Wednesday, October 27, 2021 (Kaiser News) – When Teresa Nolan Barensfeld turned 65 last year, she quickly decided on a private Medicare Advantage plans to cover her health expenses.
Barensfeld, a freelance editor from Chatham, New York, liked that it covered her medication while her local hospitals and her primary care physician were in the plan’s network. It also had a modest $ 31 monthly premium.
She said it’s a bonus that the plan includes dental, hearing and vision benefits, which are traditional Medicare do not.
But Barensfeld, who works as a copywriter, missed out on the important fine print on her plan. It covers a maximum of $ 500 annually for care of out-of-network dentists, including her longtime provider. That means getting one crown or taking care of a few holtes could make her pay the bulk of the bill. She was concerned about the limitation on dental coverage and said, “I do not expect that much for a $ 31 plan.”
Through television, social media, newspapers and mail messages, tens of millions of Medicare beneficiaries are being robbed this month – as they are every fall during the open enrollment period – by marketing Medicare Advantage plans that offer low costs and benefits not found at traditional Medicare not. Dental, vision and hearing coverage are among the most advertised benefits.
These services are also at the center of heated negotiations on Capitol Hill among Democrats as they seek to expand a number of social programs. Progressives, led by Sen. Bernie Sanders (I-Vt.), Insists on adding dental, vision and hearing benefits to traditional Medicare.
Despite strong advertising from Medicare Advantage plans launched by celebrities such as Joe Namath and Jimmie Walker, beneficiaries generally still incur significant out-of-pocket costs for many of these services, a recent study found. found by KFF. This is partly because the private plans limit benefits. While people in traditional Medicare paid an average of about $ 992 Dental care in 2018, those in Medicare Advantage plans paid $ 766, according to the study. For vision, people with traditional Medicare paid $ 242, compared to $ 194 for those covered by a Medicare Advantage plan.
“It goes without saying that there will be lower own spending in Medicare Advantage than in traditional Medicare, but the differences are not as large as one would expect,” says Tricia Neuman, senior vice president at KFF and executive director of its Medicare policy program.
More than 26 million people signed up for Medicare Advantage plans for this year – 42% of all Medicare beneficiaries. Enrollment in private plans has doubled since 2012 and tripled since 2007. Unlike traditional Medicare, these private plans generally allow coverage through a limited network of doctors, hospitals and pharmacies.
Open enrollment for 2022 plans runs from October 15 to December 7, and some Advantage plans offer lures such as hundreds of dollars worth of groceries, home-delivered meals or $ 1,000 in over-the-counter items such as bandages and aspirin.
But many seniors do not realize there are limitations to these benefits. They can only cover extras for enrollees with certain health conditions or have a narrow network of providers or annual dollar limits, often around $ 100 for vision or $ 1,300 for dentistry.
“All of these extra benefits encourage people to sign up, but people do not know what they have until they try to use it,” says Bonnie Burns, a California Health Advocates training and policy specialist who helps Medicare beneficiaries make their health plan evaluate options.
Seniors can typically choose from more than 30 Medicare Advantage plans sold by various insurers. The choice is so frightening that less than a third of seniors make the effort to shop and compare during the open enrollment window – even though costs and benefits change every year.
And for those who want to go shopping, comparisons are not easy. The Medicare.gov website provides an overview of health plan costs and benefits and allows seniors to compare plans’ premiums based on which medication the beneficiary is using. But it does not provide a comparison of which doctors, dentists or hospitals are in the Medicare Advantage network or does not provide details on limits on dental, hearing and vision care. For that information, consumers should go to each insurer’s website and read through a summary of benefits that can be tens of pages long.
Mary Beth Donahue, CEO of the Better Medicare Alliance, a research and trading group representing Medicare Advantage plans, sees things differently. “Medicare Advantage’s flexible benefit design means beneficiaries can choose a plan tailored to their needs – whether it means more robust coverage, or more basic coverage, possibly at a lower cost,” she said.
Casey Schwarz, senior advocate for education and federal policy at the Medicare Rights Center in New York, an advocacy group for seniors, said the added benefits that plans offer have increased confusion among beneficiaries. Those benefits come at a price.
“There is almost always a compromise such as narrower supplier networks, stricter drug formula or restrictions in other areas,” she said.
Jenny Chumbley Hogue, an insurance broker near Dallas and an analyst at medicaresources.org who helps seniors navigate the program, said marketing misleads some of her clients. “They see a TV ad that says they can get everything for free when they may not qualify for those benefits,” she said. “It is difficult to know whether they were misinformed or not reading the fine print.”
She added that consumers should choose a plan based on whether their doctor is in that network or their drugs are covered at the lowest cost. For example, while most plans offer a hearing aid benefit, it’s usually only for a certain type of single company device, Chumbley Hogue said.
“The devil is in the details, especially when it comes to dentistry,” she said. “The coverage is not typical of what they are used to coming from an employer plan.”
However, Medicare Advantage dental benefits are getting stronger. Nearly 90% of private plans offer dental benefits at no extra cost and most offer coverage for treatment as well as cleaning and examinations, according to a report by consulting firm Milliman. The percentage of plans that offer preventative and comprehensive dentistry has risen to 71% this year from 48% in 2019.
Plans also increase benefits to meet Medicare’s requirement to spend at least 85% of enrolled premium dollars on health services, Neuman said. Plans that do not reach that threshold may face sanctions, including not being allowed to enroll new members.
Although some consumers may find the dental benefit appealing, not all use the cover. The Medicare plan may not cover their existing dentist, so they continue to pay out of pocket, she said.
Medicare Advantage beneficiaries use their dental benefits less frequently than people with dental coverage through their employer, said Joanne Fontana, a principal at Milliman. “Not everyone buys a plan because it covers dentistry,” she said, “and it’s not from the best, or they [don’t] think of going to the dentist every year. ”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the country.
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