Medicare recipients can choose from three options: traditional Medicare, traditional Medicare with Medigap supplemental insurance, or Medicare Advantage (Part C). An article on Investopedia.com explains that the most comprehensive plan that will incur the least amount of out-of-pocket expenses is traditional Medicare with Medigap (specifically Medigap type F). They go on to say that that choice with the most limitations is Medicare Advantage. Unfortunately, many Medicare recipients are not aware of the limitations of Medicare Advantage until it is too late.
Under Medicare Advantage, consumers are only allowed to choose doctors that are part of their plan. This may sound like a fair trade-off for the extremely low premiums that some Medicare Advantage plans offer, but these plans are not as cost-effective as they appear due to the high co-payments. A Medicare Advantage plan is ideal for healthy individuals, but once they become sick or injured, the expenses are costly. Additionally, the insurers can deem services you are receiving as no longer “medically necessary” and cease coverage at their own discretion.
It is certainly possible to switch to traditional Medicare with Medigap during the next open enrollment season if you become ill, but you will still be responsible for all costs incurred up until that point. Medigap coverage also tends to be less expensive when you enroll initially, rather than later in life, as they are issue-age-rated or attained-age rated policies. The older you are when enrolling in a Medigap policy, the more costly it will be.
The Investopedia article also includes the point of view of a doctor’s experience with Medicare Advantage Plans. Dr. Brent Schillinger, former president of the Palm Beach County Medical Society Foundation pointed out the following:
• Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
• Some private plans are not financially stable and may suddenly cease coverage. This happened in Florida in 2014 when a popular MA plan called Physicians United Plan was declared insolvent, and people were called by doctors who canceled their appointments.
• One may have difficulty getting emergency or urgent care due to rationing.
• The plans only cover certain doctors, often drop providers without cause, breaking the continuity of care
• Members have to follow plan rules to get covered care.
• There are always restrictions when choosing doctors, hospitals and other providers, which is another form of rationing that keeps profits up for the insurance company but may limit patient choice.
• It can be difficult to get care away from home.
• The extra benefits offered can turn out to be less than promised.
• Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.
If you do decide to enroll in a Medicare Advantage Plan, Investopedia advises that you read all of the fine print, acquire a comprehensive list of all co-payments and deductibles, check to see if all of your doctors and medications are covered by the plan, and if not, evaluate if the doctors on the plan are acceptable to you and if they are currently taking on new patients.
Tully Law, P.C. has specializes in assisting Long Island families in finding peace of mind. Our firm attorneys can provide assistance to those looking to pursue options in Life Care Planning, Elder Law and Estate Planning, Medicaid Asset Protection and Application, and Estate and Trust Administration. For more information contact us at (631) 424-2800.