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The disadvantages of a Medicare Advantage plan

As the popularity of private health insurance coverage grows, a broker makes the case for original Medicare.

Susan Morse, Managing Editor

CDPHP health plan in upstate New York is working with Mom's Meals to offer home-delivered meals at no cost to Medicare Advantage members returning home from the hospital.CDPHP health plan in upstate New York is working with Mom's Meals to offer home-delivered meals at no cost to Medicare Advantage members returning home from the hospital.

Consumers and insurers love Medicare Advantage plans. The federal government has also touted the benefits of the private health insurance coverage for those 65 and older.

Insurers are all-in on medical, supplemental and wellness offerings and are doing well financially in a market only expected to grow as baby boomers retire.

In a recent Morning Consult poll, beneficiaries reported near-universal satisfaction with Medicare Advantage's coverage and provider networks, the latter being the often-cited drawback of the plans which have been compared to the narrow network HMO plans of the 1980s.

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It's hard to argue with MA's lower, and sometimes zero-premium, supplemental benefits for vision, dental and wellness and now telehealth coverage.

But North Shore Insurance Brokers managing partner, Ina Goldberg, does take issue, making the argument for original Medicare over a Medicare Advantage plan.

WHY THIS MATTERS

Goldberg, whose business is in Chicago, specializes in selling Medicare supplemental plans, which cost beneficiaries money out of their Social Security payments. 

Through a Medicare Advantage plan, premiums are lower, and sometimes free, and will also likely include benefits for vision and dental, something original Medicare doesn't offer.

"In America nothing is free, you pay now or pay later," Goldberg said. "It's wonderful until there is a large bill."

The reason people pay later is that as they age they get sicker. It seems common sense to state that we'll all need more medical care as we age. But relatively healthy seniors buying an MA plan at age 65 can't see down the road to the health problems they may have at age 85.

When the more serious health problems start is when seniors on Medicare Advantage plans start paying more out-of-pocket, according to Goldberg. 

What they pay will often add up to more than all of those monthly supplemental payments they would have made for original Medicare, she said. This is especially true if a beneficiary needs specialized care and sees a physician who is out-of-network.

"Medicare Advantage is a conspiracy on seniors because you pay more out-of-pocket than you ever will with a Medicare supplement," she said. "Things will happen that I can't control. But that's what the future holds."

For original Medicare, the average cost of a supplemental plan with Blue Cross is about $172 a month for the premium plus $46.20 for a prescription plan, according to Goldberg, who sells these plans. 

MA does not have those relatively large monthly expenses.

"People are going to take Medicare Advantage because on the surface it sounds good," she said. "There's going to be a major illness that will take away retirement income."

UnitedHealthcare, the nation's largest insurer, is among those payers which have the largest Medicare Advantage enrollment. Steve Warner, senior vice president of Medicare Advantage for UnitedHealthcare Medicare and Retirement, was asked to comment about Goldberg's claims that MA will be more costly for most seniors in the long run. 

He released this statement: "UnitedHealthcare offers an unparalleled portfolio of Medicare coverage choices so people can find a plan that fits their unique health, lifestyle and budget needs. Both our Medicare Advantage and Medicare Supplement plans are some of the highest-rated by consumers, and we are relentlessly committed to listening to those we serve in order to build products that meet their needs and expectations for simple, affordable coverage and an exceptional member experience. Healthcare is deeply personal, which is why it is important for people to reassess their evolving health care needs each year to make sure they are choosing the plan that is the best fit." 

THE LARGER TREND

A Medicare Advantage study found that for 2021, consumers are choosing MA not only for the telehealth benefits, but for COVID-19 supplemental benefits offered by the Part C private plans. 

MA plans continued to increase their supplemental benefit offerings for 2021, including meals and transportation to physician visits and coverage of over-the-counter drugs and wellness, benefits not covered under Medicare Parts A, B or D. 

For example, CDPHP, a regional, not-for-profit health plan in upstate New York, is working with Mom's Meals to offer home-delivered, fully-prepared meals at no cost to Medicare Advantage members returning home from the hospital.

Premiums declined for 2021 offerings, adding to the growing popularity of MA plans.

MedicareGuide found that 36% of all 68 million people eligible for Medicare are enrolled in MA plans. These plans give seniors the same access to doctors and hospital benefits as original Medicare. Many MA beneficiaries find lower premiums and a cap on out-of-pocket costs, according to MedicareGuide. But they get fewer choices of doctors and are limited to a geographic area for plan coverage.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com