Medicare Advantage is government health insurance managed by private companies. Some find it lets them down after a serious diagnosis. (Story first aired on All Things Considered on January 3, 2023.)
AYESHA RASCOE, HOST:
You've probably heard advertising for Medicare Advantage plans.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED NARRATOR: Right now is the Medicare annual enrollment period. 2024 Medicare Advantage plans are now available, so everyone on Medicare can call to see if a Medicare Advantage plan may be better for you.
RASCOE: The plans are private insurance that Americans 65 and older can sign up for instead of traditional Medicare. And lots of Americans are signing up in this open enrollment period through March. Sarah Jane Tribble with our partner KFF Health News reports that some regret signing up and then have trouble getting out.
SARAH JANE TRIBBLE: Back in 2016, when Richard Timmins first signed up for Medicare, he went to a free informational seminar with an insurance agent.
RICHARD TIMMINS: Basically, he really promoted Medicare Advantage. He just said, well, look, it's less expensive. It's broader in coverage.
TRIBBLE: For Timmins, it made economic sense to sign up for Medicare Advantage instead of traditional Medicare, and that worked out great - for a while. Then, he found a small bump on the back of his right ear.
TIMMINS: I have a family history of melanoma, so I was kind of tuned into that and thinking about that.
TRIBBLE: But it took him a long time to see the right specialist in his Medicare Advantage network, and getting the paperwork in order was confusing.
TIMMINS: It was starting to - it started to grow and started to become rather painful.
TRIBBLE: By the time Timmins finally saw an oncologist, the lesion had grown to the size of a dime. His right earlobe needed to be removed. He thinks getting care using traditional Medicare would have been faster and easier, and David Meyers at Brown University School of Public Health says he's probably right.
DAVID MEYERS: You can see any provider you want. There are many less sort of restrictions on care. You get a lot more freedom with traditional Medicare.
TRIBBLE: Timmins wishes he could switch, but there's a catch.
TIMMINS: Would I go back to traditional Medicare if it was not cost prohibitive? Absolutely.
TRIBBLE: Traditional Medicare premiums average about $170 a month. And while enrollees on Medicare Advantage plans still pay that premium, the monthly cost can be more affordable. That's because plan enrollees often don't have to pay for extra prescription coverage. They also don't have to buy supplemental insurance, usually called Medigap. That supplemental insurance is needed because, unlike Medicare Advantage plans, traditional Medicare doesn't cap out-of-pocket cost. The thing is, Timmins might not be able to get a Medigap policy anymore. Here's David Lipschutz, associate director of the Center for Medicare Advocacy.
DAVID LIPSCHUTZ: Medigap is one of the few types of insurance that can exclude you based upon preexisting conditions unless you enroll during certain designated times.
TRIBBLE: That designated time is primarily when you first sign up for Medicare. But since Timmins enrolled in a Medicare Advantage plan instead of traditional Medicare and he has a preexisting condition, he could be denied Medigap or charged a lot more for it. While federal law generally prohibits insurers from denying people coverage because of preexisting conditions, Medigap is an exception. Lipschutz again.
LIPSCHUTZ: It's a lot easier to get and stay in a Medicare Advantage plan, but a lot harder to get out and pick up a Medigap plan, depending upon where you are.
TRIBBLE: Only four states require Medigap insurers to cover applicants regardless of age or health. But Timmins lives in Washington state, which isn't one of them. He wants people to know.
TIMMINS: You can get screwed if you're on Medicare Advantage. The advantage kind of disappears once you need them.
TRIBBLE: In the meantime, Timmins worries. There's a chance that his cancer could come back, and he'll be trapped on Medicare Advantage if it does. So he's focusing on what he can control.
TIMMINS: You know, I'm a vegetarian. I don't drink. I don't smoke. I try to get exercise as much as possible.
TRIBBLE: But he knows it might not be enough.
RASCOE: That was Sarah Jane Tribble with our partner KFF Health News.
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