Insurance plans require careful thought
Medicare Advantage plans have been a godsend to millions of Americans who have placed full trust in what they have to offer — at a price they feel they can afford.
Some have very enticing offerings, such as vision and dental care and caps on copays and other out-of-pocket charges, that help the plans seem superior to traditional Medicare, although some seniors no longer would — or are healthy enough to — make use of some of the offerings available under their plans.
Again, Medicare Advantage plans have proven to be a godsend, but a wrinkle has evolved — a wrinkle that is deserving of a serious evaluation and, beyond that, personal contemplation.
Whether it will get one or both remains unclear, however.
Many people of Medicare age have yet to learn what is happening around them on the “Advantage” health-coverage front, but presumably it won’t be long before they’re in the proverbial loop.
The Wall Street Journal, in a Nov. 13 article under the headline “The sickest flee private Medicare,” focused on how taxpayers increasingly are being saddled with the financial responsibility for individuals who chose an Advantage plan but, because of serious illness or other problems, found it necessary to shift to traditional Medicare to avoid financial devastation.
Again, the shift occurred after they became seriously ill and the plan that they purchased refused to cover much, many or all of the services for which they were in need in order to survive.
Advantage plan providers have disputed some points of the Journal’s report, such as it having allegedly “focused on just a tiny fraction of the company’s Medicare recipients and that nearly all Medicare Advantage participants are satisfied with the program.”
One provider disputed that denials by insurers played a role in people’s decisions to leave Advantage plans, saying patients at the end of life might switch coverage for many reasons.
Other insurers criticized the Journal’s research for not being more focused on Advantage participants who chose to stay in their plans, including many near the end of life, who feared that leaving in the last year of life might add to costs and problems.
Taxpayers deserve transparency regarding the plans in question and data collected on how they are performing.
Consider this paragraph from the Journal’s Nov. 13 article:
“People in the final year of their lives left Medicare Advantage for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal’s analysis found. Those private-plan dropouts — 300,075 during that time span — often had long hospital and nursing-home stays after they left, running up large bills that taxpayers, not their former insurers, had to pay.”
And this paragraph:
“Medicare Advantage insurers collectively avoided $10 billion in medical costs incurred by the dropouts during that period, the analysis found. If those beneficiaries had stayed in their plans, the government would have paid the insurers about $3.5 billion in premiums, meaning the companies netted more than $6 billion in savings during that period.”
“In 2022, Medicare Advantage insurers denied 3.4 million requests for services, according to an analysis by the health-policy nonprofit KFF,” the Journal report says.
This is annual-enrollment time. Medicare Advantage plans are a godsend, but the decisions those plans sometimes deem it necessary to make sometimes are not.
Study features of several plans before selecting one that seems best suited to your needs.