When is an ADVANTAGE a disadvantage?

The carnival barking celebrities are relentless on television. They attempt to persuade you to call to check your zip code with a promise of getting money put back into your monthly social security check when you sign up for the XYZ Medicare Advantage Plan.

Extra benefits are touted over and above regular Medicare at no cost to you. The problem is the taxpayer price tag is enormous and quality of benefits is putrid.

A couple decades ago, Federal legislation was passed to improve quality of health care and lower the cost through Medicare Advantage plans. Insurance companies are required to report financial data to State regulators. Today, it is estimated close to fifty percent of Medicare eligible policyholders have signed up for a Medicare Advantage (MA) plan.

An investigative article was published in the October 22nd, 2022 The New York Times. It was reported that nine out of ten MA providers were found to have committed and been accused of fraud. These private sector MA alternatives were supposed to be better than regular Medicare. They are not.

The MA companies inflated profits and received more money from the Federal government by reporting many patients more sick (increased number of diagnosis codes) with these over-diagnoses garnering higher payments. The Federal government spends as much on MA payouts as in funding the Army and Navy. The $12-25 billion in overpayments are enough to cover hearing and vision for all individuals over the age of 65.

Federal expenditures for MA total more than budgeted for NASA, CHIP (children’s insurance), U.S. Customs & Border Protection, FBI, EPA, and the Federal prison system.

MA limits choice of physicians, specialists, and hospitals within a smaller network for coverage and payment. Additionally, policyholders must jump through hoops to acquire required care for their anomaly. Annual profit per enrollee for MA insurer is close to $2300. The MA program looks to pay out less money, restrict access to care, and gives providers a lower reimbursement.

For hearing aid benefits, an MA plan utilizes a third-party administrator. This company lowers the rate of reimbursement to audiologists to the bare minimum. This administrative company receives money from the Federal government through your Medicare payment and your co-pay of $700 to $1000 per device, issues the hearing aids to the audiologist for your fitting, and 60-90 days later mails a service reimbursement of about 14% from the entire amount they collected.

My own investigative inquiries with MA plans and administrative contractors, the actual dollar amount they pay is LESS THAN what is paid by medical assistance for the same service given to the indigent.

The MA model of providing hearing aids to policyholders encourages audiologists to get that handicapped patient in and out of their office quickly and sacrifices required care, counseling, aural rehabilitation, and computerized adjustments for patient success. The MA plan doesn’t have all manufacturers available and limits choice of product to be considered in patient fitting. Often it is a bottom level hearing aid fitted with minimal care. From a business perspective it is a churn and burn model emphasizing quantity versus quality.

Hearing handicapped patients are sacrificed. Dispensing audiologists are forced to severely reduce service and time patients. In the MA model, policyholders are forced to lower their expectations because this is a race to the bottom mentality where the patient is neglected in product and service.

Out of the delayed and low reimbursement (below the medical assistance fee schedule), to dispensing audiologists, they must pay taxes, rent, utilities, office costs, and attempt to make a profit to cover a salary. The patient may have 1-3 visits included during the first thirty days. After this time period is up, the provider is permitted to charge $60 to $125 to $225 for every single office appointment lasting about fifteen minutes. The MA policyholder/patient may think they are getting a deal in hearing benefits. However, they will pay even more in the long run or avoid seeking the required care due to the future cost.

Your Medicare ADVANTAGE plan may ultimately place you at a disadvantage.