Medigap News

Here are some great facts for our readers about ‘fee for service’ plans (Medicare Advantage Plans):

• Private fee-for-service plans have existed since 1997. They became more common after passage of the Medicare Modernization Act in 2003. Recently, they have increased rapidly in rural and non-metropolitan areas such as the Treasure Coast: Between December 2005 and February, national enrollment in these plans grew 535 percent to more than 1,338,000 people.

• Medicare pays companies a set amount per year for each Medicare beneficiary they sign. Companies, in turn, sign beneficiaries to policies offering the same benefits as traditional Medicare but also may add prescription drug, vision and other benefits. But fee-for-service enrollees are not allowed to purchase Medigap insurance to supplement their cost-sharing requirements, as are other Medicare enrollees.

• Unlike health maintenance organizations and preferred provider types of health insurance, private fee-for-service plans do not require insurance companies to maintain a network of doctors and hospitals that accept their coverage. Patients are responsible for making sure a health care provider accepts their plans’ terms of payment.

• Doctors and other health care providers can choose whether to accept a private fee-for-service plan and provide services to an enrollee at each visit.
(Source)

I think that the biggest thing that is pointed out by these bullets is that if you enroll in a Medicare Advantage Plan, you are suddenly dealing with private insurance companies - NOT the government. This is important because there are fewer requirement on these companies, which means more ambiguity for our enrolled seniors.

Why on earth should our seniors have to choose health care coverage that has more out of pocket expenses, a smaller network of doctors and hospitals, and there is no ability to supplement their coverage with outside assistance? Not to mention that this makes seniors dis enroll from their government-run Medicare coverage…

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Another day, another story about Medicare Advantage Plans reducing the quality of life and comfort of another senior.

“When I asked why, my doctor’s receptionist told me it was because Medicare didn’t cover me anymore.” Williams said. “I’m on a fixed income, and now I have to pay when I go to the doctor. And I still have to pay for my telephone, gas and taxes. They’re after me like a hound dog. I don’t know what I’m going to do.”

Williams’ plight is far from unique. Her story is one being echoed by other seniors who have changed from traditional Medicare coverage to private Medicare plans.”

Unfortunately, we could write a post a day about stories like this one where seniors are switching to Medicare Advantage Plans after being solicited in their home by salespeople who didn’t adequately explains the shortcomings of these often “fee for service” plans.

What seniors generally fail to realize is that while traditional Medicare would pay claims directly, with a Medicare Advantage Plan the patient generally has higher out-of-pocket costs. For Williams, quoted above, what used to by covered by Medicare now has out of pocket costs. These kinds of changes in a fixed income household can be devastating.

The issue here is not so much the plans (which are entirely legal and supported by the Medicare system), but rather the techniques used to sell the plans. There is often a complete lack of explanation of the benefits and how coverage would change. For instance, some seniors purchase Medicare Advantage Plans without realizing that they are actually losing their Medicare benefits plus whatever supplemental insurance they purchased.

If you or anyone you know is a senior that might be solicited for Medicare Advantage, make sure to consider these tips:

• Never, ever accept to hear a pitch by anyone who is traveling door to door. If you didn’t request the meeting or conversation, don’t engage in it.
• If you are considering a Medicare Advantage Plan, make certain that you first speak to someone who is qualified to help you understand the pros and cons of all your healthcare options.

Remember: YOU are in control of your healthcare choices. YOU have the right to make the best choice for you and your family. Stay educated and aware and you will make the best choices possible.

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Beware: Elderly are being warned about the aggressive and sometimes underhanded tactics of Medicare Advantage insurance agents who are selling Medicare Advantage plans to seniors without accurately explaining the program’s risk and benefits.

Purchasing a Medicare Advantage plan is dangerous for several reasons:

1. It’s not always understood by the insured that they are actually giving up their Medicare coverage.
2. It’s not always understood that they would be enrolling in a HMO, PPO, or fee-for-service health care plan.
3. It’s not always understood that by enrolling in Medicare Advantage, they may be giving up the right to see their doctor or visit their usual health care facilities.
4. It’s not always understood that there may be monthly premiums and/or fees for services.

If you are ever approached by an agent at home or out and about without you prior consent, make sure you are fully aware of your right to walk away or refuse a consultation. It’s your choice to receive information, not theirs. Get the agent’s name and number and report him or her to your local insurance commission if they acted inappropriately. Do not feel pressured - you are in control of your health care decisions.

Before you make any changes at all to your health care insurance, be sure to contact a licensed agent who can help you make a decision. Get referrals from happy family and friends, and make sure that the agent takes into account your entire situation - including what your income will be in the future, what coverage you may still have with a past employer, and what your particular risks and concerns are. Don’t be afraid to advocate for yourself.

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