People approaching age 65 have a wealth of choices to consider now that Medicare Advantage Plans are an alternative to Original (fee for service) Medicare.
Medicare Advantage plans are in fact private companies that contract with Medicare. Federal law specifies that Medicare Advantage consumers are entitled to the same benefits available under Original Medicare, including “items and services for which benefits are available under parts A and B.”
Medicare Advantage plans promise to provide these services at lower cost to the consumer.
Same coverage, lower cost. What could possibly go wrong? Especially since according to Medicare on its Medicare Advantage website, “No matter what you choose, you’re still in the Medicare Program and will get all Medicare-covered services.”
In Atlantic County, the lower cost of Medicare Advantage plans has driven enrollment to rise more than 78 percent from March 2016 to March 2017.
Last March, of 54,133 Atlantic County Medicare eligibles, 9,022 people, or 16.7 percent, were enrolled in an Advantage Plan.
The promise of a $0 per month premium by several plans available in Atlantic County is a powerful incentive. But the sentence that follows is the one that really matters. “Authorization rules may apply.” Translated, that often means, “Yes, you should be entitled to a particular service under Medicare, but no, this Medicare Advantage plan will not pay for it.”
You can fill in the blank with any service in you wish – inpatient hospital coverage, preventive care, diagnostic services, labs, imaging, hearing services, vision services, mental health services, medical equipment and Medicare part B drugs. All are subject to authorization.
While the argument is that securing authorization prevents unnecessary care, securing authorization can also deny or inhibit access to care when the real goal is finding cost savings.
People enrolling in a Medicare Advantage plan would be wise to carefully review the benefits of any plan promising to provide all of the coverage of Original Medicare at a fraction of the cost. “If you’re enrolled in a Medicare Advantage Plan,” says the disclaimer on the website, “most Medicare services are covered through the plan and aren’t paid for under Original Medicare.”
That Original Medicare covered benefit may simply not be a covered benefit under a Medicare Advantage plan.