An article in Forbes Magazine released last week sums it up wisely: “Older Americans say they feel trapped in Medicare Advantage Plans.” Medicare Advantage plans, also called “MA” or “Part C,” are a heavily advertised class of privatized Medicare-type insurance plans. The government pays a private insurance company a lump sum they have allocated to your care, and the insurance company provides the insurance coverage that Medicare otherwise would. That insurance company can charge additional premiums, and limit you to their provider network, but they can and normally do incorporate additional benefits, such as prescription drug coverage, dental, and vision.
Medicare Advantage plans are attractive because of their ease and similarity to employee coverage that adults are familiar with. You get once card, and you use that for everything. However, as Medicare recipients age and their medical needs grow, they are often subjected to the flip side of what seemed like a good value: Denials of expensive surgeries or treatment residents, and denial or early disapproval of rehabilitation coverage following a hospital stay or surgery. Where Medicare typically defers to medical providers and rehabilitation specialists on what procedures are needed and how long rehabilitation services continue to be appropriate, private insurance companies actively look for reasons to deny or terminate coverage of professionally recommended services. That, and specialized care (or sometimes not so specialized) can be denied in practice due to bottlenecks in any company’s approved provider network.
