How Medicare Advantage Plans Limit Your Health Care Coverage
While a lower monthly premium can make Medicare Advantage (MA) plans an attractive option over traditional Medicare, these plans can limit your freedom to choose your own doctor, the care you can receive, and your ability to stay close to home for care.
Medicare Advantage plans may look simple and easy on the surface because they include Medicare Part D while also offering a low monthly premium, but these plans have significant limitations on coverage you can receive.
Coverage Limits & Denials
Medicare Advantage plans also regularly deny care that would be covered by traditional Medicare.
MA plans are incentivized to minimize their costs and routinely deny coverage to their enrollees, even if that coverage was recommended by your doctor. Because of prior authorization, your doctor must receive permission from your MA plan before delivering a wide range of care. If your plan disagrees with your doctor, coverage can be denied by MA employees who are not medical professionals.
The guidelines used by traditional Medicare in coverage decisions are different from guidelines used by MA plans. This results in MA plans denying coverage much more often than traditional Medicare, including care that traditional Medicare covers.
Unlike traditional Medicare that offers uniform coverage across its plans, MA plans offer different coverages based on which company is providing the plan. This can cause unnecessary confusion for enrollees comparing MA plans and make it difficult to understand what kinds of care different MA plans will actually cover.
Hospital Stay & Equipment Limits
In addition to care denials, MA plans can also limit your hospital stays and access to home health and medical equipment.
With traditional Medicare, your doctor decides how long you need to stay in a hospital based on your condition and care needs. With Medicare Advantage, your plan can impose limits on how long you can stay in the hospital, even if your doctor wants you to stay longer.
If your doctor says you need surgery and five days to recover in the hospital, that’s exactly the care you would receive under traditional Medicare. But with MA, your doctor would first need authorization from the plan for the surgery (which could be denied), and then the plan will determine how long you will stay in the hospital, or if you can even stay in the hospital at all.
Additionally, MA plans never cover post-hospitalization rehabilitation, often referred to as swing-bed care, when you are partially recovered but not quite ready to return home on your own.
MA plans also limit your access to services commonly found in rural communities like physical therapy and speech therapy. Other services like home health equipment are not covered by MA, even if they are recommended by your doctor.
Talk to Your Doctor About the Risks of Medicare Advantage
MA is not a substitute for traditional Medicare. MA plans are incentivized to minimize their costs by limiting your health care coverage and denying care whenever possible.
From denying care recommended by your doctor to limiting how long you can stay in the hospital, MA plans take away your freedom to get the care you need in the community you live in.
Don’t limit your freedom to receive the coverage you need when you need it. Talk to your doctor about the drawbacks of Medicare Advantage plans and make sure you have all the facts before deciding about your health care coverage.
Learn more about the limits of Medicare Advantage plans here.
