AYESHA RASCOE, HOST:
Today is the deadline for millions of Americans 65 and older to choose Medicare options for the upcoming year. For many, the choice is between traditional Medicare and Medicare Advantage, where the federal government lets private companies manage the coverage. As the Midwest Newsroom's Macy Byars reports, Medicare Advantage plans can come with some risk.
MACY BYARS, BYLINE: When Americans turn 65, they typically enroll in Medicare. Choosing the best coverage option can be complicated, with options of supplementary coverage, drug prices and private plans. Independent insurance agent Rick Cuddeford works with Nebraska-based Saving Seniors Money, one group that helps seniors compare traditional Medicare versus a private Medicare Advantage plan.
RICK CUDDEFORD: We don't push people one way or the other. Our job is to educate people about both options, and then whatever they are comfortable with, we go with for their coverage.
BYARS: Traditional Medicare supplement coverage, often called Medigap, has premiums that can range from about $30 to well over $600 a month. Advantage plans often come with extra benefits like dental or vision, but their most enticing selling point is low-cost monthly premiums. This year, more than half of Medicare beneficiaries - nearly 36 million people - are enrolled in a Medicare Advantage plan, according to the Centers for Medicare and Medicaid Services. Jeremy Nordquist, president of the Nebraska Hospital Association, says Advantage plans have provider networks, copays and may require approval before covering a medical service. That can leave patients waiting for care or filling hospital beds that other patients could use.
JEREMY NORDQUIST: If you don't think you're going to need health care, great, fine. But very few seniors are healthy enough to avoid that, so they need to know these challenges upfront.
BYARS: Ivan Mitchell is the CEO of Great Plains Health in Central Nebraska. He says there are too many claim denials with Advantage plans and doctors can spend more time on the phone with insurers than helping patients. Great Plains Health stopped accepting Medicare Advantage last January.
IVAN MITCHELL: There are about 400 members that if they call for an appointment, we do not see them. We will not schedule an appointment with them. They have to go somewhere else for care.
BYARS: Great Plains Health isn't alone. According to the trade publication Becker's Hospital Review, 40 health systems in the U.S. have decided to drop at least one Medicare Advantage plan this year. The federal government pays Advantage plan companies per enrollee each month to distribute their benefits. The nonpartisan Medicare Payment Advisory Commission estimates those payments added $84 billion to this year's total Medicare expenditures. That extra amount frustrates critics like Mitchell.
IVAN MITCHELL: We've basically raided the Medicare Trust Fund with these for-profit insurance companies that, in my opinion, have been extremely unethical in what they've done.
BYARS: Unethical behavior that he says includes insurance companies underpaying health systems like his or causing them to lose money through extra administrative work caused by claim issues. Nonprofit advocacy group Better Medicare Alliance believes Medicare Advantage can offer more value and choice to seniors. CEO Mary Beth Donahue says the insurance industry has told the Trump administration they will take steps to streamline the claims process.
MARY BETH DONAHUE: We see that any kind of delay is unacceptable, and so there are new rules and an industry commitment that they've made to the administration to speed up the decisions.
BYARS: Meanwhile, bipartisan bills have been introduced in Congress calling for more transparency in the Medicare Advantage program. They aim to help seniors the next time they make their health coverage decisions. For NPR News, I'm Macy Byars in Lincoln, Nebraska.
RASCOE: The Midwest Newsroom is a collaboration, including NPR and member stations in Iowa, Kansas, Missouri and Nebraska. Transcript provided by NPR, Copyright NPR.
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