thank you NC. I have too many friends who have been seriously harmed by Advantage. Among the people of Medicare age I know, the majority are on some kind of Advantage plan, even if it isn’t called that. Can’t help but wonder if the Advantage stink is getting bad enough the HMO kind of places don’t want the smell on them.
I’m dropping MA this year. I just got next year’s card with supplement today. MA, what a mistake. Your doctor moves to a new location, new location doesn’t accept MA. Your health service can drop MA whenever they decide to. This also happened to me this year.
A HUGE recommendation for anyone approaching Medicare eligibility is to schedule an appointment with SHIP (mentioned in passing in the article). This is a free service which I utilized when my spouse became Medicare eligible (I am still working so I cover HC through my employer).
The SHIP service was incredibly comprehensive and thorough; we opted for a telephone consultation (I believe you can go in person as well). Medicare can be extremely complicated and signup is fraught with pitfalls. And in my understanding, there are a number of decisions that need to be made that, once made, are very difficult to change (e.g. going from Advantage back to Traditional and getting a gap policy). SHIP is indispensable for navigating. The only downside is that you need to schedule well in advance; it can take a month or two to get on the schedule.
And a shout-out to NC for covering this issue.
I have been a SHIP or SHIBA volunteer advisor for about five years in the Pacific Northwest. As others here have said, many if not most people who take MA plans do so because their monthly out of pocket premium costs are lowest – zero premium plan or even Part B giveback plans and drug plans rolled in. It’s all well and good until you get sick. People need to focus on the out of pocket annual maximum MA plan holders will pay if a black swan hits them – anywhere from a low of 5,000 (for an MA plan costing 250 a month) to 8-11,000 in network and higher out of network for zero premium plans. While there are several Rx plans with zero or very low premiums, Medigap plans (covering the 20% Medicare doesn’t cover) are in the 200-250 range in this state. However there is also a high deductible Medigap plan, costs 50-60 a month, which has a 2990 hit before coverage kicks in. Best case with such a plan you’re out 720 for the annual premiums; worst case 3710. That’s a hell of a lot better than 5,000 to 11,000 annual out of pocket for the MA plans. If you can afford it, get the high deductible and a low premium Rx plan, especially if your annual medical cost “burn rate” keeps increasing, which it does for nearly all of us beyond the age of 70-75. Not only that you can change Medigap plans on a monthly basis, meaning, you can start using the high deductible plan but then if you learn you’ll need a major surgery in four months, like new knees, you can change to the full Medigap coverage before your operation. Point being, if you have a tough health history and you sense or know your medical demands are just going to keep increasing, then paying that $ 3,000 a year for Medigap at $ 250 a month is far far better than spending, every year, 8 to 11,000 under an MA plan.
“Not only that you can change Medigap plans on a monthly basis, meaning, you can start using the high deductible plan but then if you learn you’ll need a major surgery in four months, like new knees, you can change to the full Medigap coverage before your operation.”
To switch, wouldn’t you have to go through underwriing?
Underwriting.
There are rules around changing your Medigap plan. If your plan is discontinued, you can switch to another. And, maybe the same if you move out of the coverage area. Otherwise, look up “the birthday rule” to see when you can change your Medigap plan, which only 14 states support. Most other cases as antidic noted, require underwriting, which will require higher premiums, if the company evens extends the offer to you. Chose well!
no. once you get Medigap, whether G or N or whatever, you can change to anothet Medigap without underwriting by law as I understabd it. So you can buy a high deductible plan G and then change to a full G. of course a sudden accident can strike you but if for example you know you need to replace your hip you can schedule that some time ahead and then uogtade your medigap yo save a few bucks.
Hey Boomheist, not to get into a match, but…..changing Medigap plans is not guaranteed. Look into the conditions allowing a Medigap plan change in your state. Some states have more lenient conditions, like NY. 14 states follow the birthday rule which allow you to change plans without medical underwriting. The other 36, do not. For most folks over 65, medical underwriting is not an option. And for many people, they cannot change Medigap providers unless their provider cancels service. Just be careful.
NY and CT – you can switch medigap plans at any time w/o underwriting. In NYC at least the skyhigh premium reflects this freedom. Other states allow switching w/o underwriting under only certain conditions, such as it being your birthday month. Obvs one needs to check their state rules for the specifics
My only experience is that my wife and I were caregivers for both of our fathers. Her father (Eastman Kodak retiree) had a gold-plated Medigap plan, but as Kodak went under that got scaled back to paying the monthly premium for MA. In his case we went with HMSA, BC/BS non-profit affiliate and the largest insurer in Hawaii. Had no problem getting care at least compared to what other folks seem to experience here (care in general especially for Medicare here is an issue).
My father also had retiree heath benefits. He went with Humana MA and his retiree plan had a HSA feature that reimbursed the monthly fee of around $100. Again no particular problem with Humana, though they are just a minor player here so getting through to an agent was not so easy. (My Dad first enrolled in Louisiana so when we brought him out it seemed easier to stick with Humana as he was experienced with them).
But these are not the Joe Nameth “get money back every month” plans.
For those who live in NYState: (and it might be true in other states)
I have had PART N Medigap coverage. For 10yrs. One can move to a cheaper premium, say, PART K, Medigap coverage, for several , months, and then move back to Part N, in one month notice, if you know that you are having to have a stay in a hospital. NYState is good in that respect.
One of the things you get from living in the Communist State of New York is its excellent Financial Services Department, which also rides herd on health insurers.
A friend has been on Kaiser MA for at least 10 years, Northern California. Several years ago they fixed her up completely from ovarian cancer, no questions asked, no BS. A treatment sequence that billed out around $80k (at that point) cost me about $500 total. They have been stellar ever since. They have had staffing problems since Covid started. And a strike recently, which I consider a healthy airing of grievances.
I just turned 65, and healthy with a few cheap pills, and have no problems signing up with Kaiser MA instead of trad Medicare and its many parts.
Now, when I get older and actually infirm, it will probably be a different story.
Cheers!
Jorge, apparently you think that when you are older and actually infirm, you will be able to choose a better Medicare plan. Well, don’t count on that one! All of Medicare is being crapified daily, as is all of medical care, and come to think of it, just about any government program in this country that ever did anything for the 99%. Remember the 99%? I still have the decal on my backdoor. Inside that door, I’ve got on the wall an SCLC poster of the Poor People’s Campaign 1968, and a c. 2005 photo that I purchased from the homeless person who took it of another homeless person at a demonstration holding a large red poster emblazoned “Cover the Uninsured!” Poverty hasn’t really budged since 1968, and homelessness has gotten much, much worse.
Being in a Kaiser HMO killed my late husband in 1997. Since then, absolutely nothing about American health insurance of any kind has gotten one iota better. It’s more of a race to the bottom.
Just sayin, Jorge, optimism is a nice characteristic, but in this case, it may not serve you well.
There is also help through the the Medicare Savings Program (MSP) for people with low income that is very helpful. It is a special benefit program sponsored by state Medicaid agencies – it is NOT Medicaid. It is a collection of cost-sharing programs that are income-based (income caps may vary from state to state).
Once approved for a MSP, the monthly Medicare premium for Parts A and B may be paid and recipients may qualify for an “Extra Help” Part D plan for prescriptions with the monthly premium paid by the state. Or a combination of all of the above. From my observations, they try to get the enrollee into a plan that will cover their particular medications with the lowest costs for the enrollee. Additionally, co-pays are capped (max co-pay in 2025 is $12.15 for non-generic scripts) with zero donut hole.
Medicare.gov states you should apply even if your income or resources are higher than the federal limits listed on their website (see link below) because some states don’t count certain types or specific amounts of income or resources when deciding who qualifies.
More information on the MSP and how to apply at:
https://www.medicare.gov/basics/costs/help/medicare-savings-programs
I’ve found a plain way to start the conversation about MA with friends – Medicare Advantage is neither Medicare nor is it to your Advantage.