And so it begins again, the annual deluge of advertising for private Medicare Advantage plans (also known as Medicare Part C). The open Annual Enrollment Period for Medicare begins October 15th and continues through December 7th.
As noted in Forbes, “Advertisements for Medicare Advantage plans are pervasive during the Annual Enrollment Period.” Counting the mailbox overflows, the word “pervasive” seems inadequate. “They can also make these plans seem tempting, with their myriad benefits and low premiums,” continued Forbes with this caution: “An Advantage plan could be the right plan for you, but it's important to do your research and speak to a Medicare agent about your needs rather than hastily enrolling in a plan that sounds great in its TV commercial.” Indeed, Medicare Advantage plans can be a dream come true for some, but a nightmare for others. “Before enrolling in a Medicare Advantage Plan, find out if your regular doctor(s), health care providers and hospital accept that plan…. If you want to keep your same doctor(s) and use the same hospital you’ve always used DO NOT SIGN UP FOR THAT PLAN,” cautions the Mississippi Department of Insurance. Few doctors and hospitals will speak publicly about Medicare Advantage problems. One who did was Dr. Kenneth Williams the CEO of Alliance HealthCare in Holly Springs. “They don’t want to reimburse for anything — deny, deny, deny,” he told NBC News last year. “They are taking over Medicare and they are taking advantage of elderly patients.” In September, the American Hospital Association raised the issue of prior authorization denials with the Inspector General for the U.S. Department of Health and Human Services, writing, “Hospitals and health systems continue to experience inappropriate denials and delays in care for MA (Medicare Advantage) beneficiaries.”
Denial of coverage seems to be particularly serious for rehabilitation services. An American Medical Rehabilitation Providers Association member survey found that as many as 80% of patients referred to inpatient rehabilitation hospitals and units were denied access by their MA plans. The Centers for Medicare and Medicaid Services (CMS) tightened up rules for prior authorizations last year, particularly regarding the use of algorithms, but the hospital association responded that hospitals and health systems saw little to no change in Medicare Advantage organization practices. “Indeed, MA beneficiaries continue to face persistent delays and denials of medically appropriate post-acute services.” Other issues cited with Medicare Advantage plans include large co-payments required prior to service, lack of access to network physicians while traveling, and hospital stay limits that differ from doctor recommendations. All this to say buyer beware during this year’s enrollment period. “In all your transactions you must use accurate scales and homes measurements” – Deuteronomy 25:13. Crawford is a syndicated columnist from Jackson.
6 comments:
Just Say No to MAPs
Medicare advantage plans are commercial insurance. The more the insurance company denies services, the more money it makes. Advantage plans have doctor and hospital networks and you pay more for going to an out of network provider. Also, just because your doctor is in a plan, doesn't mean they will continue to be in the plan. Advantage plans can drop a doctor at any time and the doctor can withdraw at any time. Buyer beware.
there are several class action suits currently going on over the ripoffs and denial of coverage by humana. most people don't realize that all insurance companies have been given a statutory exemption from federal regulatory laws that attempt to control collusion and anti competitive practices in the market. insurance companies DONT COMPETE with each other.... in contrast they work together to screw policy holders and keep the cost of premiums as high as possible.
next to you go down to pay one of their excessive ,rip-off premiums , ask your agent about the federal exemption from anti trust and anti competition laws and watch him get real uncomfortable.
You're suggesting what amounts to a Cartel. Say it ain't so.
All I know is the TV ads never stop. The providers must be making a ton of money to afford all the TV air time for the ads….
I am currently enrolled in Humana Medicare Advantage HMO. I am very satisfied with it. Yes there are copays, but my monthly premium is $0. Original Medicare (Part A) is free. Part B is optional and presently costs $174 per month. If you need prescription drug coverage you must buy a Part D plan (extra cost). To cover expenses not paid by part A and Part B you will need a Medicap Plan. These are very expensive and can deny or not renew if you have pre-existing medical problems. You can only enroll in a Medicare Advantage Plan that is approved for your Zip Code area. These plans are listed in the back of your Medicare Handbook. Look at what each plan has to offer, see if your doctors and hospitals are in their Provider Network and choose a plan with prescription drug coverage and $0 premiums. Nearly all Advantage Plans offer comprehensive dental coverage with an annual allowance between $1500 and $2000. I recommend an Advantage Plan to all of my Medicare friends.
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