The Register Citizen (Torrington, CT)
Medicare Advantage might fall short
The Medicare open enrollment period started last week. For two months, through Dec. 7, eligible Connecticut residents can choose between traditional Medicare or private Medicare Advantage plans.
Nationwide, onethird of people eligible for Medicare select Medicare Advantage, which can provide benefits beyond traditional coverage, but limit access to doctors, hospitals and other health care providers.
As a member of Congress and a leading Medicare advocate, we urge Connecticut residents to look and think carefully before making a choice. Be sure the MA plan you are considering covers your providers, or providers you are comfortable with. Consider whether MA is actually the best choice for you, remembering that private MA plans can terminate your providers from your plan during the year.
Recent news from Anthem Blue Cross Blue Shield was a stark reminder of this. Anthem recently terminated many doctors from one of its MA plans. This was the decision of the private insurer, not the doctors. Indeed, many of the physicians were surprised to learn about it, and many beneficiaries will not know the ramifications of this decision until it is too late.
We fear the Anthem MA decision, coming so soon before open enrollment, could adversely impact thousands of residents in Connecticut. It could leave insufficient access to physicians, particularly for those who most need it.
The Connecticut congressional delegation asked Anthem for full transparency, in order to know the full impact of the MA doctor cuts. The questions we asked include:
Anthem recently terminated many doctors from one of its MA plans. This was the decision of the private insurer, not the doctors.
⏩ How many people will be impacted by this decision?
⏩ How many doctors have been cut? Why them and not others?
⏩ What is the process to appeal the termination decision?
⏩ How likely is it that a termination can be reversed?
⏩ How will Anthem’s MA network of available doctors meet the law’s network adequacy requirements?
The congressional delegation asked these questions. Anthem still has not answered.
This incident should be a signal to people considering Medicare Advantage. It should be a reminder to Congress that more protections are necessary for older adults and individuals with disabilities who choose Medicare Advantage.
MA patients have no recourse to stop these kinds of harmful actions by the private plans. We see it again and again. Further, the nonpartisan federal watchdog, the Government Accountability Office, confirmed as much in its in 2015 investigation. It called for more federal protections.
One such protection is the Medicare Advantage Bill of Rights Act that Rep. DeLauro will soon reintroduce in Congress. It prohibits Medicare Advantage plans from dropping providers during the middle of the year. It requires insurers to provide better notice to plan enrollees about any changes to provider networks before people commit to joining the plan.
Open enrollment ends Dec. 7. For the next two months, we urge Medicare eligible Connecticut residents to look and think carefully about the real pros and cons between traditional Medicare and Medicare Advantage. Be sure the plan you are considering covers your health care providers. Remember that any Medicare Advantage plan will limit the doctors and health care providers you can use, and that MA plans can cut doctors during the year. This will not happen in traditional Medicare.
Anthem’s announcement provides a stark reminder about of these realities.