Medicare Advantage Plus. Worth the money or ripoff? David Lipschutz, attorney for California Health Advocates, has this to say about the Medicare Advantage plus plans sold to unsuspecting seniors.
from a public policy standpoint, the upsurge of these products aimed at filling in the gaps of Medicare Advantage plan packages – despite the overpayments that MA plans currently receive – underscores the failure of many MA plans to provide truly comprehensive benefits to their enrollees. It also further distances the MA program from the goal of creating an efficient, cost-effective means to access Medicare benefits.
In other words, while the Medicare Advantage Plus may have merit, the question is, does a Medicare Advantage Plus offer a good value or is it just wasted dollars?
Many Medicare Advantage plans charge significant cost-sharing for covered services, including the same amount(s) that someone in the Original Medicare program would pay for the same services, and in some cases, even more. For example, it is not uncommon for MA plans to charge the full 20% coinsurance for durable medical equipment, Part B covered drugs, including chemotherapy, and the full Part A first-day hospital deductible (or similar amounts). These significant out-of-pocket costs – often hidden to MA enrollees who believe they will receive “comprehensive benefits” through their private Medicare plan – frequently become unaffordable for plan enrollees who must use these services.
So even with an MA plan and a Medicare Advantage Plus, seniors can pay MORE than they would have if they had original Medicare and a Medigap plan.
This observation further exposes the real cost of coverage and lays bare the reasons why seniors would consider a Medicare Advantage Plus plan.
Some of the marketing tricks use by agents to sell Medicare Advantage Plus may include lines like this. A company training guide offers this selling tip to their agents.
When describing Medicare Advantage Plus to agents, the company asks: “When selling Medicare Advantage plans are you thinking about how they will pay the hospital, skilled nursing, ambulance and other co-payments” that the plan charges? The pitch then proceeds to describe a “scenario that could be quite frightening to a Medicare Advantage consumer.” The description posits a 65 year old, “on a very limited income” who “could not afford a traditional Medicare Supplement,” so instead s/he enrolls in a $0 premium Medicare Advantage Private Fee-for-Service (PFFS) plan with a $3,000 maximum out of pocket limit, a hospital co-payment of $150 per day for 4 days and an ambulance co-payment of $150. The scenario continues
“Your client has been enjoying the benefits of a $0 premium PFFS plan, but a few months into the plan, they have an illness strike that causes them to be rushed to the hospital by ambulance and they spend 6 nights in the hospital. Just the ambulance trip and hospital stay will equal $750 …. [t]he question is, how are they going to afford a minimum of $750 during a one month period. That’s where our Medicare Advantage Plus plan comes into play. For a small monthly premium of just $21.44 , you could provide that same client with a Medicare Advantage Plus plan that includes $150 daily hospitalization coverage and a $200 ambulance benefit. In the same scenario, your client would have had $1100.00 paid to them directly by the insurance company, which would have been plenty to offset the large bill they received.”
Have you been duped by a Medicare Advantage Plus sales pitch?
A recruiting ad for agents says “Selling Medicare Advantage Plans? FILL the GAPS with Medicare Advantage Plus.”
“SAVE your clients out-of-pocket expenses such as co-pays, deductibles and coverage gaps with Medicare Advantage Plus. Now you can offer them coverage that pays above and beyond what Medicare Advantage, Medicare Supplements and other retiree health plans fail to cover. … We are so confident in Senior’s [sic] interest in this product we will give you 500 leads, just for contracting!”
Free leads and a way to earn extra commissions. Such a deal.
“Medicare Supplements were designed to fill the gaps in Medicare. Medicare Advantage Plus was designed to fill the gaps in Medicare Advantage Plans!”
Who could resist that pitch?
Medicare Advantage Plus plans are not specifically designed to fill the gaps in a Medicare Advantage plan, nor are they a substitute for Medicare or Medicare and a Medigap plan. Medicare Advantage Plus is a limited benefit plan that pays specific amounts for hospitalization, surgery and other medical procedures.
These costly Medicare Advantage Plus plans cannot compare in value or coverage to having original Medicare plus a competitive Medigap plan. Don’t waste your money on a Medicare Advantage Plus plan. Ask us for a quote on a low cost Georgia Medigap plan.
