More insurance brokers would choose traditional Medicare over Medicare Advantage: Report

[somarco]

Very good points & I agree with all of them, but wouldn't having a PPO solve that problem? I do know that all doctors may not accept your PPO plan, but if your plan is accepted almost everywhere like BCBS, wouldn't that solve the problem of choice?

A number of large, specialty hospitals do not accept MAPD plans, or only accept a limited number of plans. Mayo, Sloan-Kettering, MD Anderson, Cleveland Clinic and Johns Hopkins come to mind but there are others as well.

Same is true for large medical practices, especially those owned by hospitals.

In some cases the issue is low reimbursement, but more often the conflict involves prior authorization required by most, if not all, MAPD plans. Original Medicare.only requires pre-authorization for certain DME supplies.

In the last few years some of the larger hospitals in Atlanta have had contract disputes with Anthem (BX) and UHC. Until the disagreement is ironed out, and a new contract is agreed upon, they will not admit new patients. This also applies to medical practices owned by the hospital.

Scheduled admissions and appointments are cancelled until after a new contract is executed.

This is unique to MAPD but does not apply to patients that have original Medicare.

 

[somarco]

Im unsure why its ok to have managed care from age 0-64... then suddenly when you hit 65 its imperative that you have zero networks and complete freedom of providers.

Under 65 the only choice is a managed care plan. Ask anyone who has had to delay treatment or appeal a claim denial how well they like their plan.

This happens more often than some agents believe. In addition to anecdotal situations there are plenty of credible third party studies that attest to this problem.

When one is Medicare eligible they have a choice between original Medicare and unfettered access to care, or continue with a managed care plan. Almost all of my new clients are T65 and can obtain a Medigap plan without medical underwriting. Many of them have pre-existing conditions that preclude getting a Medigap plan if they have to go through underwriting.

A number of T65 clients have experienced the challenges of managed care first hand and don't want to go through that again in the future.

A common question by folks who are T65 is . . . Can I keep my doctor? With Medicare the answer is almost always yes.

Making prospects aware of these issues is not a "scare tactic", it is simply the truth.

 

[InsuranceGuy29]

I can only speak for my area, but Medicare Advantage has gotten so good and so strong here, I'd have to be a moron to piss money away on a supplement every single month. MAPD PPO.....99% of hospitals are all in-network. I very rarely ever find a doctor or specialist that isn't in-network, low MOOP, a $75 Part B buyback, and another (estimated) $250/month savings in not having to get a supplement, Part D plan, and dental/vision plan. If you want an honest take from an agent that offers both supplements and medicare advantage plans in Illinois, folks....there it is. I have over 500 clients and they're all as happy as can be on their MAPD.

 

[somarco]

FWIW . . .

10 illegal Medigap practices to watch for
Call the Inspector General's hotline if you believe a federal law has been broken, like if someone tries to:

Pressure you to buy a Medigap policy or lie to get you to switch to a new company or policy.
Sell you a second Medigap policy when they know you already have one. (They can sell you a policy if you state, in writing, that you plan to cancel your existing policy.)
Sell you a Medigap policy if they know you have Medicaid, except in certain situations.
Sell you a Medigap policy if they know you're in a Medicare Advantage (MA) Plan. (They can sell you a policy if your MA plan coverage will end before the Medigap policy's effective date.)
Claim that a Medigap policy is part of the Medicare program or any other federal program. Medigap is private health insurance.
Claim that a Medicare Advantage Plan is a Medigap policy.
Sell you a Medigap policy that can't legally be sold in your state. Check with your State Insurance Department to make sure the policy you’re interested in can be sold in your state.
Misuse the names, letters, or symbols of these:
U.S. Department of Health & Human Services (HHS)
Social Security
Centers for Medicare & Medicaid Services (CMS)
Any of their programs, like Medicare.
For example, they can't suggest the Medigap policy has been approved or recommended by the federal government

Claim to be a Medicare representative if they work for a Medigap insurance company.
Sell you a Medicare Advantage Plan when you say you want to keep Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn't the same as Original Medicare. If you enroll in a Medicare Advantage Plan, you'll be disenrolled from Original Medicare and can't use a Medigap policy.
https://www.medicare.gov/supplement...t-insurance-medigap/illegal-medigap-practices

 

[rmhaire]

In the last few years some of the larger hospitals in Atlanta have had contract disputes with Anthem (BX) and UHC. Until the disagreement is ironed out, and a new contract is agreed upon, they will not admit new patients. This also applies to medical practices owned by the hospital.

Scheduled admissions and appointments are cancelled until after a new contract is executed.

But what about the other parts of Georgia?

I'm in Albany. Two hundred miles south of Atlanta. Population around 80,000. Only one hospital.

But everything Somarco posted is happening here. No Anthem and no UHC. Two of the biggest in the state and nobody will take them.

 

[Newby]

Very good points & I agree with all of them, but wouldn't having a PPO solve that problem? I do know that all doctors may not accept your PPO plan, but if your plan is accepted almost everywhere like BCBS, wouldn't that solve the problem of choice?

You still would want to try to limit yourself to in network providers. If your goal is to limit out of pocket expenses going out of network would add to your costs wouldn’t it?

 

[rmhaire]

I can only speak for my area, but Medicare Advantage has gotten so good and so strong here

Exactly where is here. I'm betting somewhere near Chicago or one of your other big cities.

I'm willing to admit that MA plans have improved over the last few years but the most improvements have been in the bigger cities. Miami, San Fran and others.

Not so much in the rural and less populated areas.

Part B give back? Come to South Georgia and find one. You'll be looking for a needle in a haystack.

 

[somarco]

But what about the other parts of Georgia?

I'm in Albany. Two hundred miles south of Atlanta. Population around 80,000. Only one hospital.

I may be wrong, but I believe Phoebe Putney did not accept BCBSGA a few years ago. This dispute was protracted for several months.

When SHBP changed to UHC there were hospitals & docs in parts of GA that were not in network.

UHC and Northside Hospital (Atlanta) also allowed a contract to expire a few years ago. I had a client at the time that was undergoing chemo there and was concerned about losing access to the Northside facilities.

More recently, Piedmont Hospital (Atlanta) and Anthem could not agree on a contract in 2021 or 2022 and would not admit patients who had Anthem coverage. This extended to physician practices that were owned or affiliated with Piedmont.

I had several calls from clients who had Anthem Medigap plans and they were told a physicians cardiology group would not accept their plan and they needed to make a switch to an MAPD plan suggested by the practice. This was outside of open enrollment (MAPD) and they would not pass underwriting for a Medigap plan.

I told them as long as the practice accepted Medicare their Anthem Medigap was also.

Still, the office manager was insistent that I was wrong. I had to get a honcho from Anthem to call the office manager and send a letter explaining that Anthem Medigap plans were still accepted by Piedmont & affiliates.

Sometimes these managed care disputes spill over into the Medigap side and that makes life interesting.

Contract disputes between providers and managed care plans can happen anywhere but seem to be more prevalent in larger cities.

 

[somarco]

limit yourself to in network providers

Sounds great, but not always possible.

Hospital inpatient is a good place for hidden providers to show up, especially in PARE claims.

 

[rmhaire]

I may be wrong, but I believe Phoebe Putney did not accept BCBSGA a few years ago. This dispute was protracted for several months.

Not sure of the time frame but it's still on going. They're still not showing up when I run a quote. Neither is UHC.

A bigger problem down here is with doctors. Both Phoebe and non Phoebe. Seems they are turning away new patients that have anything other than OM.