The back story behind the Medicare Advantage ads
Almost daily a solicitation arrives in my mailbox trying to entice me into buying a Medicare Advantage (MA) plan. Open enrollment is approaching October 15. Advise, an outfit that claims they are health Plan Medicare experts, wants me to “get the most from Medicare.” Another outfit, eHealth Insurance Services, said new benefits were available in my county, and a third seller, Medicare Advocates in South Jordan, Utah, advised, “You may experience changes to your Medicare Plan next year.”
Another year, another batch of solicitations. The Advantage plan sellers’ quest for new sign-ups is as predictable as red leaves in the fall. Just as predictable, many Hoosiers will be swayed by slick TV ads or sales pitches promising extra benefits like dental, vision and hearing, but whose fine print limiting actual coverage is usually not explained.
This year’s push for new sign-ups includes tweets and ads touting a new study by the Better Medicare Alliance, an industry-financed lobbying group noting that 98% of beneficiaries were satisfied with their coverage; 97% were “specifically satisfied” with their network of physicians, hospitals, and specialists; and that Medicare Advantage’s overall satisfaction rate rises to 99% among minority beneficiaries.
The lobbying group also applauded 70 members of Congress, including
Jim Banks of Indiana, for supporting Medicare Advantage plans. Such a gesture is like a valentine, a lobbyist once told me, to flatter legislators into supporting the group’s agenda.
As I recall from my previous reporting over the years on consumer surveys, it is extremely unlikely any group surveyed is nearly 100% satisfied with what is being examined. I grew more suspicious when I discovered a significant study recently reported in the health policy journal Health Affairs that exposed a dark side of Medicare Advantage plans usually not mentioned in the sales pitches nor seen by the public.
Understanding the pitfalls of choosing Advantage plans is important particularly if you have a chronic illness and need to see a physician regularly.
People are enticed by cheaper premiums and extra benefits, but they don’t often go beyond the premiums to understand how the plans’ cost-sharing and provider networks really work. They can make a change and find themselves without a doctor especially if they have a serious, unforeseen illness.
Last March Health Affairs published a significant study with strong warnings for Advantage plan members especially rural residents. Medicare beneficiaries in rural areas are twice as likely to leave a Medicare Advantage plan as people who live in urban or suburban areas. Simply put, more beneficiaries in rural areas who had chosen Advantage plans were not happy with their coverage. About 20 percent of beneficiaries in rural areas who were not satisfied with the ease of getting to their doctor or getting care at the same location switched to traditional Medicare.
“These findings suggest that Medicare Advantage members in rural areas are experiencing limited access to care,” said Sungchul Park, an assistant professor at Drexel University’s School of Public Health and the lead author of the study. “They may realize that staying in an Advantage plan is not good for them, and they switch.”
If you’re living in a rural area, you might have fewer doctors to choose from and accessing care in a plan with a restricted network, which is the case with many Advantage plans, could make getting the care you need very challenging.
To explore how hard it is for Medicare beneficiaries to find doctors in rural areas, I contacted the State Health Insurance Assistance Program (SHIP) in several rural states asking about Medicare options for a hypothetical relative. An Indiana SHIP counselor told me doctors “can leave an Advantage plan for any reason they see fit. It’s definitely not uncommon.” A North Dakota counselor was also candid. “There aren’t a lot of doctors in rural areas, and people have to travel to bigger areas. Original Medicare might be a better option because it is accepted nationwide. It’s more broad.”
Hoosiers who will be choosing Medicare options for the first time should heed those warnings and think carefully about their choices. Too many times I’ve heard beneficiaries say, “I’m healthy and not likely to get sick so I’ll take a chance with the lowest cost option” - often a Medicare Advantage plan rather than traditional Medicare and a supplement that covers Medicare’s gaps. Unfortunately, this approach doesn’t account for an unexpected illness that may strike.
Before making a decision, consult the SHIP program, the Indiana State Health Insurance Assistance Program, at (800) 452-4800 for help in working through the various options.