Medicare open enrollment kicks off Oct. 15, allowing older adults to choose whether to keep or switch their current healthcare coverage.
But some of those folks who are on Medicare Advantage plans may find that their current plan has disappeared, with no comparable replacement. North Texas is expected to be hit especially hard, with roughly 28% of Medicare Advantage plans disappearing by the end of this year.
Dan Weissman is with the podcast ‘An Arm and A Leg‘ which examines why health care is so expensive, while also providing advice and resources to folks navigating the system.
He joined NTX Now hosts Miranda Suarez and Ron Corning to share insights about why these plans are disappearing, and offer tips for seniors who may be scrambling to find new healthcare plans.
These interview highlights have been edited for length and clarity. To hear the conversation in full, click the ‘play’ button above.
Medicare Advantage vs traditional Medicare plans
Weissman says when you go to sign up for Medicare, you’re given two plan options: Advantage or Original, also called Traditional. Traditional Medicare is run by the United States government, while Medicare Advantage plans are run by private insurance companies like United Health Care or Humana.
“Medicare Advantage plans have been very popular because they look like they’re going to save you money,” Weissman said.
He said advantage plans cover things like vision, hearing, and dental that traditional Medicare plans typically do not cover and they often come with a lower monthly premium. The drawback to these plans is that the companies will only cover specific doctors or procedures.
“Then you’re fighting with them and as you get older, maybe you rack up more things that you need,” Weissman explained. “That’s a huge deal.”
Traditional Medicare plans are slightly different.
“Traditional Medicare only covers 80% and 20% of everything else is a lot and there’s no [out of pocket] limit,” he said.
That’s why a lot of older adults signed up for traditional Medicare plans often need a supplemental plan.
“That’s another couple hundred dollars a month, maybe more or less, depending where you live,” Weissman said. “Those are some big gaps.”
Why are Medicare Advantage plans disappearing?
Weissman says some Advantage plans are disappearing simply because they are not bringing in enough money to the private insurance companies offering them.
“That’s par for the course, it’s how things go,” he said. “They’re for-profit companies. That’s what drives decisions like, ‘You’re only going to see these doctors’ or ‘We’re not going to pay for that treatment’ and they can also run the numbers and be like, ‘You know what? This plan we’re offering to people in Dallas County, I don’t think it’s going to be a moneymaker for us. We’re not gonna offer it next year.’ Nobody can make them and that’s what’s happening.”
Resources for seniors
For seniors facing this changes to their Medicare plan, Weissman lays out three main resources in this “An Arm and A Leg” newsletter.
- Look into state health insurance assistance programs, or SHIP. You can find your state’s SHIP chapter here.
- The nonprofit Medicare Rights Center offers well-organized guides and information. Their national helpline can be reached at 1-800-333-4114.
- If you choose to get an insurance broker, be sure they’re trustworthy. While they don’t cost you any money, they do make money from commissions, so keep that in mind.
Miranda Suarez and Ron Corning are the hosts of KERA’s NTX Now. Got a tip? Email Miranda at msuarez@kera.org or Ron at rcorning@kera.org.
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