Medicare’s Private Option Is Gaining Popularity, and Critics

The agency declined a request for an interview. But a spokesman replied that its enrollment communication efforts included a “robust and multifaceted outreach campaign that encourages consumers to review their Medicare coverage, compare alternatives and make an informed decision about options for the incoming year.”

Which type of coverage produces better health outcomes? The evidence is mixed.

“We’ve seen a number of studies that look at the available measures and try to give some indication of how Advantage is performing compared with traditional Medicare,” Dr. Neuman said. “It does better on some indicators, and on some others, traditional Medicare does better.”

Defenders of Advantage programs point to studies that conclude they are outperforming original Medicare in areas like preventive care, hospital readmission rates, admissions to nursing homes and mortality rates. And they note that the managed care approach is a key part of the program’s success.

But critics point to high levels of denial of care. Federal investigators reported in 2018 that Advantage plans had a pattern of inappropriately denying patient claims. The Office of Inspector General at the Department of Health and Human Services found “widespread and persistent problems related to denials of care and payment in Medicare Advantage” plans.

Serious illness is a common motive for leaving an Advantage plan, according to many Medicare advocates and counseling services. After his diagnosis, Mr. Stein, a retired editorial cartoonist for the now-defunct Rocky Mountain News, contacted his Advantage plan to confirm that all of the doctors he wanted to see were in his network — and was told that they were. But after surgery and the ensuing hospital stay, he found himself enmeshed in a series of conflicting messages about whether the treatment was covered.

Confusion about network providers is widespread. In a review of provider directories completed in 2018, the Centers for Medicare and Medicaid Services found that 49 percent contained at least one inaccuracy. Errors included incorrect locations and phone numbers, and whether a provider was accepting new patients.

Mr. Stein’s coverage is still in dispute, and there is no guarantee that his new plan will include his oncologist indefinitely. Advantage plans can drop providers at any time, and they do.

“We think of ourselves as sophisticated consumers, but when it comes to health care, it is almost impossible to figure it out,” Mr. Stein said.

Be the first to comment

Leave a Reply

Your email address will not be published.