CEO of Medicare & Medicaid Advisory Group Ginalisa Monterroso urges those enrolling in Medicare Advantage plans this Open Enrollment season to be extremely cautious.
Speaking at the CWA 1180 meeting in Lower Manhattan, she said: “You have to be careful of what you chose and how you chose. And Advantage plans are very aggressive; you see them all over the place. They may also offer tempting incentives.”
Recently the New York Times published an investigative report revealing that Advantage plans have been wrongfully denying service to increase profits.
“I don’t want to bash Medicare Advantage plans, but if I know if I’m in a situation where I have to go to the doctor a lot, I don’t want anyone managing me and giving me permission over whether or not I can go to the doctor or not.
"And if they denied me service? I’d want that paperwork. I’d want to appeal.”
The inspector general at the Department of Health and Human Services found “widespread and persistent problems related to denials of care and payment in Medicare Advantage.”
Not many people appeal the denial of claims - letting insurers off the hook. But on average, around 75 per cent of appeals are granted at the first level of review.
Advantage plans may be attractive to some as drugs are already included in the insurance package, so you won’t need to shop around for a Part D plan. However unlike Traditional Medicare, Advantage plans have an out -of-pocket limit on expenses.
“We all need to educate ourselves and understand that we have rights and there are federal and state regulations that protect our healthcare,” Monterroso told the room.
“Contacting them is purposefully difficult, especially for people who are retired and who have a disability and that are forced to stay on hold for lengthy periods - sometimes for over an hour.”
“These HMOs and CEOs are making millions. We need to understand what we’re doing and what we’re getting and we have to voice our opinions. It doesn’t make sense to have insurance and not be able to use it.”
Ms. Monterroso also advises that you keep a note of your doctors and the hospitals that bill you. You can open up your account on Medicare.gov, and it will have information on everybody that billed and everybody that paid.
“Don’t let anyone take what we built and what we paid into,” she concluded.
For help picking the right plan for your needs, give one of our friendly Medicare experts a call on 646-745-9122 for a free consultation.
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