People of a certain age who watch daytime television have been inundated recently with announcements about enrolling in a Medicare Advantage plan before the December 7 deadline.
Get more benefits! Low or no co-pays! Prescription drug coverage! Rides to medical appointments! Visits to specialists!
It’s the greatest thing since sliced bread!
OK, it doesn’t cover bread. But it is difficult not to be overwhelmed by the menu of choices or the promises.
The new services will be offered by some Medicare Advantage plans in more than 20 states next year. That’s expected to grow over time.
Medicare Advantage plans provide all the Part A and Part B benefits and include the following structures:
- health maintenance organizations
- preferred provider organizations
- special needs plans
- Medicare medical savings account plans
According to Medicare officials, 12 insurers will offer expanded supplemental benefits next year through 160 plans in 20 states.
In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions.
Some of the plans may offer extra benefits such as alternative medicine, visits to adult day care, or having a personal aide at home. These supplemental benefits are not covered by the traditional program.
Other perks may be free. They include gym memberships, transportation to medical appointments, or home-delivered meals following a hospitalization.
There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost. But limits do apply.
More than a third of Medicare beneficiaries, or nearly 23 million, are expected to be covered by a Medicare Advantage plan next year.
The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services
For this program, the country is divided not into regions but into counties.
Federal officials decide how much funding is available to contract with insurance companies, which then decide what benefits to offer.
Figuring out just which plan to go with, and how much it will cost, is not easy, despite the existence of various charts, pamphlets, and telephone sales representatives.
If enrollees don’t like the plan, they can go back to traditional Medicare. But the catch is that those dealing with a preexisting condition may not be able to buy a Medigap policy to help cover out-of-pocket costs.
They can also switch to another Medicare Advantage plan.
“These plans can be great, but it’s not easy to shop around. Some counties have an average 20 plans. Some have a choice of 50,” Gretchen Jacobson, associate director of the Kaiser Family Foundation, told Healthline.
So, Joe Consumer likes Plan D because it offers more benefits to people with diabetes. But Mrs. Consumer notices that Plan D has a $40 co-pay while Plan J requires only $5. Which is a better deal for the family?
The best you can do is educated guesswork and there isn’t necessarily a right answer.
This is a new approach and the insurance companies don’t have a handle yet on the best formula.
“Medicare policy has not kept up with the times,” said Sen. Ron Wyden (D-Oregon), one of the authors of bipartisan legislation that may be a catalyst for expanded services through Medicare Advantage.
Wyden told the Associated Press he’s working to bring similar options to traditional Medicare.
It is one of the few programs that has garnered support on both sides of the aisle.
“Clearly this is going to have to be an effort that is going to have to be built out,” Wyden added.
“These plans may be important to people with chronic conditions,” Sean Creighton, vice president for policy at Avalere health consultants, told Healthline.
He noted that Medicare has a long history of benefits, rules, conflicts over funding, and attempts to cut funds.
Originally, it was a paid for by the government. There are policymakers who want to move toward a system in which the insurance companies take the risk with a limited fee-for-service method.
“This model reflects the commercial side and there is a desire to move toward this model,” Creighton said.
The “commercial side” refers to those healthcare plans made available by many employers.
“In Medical Advantage plans, there is a limit on what gets paid,” Creighton said.
The plans reflect the acknowledgement that practical help in the present can help patients and save taxpayer money along the line.
For example, spending a couple of hundred dollars to install grab bars in the shower can prevent a fall leading to a broken hip, a life-changing injury.
That may also help elderly people stay in their homes longer.