Medicare open enrollment, now in progress, will end on Dec. 7.
Medicare recipients have two choices for covering their medical expenses not paid by Medicare Parts A and B: traditional Medicare, or a Medicare Advantage plan (also known as Medicare Part C.)
“Traditional Medicare” is defined in this letter as Medicare Parts A and B, plus a Medigap plan, also known as “a supplemental,” plus a Part D plan that covers medications.
Advantage plans are allowed to advertise without disclosing the financial incentives for insurance companies to market these plans at the expense of traditional Medicare, as well as the serious downsides experienced by Advantage policy-holders. Insurance companies are paid money upfront for each new Medicare Advantage enrollee, but not for a patient enrolling in traditional Medicare.
Medicare Advantage is privatized and run by insurance companies for profit, actually costing the government 6 percent more than traditional Medicare. Profits are made by frequent denials of coverage for necessary treatment including in-patient care, and by limiting the pool of physicians and health care facilities that accept the plan, with prior authorizations required to see a specialist.
Almost all doctors and health care facilities accept traditional Medicare, and prior authorizations are generally not required.
Once the patient discovers the inadequacy of their Medicare Advantage plan, past a short grace period, only four states (NY, MA, CT, ME) require the insurance companies to sell you a Medigap plan without underwriting. Return to a traditional Medicare plan that includes Medigap may not be possible.
At present our only recourse is “buyer beware.” — Linda Burke, Hinsdale
