Medicare (Dis)Advantage; responses from colleagues
This is not medical or financial advice.
I pitched this question on a social media forum, to see what others thought;
In your experience, what is better for our patients, straight Medicare or Medicare Advantage plans?
Granted, most people who responded are not of Medicare age, and a 20% co-pay can be sustancial, so a supplement is probably needed.
Here are the responses I received from people who work in the industry;
I live in Bend, OR and there is a single hospital system for all of central Oregon. They just announced they are considering dropping all advantage plans.
Never Medicare Advantage plans! They sound so good on their promotional advertising, but they get their money by restricting visit numbers in home health, limit or refuse stays in rehab, LTACs, SNFs. They can also limit visit numbers in OP clinics or quickly deny further visits. This doesn’t affect us as PTs directly, but they often do not allow patients to see their usual MD providers, having them switch to certain providers on their approved list. And getting auth is such a burden on staff. Like pulling teeth. Humana is the worst, but all have problems for providers and patients. Regular Medicare, parts A and B with a supplement and part D for medications is the way to go!
The government did a report on this a few years ago. Advantage plans defrauded the government by billions of dollars, provided worse care, and literally caused deaths by refusing necessary care and medications. You can find the report online. They only still exist because they paid off politicians to keep them around.
Straight medicare is usually the way to go- if they EVER need post-acute care of some type, it seems to be infinitely more accessible with straight medicare. Any advantage plan takes a big fat fight to get someone placed and they spend way longer in the hospital.
From the acute inpatient side, always straight Medicare. Patient has a stroke, amputation, whatever, they need rehab, they get rehab. Advantage plans always deny through several rounds of appeals and P2P.
Photo by National Cancer Institute on Unsplash I consider this as part of my job as a physical therapist to educate patients about the evil that is Medicare advantage plans. I even tell my 40 year old patients to make sure they never let their parents sign up for a Medicare advantage plan. It is fraudulent that they are even allowed to go by that name, deceiving the elderly into signing up.
Always Medicare, add a supplemental insurance
AARP is pretty good supplemental ime. Would never let my parents get a Medicare advantage plan based on how they treat their inpatient rehab pts.
- AARP were once an advocate for seniors, but then they teamed up with Cartel Unidas, so I'm more skeptical of them these days. Thank you for responding.
I can't speak for the AARP in general, but their Medicare supplement has been great for my patients over the years.
Traditional Medicare! Never Medicare “Disadvantage”!!
There is no advantage to advantage plans.
Med advantage plans are usually quite bad with coverage, BCBS is the closest one to straight Medicare in terms of coverage in my experience for certain settings
If somebody has any need for inpatient rehab or complex DME then Medicare advantage plans (United especially, but the others are bad too) are awful.
I have witnessed nothing but problems with patients on advantage plans in regards to physical therapy. I’m wondering what advantage plans are like for other services like doctor visits, surgeries, medications etc. Anyone have any insight to that?
I've had a number of patients who have had surgeries delayed/canceled because of auth issues with Medicare Advantage plans. I honestly do not understand how they get away with not actually following me Medicare guidelines. My dad is a retired pharmacist, when he became eligible for Medicare I brought up the issues I had seen with advantage plans and he told me he was never considering one because of all the issues he saw in the pharmacy. It's honestly to the point that I'm not sure what the advantage to any of these plans is to a patient, because it seems to be worse in every aspect I have seen.
We found something we all agree on! Just today in a meeting (I’m a HH PT and manager) I used the phrase “whatever corner of Mordor where UHC forges their policies in” when describing the issues with Med Adv plans.
Not advantage. They do everything they can to fuck over their constituents. Aka deny IPR no matter what and cut their SNF days if they ain’t walking + 1000 ft in 2 days.
Honestly we should all stop taking Advantage plans to force patients to go back to Medicare.