Herald Tribune: Medicare plans found deficient
The Centers for Medicare and Medicaid Services reported these findings:
In more than half of all audits, “beneficiaries and providers did not receive an adequate or accurate rationale for the denial” of coverage when insurers refused to provide or pay for care.
When making decisions, insurers often failed to consider clinical information provided by doctors and failed to inform patients of their appeal rights.
In 61 percent of audits, insurers “inappropriately rejected claims” for prescription drugs.
Medicare plans frequently missed deadlines for making decisions about coverage of medical care, drugs and devices.
Be careful out there.
Medicare Advantage plans are attractive as many are zero cost from a premium perspective. It’s when you use them the costs become apparent. Original Medicare, combined with a supplement typically limits you out of pocket for covered expenses to a very small amount.
Also, keep in mind if you develop a chronic condition, you can become “stuck” in the Medicare Advantage arena. You can always return to Original Medicare, but you are not guaranteed a supplement. Yes, that’s right. You are guaranteed issue a supplement when you turn 65, but after that, if you want a supplement, the issuers can ask medical questions. As I said, be careful out there.