Traditional Medicare has no out-of-pocket cap and covers 80 percent of medical expenses. Unlike Medicare Advantage plans, in traditional Medicare, seniors can choose whatever provider they want, and coverage limitations are far less stringent. Consequently, there’s a huge upside to going with traditional Medicare, and the downside is mitigated by the purchase of a Medigap plan, which covers the other 20 percent that Medicare doesn’t pay.
While this coverage is more expensive than most Medicare Advantage plans, nearly everybody in their old age would like to be able to choose their doctor and their hospitals, and everybody would want the security of knowing that they won’t be denied critical treatments. In 46 states, however, Medigap plans are allowed to engage in what’s called underwriting, or medical health screening, after seniors have already chosen a Medicare Advantage plan at age 65.
Only four states—New York, Connecticut, Maine, and Massachusetts—prevent Medigap underwriting for Medicare Advantage patients trying to switch back to traditional Medicare. The millions of Americans not living in those states are trapped in Medicare Advantage, because Medigap plans are legally able to deny them insurance coverage.
Medicare Advantage little resembles Medicare as it was traditionally intended, with tight networks and exorbitant costs that threaten to bankrupt the Medicare trust fund. (A recent estimate from Physicians for a National Health Program found that the program costs Medicare $140 billion annually.) - The American Prospect
Thursday, December 7, 2023
A big Medicare Advantage loophole is screwing seniors
If you're pushing 65 you probably especially want to know about this before decision time arrives.
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There is another "gotcha" to watch out for -- services provided by "In-network" or "Out-of-network" may not seem important ... but it is.
ReplyDeleteWhile some Medicare Advantage programs charge a premium for "Out-of-network" providers, some do not ... but you are not of the woods just yet. Because the hospitals and doctors can decide if they want to accept "Out-of-network" patients.
I was all set to move my Medicare Advantage policy to what appeared to be a better plan ... only to find out that the hospital that was 12 miles from my home was not accepting "Out-of-network" patients ... they wanted to keep beds/services available for their "In-network" clients.
I wish that there was some regulation that prohibited the "network" ... like an insurance company cannot tell you where to take your car to be repaired, they shouldn't be able to tell you to travel farther distances to get medical treatment nor force you to use lower rated facility.
We need Medicare For All.