By Diane Archer, JustCareUSA.
Listen to Diane Archer speak about Medicare Advantage Plans here:
And visit her healthcare blog at JustCareUSA.
There is a lot of confusion surrounding Medicare Advantage plans, commercial health insurance for people with Medicare, and the ways Medicare Advantage plans differ from traditional Medicare. You are likely to hear about their low upfront costs relative to traditional Medicare and their “extra” benefits. But, what you hear may be very different from what you get.
While Medicare Advantage plans are far more heavily regulated than commercial insurance in the private sector, they still have all of the core failings of commercial insurance–for individuals, for taxpayers and for the public good.
- Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and generally have little incentive to include providers who deliver value in their networks. They generally do not compete with one another to deliver value and meet the needs of Americans who need costly care. For this reason, sicker people are more likely to disenroll from them.
- Meaningless choice: Medicare Advantage plans do not offer people information that would allow them to understand what they will pay out of pocket when they need costly care and which doctors and hospitals they will be able to use.
- Inequitable: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap of nearly $7,000 each year undermine access and ration people’s care based on their ability to pay.
- Unreliable coverage: Medicare Advantage plans cannot offer reliable coverage or continuity of care as they are constantly changing the products and services they offer, the providers in their network, as well as their enrollees’ cost-sharing obligations. And, at times, they are pulling out of the market altogether.
- Unsustainable: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending.
- Inefficient: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.
- Profit-driven: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put shareholders first, with incentives to maximize profits and delay and deny medically necessary care.
- No innovation for the public good: Medicare Advantage plans have no incentive to innovate for the public good or disclose information about medical protocols, devices and other treatments that would benefit the public at large. What they learn about what’s working and not working in our health care system, they tend to keep to themselves.
- Unaccountable: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers.
- Unethical: Medicare Advantage plans may engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectivelyand hold them accountable for inappropriate behavior, let alone illegal activities.