Medicare Advantage...What does "covered" mean?Jan 12, 2021
Every year I go through training for the Medicare Annual Enrollment Period.
It usually takes around a week to take the courses and pass the tests required to verify that I know what I need to know to help people who are going on Medicare understand how Medicare works and what their options are with Medicare.
This year one phrase in the training stood out because it discussed a very deceptive part of Medicare Advantage plans.
As you probably know if you have read any of my writings, I strongly believe Medicare Advantage plans are one of the most deceptive and harmful ideas the government has ever allowed to be perpetrated on the American people.
Medicare Advantage plans such as Humana Gold Plus and Kaiser Permanente are private, for-profit, restricted access plans in which the managers of the plans have a fundamental conflict between providing the health care their members need and minimizing health care costs in order to maximize their profits.
Medicare Advantage plans routinely say "no" to expensive but needed health care services such as MRIs, skilled nursing stays, expensive cancer treatments and joint replacements when regular Medicare would say "yes".
The phrase that stood out to me said
"Medicare Advantage plans are required to cover all health services available under Medicare Parts A and B."
In this case, the word "cover" is the key.
What does "cover" mean in this situation?
It does not mean that a person on Medicare who has left regular Medicare for a Medicare Advantage plan will have the same access to expensive treatments they may need as they would with regular Medicare.
The reason for this is Medicare Advantage plans use a much more restrictive set of guidelines before they will approve expensive care.
If two people have identical degenerative bone disease conditions and need a hip replacement - but one is on regular Medicare and the other has left Medicare for a Medicare Advantage plan - the one on regular Medicare is much more likely to be approved for the hip replacement than the person on the Medicare Advantage plan.
The only way Medicare Advantage plans make a profit is by spending less on their members' health care than if those members were still on regular Medicare. And they make a lot of profit!
Every time a Medicare Advantage plan says "no" to expensive medical tests such as an MRI, they are saying "yes" to more income for the Advantage plan and more bonuses for their executives.
It is somewhat like the old question "If a tree falls in the forest and no one is there to hear, does it make a sound".
Accordingly, if a Medicare Advantage plan "covers" MRIs, joint replacements and expensive cancer treatments but says "no" when they are needed, do the plan's members really have the health care they need?
Unfortunately, the answer is "no".
We appreciate the privilege of assisting you with learning about your Medicare options so you can make the right permanent Medicare decision.
Charles Bradshaw is the President and Founder of MedicareAnswerCenter.com.
p.s. If you know of someone who needs help with their Medicare, please share this with them.
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