Why are Medicare Advantage Plans Called Bad?

Just yesterday I sat down with a couple to help explore options. Both were on different variations of a group Blue Cross Blue Shield plan through their employer. Like every client consultation, my goal is to find out what they know and educate at a high level first on what all of their options are. When I asked what they knew I received two immediate answers:

• We don’t know anything, that’s why we are here!
• We did hear not to do Advantage.

This has become so commonplace that I don’t skip a beat at the sound of those words, but I do like to follow up with some questions like:

• Who exactly has said that to you? – A group of friends that do not have Medicare Advantage told us that.
• Did they give a reason why? – They just said they have been told that over and over again.

The funny thing was after prodding a little I got another remark that these folks had been told by their Son-in-Law, who is an executive at a major hospital and provider network in Memphis that Medicare Advantage plans are a lot better than they used to be. So, at this point, I tried to get into education on both sides, and led with let’s put aside any outside advice that may be skewed or ill-informed and let’s focus on your budget, your healthcare expectations, your concerns, and your desires.

They agreed that was the best way forward.

When we sit with Medicare Beneficiaries either on the phone or in person, we educate them on both options (Medicare Advantage or Part C compared to Medicare Parts A and B with a Medigap Plan and stand-alone Part D plan). When we do this we see an evening out of the split between the two options. When I first started I saw heavy Medicare Supplement enrollment versus Medicare Advantage enrollment, most likely because I skewed in that direction due to the more limited Medicare Advantage options and less robust networks and plan designs in the area I was serving. Considering that huge strides have been made by plans in many areas in the country and that well over half of Medicare beneficiaries choose Medicare Advantage, our practices and results have changed.

We still love writing Medicare with a supplement for the right person, but we do not shy away from Medicare Advantage either. And if you’re using a broker that writes over 90% one way or the other, you probably need to find someone taking a less biased approach to sales or education in this arena.

So to get to the meat of why people say Medicare Advantage plans are bad I’ll hit on a few points:

They used to be!

That’s the cold hard truth! When I started in this business, Medicare Advantage had started getting widely accepted in Metropolitan areas, but in rural communities around the country it had not developed its provider networks adequately or its benefits to be acceptable yet. That has changed in so many areas now that even places like Wyoming and Mississippi have adequate Medicare Advantage options.

Prior Authorization

This one scares everyone. It’s sad because Traditional Medicare has an authorization process as well, but currently they’re more relaxed in their approach than Medicare Advantage. Medicare Advantage was designed to save the Federal Medicare program money because several politicians had the crazy idea that government bureaucrats wouldn’t spend taxpayer dollars efficiently and a private company would be better at it. Part of that “better at it” is prior authorization. I do think the process needs to be frictionless, and with CMS push and carrier sentiment trending towards that idea, we have seen a commitment of at least 20% less Prior Authorization requests starting in 2024. Also, it is important to note that all services do not have prior authorization requests. This is specific to things like tests and therapy that can be costly. The plan wants to know that Medicare’s requirements to have this procedure approved have been met. As a taxpayer, we should all care that healthcare businesses are being held to an appropriate standard as well.

Network Adequacy

This one is tied to old days of Medicare Advantage. When Medicare Advantage originally rolled out small provider offices would put up signs saying they didn’t accept it. Also, people who are on Medicare now had parents that got on it back then and had a bad experience. There were also an increased number of HMOs over PPOs and the PPOs were regional versus nationwide. Most national carriers like Aetna, UnitedHealthcare, Wellcare or Centene, Blue Advantage or Anthem/Elevance, Cigna and Humana have NATIONWIDE PPO networks now. Also, if you do have an HMO and are outside of the coverage area, emergencies are covered.

The Blue Advantage network has MD Anderson in their network now even. Some of these networks are approaching the level of having more doctors and hospitals accept them than accept Traditional Medicare nationwide. Just make sure your broker checks each doctor and prescription you are on to see if your plan covers all of them. The good news is more options and increasing benefits and network adequacy gives the consumer a win. Less options is never better and some politicians would like nothing more than to remove your options as the Medicare consumer. Don’t think for a second their actions are altruistic.

Republicans are historically pro-Medicare Advantage and anti-Obamacare while Democrats are historically pro-Obamacare and anti-Medicare Advantage. This is an oxymoron as both programs operate on the same concept of government subsidized private health insurance. So leave politics at the door.. Leave your neighbors opinion of a plan type at the door.. And work with a broker who can help you look at both options and choose the path that’s best for you and your family!

If you need a broker you can trust in all 50 states, we can help. You can set an appointment with us or give us a call at 662-844-3300.