What are the Worst Medicare Advantage Plans?
Every year, Medicare publishes a list of sanctioned Medicare Advantage plans. These are the worst Medicare Advantage plans. They also publish 5-star ratings for all Medicare Part C and Part D plans.
This is the first year, since I started MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. in 2012, that there were no sanctioned plans. And, even more importantly, we have more 4.5- and 5-star plans this year than ever before.
Worst Medicare Advantage
As of January, 48% of people on Medicare have opted to join a Medicare Advantage plan. The private health plan option continues to grow at a rapid rate, adding an additional 2.7 million beneficiaries in 2023.
If Medicare Advantage is so bad, why is this rapid growth happening?
Simply put, Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are a balance between costs and benefits. Medicare Advantage plans have the ability to offer more benefits and services, and they can set their own rates. As a result, some plans are not as beneficial for some people as they might be for others.
For this reason, it isn’t fair to say that a plan is bad because it costs one member more than it costs another. In reality, a plan can be both the worst option for one person and the best for another.
How can this be?
It all comes down to matching Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. and additional benefits to the individual needs of the A person who has health care insurance through the Medicare or Medicaid programs.. Let’s face it, a zero-premium HMO plan, that charges 20% Coinsurance is a percentage of the total you are required to pay for a medical service. for doctor and specialist visits, and 40% coinsurance for hospital stays, probably isn’t a good option for an aging diabetic with compounding health conditions.
Yet, every day, people jump into a plan that they have no business being in because they look at the monthly cost, not the overall cost and their healthcare needs. Then they turn around and bash the plan for doing what it is supposed to do, cutting costs for a healthy individual who needs basic health maintenance.
Weigh All Potential Issues Before Deciding
Medicare gives us a choice. As beneficiaries, we can choose Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. and enjoy the traditional fee-for-service system, or we can join a private health plan. The choice is ours. So is the responsibility to balance our individual needs with a plan we can afford.
Sit down at the kitchen table or your desk and pencil out your needs and the healthcare service you use today and are likely to use in the next few years.
How often do you have regular doctor visits?
How often do you need emergency room or hospital services?
Do you need additional services that Original Medicare doesn’t cover, such as routine dental, vision, or transportation services?
Are you a healthy individual who rarely uses healthcare services, outside of preventive care, who can truly save money with a plan that includes prescription coverage, dental, vision, and a gym membership?
Plans with High Out-of-Pocket Costs
Let’s be honest about what Medicare Advantage plans really are. They are a product that makes money for the companies offering them.
As previously mentioned, Medicare Advantage plans are a balance between costs and benefits. Said another way, plans that give you more freedom generally have higher A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. and out-of-pocket maximums.
In this case, freedom might mean the ability to use services without Prior authorization is a process used by health plans to control healthcare costs. Most HMO plans and some PPO plans require authorization before receiving certain treatments, medical services, or prescription drugs., or the freedom to choose a provider that isn’t in a plan’s network. This is the difference between Health Maintenance Organization (HMO) plans and Preferred Provider Organizations (PPOs).
HMOs are very rigid. All services must be Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... or you pay all costs. PPOs have higher costs in most areas, but they allow for both in-network and out-of-network healthcare services. However, PPOs generally have high out-of-pocket limits on out-of-network services.
Limited Provider Networks
Unlike Original Medicare, most Medicare Advantage plans have local provider networks. And, in some cases, the availability of certain specialists may be very limited or not available in the network at all. This is particularly true with HMO plans in rural areas.
Additionally, HMO plans tend to put up more obstacles to specialist care and certain procedures. Referrals are required to schedule appointments with specialists, and plan administrators decide which services are approved.
HMO plans often include more additional benefits and lower costs, but it comes at the cost of freedom and choice. That’s why these plans work best for healthy people whose primary need is health maintenance.
Every year the The Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS) publishes comprehensive 5-star ratings on all Medicare Advantage plans and Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... (prescription drug) plans. One of the problems with these ratings is that they get rolled up into a summary rating.
Unfortunately, people look at the summary rating an make a snap decision about the plan. This is the reason MedicareWire publishes each rating category CMS uses to create the summary.
Each health plan is rated overall on the following metrics:
- Staying Healthy: Screenings, Tests, Vaccines
- Managing Chronic (Long Term) Conditions
- Member Experience with Health Plan
- Complaints and Changes in Plans Performance
- Health Plan Customer Service
Drug plans are rated using four major metrics:
- Drug Plan Customer Service
- Complaints and Changes in the Drug Plan
- Member Experience with the Drug Plan
- Drug Safety and Accuracy of Drug Pricing
As a result, a plan that includes a Part D drug plan receives a summary rating that includes all 9 metrics. This has the ability to mask bad customer service ratings. For this reason, it is very important to look at the individual metrics, not just the summary.
Just like Original Medicare has a 20% A period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage., Medicare Advantage plans have a coverage gap. The difference is that all Medicare Advantage plans have an annual cap on in-network and out-of-network coverage.
However, and this is a big issue to be aware of, the coverage gap on a specific service may be more or less than 20% with a Medicare Advantage plan.
How can this be?
Simple. Medicare Advantage plans are allowed to set their own rates for each specific service.
In fact, I’m seeing a growing trend with private Medicare plans on hospitalization. More and more I see plans with a 20 to 40% coinsurance.
Now, this might make sense if you are an exceptionally healthy person and buy additional insurance for accident coverage or hospitalization. But, if you got into a plan with a high coinsurance for hospitalization, because you didn’t carefully consider all of the costs, you could be in for a whopper of a bill for a 5-day stay (the average).
MedicareWire publishes all out-of-pocket costs on every Medicare Advantage plan. And, we allow you to download this information as a PDF so you can print it and compare plans side-by-side.
How to Supplement a Medicare Advantage Plan
Most experts agree Original Medicare and a Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policy offer the most comprehensive coverage you can buy. With a comprehensive Medigap policy, the costs and concerns listed above simply go away. Unfortunately, not everyone can get a Medigap policy, and a growing number of seniors can’t afford one.
Here are some additional options that work with a Medicare Advantage plan.
Accident insurance covers medical and other out-of-pocket costs that you may incur after an accident. Some of the costs this type of insurance covers include emergency treatment, hospital stays, medical exams, and transportation.
Accident insurance is beneficial in filling the gap between a health plan and vehicle insurance. So, for example, if you are a motorcyclist, like me, and you have an accident, your motorcycle policy may cover some of your personal injury costs. Even so, your Medicare policy may not cover the remainder. Accident coverage helps cover the gap.
Hospital Indemnity Policies
Hospital indemnity insurance works with your Medicare plan to help pay expenses for hospital stays. Depending on the policy, a hospital indemnity plan gives you cash payments to help you pay the bills coming your way while you recover.
Like accident plans, hospital plans are relatively low-cost. They are very effective in their ability to offset inpatient hospitalization out-of-pocket costs.
Unlike a hospital indemnity plan, which helps with hospitalization costs, cancer plans assist with all costs related to cancer treatment (both inpatient and outpatient). The most costly cancer treatments tend to be medications covered under Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services.. So, if you choose a Medicare Advantage plan with a 20% coinsurance on Part B medications, you could receive a whopper of a bill.
Purchasing a basic cancer plan will help pay you a lump sum if you’re diagnosed with cancer. You can use this payment for anything you choose, including the cost of chemotherapy administered in your doctor’s office.
How To Get Help Finding The Right Medicare Plan
While Medicare Advantage plans have many advantages, they potentially have just as many pitfalls. Extra benefits and low A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. are great, but you have to make sure the services you need most are covered at a cost you can afford. And, unfortunately, doing so can be complicated.
This is exactly why MedicareWire has partnered with HealthCompare.
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