Medicare enrollees are moving in greater numbers than ever to the program’s managed care option to save money. However, the tradeoff are hidden costs and plan restrictions, beginning with much less ability to use their preferred doctors and hospitals.
In theory, prospective Medicare Advantage enrollees can review lists of in-network providers before opting into a plan. But a study by the Kaiser Family Foundation (KFF) finds that provider data often is very difficult to review, can be out of date and frequently contain inaccurate information.
KFF’s review also found shortcomings in the quality of providers in some Medicare Advantage provider networks. One out of every five plans did not include a regional academic medical center – institutions which usually offer the highest quality care and top specialists.
The upshot: Medicare Advantage may be just fine if you are healthy and remain healthy. However, problems with the plan may crop up if your healthcare needs become more complex and you have specific healthcare provider preferences.
When you sign up for Medicare Advantage, your Part B premium goes to the insurance company providing the plan. The largest providers are UnitedHealthcare, Humana and BlueCross BlueShield.
Advantages and pitfalls
Medicare Advantage plans often offer extra benefits, such as health club memberships, vision care and some limited dental care. Many plans also provide prescription drug coverage with no extra premium.
The trade-off is limited provider networks – and the challenges prospective enrollees face in determining who they are allowed to see for healthcare, and who is off-limits. Researchers at KFF found provider directories often were riddled with errors, omissions and outdated information.
Even when Advantage enrollees are able to confirm participation by their healthcare providers, there is no guarantee that will continue. Medicare Advantage plans are free to add or drop health providers during the course of an enrollment season. While not law yet, the United States Congress have proposed legislation that would prohibit Medicare Advantage plans from dropping providers without cause during the middle of an enrollment year.
Under current rules, plans must provide 30 days’ notice to enrollees when providers are dropped. Enrollees who lose access to a provider can make a midyear plan change only under very limited circumstances.
The annual enrollment period for Medicare Advantage and Part D prescription drug plans are held from October 15 to December 7 each year. At that point, a member could switch to a different Medicare Advantage plan, or shift back to traditional Medicare. But a serious diagnosis in January would leave you hamstrung until the following year. It can be a roll of the dice.
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