Medicare Advantage Plans are a very popular option for many people who are 65 years old or older.
Some of the reason they are so popular are for the following reasons:
When a consumer see all of these value added benefits they ask themselves why would I not go this direction. Or they might think this is the only option they have as that is what their friends did or the perception of this is what everyone else is doing.
On the surface one could say I would have to be crazy not to obtain a Medicare Advantage plan. In addition many Medicare Agents only sell Medicare Advantage plans because they don’t know better as the Medicare Insurance Carriers main focus in their required training only goes over Medicare Advantage plans. If the Medicare Insurance Agent is not shown or taught about the Medicare Supplemental plans there focus will only be Medicare Advantage plans. In addition they are not taught how to sell a Medigap plan. So these Agents are required to conduct a lot of independent research on their own or just go with the flow and only present and sell Medicare Advantage Plans.
I wanted to share a piece that was done by Good Morning America and posted on YouTube back in 2013.
In this News Report, Good Morning America interviews a patient who was experiencing major medical issues in which she sought medical attention at a Hospital. Her Private Medicare Advantage Insurance plan refused to allow her to be treated at the Hospital for her medical condition. The Medicare Advantage plan stated it was not “medically necessary” as defined by the Medicare Advantage plan medical group NOT her Doctor or Hospital. However after a second visit to the Hospital with a new problem in addition to the prior issue (a week later) she filed an appeal to the insurance company which took another month for them to provide a decision on.
I don’t know about you but being in so much pain that you had to go to the hospital twice and then live with the pain for 40 or so days for something that was deemed not medically necessary by the insurance carrier / medical group sounds pretty NOT OKAY to me.
In addition they reversed their decision which means it actually was MEDICALLY NECESSARY on day 1. The Hospital was shocked of the denial as they knew if this person had been covered under Original Medicare with a MediGap policy it would have been taken care of on day 1 and would have prevented the addition issue that developed. This is because under Original Medicare the Doctor decides what is or what is not medically necessary not the insurance company. Enjoy the news cast below.
Our job is to educate our clients and then allow you to make a decision. If the news report from 2013 was not alarming enough for you as it was for us, this next report which is from September 2018 might help you make your decision for you a bit easier. I know, I know, 2013 was so long ago I am sure the Medicare Advantage carriers have fixed that issue right? WRONG
I love how on page 2 of the report it states: “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials”. I don’t know about you but that is not a good starting point for a 35 page report.
Following are a few Highlights of the report. I have attached to the right the full report for your review.
The word Disadvantage or Advantage can bring about many different viewpoints. One person’s view of a Disadvantage may not be viewed as a disadvantage to someone else. For instance many people like how an HMO works (or maybe they like the lower monthly premium). They don’t mind being apart of a specific network as it has always worked out just fine for them in the past. While someone else has had either one bad experience with an HMO or several bad experiences and would not touch them with a ten foot pole.
Below we will share a story from Dr. Brent Schillinger and we will do our best to list disadvantages that people have shared with up over the years.
In 2012, Dr. Brent Schillinger, former president of the Palm Beach County Medical Society, pointed out a host of potential problems he encountered with Medicare Advantage Plans as a physician. Here’s how he describes them:
In addition to the above items listed a few more items have been mentioned by people who are on Medicare Advantage Plans.
Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:
“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.’”