Ten ways Medicare Advantage plans differ from traditional Medicare

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 may hear about their low upfront costs relative to traditional Medicare and their “extra” benefits. But, they do not provide you with the same access to care you get with traditional Medicare, and your out-of-pocket costs can be many thousands of dollars.

Medicare Advantage plans are supposed to deliver all the benefits of Medicare, but a slew of federal government audits reveal that they too often do not meet the needs of people with costly conditions. These audits show that many of them engage in inappropriate delays and denials of care and coverage, threaten the health and safety of their members, have highly inaccurate provider directories and overbill the federal government billions of dollars a year. They have all of the core failings of commercial insurance–for individuals, for taxpayers and for the public good.

1. Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and have little incentive to include providers who deliver value in their networks. They do not compete with one another to deliver high value care and meet the needs of Americans who need costly care. If they attract people with costly conditions, they profit less. For this reason, sicker people are more likely to disenroll from them.
2. Meaningless choice: Medicare Advantage plans do disclose what they charge people out of pocket when they need costly care and which doctors and hospitals they will be able to use. They have never disclosed even average out-of-pocket costs to their members for costly care.
3. Inequitable: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap that can be as high as $6,700 each year, for in-network care alone, undermine access and ration people’s care based on their ability to pay.
4. 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. Moreover, according to the US HHS Office of the Inspector General, they engage in widespread inappropriate delays and denials of care and coverage.
5. Unsustainable: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending. They simply shift increasing costs onto their members.
6. Inefficient: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.
7. Profit-driven: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put their shareholders first, with incentives to maximize profits and delay and deny medically necessary care.
8. 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.
9. Unaccountable: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers. According to the Medicare Payment Advisory Commission, MedPAC, they have failed to disclose complete and accurate data regarding the health care services their members receive, though required by law for effective oversight.
10. Unethical: Medicare Advantage plans engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectively and hold them accountable for inappropriate behavior, let alone illegal activities.

With Medicare for All, there would be no need for Medicare Advantage plans. Everyone would have an improved and expanded Medicare, with freedom to use the doctors and hospitals of their choice anywhere in the nation without worry about the cost.

If you support Medicare for All, please let your members of Congress know. Sign this petition.

Here’s more from Just Care:

• Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
• Medicare ratings of Medicare Advantage plans a farce
• New study finds Medicare Advantage plan enrollees end up in lower quality nursing homes than people in traditional Medicare
• Medicare Handbook misleading
• Social Security benefits will rise 1.6 percent in 2020
• With drug prices soaring, millions buy drugs abroad