Better Plans In 2025
Medicare Advantage 33 million recipients, including those with disabilities, believe these plans have proven over time to deliver better healthcare results as well as access to care than Original Medicare’s fee for service model. This is according to AHIP’s recent published article in mid-August.
They cited cancer screenings, cardiovascular disease patients as well as COPD, diabetic and musculoskeletal disease patients in this survey.
What they are really stating is that better care is provided by MAPD plans over Original Medicare recipients. The only conclusion is the MAPD plans have greater control over their doctors than Original Medicare. Makes sense to me because when has the government ever done things better than private industry? Never comes to mind.
The watchdogs at CMS do not have the time to monitor all the independent physicians that serve the Medicare community. They can selectively monitor when complaints are received but not all CMS doctors or hospitals.
While on the other side, MAPD plans are heavily monitoring their doctors to ensure they stay competitive against all the other MAPD plans, so they don’t lose clients.
The number one complaint from MAPD clients is their doctors change too often. That is a matter of physician choice to remain in a plan or change it, but access is usually quick. Remember MAPD clients can change plans twice each year so the doctors and staff must maintain a good relationship with their patients to keep them. Too many complaints to the plan about the doctor can get that doctor released from the plan. That leads to doctors losing significant amounts of money which is always a deterrent to bad service.
These MAPD plans offer many other benefits that Original Medicare does not like, gym memberships, ancillary dollars to receive many over-the-counter items at no cost, and other benefits not provided by Original Medicare, with or without a supplement policy.
Original Medicare with a supplement usually only covers Medicare services, not ancillary services. As a supplemental patient myself, I only get medical services covered by my plan. It does not include any ancillary benefits.
There is a trend by several supplemental providers to offer some ancillary benefits as these plans are losing their clients to MAPD plans. The reason these clients move to MAPD plans is two-fold. One, the cost of thesesupplemental plans is escalating based on claims and as their population gets older, the costs increase. Secondly, the ancillary benefits are another incentive to move plans. In Nevada, I authored a birthday rule which allows a supplemental recipient to change plans the moth of and the month after their birthday so supplemental carriers cannot remain complacent and have to keep up with competition on pricing and ancillary benefits. This is in its infancy so time will tell the trend.
Wrap It Up
To sum it up; the MAPD plans are feature rich in ancillary benefits while the Medicare Supplement carriers are mostly just picking up the medical costs and not providing ancillary benefits.
There are many reasons to choose one plan over another and are too numerous to mention here other than the obvious reasons which have been mentioned above.
Hope this blog gives you some insight to the complexities of both plans and that when in the position to make a decision that you consider using an independent local broker who knows the area and plans. They can provide an impartial assessment of the plans based on your medical needs.
I hope this information is useful. If anyone has questions, please contact me via phone or email, and I will respond quickly.
Also, if you need Medicare information, Please reach out to us.
The Barend Agency Inc.
Len Barend, Broker
Cell:702-250-2200
Email: len@insurance4unevada.com