There’s an age old saying: “If it sounds too good to be true it probably is.” Millions of Seniors are now learning this the hard way due to Medicare Advantage Plans. Though these plans look good on the surface, they offer limited benefits when compared to comprehensive Medicare Supplemental Insurance Plans. Often these plans have as many or more limitations than Medicare alone without Medigap Insurance. Many plans restrict seniors ability to choose their healthcare providers and put restrictive administrative regulations in the way of the doctor’s ability to get their patient the best healthcare possible. Such a reduction in access to the best available healthcare possible can cause preventable or prolonged illness or complications of illness and even preventable death.
The Truth About Medicare Advantage Plans
A Medicare Advantage Plan is a private insurance plan that takes the place of Medicare based on an insurance company’s contract with Medicare. There are two types of Medicare Advantage Plans: Managed Care Plans such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) and Private Fee for Service Plans. To enroll in a plan you must voluntarily drop out of Medicare and sign up with the Insurance Company offering the plan. What’s more, each plan can choose not to renew their contract with Medicare each year in any service area they please and, if they do so, you will be dropped from the plan. Medicare Supplemental insurance, on the other hand, is Guaranteed Renewable for life. You cannot lose your coverage for any reason as long as you pay your premiums.
The Truth About Medicare Advantage Plans
Once you enroll in a Medicare Advantage HMO or Fee for Service plan you no longer have health coverage through Medicare. Medicare will pay the Insurance Company a pre-negotiated monthly rate as long as you are enrolled.
In most cases you will also have to pay a small premium to the insurance company as well. Medicare Advantage Plans normally market these plans to you by comparing their smaller premium to the higher premium of a Medicare Supplemental Plan F (which provides 100% coverage of all Medicare approved doctor and hospital expenses.) Yet this is not an apples to apples comparison. Though the premium is less, so is the coverage. Also, many Seniors enroll in Medicare Advantage plans in order to receive the prescription drug coverage without knowing that prescription drug coverage is available to them without restricting their access to healthcare options through Medicare Part D.
The truth is Medicare Advantage plans leave gaps in coverage even for simple doctors’ visits. In addition, there are often copayments for hospital visits, skilled nursing care and emergency room care where a Medicare and Medicare Supplemental plan F would cover every penny of your expenses. These gaps can wind up costing from a small amount to thousands of dollars per year based on usage.
Yet these copayments and coverage gaps are not the worst part of having a Medicare Advantage Plan. Often times people sign up for a plan because it is “Medicare Approved” without knowing they are signing up for an HMO, PPO or restrictive Fee for Service Plan. This takes away the patients right to choose their own doctor, hospital or specialist. They are confined to the doctors and hospitals that are in the insurance company’s network.
In the case of Fee for Service Plans, there is no network to choose from but many doctors will not accept the plan because of long delays in payments and complicated claims procedures. When choosing an HMO, they are often forced to first make an appointment with their “primary care physician” to get a referral before seeing a specialist. Then, as if this unnecessary step wasn’t hard enough for someone with a serious medical condition, they force the patient’s doctor to work with complicated administrative processes just to get their patient the care that they need.
Even then the physician has limited choices. For instance, if a cancer patient wishes to go to a cancer treatment center that boasts a lot higher success rate than local hospitals, that center may not be in the insurance company’s network. Therefore the patient is forced to accept treatment at a local hospital that does not specialize in such treatment and may run a lot higher risk of dying from their disease than if they had kept their Medicare coverage and were able to go to the treatment center of their choice. What’s worse, the patient has now opted out of Medicare so they can’t even fall back on Medicare Coverage if they wish to choose their own treatment facility.
The bottom line is that the choice of health insurance that you make determines the type of treatment you will recieve when the time comes that you need treatment. Often, making the wrong choices now could mean the difference between life and death later. When you look back on all the tax dollars that you paid over your lifetime so that you would have good health insurance during your Golden Years, why would you throw your choices away just to try to save a few dollars when the odds of you needing quality healthcare are the highest they’ve ever been?
It is the opinion of Medigap360 that no senior should give up their freedom to choose quality healthcare by giving up the Medicare Coverage they have been paying for their entire life to take a restrictive Medicare Advantage Plan. We do not say this because we are in competition with them. In fact, we get offers to sell Medicare Advantage Plans from the top insurance companies all the time but choose not to do so as we feel that these plans are ruining our nation’s healthcare system for Senior Citizens.
Even if you cannot afford Medicare Supplemental Insurance, we recommend that you keep your Medicare coverage by itself and not enroll in a Medicare Advantage Plan. Traditional Medicare by itself is comparable in benefits with Medicare Advantage plans, even without a Medigap plan to Supplemental the gaps in coverage, and offers you the freedom you deserve to find the best healthcare possible when you need it.