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As many as 22 million seniors are now enrolled in Medicare Advantage (MA) plans, also called Part C plans. These plans can cover a broad array of health services at low cost -- that is, until one gets sick, at which point out-of-pocket costs can soar. But once in an MA plan, getting out can be even less affordable. Switching out of a MA plan can incur exorbitantly higher costs the next time the need for a serious medical intervention arises. And moving to traditional Medicare and a prescription plan still necessitates a supplemental Medigap plan to pick up the 20% copays and deductibles. Medigap plans in all but four states can and do reject people with pre-existing conditions or require prohibitively higher premiums. Diabetes, heart disease, or even a knee replacement can be criteria for exclusion. Enrollees are not often told about this side of MA when the enroll at age 65. "You hear the pros, but nobody lists the cons.” Ads tout Medicare Advantage's array of services: dental, vision, hearing, gym membership, rides to medical appointments, doctor and nurse visits by phone, and even meal delivery and home aid. "Get what you deserve ... at no additional cost," ads say. "Call now -- it's free.” Seniors are lured to advantage plans by misinformation and confusing sales techniques these groups say, and claim that plan inadequacies result in delay in nursing home placement for some members, or produce poor service for some due to difficulties with physical therapy and rehab services. The number of days approved (for payment) has tended to be too short and the extent of rehab services too limited. MA plans, which are managed by private insurers, can be very complex, with the potential for substantial out-of-pocket costs when beneficiaries get sick played down. Medigap policies, which pay for many expenses not covered in basic Medicare, may cost more in monthly premiums up front, but once one is enrolled, premiums are set solely through "community rating" and beneficiaries' age. New-onset health issues do not lead to premium increases. The catch is that if one initially enrolls in an MA plan and then decides to switch out more than a year later, Medigap insurers will take into account the individual's pre-existing conditions, and may decline coverage or demand high premiums. If your health is good, maybe these plans may represent value for some patients, like providing gym memberships. But that can change in the blink of an eye with a stroke or an accident or some acute medical condition and they need a rehabilitation stay. Then, services are restricted so much that they can't recover adequately from the stroke, or they bankrupt themselves staying another month to get a good recovery. Then they're eligible for Medicaid, which pays doctors much less; lots of doctors don't take Medicaid for obvious reasons. Advocates claim that Medicare should not let people with serious health risks buy MA plans in the first place. And some critics say MA across the board is basically a scam. Medicare.gov websites aren't always clear about the process of transferring out of MA to traditional Medicare with a Medigap plan, but the general bottom line is that getting accepted by a Medigap plan is guaranteed only within the first 12 months after enrolling in Medicare at age 65. Some advocacy groups are pushing to mandate tighter plan rules and disclosure, with lists of network specialists. Calling on the Centers for Medicare & Medicaid Services and other stakeholders, including the senior citizens' lobby AARP, groups are advocating making the process of choosing Medicare plans less confusing and more transparent. The newly revised Medicare Plan Finder tool does not explain these possibilities. Nor does another CMS website. A third Medicare.gov website, "When can I buy Medigap?" is more specific, explaining in the third section that "there's no guarantee that an insurance company will sell you a Medigap policy if you don't meet the medical underwriting requirements," meaning the Medigap issuer's stance on pre-existing conditions. Yet another Medicare publication does explain that if beneficiaries enroll in a Medicare Advantage plan at age 65 and want to get out, they must do so within 1 year, and then they have another 63 days from the disenrollment date to buy a Medigap plan without risk of coverage denial or being subject to underwriting. But many of these documents are full of terms unfamiliar to ordinary laypeople. Besides MA's lack of transparency on costs, critics also cite problems with insurers' provider networks. One report found that 35% of plans studied were served by a "narrow" physician network, meaning that fewer than 30% of the physicians in that county were contracted. Plans may purposefully understaff specialties to avoid attracting enrollees with expensive pre-existing conditions like cancer and mental illness. Veteran consumer advocate Ralph Nader blasted MA plans as nothing more than a way to enrich health insurers at seniors' expense. Calling the plans "Medicare Disadvantage" and a "corporate trap," Nader took the AARP, which offers its brand of Medicare Advantage through UnitedHealthcare, to task for being asleep on the issue, and in conflict because it gets a 4.95% commission. Source: https://www.medpagetoday.com/publichealthpolicy/medicare/83661