Are Your Patients Being Told That “Traditional Medicare” is No Longer Available?

Two of my patients have told me that during open enrollment (which just ended) they were told that traditional Medicare was no longer available and they had to choose a Medicare Advantage (MA) Plan. I have advised several wound care patients to change from an MA plan to traditional Medicare so that they would have unfettered access to cellular and/or tissue based products (CTP’s) – often called skin substitutes – which are usually restricted to only one or two products by MA plans, and because I often can’t get advanced therapeutics approved at all by their MA plan. Furthermore, the MA plans do not seem to be reducing their out-of-pocket expenses. I’m no expert, but they still have a high deductible and co-pays, so I don’t see why this is a better deal for the patient. I do understand why it saves Medicare dollars, because that’s the point of rationing.

There are recent news reports that Medicare Advantage is being promoted over traditional Medicare in its education and outreach materials for open enrollment such as CMS’ eMedicare initiative and the email campaign the agency conducted for the 2019 enrollment period.  Advocates alleged that CMS’ draft Medicare & You handbook for 2019 distorted the facts about traditional Medicare and Medicare Advantage in favor of the private plan options. CMS did make improvements to the final version of the handbook in response.  Criticisms included the fact that the eMedicare quiz didn’t include questions about whether the beneficiaries’ providers are in an MA plan’s network, the limitations to Medigap coverage, and the fact that there are supplemental coverage options for the portion that Medicare does not cover.

I am worried about the future of Medicare. I’m particularly frustrated that there’s a lot of Medicare fraud and it’s damn near impossible to stop it, speaking as someone who’s tried pretty hard to do so. You report Medicare fraud, provide the evidence and then nothing happens. No wonder it keeps happening. In that scenario, the answer is to let the private payers be the junkyard dog. I don’t like that option because the private payers are not accountable to anyone. However, if we are seriously looking at socializing healthcare, I’d rather have the private payers in charge than the government, since that has an unbroken track record of failure in every country in the world. I feel like we are between a rock and a hard place. If you want to read about my experience in a socialized system, read this blog post.

Medicare for All is a looming reality, as the country throws away its future and becomes the Unites States Socialist Republic.

Open enrollment ended December 7th. I wondered if anyone else has had patients report that they were told they HAD to enroll in Medicare Advantage?