We are in the Medicare open enrollment period until December 7th and seniors and persons with disabilities are getting a barrage of advertising in their mail, email and in television and newspaper ads. Medicare has become more profitable for these private and nonprofit health plans in Medicare with the government boosting their payments by 3.45% for 2019. There are now 3700 such local and regional plans across the nation. The Trump Administration is predicting up to 50% of beneficiaries will soon choose these plans. About 23 million Medicare beneficiaries are predicted to be in Medicare Advantage in 2019. This has become a very confusing exercise for many beneficiaries unless they decide to simply stay with original Medicare and can have their choice of doctors and providers.
The Advantage plans though are trying to entice beneficiaries with $0 monthly premiums, gym memberships and some dental and hearing aid costs covered along with other perks. How do they do this? They try to attract healthier persons and have a restricted network of providers. They also have prior authorization rules for some treatments In fact, a recent report from the Office of Inspector General at the Department of Health and Human Services says it has found “widespread and persistent problems related to denials of care and payment” in the Medicare Advantage program. It found that 75% of appeals were overruled though most people do not appeal or know how to.
The Medicare Care Advantage market nationwide is dominated by Aetna, Humana and United Healthcare but there are many smaller and more regional insurers. 10,000 persons are turning 65 every day and they are more accustomed to having managed care coverage from private employers. With government funding increasing many insurers are entering the Medicare market and the three dominant companies plan to expand into 97 more counties nationwide. The for profit companies are reportedly making a profit margin that is double that of other nonprofit Medicare Advantage plans.
Progressive activists are continuing to push for a Medicare for All single payer plan nationwide to extend health coverage to all Americans and cut into the overhead and profit of private insurers.