By Phil Galewitz | KHN
October 31, 2021
When Teresa Nolan Barensfeld turned 65 last year, she quickly switched to a private Medicare Advantage plan to cover her health expenses.
Barensfeld, a freelance writer from Chatham, New York, liked this to cover her medications, while her local hospitals and primary care doctor were part of the plan’s network. He also had a modest monthly bonus of $ 31.
She said it was a bonus that the plan included dental, hearing and vision benefits, which traditional health insurance does not.
But Barensfeld, who works as an editor, missed some of the important fine print of her plan. It covers a maximum of $ 500 per year for out-of-network dental care, including its long-time provider. This means that getting a crown or dealing with a few cavities could leave him with most of the bill. She was wary of the dental coverage cap, saying, “I don’t expect that much from a $ 31 plan.”
Across television, social media, newspapers and the mailings, tens of millions of Medicare beneficiaries are inundated this month – as they are every fall during the open enrollment period – by marketing plans. Medicare Advantage touting low costs and benefits not found with traditional Medicare. Among the most advertised benefits are dental, vision and hearing care.
These services are also at the center of heated negotiations on Capitol Hill between Democrats as they seek to expand a number of social programs. The progressives, led by Sen. Bernie Sanders (I-Vt.), Are pushing to add dental, vision and hearing benefits to traditional medicare.
Despite the powerful publicity of Medicare Advantage plans presented by celebrities like Joe Namath and Jimmie Walker, beneficiaries typically end up with large out-of-pocket costs for many of these services, a recent KFF study found. This is in part because private plans limit benefits. While people on traditional health insurance paid an average of about $ 992 for dental care in 2018, those on Medicare Advantage plans paid $ 766, according to the study. For vision, people with traditional Medicare paid $ 242, compared to $ 194 for those covered by a Medicare Advantage plan.
âIt stands to reason that there would be less personal spending in Medicare Advantage than in traditional Medicare, but the differences are not as large as you might expect,â said Tricia Neuman, senior vice president of KFF and Executive Director of its Medicare Policy Program.
More than 26 million people were enrolled in Medicare Advantage plans for this year, or 42% of all Medicare beneficiaries. Enrollment in private plans has doubled since 2012 and tripled since 2007. Unlike traditional health insurance, these private plans generally allow coverage through a limited network of doctors, hospitals and pharmacies.
Open enrollment for the 2022 plans runs from October 15 to December 7, and some Advantage plans offer incentives such as hundreds of dollars of groceries, home delivered meals, or $ 1,000 in over-the-counter items like than adhesive bandages and aspirin. .
But many older people don’t realize that there are restrictions on these benefits. They may cover extras only for registrants with certain health conditions or have a close network of providers or annual dollar limits, often around $ 100 for vision or $ 1,300 for dental care.
âAll of these added benefits encourage people to sign up, but people don’t know what they have until they try to use it,â said Bonnie Burns, training and policy specialist. for California Health Advocates which helps Medicare beneficiaries evaluate their health plan options. .
Seniors can generally choose from over 30 Medicare Advantage plans sold by several insurers. The choice is so daunting that less than a third of seniors bother to shop and compare during the open registration window, even as the costs and benefits change every year.
And for those who want to shop, comparisons are not easy. The Medicare.gov website provides an overview of the costs and benefits of health plans and allows seniors to compare plan premiums based on the drugs the beneficiary is using. But it doesn’t offer a comparison of doctors, dentists, or hospitals that are part of the Medicare Advantage network, or details on the limits of dental, hearing, and vision care. For this information, consumers should go to each insurer’s website and read a summary of benefits, which can be dozens of pages long.
Mary Beth Donahue, CEO of the Better Medicare Alliance, a research and trade group representing Medicare Advantage plans, sees it differently. âThe flexible design of Medicare Advantage benefits means that beneficiaries can choose a plan that suits their needs, whether it is stronger coverage or more basic coverage, potentially at lower cost,â she said.
Casey Schwarz, senior education and federal policy attorney at New York’s Medicare Rights Center, an advocacy group for seniors, said the additional benefits offered by the plans have increased confusion among beneficiaries. These benefits come at a price.
âThere is almost always a trade-off such as tighter supplier networks, a stricter drug formulary or restrictions in other areas,â she said.
Jenny Chumbley Hogue, an insurance broker near Dallas and analyst at medicareresources.org who helps seniors navigate the program, said the marketing is misleading some of its clients. âThey see a TV commercial that says they can get everything for free when they might not qualify for these benefits,â she said. “It’s hard to know if they are misinformed or if they don’t read the fine print.”
She added that consumers should choose a plan based on whether their doctor is part of this network or whether their drugs are covered at the lowest cost. For example, while most plans offer a benefit for hearing aids, it’s usually only for a certain type of device from one company, Chumbley Hogue said.
âThe devil is in the details, especially when it comes to dental care,â she said. âThe coverage is usually not what they are used to under an employer plan. “
However, Medicare Advantage dental benefits are becoming more and more robust. Almost 90% of private plans offer dental benefits at no additional cost and most offer coverage for treatments as well as cleanings and exams, according to a report by consulting firm Milliman. The percentage of plans offering preventive and comprehensive dental care has increased to 71% this year, from 48% in 2019.
The plans also increase benefits, so they meet Medicare’s requirement to spend at least 85% of enrollees’ premiums on health services, Neuman said. Plans that do not meet this threshold may be subject to penalties, including not being allowed to register new members.
Although some consumers may find the dental benefits attractive, not everyone uses the coverage. Medicare may not cover their current dentist, so they continue to pay out of pocket, she said.
Medicare Advantage beneficiaries use their dental benefits less frequently than people with dental coverage through their employer, said Joanne Fontana, director at Milliman. âNot everyone buys a plan because it covers dental care,â she said, âand it’s not a priority or they [donât] consider going to the dentist every year.
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