18 Nov Medicare Advantage Plans: Advantage? Really?

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text] Medicare Advantage Plans: Advantage? Really? [/vc_column_text][vc_column_text css=".vc_custom_1637259675368{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #fafafa !important;}"]advantage [ ad-van-tij,] Noun Any state, circumstance, opportunity, or means especially favorable to success, interest, or any desired end: Benefit; gain; profit; superiority or ascendancy (often followed by over or of):[/vc_column_text][vc_empty_space height="25px"][vc_column_text] ‘Tis the season of Medicare open enrollment. Odds are, you've seen those Medicare Advantage TV commercials featuring the likes of William Shatner, George Foreman, Jimmie Walker and Joe Namath touting the "free" health insurance plans offering enticing benefits not available from so-called "Original Medicare" (also called "traditional Medicare"). But are they for real? As an elder advocate for the last 48 years, I have experienced many government programs for the elderly. The most egregious program in my opinion is The Medicare Advantage Plan. Through television, social media, newspapers and mailings, tens of millions of Medicare beneficiaries are being inundated — as they are each autumn during the open enrollment period — by marketing from Medicare Advantage plans touting low costs and benefits not found with traditional Medicare. Dental, vision and hearing coverage are among the most advertised benefits. While people in traditional Medicare paid on average about $992 for dental care in 2020, those in Medicare Advantage plans paid $766, according to the study. For vision, people with traditional Medicare paid $242, compared with $194 for those covered by a Medicare Advantage plan.[/vc_column_text][vc_empty_space height="25px"][vc_column_text]A client of mine recently related this story to me. [blockquote text="“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.”1" text_color="" width="" line_height="undefined" background_color="" border_color="" show_quote_icon="yes" quote_icon_color="#fafafa"][/vc_column_text][vc_empty_space height="25px"][vc_column_text]A Medicare Advantage Plan, also called a Part C or an MA Plan, may sound enticing. It combines Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and usually Medicare Part D (prescription drug coverage) into one plan. These plans cover all Medicare services, and some offer extra coverage for vision, hearing, and dental. They are offered by private companies approved by Medicare. Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health. While a MA plan might sound like a good idea when you are younger and healthier, as you age and get sicker,...