Disadvantages of Medicare Advantage

Longtime readers of this blog are aware of this, but it’s Medicare’s open enrollment period until Dec. 7, so let’s take a look at it again.

During this period you can switch between privately-run Medicare Advantage plans or to original, government-run Medicare.

This morning, KFF Health News has an article titled “Complaints about gaps in Medicare Advantage networks are common. Federal enforcement is rare.”

Federal requirements are supposed to protect people with Medicare Advantage coverage when contract disputes lead their health care providers and insurers to part ways, says KFF.

But government documents obtained by KFF show that the agency overseeing Medicare Advantage does little to enforce long-standing rules intended to ensure that about 35 million plan members can see doctors in the first place.

Medicare Advantage beneficiaries are generally locked into their plans for the year. But hospitals, doctors, pharmacies, and other health providers can leave the plans anytime.

When providers and insurers separate, Medicare Advantage members can lose access to longtime doctors or preferred hospitals in the middle of the year.

Sometimes the Centers for Medicare & Medicaid Services gives Medicare Advantage customers a “little-known escape hatch” called a “special enrollment period” to change plans or enroll in traditional Medicare midyear, says KFF.

But the way CMS decides who gets an SEP is a mystery even to well-versed state insurance regulators and to senators who oversee federal health programs, KFF says.

Here are pros and cons of Medicare Advantage and ways to get more guidance on it, from the National Council on Aging.

Here is more on disadvantages of Medicare Advantage, from Investopedia.

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