The Medicare Advantage … Advantage

Medicare Advantage, sometimes referred to as Part C, has once again been the target of attacks by Democrats who are trying to scare seniors away from these increasingly popular plans. They do not like Medicare Advantage because it frustrates their long-term healthcare goal of a centralized system under government control.

In the reconciliation spending bill enacted earlier this year, Democrats sought to spend $285 billion in a transparent attempt to pull unwilling seniors out of Medicare Advantage plans and into traditional government-run Medicare. Thankfully, they failed, but there is no doubt they will keep trying.

Medicare Advantage has proven to be a great option for seniors, offering better coverage than traditional Medicare. As a result, each new enrollment period shows record number of seniors switching from Medicare to Medicare Advantage.

The Medicare Advantage program is the alternative way for seniors to get Medicare Part A and Part B coverage through plans offered by private insurance companies. Part A covers inpatient care in hospitals whereas Part B is medical insurance, covering the services of physicians and other health care providers. Part D helps cover the cost of prescription drugs.

Medicare Advantage plans can offer extra benefits, such as coverage for dental, vision, and hearing, and in some cases gym memberships, transportation to doctor’s appointments, and in-homepreventative care visits. “Special Needs Plans,” which cover conditions such as diabetes and cardiovascular issues, may also be available in some regions.

Medicare Advantage plan participants have high customer satisfaction ratings, with one survey showing a 98% approval rate. It’s no surprise that enrollment in these plans is increasing each year and “is expected to make up more than half of total enrollment for 2023.”

With traditional Medicare, there’s no limit on out-of-pocket expenses. Even after reimbursements, close to a quarter of Medicare participants pay an average of 20% of their annual income on out-of-pocket expenses. Yet for Medicare Advantage customers, their 2022 in-network plans have a maximum out-of-pocket limit of $7,550.

Comparing Medicare to Medicare Advantage can unearth the stark differences in their approach to coverage. Medicare pays for treating illnesses, so health care providers are financially incentivized to treat seriously ill patients over healthy ones.

Since each treatment has an assigned billing code, income is generated by submitting bills to Medicare with multiple codes. One sick patient with ten treatment codes makes more money for the healthcare facility than a healthy patient with one or two billing codes.

The government annually sets a fixed amount to treat each Medicare or Medicare Advantage participant. With Medicare, the participant is responsible after a deductible is met whereas with Medicare Advantage, the insurer is responsible. This difference gives the Medicare Advantage plan a strong incentive to maintain the health of the patient since a healthy patient shouldn’t exceed that previously determined fixed amount.

Because private insurers are competing with one another and can’t exceed the fixed amount, they have to offer the best product at the best price. Often their best product is bundled with dental, vision and hearing coverage, something not offered through original Medicare.

Being proactive in maintaining overall patient health, Medicare Advantage plans have participants with less emergency room visits and hospital stays.

Medicare Advantage enrollees now have more plan options to choose from, nearly double what was offered in 2018, improving quality and lowering costs. In 2022 there were 87 five-star plans compared to 28 the previous year while the estimated annual premium has gone down by 8 percent.

With quality surveys showing seniors are satisfied with Medicare Advantage, with enrollments up each year and premiums producing real savings, why are the Democrats continually attacking Medicare Advantage? You would think a government program that people actually like would be cause for celebration, not the object of surreptitious plans to undermine it.

Democrats need to stop wasting taxpayer money on attacking Medicare Advantage. The Medicare Advantage plan is the advantage seniors need.

Dr. Jeffrey Davenport, MD is the founder of One Focus Medical in Edmond, OK. He is a Family Medicine Specialist with 19 years of experience. 

This article was originally published by RealClearHealth and made available via RealClearWire. Here.

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