Pitfalls of Medicare Advantage Plans

Pitfalls of Medicare Advantage Plans

Medicare Advantage plans do not offer this level of choice. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage plans can’t cherry-pick their customers (they must accept any Medicare-eligible enrollee), they discourage people who are sick by the way they structure their co-pays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

via investopedia Pitfalls of Medicare Advantage Plans