Virtually every Medicare Advantage Part C advertisement that I have seen on television is fraudulent and misleading. None of these advertisements advise consumers that by signing up for Medicare Advantage with a private insurance company, they are being disenrolled from U.S. government Medicare.
This is critically important to consumers because, under Original Medicare, patients can see any physician or go to any hospital that accepts Medicare without pre-clearance.
The Limitations of Medicare Advantage
The Medicare Advantage programs offered by private insurance companies only allow patients to see physicians within that insurance company’s network. They also require pre-clearance before a patient can see a specialist.
So, if a patient signs up for a Medicare Advantage plan with United Healthcare, Humana, CIGNA, Aetna, or Blue Cross Blue Shield, the patient can only see doctors within the network contracted by the insurance company they sign up with. These private insurance companies get a flat rate from the U.S. government, and the patient is disenrolled from U.S. government Medicare.
The private insurance companies make money by limiting care to costs less than what the U.S. government has paid them. That is how they can offer small sums of money for groceries, dental care, or hearing aids.
Saunders & Walker, P.A. Real Client Example
I had one client who signed up for a Medicare Advantage program based on the promises of grocery money, dental care, and hearing aids. Then when she tried to see the doctors who had been treating her for years, they all told her that they were not on the private insurance company plan and could no longer see her.
This client was never told that she could no longer see any of her doctors and was limited to the doctors picked by the private insurance company. So she called back the private insurance company agent who sold her the plan and canceled the plan. She did not realize that by signing up for Medicare Advantage, she had been disenrolled from her U.S. government Medicare plan and could not re-enroll until the December re-enrollment period, which was seven months away.
She only found this out when she fell and broke her hip and received over $100,000 in medical bills from the hospital that advised her that she had no insurance at all because she had been disenrolled from Medicare and she had canceled her Medicare Advantage plan.
The Concept Behind Medicare Part C
The concept behind Medicare Part C (the Medicare Advantage plan) is that, in some cases, private enterprise may do a better job of controlling costs or providing medical care than the U.S. government bureaucracy. For some consumers, Medicare Advantage may be the best choice. It can work well for those who are comfortable staying within a private insurance company’s network.
It may also appeal to individuals who value added benefits. These can include grocery allowances, dental coverage, or hearing aids. These are benefits not typically offered by Original Medicare.
The issue is that the private insurance company advertisements for Medicare do not provide consumers with the critically important information needed to make the decision to go with Medicare Advantage. This results in their disenrollment from U.S. government Medicare and restricts their choice of physicians in hospitals to those chosen by the private insurance company.
A Note From Joe Saunders of Saunders & Walker, P.A.
As a consumer justice lawyer, I believe it is important for the public to have this basic information before making a choice between U.S. government Medicare and Medicare Advantage. Our law firm is a consumer justice law firm that represents seriously physically injured and abused individuals, and we do not accept consumer fraud cases relating to choice of Medicare Advantage.