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Presidential Candidates: on Medicare

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Presidential Candidate Questions on Medicare

 

1. “Can you explain your stance on the current state of Medicare in the United States? What would you say are its most significant strengths and weaknesses?”

2. “Many Americans are worried about the sustainability of Medicare. As a Presidential candidate, what steps do you propose to ensure Medicare’s long-term viability?”

3. “How will your administration address the high cost of prescription drugs, which has a significant impact on Medicare beneficiaries?”

4. “What are your plans to improve access to Medicare for the most vulnerable populations, such as the elderly, the disabled, and those in rural areas?”

5. “Medicare Advantage plans are growing in popularity, but there is debate about their cost-effectiveness and the quality of care they provide. What is your stance on Medicare Advantage, and how will it influence your policy-making?”

6. “Should there be a cap on out-of-pocket expenses for those using Medicare? If so, what do you think would be a reasonable limit?”

7. “Some argue that expanding Medicare to include vision, dental, and hearing care is necessary. What is your position on expanding Medicare’s coverage?”

8. “There have been proposals for ‘Medicare for All’ as a solution to America’s healthcare issues. What is your position on this idea, and how do you believe it would impact the overall healthcare system?”

9. “Medicare fraud is a significant issue, costing taxpayers billions of dollars each year. What measures will your administration take to tackle this problem and improve program integrity?”

10. “Do you believe that the age of eligibility for Medicare should be lowered, or should there be alternatives to cover those who are younger and uninsured?”

These questions are of major importance to the more than 54 million actual voting seniors on Medicare.


Christopher Westfall
1-800-729-9590
[email protected]

Disadvantages of Medicare Advantage

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Medicare Advantage Disadvantages: Understanding the Downsides of Medicare Advantage Plans

Introduction

Medicare Advantage plans, also known as Medicare Part C, offer an alternative way to receive Medicare benefits. While these plans come with several advantages, it’s important to be aware of their potential disadvantages. In this article, we will explore the Medicare Advantage disadvantages, shedding light on the drawbacks associated with these plans.

Medicare Advantage Disadvantages

Medicare Advantage plans, despite their benefits, may have some downsides that beneficiaries should consider before enrolling. Let’s take a closer look at the disadvantages of Medicare Advantage plans:

1. Limited Network of Providers

Medicare Advantage plans typically have a network of preferred providers. This means that you may need to seek healthcare services from doctors, hospitals, and specialists within the plan’s network. Going out-of-network may result in higher out-of-pocket costs or may not be covered at all.

2. Lack of Nationwide Coverage

Unlike Original Medicare, which provides coverage nationwide, Medicare Advantage plans often have limited geographic coverage. If you frequently travel or spend time in different states, it’s important to check whether your plan will cover you outside its designated service area.

3. Potential for Higher Out-of-Pocket Costs

Medicare Advantage plans often require beneficiaries to pay certain cost-sharing amounts, such as copayments and coinsurance, for services rendered. These out-of-pocket costs can add up, particularly if you require frequent medical care or specialized treatments.

4. Prior Authorization Requirements

Some Medicare Advantage plans may require prior authorization for certain medical procedures, treatments, or medications. This means that you would need approval from the plan before receiving the service, which can introduce delays and additional administrative steps.

5. Limited Prescription Drug Formularies

Many Medicare Advantage plans include prescription drug coverage, known as Medicare Part D. However, these plans may have limited formularies that only cover specific medications. If you take medications that are not included in your plan’s formulary, you may need to pay the full cost out-of-pocket.

6. Potential Disruption of Doctor-Patient Relationships

When you enroll in a Medicare Advantage plan, you may need to change doctors if your current healthcare providers are not part of the plan’s network. This can be particularly challenging if you have established a trusting relationship with your doctors and specialists over the years.

7. Difficulty Comparing Plans

Medicare Advantage plans can vary significantly in terms of coverage, costs, and benefits. Comparing these plans can be complex and time-consuming, especially considering the frequent changes in plan offerings from year to year.

8. Risk of Plan Discontinuation

Medicare Advantage plans are offered by private insurance companies, and these companies can choose to discontinue or modify their plans from year to year. If your plan is discontinued, you would need to find a new plan during the next Medicare Annual Enrollment Period.

9. Extra Costs for Non-Essential Services

While Original Medicare covers medically necessary services, Medicare Advantage plans may offer additional benefits such as dental, vision, or hearing coverage. However, these added benefits may come with additional costs, either through higher premiums or increased out-of-pocket expenses.

10. Potential for Coverage Limitations

Medicare Advantage plans may have limitations on certain services or treatments. For example, they may impose restrictions on the number of physical therapy sessions covered or limit the frequency of certain diagnostic tests.

11. Difficulty Accessing Specialists

Specialist care may be more challenging to access under a Medicare Advantage plan. Some plans require referrals from primary care physicians to see a specialist, which can introduce delays and additional administrative steps.

12. Risk of Plan Non-Renewal

Similar to discontinuation, Medicare Advantage plans can also choose not to renew their contracts with Medicare. If your plan is not renewed, you would need to find an alternative plan during the next Medicare Annual Enrollment Period.

13. Inflexible Enrollment Periods

Medicare Advantage plans have specific enrollment periods, such as the Initial Enrollment Period and the Annual Enrollment Period. Missing these enrollment windows may limit your options or result in a gap in coverage.

14. Potential for Disenrollment Restrictions

Once enrolled in a Medicare Advantage plan, beneficiaries may face limitations on changing plans or returning to Original Medicare. It’s important to carefully consider your healthcare needs and plan options before making a decision.

15. Limited Coverage for Certain Medical Facilities

Not all healthcare facilities, such as specialized hospitals or renowned medical centers, may be part of a Medicare Advantage plan’s network. This can restrict your choices when seeking care from specific facilities.

16. Complexity of Plan Rules and Regulations

Medicare Advantage plans often have their own set of rules and regulations that beneficiaries must navigate. Understanding these complexities can be challenging, particularly for individuals who are not familiar with health insurance terminology and processes.

17. Potential Loss of Access to Medigap Plans

If you choose to enroll in a Medicare Advantage plan, you will not be able to purchase a Medigap policy. Medigap plans help cover out-of-pocket costs associated with Original Medicare, providing additional financial protection.

18. Lack of Standardization Across Plans

Medicare Advantage plans can differ significantly from one another in terms of coverage, cost-sharing, and network providers. This lack of standardization can make it harder to compare and select the best plan for your specific needs.

19. Limited Flexibility for Snowbirds

If you are someone who spends part of the year in a different state, a Medicare Advantage plan may not provide the flexibility you need. Some plans may only cover emergency care outside their service area, which may not be suitable for individuals with seasonal residency.

20. Potential for Plan Changes Throughout the Year

Unlike Original Medicare, which remains relatively stable, Medicare Advantage plans can modify their coverage, network, and costs during the year. These changes can impact your access to services and the affordability of your healthcare.

21. Difficulty in Dispute Resolution

If you have a disagreement or dispute with your Medicare Advantage plan, resolving the issue can be challenging. Navigating the appeals process and communicating with the insurance company may require time and effort.

22. Limited Coverage During Travel Abroad

Medicare Advantage plans usually do not provide coverage for healthcare services received outside the United States. If you frequently travel internationally or reside abroad, it’s important to explore other options for healthcare coverage during your time outside the country.

23. Risk of Plan Marketing Misinformation

Medicare Advantage plans may be marketed heavily, and the information provided by insurance companies may not always be entirely accurate or clear. It’s crucial to conduct thorough research and verify the details of a plan before making a decision.

24. Potential for Higher Administrative Burden

Medicare Advantage plans often require beneficiaries to navigate various administrative tasks, such as obtaining prior authorizations, coordinating care between providers, and understanding plan-specific guidelines. This increased administrative burden can be overwhelming for some individuals.

25. Impact on Low-Income Individuals

While Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, certain low-income individuals may have better access to financial assistance through programs like Medicaid if they stick with Original Medicare.

FAQs about Medicare Advantage Disadvantages

Q1: Are Medicare Advantage plans better than Original Medicare?

A1: Whether Medicare Advantage plans are better than Original Medicare depends on your individual needs and preferences. While Medicare Advantage plans offer additional benefits and may have lower premiums, they also come with potential disadvantages.

Q2: Can I switch from a Medicare Advantage plan to Original Medicare?

A2: Yes, you can switch from a Medicare Advantage plan to Original Medicare during the Medicare Annual Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31).

Q3: Can I have both a Medicare Advantage plan and a Medigap policy?

A3: No, it’s not possible to have both a Medicare Advantage plan and a Medigap policy. Medigap policies only work with Original Medicare.

Q4: Can Medicare Advantage plans deny coverage for pre-existing conditions?

A4: No, Medicare Advantage plans cannot deny coverage based on pre-existing conditions. However, they can impose waiting periods for certain treatments or services.

Q5: Are all Medicare Advantage plans the same?

A5: No, Medicare Advantage plans vary in terms of coverage, costs, network providers, and additional benefits. It’s important to review and compare different plans to find the one that suits your needs.

Q6: Can I join a Medicare Advantage plan if I have end-stage renal disease (ESRD)?

A6: In most cases, individuals with end-stage renal disease (ESRD) are not eligible to enroll in a Medicare Advantage plan. However, there are certain exceptions and special circumstances.

Conclusion

While Medicare Advantage plans offer several advantages, it’s essential to be aware of their potential disadvantages. From limited provider networks to higher out-of-pocket costs, understanding these drawbacks can help you make an informed decision about your healthcare coverage. Remember to carefully review and compare different plans before enrolling to ensure they align with your specific needs and preferences.e

We help compare all plan types here at the Senior Savings Network.
We can be reached at 1-800-729-9590.

STOP Medicare Advantage! NYC Lawsuit Filed

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New York City Retirees Fight Against Medicare Coverage Changes

An important development regarding retirees’ access to health insurance is the class-action lawsuit that has been brought against the City of New York. The complaint, which was filed on May 31, 2023, contests the City’s intention to convert almost a quarter million retirees who are aged and disabled from their current Medicare coverage to “Medicare Advantage,” a less comprehensive form of coverage.
[source]

In contrast to the government-run Medicare program that has protected City retirees for more than 50 years, the new insurance policy, known as the Aetna Medicare Advantage plan, is a private, for-profit venture. The lawsuit asserts that the new policy exposes retirees to debilitating healthcare expenditures, has a small network of medical providers, and does not cover a wide range of medical services unless certified “medically necessary” by Aetna.[source]

The action also asks for a preliminary injunction to prevent the City’s plan from being executed and to stop the forced move to Medicare Advantage immediately. They include causing risky denials of and delays in medical care, requiring senior adults on limited incomes to forgo medical care and other requirements, and prohibiting retirees from visiting their preferred doctors and staying in their continuing care homes.[source]

The lawsuit alleges that the City has promised every active and retired City worker since the 1960s that they would be entitled to City-funded healthcare through a combination of Medicare and Medicare “supplemental” insurance, which covers healthcare expenses that Medicare does not. The retirees argue that they reasonably relied on this promise and insist that the City must continue to honor it. The lawsuit alleges eleven other ways that the City’s new healthcare policy violates the rights of retirees, including violations of the New York State Constitution, the Retiree Health Insurance Moratorium Act, the New York State and New York City Human Rights Laws, the City Administrative Procedure Act, and the Donnelly Act.[source]

The legal filings include hundreds of affidavits from retirees, experts, and former high-ranking City officials supporting the allegations in the complaint.[source] Jake Gardener, a partner at Walden Macht & Haran LLP and counsel to the retirees, criticized the City’s new healthcare policy, saying, “The City’s new healthcare policy imperils the health of hundreds of thousands of senior citizens and disabled first responders and flagrantly violates their rights. To deprive them of those benefits now“`html
, in their old age, is an unconscionable bait-and-switch.”[source]

Marianne Pizzitola, President of the New York City Organization of Public Service Retirees, expressed her disappointment, stating, “As a former EMT who became sick working at Ground Zero, I feel disgusted and betrayed by the Mayor and union leaders, who chose to enrich themselves at the expense of elderly and disabled retirees. Retired municipal workers devoted themselves to this city for little pay. We were guaranteed certain healthcare benefits in return. To deny us that after a lifetime of service is outrageous and immoral.”[source]

The class-action lawsuit, a hybrid of a class action and Article 78 proceeding, was filed in the New York State Supreme Court. The retiree plaintiffs are being represented by Walden Macht & Haran LLP, with assistance from co-counsel at Pollock Cohen LLP.[source] As the case proceeds, the implications for the future of healthcare coverage for retirees in New York City remain to be seen.

The Senior Savings Network is a broker specializing in Medicare benefits throughout the United States. We are continuing to monitor this situation and provide help for alternative solutions for those who need it.  The Senior Savings Network can be reached at 1-800-729-9590.

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