There’s an age old saying: "If it sounds too good to be true it probably is." Millions of seniors are now learning this the hard way due to Medicare Advantage Plans.  Although these plans look good on the surface, they offer limited benefits when compared to comprehensive Medicare Supplement Insurance Plans. These plans often have more limitations than Medicare alone without Medicare Supplement (Medigap) Insurance. Many plans restrict a senior’s ability to choose their healthcare providers and put restrictive administrative regulations in the way of the doctor's ability to get their patient the best healthcare possible. Such a reduction in access to the best available healthcare possible can cause preventable or prolonged illness or complications of illness and even preventable death.

The Truth about Medicare Advantage Plans!

A Medicare Advantage Plan is a private insurance plan that takes the place of Medicare based on an insurance company's contract with Medicare. There are two types of Medicare Advantage Plans: Managed Care Plans such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) and PFFS (Private Fee for Service) Plans. To enroll in a plan you must voluntarily drop out of original Medicare and sign up with the insurance company offering the plan. What's more, each plan can choose not to renew their contract with Medicare each year in any service area they please and, if they do so, you will be dropped from the plan.   Medicare Supplement insurance, on the other hand, is guaranteed renewable for life. You cannot lose your coverage for any reason as long as you pay your premiums.

What Your Medicare Advantage Agent May Not Tell You!

Once you enroll in a Medicare Advantage HMO, PPO or PFFS plan you no longer have health coverage through Medicare. Medicare will pay the Insurance Company a pre-negotiated monthly rate as long as you are enrolled. In most cases you will also have to pay a small premium to the insurance company as well.  Medicare Advantage Plans normally market these plans to you by comparing their smaller premium to the higher premium of a Medicare Supplement F (which provides 100% coverage of all Medicare approved doctor and hospital expenses.) Yet this is not an apples to apples comparison. Though the premium is less, so is the coverage.  Many seniors enroll in Medicare Advantage plans in order to receive the prescription drug coverage without knowing that prescription drug coverage is available to them without restricting their access to healthcare options through Medicare Part D.

The truth is Medicare Advantage plans leave gaps in coverage even for simple doctor’s visits. In addition, there are often copayments for hospital visits, skilled nursing care and emergency room care where a Medicare and Medicare Supplement Plan F would cover every penny of your expenses. These gaps can wind up costing from a small amount to thousands of dollars per year based on usage.

Yet these copayments and coverage gaps are not the worst part of having a Medicare Advantage Plan.  People often sign up for a plan because it is "Medicare Approved" without knowing they are signing up for an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) or restrictive PFFS (Private Fee for Service Plan). This takes away the patients right to choose their own doctor, hospital or specialist. They are confined to the doctors and hospitals that are in the insurance company's network or who will accept the plan.

In the case of PFFS (Private Fee for Service) Plans, there is no network to choose from but many doctors will not accept the plan because of long delays in payments and complicated claims procedures. When choosing an HMO (Health Maintenance Organization), they are often forced to first make an appointment with their "primary care physician" to get a referral before seeing a specialist. Then, as if this unnecessary step wasn't hard enough for someone with a serious medical condition, they force the patient’s doctor to work with complicated administrative processes just to get their patient the care that they need.

Even then the physician has limited choices!  For instance, if a cancer patient wishes to go to a cancer treatment center that has a lot higher success rate than local hospitals, that center may not be in the insurance company's network. The patient is forced to accept treatment at a local hospital that does not specialize in such treatment and may run a lot higher risk of dying from their disease.  If they had kept their Medicare coverage they would be able to go to the treatment center of their choice. What's worse, the patient has now opted out of Medicare so they can't even fall back on Medicare Coverage if they wish to choose their own treatment facility.

The bottom line is that the choice of health insurance that you make determines the type of treatment you will receive when the time comes that you need treatment. Making the wrong choices now could mean the difference between life and death later. When you look back on all the tax dollars that you paid over your lifetime so that you would have good health insurance during your Golden Years, why would you throw your choices away just to try to save a few dollars when the odds of you needing quality healthcare are the highest they've ever been?

Recommendations!

It is the opinion of Heinrich Associates that no senior should give up their freedom to choose quality healthcare by giving up the Medicare coverage they have been paying for their entire life to take a restrictive Medicare Advantage Plan. We do not say this because we are in competition with them. In fact, we get offers to sell Medicare Advantage Plans from the top insurance companies all the time but choose not to do so as we feel that these plans are ruining our nation's healthcare system for Senior Citizens.