Medicare patients — choose carefully
Kudos to for publishing the Helaine Olen piece (“Medicare disadvantage — more like disadvantage,” Commentary, Dec. 1). Her article exposes the corrupt underbelly of the private insurance companies profiteering off of Medicare with these deceptive plans and slick marketing to vulnerable seniors. Because we are near the end of the annual enrollment period, it is essential to get the word out to Medicare patients to choose carefully what plan they enroll in based on their specific situation.
As a treating physician practicing in a rural community with very limited resources and access to specialty care, I see the rationing of care by these plans every day. Many times there is not an “in-network” specialist within a hundred miles of the patient’s location and even then, roadblocks to care are repeatedly put in place, like prior authorizations even for referrals to one of these specialist.
Attempting to get routine tests performed is an even greater challenge and often leads to the testing being delayed or never performed. Simple testing such as a sleep study requires no prior authorization from Medicare but routinely does so for any advantage plan, as an example.
Numerous studies comparing Medicare patients to Advantage plan patients confirm that many essential services and routine screenings are performed less often in the Advantage plan patients, leading to poorer health outcomes. Medicare has even sued several insurers over this matter in California. Plus, many of these plans are only going to cover you within the state, so if you need care outside of New Mexico, you will not be covered. For many folks living along the border with Texas, the nearest specialty care is going to be across the border, not four hours away in Albuquerque.
The situation is even worse when it comes to prescribing medications for these patients, as they often deny even the basic generic medications I routinely prescribe or require usage of outdated medications that do not meet standard of care. In addition, these plans change their pharmacy benefits every year without notice, meaning that a previously covered essential medication is no longer covered come Jan. 1, much to the patient’s surprise and anger.
The reality is that unless you are very healthy, take very few medications, have no chronic illnesses and live in a major city with lots of specialists, these Advantage plans are not the answer for you.
Given that New Mexicans have one of the highest rates of chronic illness, lowest per capita physician staffing levels and rural locations with long travel distances to care, I advise all of my patients to stick with straight Medicare and a Medigap policy if they can afford the premium.
In the end, they will be better off both in terms of the care they receive, access to care and the final tab out of their pocket at the end of the year. And their treating providers will be far less frustrated trying to provide them with the care they deserve. Don’t let the slick TV ads trick you into lining the pockets of insurance companies making record profits at your expense.