Posts Tagged "insurance company"

What’s Up with Medicare Advantage Ads?

Starting months before my 65th birthday, my mailbox has been swamped with advertisements for Medicare Advantage insurance plans. The ads are still coming in.

And then there are the television commercials with promises of Advantage plan benefits that original Medicare doesn’t cover – vision, dental and hearing services, rides to doctors’ appointments, zero premiums. Sounds amazing, doesn’t it?

The advertising blitz surely has contributed to the doubling in Advantage plan enrollment since 2013, to 28 million last year. The plans are overtaking Medigap plans, which the nonprofit Commonwealth Fund estimates do not bring in as much profit for brokers as Advantage plans.

It is true that the vast majority of Advantage plans provide some type of vision, dental and hearing coverage. And retirees with these benefits in their Advantage plans spend slightly less for the services than other retirees, the Kaiser Family Foundation, a healthcare non-profit, found.

But the devil is in the details.

For example, the average dollar limit for vision benefits in Advantage plans was $160 in 2021, said Meredith Freed, Kaiser’s senior policy advocate. That $160 probably wouldn’t be enough to pay for an exam and buy the prescription glasses. The television and mailed advertisements are short on these details.

Or consider dental coverage for preventive services, such as cleanings and X-rays. This coverage might be useful, but the plan might not cover cavities, root canals and caps. Or, if they are covered, a $1,000 limit is fairly common and insufficient for many expensive procedures, Freed said. And what about the two out of three Advantage plans that do not charge a premium? The ads touting “zero premiums” aren’t usually clear that you’re still responsible for Medicare’s Part B premium of $164.90 per month.

“I’m hesitant to use the word misleading,” Freed said. But when choosing a Medicare Advantage plan, “Unfortunately, it’s on the consumer to dig more when they’re interested in a plan” to understand not only how the specific plans work but also how Medicare’s underlying benefits work, she said.

An analysis of Google search data has found that older Americans are not finding the kind of information online that they are seeking about their Medicare options. Instead, they are being bombarded with advertising by insurance companies, agents, and brokers, according to the Commonwealth Fund.

Older people search for Medicare information online from a diverse range of sources – patient advocacy groups, the media, and federal agencies including Social Security and the Centers for Medicare and Medicaid Services (CMS). A minority of the searches are for insurance industry information.

But online advertisements by agents, brokers, and insurers are prevalent in the top links in their Google searches and account for 87 percent of all online Medicare ads. …Learn More

Get Help with Medicare Coverage Denials

The United States has a notoriously complex healthcare system, and Medicare is no different.

In the early months of the pandemic, the Medicare Rights Center received a large number of calls to its telephone help line from people over 65 who had suddenly been laid off and lost their employer coverage. Even when there isn’t a crisis, the center’s staff and volunteers answer all manner of questions about Medicare enrollment rules, insurance options, and what to do when an insurance company denies them coverage.

Sarah Murdoch is the center’s director of client services and oversees the helpline. She spoke with Squared Away about the common issues retirees face and how they can address them.

Question: Your helpline fielded 42,000 questions about Medicare in 2020 and 2021. How does that compare to past years?

It’s in that ballpark year to year – around 20,000 questions. But we saw, within that 42,000, a shift in the actual trends.

Throughout the pandemic, particularly in 2020 when there were lockdowns and people were getting laid off left and right, we got a lot of calls from people who unexpectedly had no income. We heard from people who had insurance through their job and that was not an option anymore. Or they were already on Medicare and were trying to figure out how to pay their costs, or they were laid off and had to figure out how to get into Medicare. That has eased up but was a big thing we saw in the beginning of the pandemic.

We also had questions related to benefits for low-income people. We told people who suddenly had zero income about the income requirements for the Medicare Savings Program, Medicaid, and the state pharmaceutical assistance programs – anything that can lessen the hardship.

In 2020 and 2021, nearly a third of the complaints on your helpline were about service denials by insurers that provide Medicare Advantage or Part D drug plans. Start with Advantage plan denials – are they a big issue for retirees?

The Medicare Advantage plans often have doctor and hospital networks, whereas original Medicare doesn’t have networks. People may be denied coverage by an Advantage plan if they have an out-of-network provider. It could also be a denial of a medical service or a prescription medication. We do see it more but it’s hard to tease that out from the fact that more people are just enrolled in Medicare Advantage.

Do Medigap supplements to Medicare have similar issues with denial of coverage?

Medigap is different – the plans are never making their own claim determinations. If something is approved by original Medicare, then Medigap is going to pay for it as long as the retiree has a Medigap plan that has that type of coverage. In the Medicare Advantage policies, however, insurers are making the claims determination. All of the insurance companies have their own claims adjusters making those decisions – as opposed to contractors who process claims for the Medigap plans on behalf of the Centers for Medicare and Medicaid Services. The Medigap insurer isn’t making any decisions as to whether something is covered or not – it has already happened at the government level. …Learn More

Employers Want Help with Health Costs

The cost of employer health insurance has skyrocketed, and workers are picking up some of that growing tab. Amid employees’ grumbling, employers are loath to push more of the cost onto their workers.

That’s why the consensus view among major employers, expressed in a recent survey, sounded like a cry for help. Calling rising insurance costs “unsustainable,” the vast majority said they need help from the government either to provide alternative forms of coverage or control health care and prescription costs.

Employers “have reached their limit,” said Elizabeth Mitchell, chief executive of the Purchaser Business Group on Health, an employer advocacy organization that collaborated with the Kaiser Family Foundation on the survey.

Employers, she said, “are tired of pouring tons of money into a broken health care market that delivers uneven quality at bloated costs.”

And these are the major corporations and non-profits with more than 5,000 employees. They have some leverage to negotiate with insurers and more financial wherewithal to pay for the plans. Smaller employers – if they provide health insurance at all – pay roughly the same premiums as large employers, and their workers shoulder a larger share of the cost for family plans.

Last year, employers with more than 50 workers paid $21,342 in premiums to cover employees with family plans – that’s still 50 percent more than a decade ago, despite a recent slowdown in health care inflation, according to Kaiser.

When employers’ insurance costs rise so quickly, that squeezes out money they might use for wages and other benefits. Workers are also paying more, though each employer decides how much of the added costs to pass on to workers.

In 2020, employees paid nearly $5,600 – more than a quarter – of employers’ total costs for family plans. To curb their health insurance expenses, employers increasingly are offering high-deductible plans, and the deductibles workers pay for these plans are also rising.

The major employers said in the survey that they’re open to a range of federal policies that would either cut health care costs or get the government more involved in providing health care. …Learn More