Health matters

Advantage plans for seniors under fire

Conway McLean, DPM, Journal columnist

American healthcare is a system in crisis. Many Americans have no health insurance and are one injury away from homelessness. Debts resulting from medical care too often lead to bankruptcy or worse. And though there are a multitude of factors at play, many experts believe it is due in part to our profit-driven healthcare system.

For over 50 years, we have provided our senior citizens with healthcare, referred to as Medicare. This program has provided healthcare to millions of Americans. Although many problems exist with this system, our seniors, who typically are no longer working, have had reliable medical care.

Extensive lobbying efforts resulted in the passage of laws nearly 20 years ago, allowing the major insurance companies to provide seniors with insurance. This, in effect, allowed them to compete with Medicare. These plans were termed ‘Advantage’ plans, although they were marketed in such a way that our seniors were uncertain of what they were getting or who was providing it. The answers to such important questions is always buried under slogans and reams of fine print.

The tactics utilized by the major insurers are numerous, with pre-authorizations, outright denials, and various methods of obfuscation used to delay care, deny or withhold payments. One of their most successful methods of increasing their profits is to refuse to pay for services rendered. Tens of millions of denials have been issued inappropriately each year, according to a recent federal audit.

Prior authorizations is another method, whereby the prescribing physician must get on the phone with a nurse, lobbying for the therapy which the doctor has prescribed. All serving to put more coin in their coffers. In addition, they lobbied for government subsidies to be written into their contracts, providing them an advantage over Medicare.

The marketing tactics employed by the private health insurance companies have been ruthless but very effective. Senior citizens have signed on to the Advantage plans in droves. Unfortunately, most of the consumers who have opted to go with an “Advantage” plan have NO idea they don’t have Medicare. But then, the public is grossly ill-informed on the topic, which suits the major insurers just fine.

The advantage plans have used million dollar ads and misleading claims, devious marketing to entice this age group. The private insurance advantage plans have no interest in educating consumers about the differences between Medicare and these plans. The term itself is misleading: “Medicare Advantage” has the word ‘Medicare’ right there in the title. These plans will loudly proclaim they provide the same coverage, but as we all know, there is no truth in advertising.

The techniques employed by the insurance companies have been tremendously successful, and consequently, the major insurers have had record profits, to the tune of nearly 60 billion dollars according to some estimates. The data is revealing an ugly truth: individuals with Advantage plans received poorer medical care. To those in the industry, practicing medicine, or involved in healthcare administration, it has become clear, the Advantage plans are not conducive to good health.

But at last, the dangers of this approach are being brought to light. Several high profile billion dollar lawsuits have been filed against several of the major insurers, due to the fact that they are indeed gaming the system, techniques that have clearly benefitted their bottom line. Several major healthcare systems have dropped these plans from their lists of options. Experts in the field are calling for restraints or changes in how these plans are administered. Unfortunately, the public has been slow to learn of these concerns.

If you don’t need health care, it’s true you can save money with these privately administered plans. But what age group is most likely to need health care than those being targeted by these deceptive practices. Investigators agree, the care provided by the Advantage plans is inadequate. But this isn’t just big business; this is HUGE business.

If your insurance card says ADVANTAGE somewhere on it: you don’t have Medicare. And be wary of the Advantage plan ads: they have a product to sell and don’t need to be honest. The devil is in the details, as the cliché goes, and this clearly applies to insurance contracts. If you have switched to an Advantage plan, whether willingly or not, your healthcare is now controlled by an entity whose sole purpose is to make money. Become a better educated consumer of your healthcare. After all, your health is an important part of your life.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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