Seniors Stuck in Medicare Advantage Nightmare: ‘Designed to Confuse’ Us

A growing number of Americans are finding insufficient coverage options or jaw-dropping medical bills after unknowingly signing up for Medicare Advantage.

Today, more than half of seniors are enrolled in these privatized plans. The appeal is easy to understand when looking at the minimal or zero premiums and perks like dental care and gym memberships.

However, some have found the darker side after signing up for the plans.

If you want to go back to traditional Medicare, for instance, your options will be limited. You also might have to travel much farther for healthcare and be stuck with a doctor you don’t want.

And many of these things aren’t advertised to seniors when they pick up Medicare Advantage marketers’ calls.

According to a Senate Finance Committee report by Oregon Democratic U.S. Senator Ron Wyden, customer complaints about Medicare Advantage’s marketing skyrocketed to double from 2020 to 2021, bringing the total to 41,000.

Some Americans might not even be aware of the difference between traditional Medicare and privately run Medicare Advantage, but one in five seniors reported issues getting care due to the prior approval process, according to a recent Retirement Living study. Another study found half of beneficiaries switched to a different plan after five years.

“Imagine foregoing your original Medicare you paid your entire life into for gym membership,” Brandon Selfors, a Medicare broker and the founder of Tampa-based Bridge Insurance. “Sounds ridiculous but that is over half of seniors in the U.S. who traded their birthright for a privatized plan.”

“These plans are pushed too quickly on seniors who only have seven months to make a potentially life-altering decision.”

Medicare Advantage Turns Sour With Age

Retired Pharmacist Cheryl Mozer, who lives in Blue Springs, Missouri, said she’s seen it time and time again. While elderly patients generally enjoy their Medicare Advantage plans while healthy, it takes a turn for the worse when their health begins to decline.

“When their health declined and they needed expensive care costing thousands of dollars, such as rehab following a hospital stay, we had denial after denial as being ‘medically unnecessary’ even though their doctors said it was necessary,” Mozer told Newsweek.

While Mozer said seniors are occasionally able to win their appeals, it took away “precious time” while they were ill.

“I tell every elderly person I know not to sign up for an Advantage plan,” Mozer said. “It is not worth the stress when you are ill and need care.”

“All of the advertising on TV hooks people in,” Mozer said. “Yes, they may get free dental and a gym pass, but denial for expensive care is the issue.”

And once you are in, the government has rules that make it hard to get out of these plans, Mozer said.

Linda Muñoz, a 70-year-old senior loan officer, said she didn’t realize until this December that she had an Advantage plan. She initially chose an Aetna Advantage plan because it was the most affordable, with the premium paid by the deduction she’d otherwise pay to the Social Security Administration.

“The representative I spoke with said that I would be covered for my minimal drug needs and some dental and some over-the-counter drugs,” Muñoz told Newsweek. “I am a 70-year-old healthy individual so the explanation seemed to fit my needs.”

However, after visiting her dermatologist, she found out she was limited to doctors contracted with Aetna, so hundreds of dollars in bills were not covered despite having $165 deducted from her SSA payment monthly, she said.

“I’m now in a situation where I have a plan that I have to fight for coverage with, but I’m very concerned about my future needs and being stuck in a program that may well turn out to be less coverage than I could have, presently being employed, with my employer,” Muñoz said.

And even when looking at the official information, it’s easy to be led astray and make the wrong decision.

“The 200-plus page Medicare plan booklet hardly makes these decisions easier,” Muñoz said, adding she has a post-graduate degree and still found herself confused and deceived.

“In fact, it seems like the government is in league with the insurance companies to put together information that is absolutely designed to confuse the consumer… What hope does the senior, whose educational experience might be less and whose economic situation might be worse than mine, have?”

How to Protect Yourself

While these experiences show Medicare Advantage plans are undoubtedly not the right choice for everyone, insurance companies still say there are some who will get exactly what they need from the plans and at a moderate price.

Ernesto Jaboneta, the IT Director of California-based Medicare insurance agency Agent Pitstop, acknowledged there are many predatory salespeople who will jump to have you join a plan that doesn’t end up helping you in the long run. Still, there are precautions you can take to make falling into this trap less likely.

“The first thing anyone can do is invite along a family member or trusted friend to any appointments with an insurance agent,” Jaboneta told Newsweek. “Don’t feel pressured to decide right away.”

Before you commit to anything, you should compare plans and find out if your doctors will remain in your network. And if you’re unsure about some of the information you received from an insurance agent, you can also call 1-800-MEDICARE for more assistance.

Jaboneta also said there’s a big difference between captive insurance agents and independent agents, as well, and seniors should take note of this.

“A captive agent is an insurance agent who works directly for an insurance carrier,” Jaboneta said. “They have no incentive to compare options outside their own company, which is different than an independent agent who can compare all the options available. In many cases, when a beneficiary calls into an insurance company to find information, they will be talked into enrolling.”

The open enrollment period lasts from October 15 to December 8, but there’s another enrollment period from January 1 to March 31 for anyone unhappy with their Medicare Advantage plan who wants to switch or revert to Medicare.