Medicare Advantage May Not Be for Everyone

Did you know that Mayo Clinic does not accept patients with Medicare Advantage Plans? How about the fact that Medicare Advantage customers have higher deductibles and copays and that over 50% of Medicare Advantage plans pay physicians below prevailing Medicare rates?

The WSJ posted an article featuring statements from three individuals in the medical and health care industries, which stress how some people are better off without Medicare Advantage.

Colleen David Stinar, BSN, MS, a registered nurse and office manager of a small subspecialty (pulmonary) physician practice, was quoted in the article saying: “I am amazed at “Republicans’ Quiet Health Victory” by Bobby Jindal endorsing how wonderful Medicare Advantage plans are. He mentions the Mayo Clinic, but fails to mention it will not see patients with advantage plans.

I have traditional Medicare and a supplemental policy. If I have a rare brain tumor, I can more easily go to the best neurosurgeon in the country. In many “advantage” plans the copay to see a specialist is often double the amount to see a primary-care provider. I guess the plans are so “consumer oriented” they want enrollees to see the physician with three to six years less training.”

Colleen went on to say that she thinks the patient is vastly ahead with traditional Medicare.

The second statement came from Walter M. Gerhold, M.D. in Osprey, Fla., and reads: “Mr. Jindal presents Medicare Advantage as beneficial for patients just because it is ‘private.’ It introduces a new layer of bureaucracy with highly paid executives at the expense of the taxpayer and sick people.”

A final statement was included which was attributed to Paul J. Schilling, M.D., FACRO in St. Augustine, Fla., who said:

“Advantage plan companies receive 12% to 19% more money than those in traditional Medicare. Seniors enrolled in Medicare Advantage are faced with higher deductibles and copays. More than 50% of Medicare Advantage plans pay physicians below prevailing Medicare rates. Insurers cherry pick the healthiest, less risky seniors.

Medicare Advantage is inconvenient for those with chronic illnesses (the more costly patients). Those enrolled in Medicare Advantage consume 66% of the average Medicare dollars of traditional Medicare patients. Conversely, patients leaving Medicare Advantage go on to spend 180% of the cost of patients enrolled in traditional Medicare during the first year after leaving. This indicates that when patients get sick they leave Medicare Advantage, possibly due to higher copays and out-of-pocket costs, and perhaps less access to care as well.

If Medicare Advantage becomes the “default plan” and insurers lose the ability to cherry pick the healthiest, most profitable seniors, insurance companies will leave in droves. Doctors who don’t want to be paid less than they are under traditional Medicare will likely exit as well.”

If you are subscribed to the WSJ, you can read the original article by clicking on this link.