By Robert Pear
WASHINGTON — Older Americans have been flocking to Medicare’s private plans, which promise predictable costs and extra benefits.
the private Medicare Advantage plans have also been getting an
unpublicized boost from the Trump administration, which has in the last
few weeks extolled the virtues of the private plans in emails sent to
millions of beneficiaries.
annual open enrollment period closes on Friday. Administration
officials predict that almost 37 percent of the 60 million Medicare
beneficiaries will be in Medicare Advantage plans next year, up from 28
percent five years ago.
The officials deny that they are steering patients to private plans, but the subject lines of recent emails read almost like advertisements. “Get more benefits for your money,” says a message dated Oct. 25. “See if you can save money with Medicare Advantage,” said another sent a week later.
The messages — “paid for by the U.S.
Department of Health and Human Services” — urge beneficiaries to “check
out Medicare Advantage” and point to an online tool, the Medicare plan finder, to compare the different options.
“You may be able to lower your out-of-pocket costs while getting extra benefits, like vision, hearing, dental and prescription coverage,” said an email sent to beneficiaries on Wednesday.
“With Medicare Advantage,” says another email, “one plan covers all of your care.”
small print, the emails say they were “created and distributed by the
Centers for Medicare and Medicaid Services” to people who “signed up for
email updates from the Medicare team.”
Verma, the administrator of the Centers for Medicare and Medicaid
Services, said the agency was not favoring private plans over the
original government-run Medicare program.
“We are not steering any Medicare beneficiary anywhere,” she said.
But Richard S. Foster, who was for many years the nonpartisan chief actuary of the Medicare program, said the emails sounded “more like Medicare Advantage plan advertising than objective information from a public agency.”
made in the emails are generally accurate, but they are one-sided,” Mr.
Foster said. “The advantages of M.A. plans are emphasized, while the
disadvantages are not mentioned.”
example, he said, private plans generally require beneficiaries to use a
defined network of health care providers or pay more for care outside
the network. By contrast, in traditional Medicare, beneficiaries can go
to any doctor who accepts Medicare, as most doctors do.
Murphy, who has counseled thousands of Medicare beneficiaries as the
director of Michigan’s State Health Insurance Assistance Program, said:
“It seems that there are a whole lot of promotional emails coming from
the federal government. There does seem to be encouragement to go to
Medicare Advantage, part of a trend favoring private companies over
traditional Medicare, for whatever reason.”
Federal spending on Medicare Advantage will nearly triple in the coming decade, to $584 billion in 2028, from $210 billion this year, the Congressional Budget Office estimates.
executives and investors are also bullish on the outlook for the private
Medicare plans, offered by companies like UnitedHealth and Humana,
which do extensive marketing of their own at this time of year.
Congress passed the Affordable Care Act in 2010, it helped offset the
cost by cutting payments to Medicare Advantage plans. The Congressional
Budget Office and other experts predicted that enrollment in the plans
would decline. Instead, it has surged to more than 20 million today,
from 11 million in 2010.
Democratic members of Congress from Connecticut recently sent a letter to the administration expressing concern that officials were “inappropriately working to steer Medicare beneficiaries to Medicare Advantage plans.” The agency has an obligation to “provide beneficiaries with accurate information from a neutral, balanced perspective,” said the letter, signed by Senators Richard Blumenthal and Christopher S. Murphy and Representative Rosa DeLauro, among others.
Even without encouragement from the government, Medicare beneficiaries might be gravitating to private plans.
people have become accustomed to managed care plans through their
employment. When they reach age 65, they are comfortable opting for a
private plan — in some cases, a Medicare Advantage plan offered by the
same company that provided their employer-based coverage.
this past week in The New England Journal of Medicine, Patricia H.
Neuman and Gretchen A. Jacobson of the Kaiser Family Foundation pointed
to other possible attractions.
Advantage plans offer a variety of extra benefits like dental care and
gym memberships, they said. Private plans protect against catastrophic
health care costs, with an annual limit on out-of-pocket spending for
doctors’ services and hospital care. In addition, they said, private
plans “offer the convenience of one-stop shopping for all their
By contrast, beneficiaries
in traditional Medicare typically pay one premium for coverage of
doctors’ services, another premium for drug coverage and often a third
premium for supplemental insurance like a Medigap policy or a retiree
Ann E. Mason, 77, of
Rochester, said she was “very, very satisfied” with her Medicare
Advantage plan. The plan, offered by the local Blue Cross and Blue
Shield company, has a network of providers, but most local doctors are
in it, she said.
Private plans boast of providing superior-quality care, but the evidence is mixed. Researchers have found that patients in poor health are somewhat more likely than others to disenroll from Medicare Advantage and switch to traditional Medicare.
McAuliffe, 77, and his wife, Ann, 78, were in a Medicare Advantage plan
and were generally satisfied with it until she had a severe stroke in
Charlotte, N.C., in 2017. After a few months, the insurer refused to pay
for further care, and the couple challenged the denial through several
levels of appeal until they finally prevailed in a hearing before an
administrative law judge.
back to traditional Medicare, with a Medigap supplement policy, and it’s
been excellent,” Mr. McAuliffe said. “Everything is paid for.”
McAuliffes were fortunate. People in a private Medicare plan can go
back to traditional Medicare, but are not always able to buy Medigap
policies if they have health problems.
Some people with serious illnesses see value in the private plans.
Bruce Hutchinson, 73, of Salt Lake City, said he had prostate cancer this year and chose a Medicare Advantage plan for 2019 because it had “an annual dollar limit” on out-of-pocket costs.