One Medicare plan is all seniors need! The concept of giving consumers many Medicare insurance choices has been drummed into our heads as a good thing. More choice means more competition between companies and therefore lower prices and higher quality. Unfortunately, when it comes to private health insurance options for the Medicare-eligible consumer, choice does not deliver much (if any) financial or quality benefit. Unlike most other businesses in the United States, healthcare businesses do not operate in a competitive marketplace. An unresolved shortage of healthcare providers keeps fees high and the incentives to improve quality of service low. More health insurance choices does not correct this situation.
Extra health insurance choices outside of Medicare simply serve to distract the consumer from the real need for structural reform and quality improvement under one Medicare plan. Private insurance choices subdivide one Medicare risk pool into many smaller and smaller units. This situation financially benefits the private health insurance companies with little to no benefit trickling down to the Medicare-eligible consumer.
Too Many Private Health Insurance Choices
For Medicare beneficiaries, private health insurance choices add confusion and complexity to the management of their healthcare spending.
- Medicare-eligible beneficiaries are expected to annually decide between original Medicare versus several private Medicare Advantage plans. My mom (Donna) has a choice of 5 Medicare Advantage plans but only one includes her doctors in their limited networks. Because my mom does not drive and must ask for rides from family and friends, limited network healthcare providers at distant locations is problematic. If my mom chooses the Medicare Advantage plan with prescription drug coverage (MA-PD), then she is tied to one drug formulary than may not be the most financially advantageous for my mom.
- On the Medicare website, my mom has a choice of 25 Medigap Plan F policies and countless other Medigap plans. Her independent insurance broker has many more Medigap choices from which to choose. As her Medigap premiums increase with age, she may soon find the cost unaffordable. Looking for better Medigap prices means being subjected to underwriting (i.e., if she is not healthy, she will pay through the nose).
- If my mom chooses to purchase a stand-alone Medicare Part D prescription drug plan, she has 25 plans to evaluate. These plans have confusing premium/annual deductibles/copay/coinsurance/formulary combinations honed for maximum insurance company profitability. Picking the best plan with minimum out-of-pocket expenditure is difficult since it requires predicting future drug needs.
- My mom does not purchase long term care insurance because it is much too expensive. She prays that she doesn’t require long term nursing home care because even a short stay will impoverish her.
Without internet access at home, these choices are impossible for my mom to navigate on her own. If I didn’t manage her health insurance choices, then my mom would simply keep whatever health insurance combination she currently has and hope that her income supports it. Insurance companies love people who do not shop around for the best value. Many elderly Americans do not have a family member or friend who is able to take on the work necessary to act on these changing and complex healthcare choices.
When people are given too many complex choices, they become overwhelmed and paralyzed with inaction. Making intelligent healthcare choices requires more knowledge than the vast majority of Medicare beneficiaries possess. Our government throws the choices at the elderly without the necessary education to absorb them. This doesn’t stop our government from foisting more and more pocketbook-depleting choices onto the elderly in misguided attempts at controlling the high cost of healthcare in the United States.
More Health Management Required
Having to augment one Medicare plan with several other health insurance policies introduces additional health management from a population that is ill equipped to do so. Choosing a private Medicare Advantage plan entails reading more fine print than elderly, declining eyes and brains wish or are able to navigate. For Medicare Advantage plans, one has to hunt down whether one’s doctors are in network. This requires either making one or more telephone calls and/or seeking the information online (if an internet connection is available). Introduce major sickness into the equation and the ability to manage one’s health care goes out the windlow.
I have a 64 year old friend, Libby, who can’t wait to become Medicare-eligible next year to decrease the headaches associated with her employer-sponsored, managed care health insurance plan. As her self-insured employer jockeys for decreased employee insurance costs, Libby has had to swallow increasing cost share and narrower healthcare provider networks. With reduced administrative fees, the health insurance company tries to extract every possible dollar out of her. She must fight over coverage denials, contend with long waits on automated telephone systems, and pay cost share before treatments are even scheduled. Libby’s hospital demands estimated upfront cost share for all procedures and testing and is always calculated so that a surplus payment always results (the healthcare provider doesn’t want to have to go after any shortage). The patient must then ask for the money back after the bill is fully paid. How many elderly patients are going to forget to demand the surplus back?
Libby’s husband is already on Medicare and has a Medigap F policy and a Part D prescription drug policy. While the electronic payment coordination between Medicare and the Medigap F policy minimizes paperwork and coordination, it still demands attention when diagnostic codes are incorrectly inputted to Medicare’s satisfaction. The separate Part D prescription drug insurance must also be watched especially when prescription drugs are added and not on the formulary.
Libby and I have both helped older relatives and friends negotiate increasingly complex financial and health insurance communication as private insurance companies and healthcare providers squeeze every last dollar possible out of the consumer. One doctor is incorporated under several different names and calling about a bill to one of his billing services is very confusing. I had a question about a bill, called the number given, and was greeted with “how may I direct your call?” This billing service has a mailing address in one state (not the doctor’s) and the person talking on the phone is located in another state. This same doctor also bills as a single contractor to the local hospital and a fraction of his charges are billed separately by the hospital in his name. The billing service handling his group LLC charges have no record of the separated charges. Must I call the hospital if I have questions? I cannot imagine any elderly patient handling any of this complex billing and communication necessary under our present healthcare system.
Libby and I have seen elderly loved ones use every last bit of their strength and mental power to fight increasing fragility and sickness. By age 80 (or sooner), resilience, mental capacity, and overall coping skills are all diminished even without major sickness weighing a person down. We have seen healthcare providers and especially hospitals take advantage of this situation to over-treat and over-test for financial gain. We routinely observe a lack of coordination of care between different healthcare provider businesses treating different “parts” of our family and friends. This situation requires a “pushy” and well-informed patient advocate—something many elderly patients do not have. This is our healthcare reality.
The Bottom Line — One Medicare Plan
Has all this choice of plans and health insurance companies brought us affordable and quality health care? No. Our government verbalizes the same tired idea that more choices means competition and competition means lower prices. These private insurance choices only serves to fragment the one Medicare risk pool into many smaller and smaller units. Our government throws taxpayer money at inefficient insurance companies to make sure they continue to offer consumers choices. This financially benefits the health insurance companies and not the Medicare-eligible consumer.
Extra choices outside of one Medicare plan simply serve to distract the consumer from demanding financial and quality improvement within original Medicare. We need one Medicare plan that is affordable to all Americans and uses its market power to demand coordinated, quality health care.
Even without major sickness weighing them down, the elderly face diminished resilience, mental capacity, and overall coping skills. They are simply not equipped to handle constantly changing health insurance choices and complexity in their lives that delivers little to no benefit.
Let’s get together as a group to demand one Medicare plan that meets our needs. Join BB’s Healthcare Brigade for Affordable Health Care and Beyond for ALL Americans today.