Value Of Medicare Advantage Plans Questioned

"Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare," The Associated Press reports. But critics say "that the plans put profits above care and denials of service are routine.

Profits at the insurers offering Medicare Advantage have far outpaced expectations, and their expenses to treat clients have been far lower than projected." Advantage plans are required to offer extra perks to clients, such as "gym memberships or hearing aids," but "there is no standardization of the thousands of plans seniors can choose from, and co-pays and premiums vary widely."

In the health reform debate, Medicare Advantage is often used as an example of waste. "Government payouts for Advantage of $111 billion a year and, on average, 14 percent more per patient than traditional Medicare have made the plans a key target for lawmakers and President Barack Obama, who has cited it frequently as too costly." But Advantage supporters and those seniors who like the coverage they get from these plans "hail its added benefits and care coordination. But even many backers acknowledge one of its toughest problems is few seniors understand the essential difference in private plans: Even services covered by traditional Medicare that doctors deem medically necessary routinely need the insurers' advance approval and are sometimes denied" (Sedensky, 8/30).

Another problem is the "shady sales practices" of Medicare Advantage insurers, AP reports in a second story. "Regulators clamped down last fall" on the plans with a new set of regulations, which "banned unsolicited phone calls and door-to-door sales" and "stopped agents from churning up commissions by switching customers to new policies.

Meals tied to marketing activities also are now forbidden." Nonetheless, "customers and advocate groups say the plans' confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up. Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn't include their longtime doctors or hit them with unexpected costs, things they learn weeks later" (Murphy, 8/30).

Source-Kaiser Health News
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