Be wary of the complex pros and cons of Medicare Advantage plans during open enrollment through Dec. 1, columnist advises

By Trudy Lieberman

Community Health News Service

Along with crunchy leaves and pumpkins, fall brings a slew of advertising for insurance plans that fill the gaps in Medicare coverage.

Misleading and confusing messages continue to reach beneficiaries and those nearing Medicare age. To take myself as an example, I’ve received an invitation to a Medicare Advantage plan informational meeting. I’ve gotten a solicitation from my physician’s medical group offering a “zero-cost, no obligation way to review coverage” online or over the phone. The “review” is likely to bring a sales pitch for a plan.

A mailer from another plan offered “a friendly, money-saving Medicare Advantage Plan” that seemed to promise the moon: savings of up to $2,380 a year, maximum dental coverage of $1,500, and a $750 hearing aid allowance, a drop in the proverbial bucket considering the average cost of two hearing aids is about $4,500. One seller seemed to think I was on both Medicare and Medicaid and pitched a “special needs plan.” Since I wasn’t a candidate for such an arrangement, was the insurer trying to get in the door to sell a regular Medicare Advantage plan?

Too many people fall for those kinds of pitches during Medicare's open enrollment period, which runs through Dec. 1. Shopping to cover the gaps in Medicare is a task no one should take lightly. The stakes are too high.

Medicare is a fine program, but it was never meant to cover everything. It’s based on the old Blue Cross model of insurance common in the 1960s, where the company paid 80 percent of the medical bill and the patient paid 20 percent. An industry selling "Medigap" policies sprang up to cover the 20 percent, and deceptive sales practices plagued the business for years.

Congress ended that and standardized the coverage into 10 plans (now 11, including a high-deductible option) that give people a broad choice for covering what Medicare does not pay. If people bought Plan F or Plan C as their supplemental insurance, they were pretty much covered for most illnesses.

Beginning next year, however, new Medicare beneficiaries – those who turn 65 on or after Jan. 1, 2020 – won’t be allowed to buy Plan F or C. Congress wants more beneficiaries in Medicare Advantage plans, so it eliminated the option to buy the most comprehensive plans. Lawmakers wanted seniors to pay more for their care.

They can still buy Plan G, which offers the same protection as F except that it doesn’t cover the Medicare Part B deductible, which is $183 next year. People already on Medicare can still buy Plans F or C.

The goal is to push more people into Medicare Advantage plans, a private alternative that is a step toward privatizing the entire program. To move the process along, the government has overpaid insurers to provide the care, which enables them to offer inducements to join. About one-third of Medicare beneficiaries have moved to MA plans, so that strategy seems to be successful.

But does it come at a cost?

Serious questions have arisen about the overpayments the government has made using taxpayer dollars– overpayments that allow plans to offer gym memberships and even Apple watches, as monitoring devices, to new enrollees as one plan is doing. In September six Democratic senators wrote to the Centers for Medicare and Medicaid Services, noting that taxpayers have overpaid Medicare Advantage plans more than $30 billion over the last three years and that CMS has “taken little to no action to correct” the overbilling and overpayments.

Even more troubling, the letter also says that several other government agencies such as the Office of the Inspector General in the Department for Health and Human Services have raised “serious concerns” about Advantage plans that fail to meet needs of older adults and those with disabilities.

The letter raises questions about the kind of care beneficiaries are actually receiving, and notes that Medicare’s own audits have found “widespread and persistent Medicare Advantage performance problems related to denials of care and payment” that “threaten the health and safety of their members.”

Those are government watchdogs raising a red flag about problems getting care when you’re really sick and need good insurance.

Medicare Advantage plan advisers note that traditional Medicare does not put a limit on the amount a beneficiary must pay out of pocket each year, while Advantage plans do – $6,700 for in-network providers and $10,000 for those out of network. They usually don’t mention that a good Medigap policy will cover those amounts, but the premiums may be higher than for an MA plan heavily subsidized by the government.

The trade-off becomes what it does with all insurance: Pay now in the form of higher premiums, or pay later in the form of higher expenses if the worst happens. Insurers seldom mention that tough trade-off when they host those informational meetings for Medicare shoppers.

Hearing loss can lead to cognitive decline or even dementia, but is often unaffordable, and financial aid for it is shrinking

By Trudy Lieberman
Rural Health News Service

Nearly two-thirds of adults over age 70 have hearing loss that doctors consider “clinically meaningful.” In plain English that means as people age, they are likely to become hard of hearing. Many of those people, however, don’t get the help they need, often because they simply cannot afford it.

“The prevalence of hearing loss almost doubles with each age decade of life,” says Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, but for older people, he adds, “there are multiple barriers that prevent individuals from getting their hearing loss addressed.”

Lin spoke about the subject to a group of journalists in a recent phone conference sponsored by a Washington, D.C., advocacy group the National Committee to Preserve Social Security and Medicare. He is a co-author of a June report issued by the National Academies of Sciences, Engineering, and Medicine that recommends better access and support for treating hearing loss.

Lin told the group that although hearing loss is a normal part of the aging process, “hearing care is inaccessible” to many seniors. He said studies over the last five years have shown that such loss “can increase the risk of cognitive decline.”

Using data from a longitudinal study (one that tracks data from the same people repeatedly over many years or decades) that began in 1958, Lin and his colleagues at Johns Hopkins found that those with hearing loss had a higher probability of developing dementia. The more severe the loss, the more likely the dementia.

Photo from howmanyarethere.net

That isn’t the only problem. Hearing loss is also associated with a greater risk for falls and other accidents because a person can’t hear traffic or a smoke alarm in their home. Furthermore, those with hearing loss often feel isolated and shun normal social contacts because they can’t hear others speak. That’s a blow to productive aging, the goal promoted by the late Dr. Robert Butler, a well-known gerontologist who fought against ageism.

So why, then, is hearing care so inaccessible? Cost may be the major barrier. Nearly all expenses for hearing care must be paid out-of-pocket, and for many seniors on fixed incomes, that’s sometimes hard to do. Lin told me the average cost of two hearing aids is $4,700 and rarely covered by insurance.

Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams, but only if your doctor orders those tests to see if you need medical treatment. In that case, if a person has traditional Medicare and a Medicare supplement policy, often called a Medigap, he or she has to pay 20 percent of the approved amount for the exam. Some Medicare Advantage plans may include hearings tests as part of the extra benefits they offer.

The National Committee and other advocacy groups are campaigning to add a hearing benefit to Medicare’s benefit package. Their campaign is bucking a trend in Washington to cut Medicare benefits by raising the age of eligibility, making richer seniors pay more, and requiring those with traditional Medigaps to have more skin in the game.

Politicians have already begun redesigning Medigap policies to make seniors pay more out of pocket for their care. Beginning in 2020, for example, insurers will not be allowed to sell Medigap policies that cover the deductibles for Medicare Part B that pays for physicians’ services, lab tests and hospital out patient care. The theory behind this shift is that seniors will pay more and the government less, thus helping to save Medicare money.

I asked Dan Adcock, the National Committee’s policy director, about the chances of adding benefits to treat hearing loss, or for that matter vision and dental care, when the focus has been on cutting benefits of all kinds. He said one major source of funds to pay for hearing aids could come from lowering the price of what Medicare pays for drugs. The 2003 legislation that gave seniors a drug benefit also prohibited the government from negotiating prices for the drugs it buys. Drug makers strongly oppose such negotiations.

Adcock said he remains hopeful. If better hearing means a decrease in dementia, falls and accidents, fewer people would need treatment for those conditions. The savings could potentially “pay” for the hearing aids, he said.

For now, though, seniors and their families are on their own. The National Academies offer an "Action Guide for Individuals and Families" that suggests actions people can take to prevent hearing loss, and strategies for families to cope with it when it occurs. It’s available at www.nas.edu/hearing.

What experiences have you or a family member had with hearing loss and obtaining treatment? Write to Trudy at trudy.lieberman@gmail.com.