Seniors deserve straight scoop on Medicare

Max Richtman

Rappahannock County seniors joined older Americans across the country in choosing a Medicare plan for 2019 during the open enrollment period that ended on December 7th. To make wise choices, seniors need unbiased, accurate information about their options. Unfortunately, the Trump administration failed to provide this. Instead, the Centers for Medicare and Medicaid Services (CMS) did seniors a disservice by tilting the playing field toward private Medicare Advantage (M.A.) plans versus original Medicare.

Nationally, about one-third of Medicare beneficiaries are enrolled in Advantage plans. In Rappahannock, the percentage is significantly lower — about 11 percent. That makes sense. Medicare Advantage plans compel patients to choose from a limited network of health care providers. Rural areas have fewer participating providers, so M.A. enrollment rates are lower. Original Medicare beneficiaries, on the other hand, can see any provider they choose who accepts Medicare.

You wouldn’t know this from looking at the administration’s public information products, which are openly biased toward private Medicare plans. This is in keeping with CMS’ pro-corporate slant under the leadership of director Seema Verma, who seems intent on undercutting the federally-run original Medicare program which has been providing health coverage to seniors since 1965.

Earlier this month, the New York Times reported that CMS has been sending emails to millions of beneficiaries encouraging enrollment in Medicare Advantage. The emails resemble advertising from big insurance companies. “Get more benefits for your money,” says one message. “See if you can save money with Medicare Advantage,” said another sent a week later.  None of the emails mentions original Medicare.

CMS’ online plan-finder tool is similarly skewed toward private plans. The questions in the tool’s questionnaire seem to have been selected so that the inevitable answer to the beneficiaries’ needs is — unsurprisingly — Medicare Advantage.

The enrollment information on in general is also biased, largely by omission. The website features a list of Medicare options, but “original Medicare” is absent from the list. A new beneficiary could be forgiven for not even knowing that original Medicare exists. This is confusing — and misleading.

Unlike Advantage plans, original Medicare does not limit patients to a fixed network of providers, giving patients access to the best doctors and hospitals. Original Medicare beneficiaries do not have to jump through hoops to get prior authorizations for procedures and prescriptions covered by their plan — and can see specialists without referrals from primary care doctors.

That doesn’t mean that Medicare Advantage plans aren’t better for some beneficiaries — especially younger and healthier ones. Medicare Advantage plans often include prescription drug coverage, whereas subscribers to original Medicare must enroll under a separate plan (Part D) for that. Medicare Advantage can include extra goodies — including gym memberships and transportation to doctor visits — not covered in the traditional plan.

But the administration rarely mentions the downsides of M.A. plans, which are considerable. Seniors who develop chronic or acute health problems may not be able to find their preferred practitioners in the M.A. network. Patients can encounter coverage limits and denied claims — and experience long delays in appealing claims.

Our organization has partnered with the nonprofit Center for Medicare Advocacy to provide retirees (and near-retirees) with accurate, unbiased information about the two main Medicare options so that they can make a fully informed choice during the next open enrollment period. Through this platform, Rappahannock seniors will find the unbiased, accurate information that the administration has so far refused to provide.

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, has a home in Woodville.

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